World Journal of Hepatology最新文献

{"title":"Comparison between short-course and long-course antimicrobial treatments for acute cholangitis with gram-positive coccus bacteremia after endoscopic retrograde cholangiopancreatography.","authors":"Yuntae Kim, Kazuhiro Ishikawa, Kenji Nakamura, Hikaru Ikusaka, Ryohsuke Yokosuka, Tomohiro Yamazaki, Yuichiro Suzuki, Shuhei Okuyama, Koichi Takagi, Katsuyuki Fukuda","doi":"10.4254/wjh.v17.i6.108100","DOIUrl":"10.4254/wjh.v17.i6.108100","url":null,"abstract":"<p><strong>Background: </strong>The optimal duration of antimicrobial treatment for acute cholangitis complicated by gram-positive coccus (GPC) bacteremia remains unclear. The Tokyo Guidelines 2018 recommended 14 days of antimicrobial treatment following adequate source control measures; however, evidence supporting this recommendation is limited, and deviations from real-world practice are often observed.</p><p><strong>Aim: </strong>To evaluate the efficacy and safety of shorter antimicrobial treatments for acute cholangitis complicated by GPC bacteremia.</p><p><strong>Methods: </strong>Adult patients with acute cholangitis complicated by GPC bacteremia who underwent endoscopic retrograde cholangiopancreatography between July 2003 and December 2023 were included. Patients were categorized into two groups based on the duration of effective antimicrobial treatment: (1) Short-course treatment (SCT) (< 14 days); and (2) Long-course treatment (LCT) (≥ 14 days). The outcomes assessed included mortality, recurrence, reinfection with the same organism related to the cholangitis, and length of hospital stay.</p><p><strong>Results: </strong>A total of 44 patients were included in the study: (1) 19 patients in the SCT group; and (2) 25 patients in the LCT group. The median duration of antimicrobial treatment was 9 days [interquartile range (IQR): 2.5-11.0 days] and 16 days (IQR: 15.0-19.0 days) in the SCT and LCT groups, respectively, with a statistically significant difference (<i>P</i> < 0.05). No significant differences were observed in 30-day mortality, cholangitis recurrence, or reinfection with the same organisms within 3 months. However, the length of hospital stay was shorter in the SCT group (median: 12.0 days <i>vs</i> 14.0 days, <i>P</i> = 0.092).</p><p><strong>Conclusion: </strong>For acute cholangitis complicated by GPC bacteremia, shorter antimicrobial treatment may be a viable option following appropriate biliary drainage. Further studies with larger sample sizes are warranted.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 6","pages":"108100"},"PeriodicalIF":2.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in the diagnosis and management of clinically significant portal hypertension in cirrhosis: A narrative review.","authors":"Xiao-Yu Xie, Amine Benmassaoud","doi":"10.4254/wjh.v17.i6.104761","DOIUrl":"10.4254/wjh.v17.i6.104761","url":null,"abstract":"<p><p>Clinically significant Portal hypertension (PH), defined by a hepatic venous pressure gradient (HVPG) greater than 10 mmHg, is a key predictor of decompensation events in cirrhosis, leading to variceal hemorrhage, ascites, and hepatic encephalopathy. This narrative review explores the pathophysiology of PH in cirrhosis, evaluates diagnostic methods for identifying clinically significant PH (CSPH), and discusses guideline-driven strategies to prevent initial and further decompensation. While HVPG remains the gold standard for diagnosing CSPH, non-invasive tools such as liver stiffness measurement and spleen stiffness measurement are increasingly used for initial risk stratification. The combined use of these tools reduces the proportion of patients in the diagnostic \"grey zone\". Endoscopic ultrasound-guided portal pressure gradient is an emerging diagnostic tool that requires further validation. Non-selective beta-blockers are the cornerstone of primary prophylaxis for decompensation, and their combination with endoscopic variceal ligation is the first-line therapy for secondary prophylaxis of recurrent esophageal variceal bleeding. Statins show promise in reducing PH and preventing decompensation while further studies are still needed. This review also discusses the indications for preemptive transjugular intrahepatic portosystemic shunt and its role in managing refractory ascites and variceal bleeding.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 6","pages":"104761"},"PeriodicalIF":2.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding acute kidney injury in cirrhosis: Current perspective.","authors":"Sayan Malakar, Sumit Rungta, Arghya Samanta, Umair Shamsul Hoda, Piyush Mishra, Gaurav Pande, Akash Roy, Suprabhat Giri, Praveer Rai, Samir Mohindra, Uday C Ghoshal","doi":"10.4254/wjh.v17.i5.104724","DOIUrl":"10.4254/wjh.v17.i5.104724","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is present in 30%-40% of hospitalized patients with cirrhosis. Its incidence is higher in patients with severe alcoholic hepatitis, spontaneous bacterial peritonitis, and acute-on-chronic-liver failure (ACLF). Kidney injury is an important landmark event in the natural history of cirrhosis as it is associated with higher mortality. Overwhelming systemic vasodilation, cardiac dysfunction, hypoperfusion, endotoxemia, and direct nephrotoxicity predispose patients with cirrhosis to kidney injury. Infection is present in 25% of patients with decompensated cirrhosis and 35%-40% of patients with ACLF. Advanced cirrhosis with portal hypertension leads to a sluggish portal flow, leading to increased gut congestion, altered gut permeability and bacterial translocations. They drive infection and endotoxemia in such patients. Pathogen-associated molecular patterns activate inflammatory cascades, which leads to further deterioration in hemodynamics and reduced glomerular filtration rate. Infections and pro-inflammatory cytokines like interleukin 6 (IL-6), IL-1, and tumor necrosis factor alpha may directly cause kidney parenchymal injury. The combined effect of dysfunctional albumin and systemic and splanchnic vasodilatation leads to low effective blood volume, activating the renin-angiotensin-aldosterone system. This causes renal vasoconstriction, water retention, and ascites, which progresses to hepatorenal physiology and AKI development. Vasoconstriction and volume expansion effectively improve arterial blood volume and systemic hemodynamics, thereby improving renal blood flow. It is of paramount importance to predict, detect, and treat AKI in its early state, as progressive renal dysfunction is invariably associated with higher mortality in patients with decompensated cirrhosis and ACLF. This comprehensive review will focus on the recent evolving concepts of the pathophysiology, diagnosis, and management of AKI in patients with cirrhosis.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 5","pages":"104724"},"PeriodicalIF":2.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not all reoperative laparoscopic liver resection procedures are feasible for hepatolithiasis patients with a history of biliary surgery.","authors":"Wen-Jun Zhang, Guang Chen, Da-Fei Dai, Xiao-Peng Chen","doi":"10.4254/wjh.v17.i5.105890","DOIUrl":"10.4254/wjh.v17.i5.105890","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic hepatectomy (LH) has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes. However, reoperative LH (rLH) includes multiple procedures, and the no studies have examined the clinical value of individual laparoscopic procedures.</p><p><strong>Aim: </strong>To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.</p><p><strong>Methods: </strong>Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied. Liver resection procedures were divided into three categories: (1) Laparoscopic/open left lateral sectionectomy [reoperative laparoscopic left lateral sectionectomy (rLLLS)/reoperative open left lateral sectionectomy (rOLLS)]; (2) Laparoscopic/open left hemihepatectomy [reoperative laparoscopic left hemihepatectomy (rLLH)/reoperative open left hemihepatectomy (rOLH)]; and (3) Laparoscopic/open complex hepatectomy [reoperative laparoscopic complex hepatectomy (rLCH)/reoperative open complex hepatectomy (rOCH)]. The clinical outcomes were compared between the rLLLS, rLLH, and rLCH groups, and subgroup analyses were performed for the rLLLS/rOLLS, rLLH/rOLH, and rLCH/rOCH subgroups.</p><p><strong>Results: </strong>A total of 185 patients were studied, including 101 rLH patients (40 rLLLS, 50 rLLH, and 11 rLCH) and 84 reoperative open hepatectomy (40 rOLLS, 33 rOLH, and 11 rOCH). Among the three types of rLH procedure, rLLLS required the shortest operation time (240.0 minutes <i>vs</i> 325.0 minutes <i>vs</i> 350.0 minutes, <i>P</i> = 0.001) and the lowest blood transfusion rate (10.0% <i>vs</i> 22.0% <i>vs</i> 54.5%, <i>P</i> = 0.005), followed by rLLH. The rLCH had the highest conversion rate (<i>P</i> < 0.05) and postoperative intensive care unit stay rate (<i>P</i> = 0.001). Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery, while there were no differences in all outcomes between the rLCH and rOCH subgroups.</p><p><strong>Conclusion: </strong>The rLH is safe for hepatolithiasis patients with a history of biliary surgery. The rLLLS and rLLH can be recommended for these patients, whereas rLCH should be applied with caution.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 5","pages":"105890"},"PeriodicalIF":2.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open questions on how metabolic dysfunction-associated steatotic liver disease shapes the course of drug-induced liver injury.","authors":"Mariana M Ramírez-Mejía, Rolf Teschke, Nahum Méndez-Sánchez","doi":"10.4254/wjh.v17.i5.105072","DOIUrl":"10.4254/wjh.v17.i5.105072","url":null,"abstract":"<p><p>In this article, we discuss the article recently published by Zhao <i>et al</i>. This study focused on the intersection of metabolic dysfunction-associated steatotic liver disease (MASLD) and drug-induced liver injury (DILI), two major contributors to the global burden of liver disease. By analyzing clinical characteristics, metabolic parameters, immune profiles, and liver pathology, Zhao <i>et al</i> comprehensively explored how MASLD influences the presentation, severity, and prognosis of DILI. Additionally, this study underscores the importance of structured diagnostic tools, such as the Roussel Uclaf Causality Assessment Method, to accurately assess the causality of DILI within the MASLD population. Although this study provides valuable insights, limitations such as its retrospective design and cohort heterogeneity underscore the need for future prospective research to refine diagnostic approaches and therapeutic strategies.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 5","pages":"105072"},"PeriodicalIF":2.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia and frailty: An in-depth analysis of the pathophysiology and effect on liver transplant candidates.","authors":"Grigorios Christodoulidis, Kyriaki Tsagkidou, Dimitra Bartzi, Ioana A Prisacariu, Eirini S Agko, Konstantinos E Koumarelas, Dimitrios Zacharoulis","doi":"10.4254/wjh.v17.i5.106182","DOIUrl":"10.4254/wjh.v17.i5.106182","url":null,"abstract":"<p><p>Cirrhosis represents the end stage of chronic liver disease, significantly reducing life expectancy as it progresses from a compensated to a decompensated state, leading to serious complications. Recent improvements in medical treatment have created a shift in cirrhosis management. Various causes, including hepatitis viruses, alcohol consumption, and fatty liver disease, contribute to cirrhosis and are closely linked to liver cancer. The disease develops through hepatocyte necrosis and regeneration, resulting in fibrosis and sinusoidal capillarization, leading to portal hypertension and complications such as ascites, hepatic encephalopathy, and organ dysfunction. Cirrhosis also holds an increased risk of hepatocellular carcinoma. Diagnosing cirrhosis involves assessing fibrosis scores through blood tests and measuring liver stiffness through elastography. Liver transplantation is the definitive treatment for end-stage liver disease and acute liver failure.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 5","pages":"106182"},"PeriodicalIF":2.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut feeling gone wrong: Tangled relationship between disorders of gut-brain interaction and liver disease.","authors":"Manjeet Kumar Goyal, Prerna Goyal, Omesh Goyal, Ajit Sood","doi":"10.4254/wjh.v17.i5.105582","DOIUrl":"10.4254/wjh.v17.i5.105582","url":null,"abstract":"<p><p>Functional gastrointestinal disorders, now termed \"disorders of gut-brain interaction\" (DGBI), are characterized by a spectrum of chronic gastrointestinal symptoms driven by dysregulated gut-brain interaction. DGBIs frequently coexist with liver diseases, including cirrhosis, thereby exacerbating clinical manifestations and complicating management; this overlap is underpinned by shared mechanisms, including gut dysbiosis, increased intestinal permeability, systemic inflammation, and altered neuroimmune signaling. Portal hypertension in cirrhosis promotes small intestinal bacterial overgrowth and microbial translocation, thereby triggering inflammatory pathways that worsen gut and liver function. This minireview explores the gut-liver axis as a central mediator in the interplay between DGBIs and liver disease/cirrhosis. Clinically, these interactions manifest as refractory gastrointestinal symptoms, nutritional deficiencies, and impaired quality of life. Emerging research emphasizes the need for integrative diagnostic approaches, such as combining advanced imaging, microbiome analysis, and biomarker profiling, to unravel the complex interplay between DGBIs and liver disease/cirrhosis. Therapeutic interventions targeting the gut microbiome, neuroimmune pathways, and lifestyle modification can mitigate disease burden. This review underscores the importance of a multidisciplinary framework for enhancing patient outcomes and guiding future research in this intersectional field.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 5","pages":"105582"},"PeriodicalIF":2.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbial characteristics of gut microbiome dysbiosis in patients with chronic liver disease.","authors":"Chi Ma, Juan Yang, Xin-Nian Fu, Jiang-Yan Luo, Pei Liu, Xue-Li Zeng, Xin-Yi Li, Shun-Ling Zhang, Sheng Zheng","doi":"10.4254/wjh.v17.i5.106124","DOIUrl":"10.4254/wjh.v17.i5.106124","url":null,"abstract":"<p><strong>Background: </strong>In this study, we are committed to exploring the characteristics of the gut microbiome in three different stages of chronic liver disease (CLD): Chronic hepatitis B, liver cirrhosis, and hepatocellular carcinoma (HCC).</p><p><strong>Aim: </strong>To delineate the gut microbiota traits in individuals with chronic liver ailments (chronic hepatitis B, cirrhosis, HCC), scrutinizes microbiome alterations during the progression of these diseases, and assesses microbiome disparities among various Child-Pugh categories in cirrhosis sufferers.</p><p><strong>Methods: </strong>A cohort of 60 CLD patients from the Third People's Hospital of Yunnan Province were recruited from February to August 2023, together with 37 healthy counterparts. Employing 16SrDNA high-throughput sequencing, we evaluated the diversity and composition of the gut microbiota.</p><p><strong>Results: </strong>Compared to healthy subjects, patients exhibited a reduced presence of <i>Firmicutes</i> and a corresponding decline in butyrate-producing genera. In contrast, an upsurge in <i>Proteobacteria</i> was observed in the diseased cohorts, particularly an increase in <i>Enterobacteriaceae</i> that intensified with the disease's progression. At the genus level, the occurrence of <i>Escherichia_Shigella</i>, <i>Parabacteroides</i>, <i>Streptococcus</i>, <i>Klebsiella</i>, and <i>Enterococcus</i> was higher, with <i>Escherichia_Shigella</i> numbers augmenting as the disease advanced. Furthermore, in cirrhosis patients, an increase in <i>Proteobacteria</i> was noted as liver reserve diminished, alongside a decrease in <i>Ruminococcaceae</i> and <i>Bacteroidaceae</i>.</p><p><strong>Conclusion: </strong>The reduced abundance of short-chain fatty acid-producing bacteria in the intestine, alongside the increased abundance of gram-negative bacteria such as <i>Escherichia_Shigella</i> and <i>Parabacteroides</i>, may promote the progression of CLD.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 5","pages":"106124"},"PeriodicalIF":2.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic challenges in alcoholic hepatitis: From scoring systems to clinical predictors.","authors":"Mariana M Ramírez-Mejía, Arnulfo E Morales-Galicia, Nahum Méndez-Sánchez","doi":"10.4254/wjh.v17.i5.105769","DOIUrl":"10.4254/wjh.v17.i5.105769","url":null,"abstract":"<p><p>In this article, we discuss the recently published article by Yang <i>et al</i>. This retrospective analysis, which was conducted at a large urban tertiary care center, focused on comparing Lille model scores at days 3 and 7 with established scoring systems and identifying critical clinical predictors, such as renal dysfunction, nutritional status, and underlying cirrhosis. Alcoholic hepatitis (AH), a severe manifestation of alcohol-related liver disease, is associated with high morbidity and mortality, necessitating accurate prognostic tools and comprehensive clinical assessments. Prognostic tools are invaluable for early risk stratification, but they must be contextualized within the multifactorial nature of AH. Acute renal dysfunction and poor nutritional status, for example, are not just complications but pivotal markers of disease severity and systemic impact. Addressing these factors requires a holistic approach that extends beyond scoring systems to include targeted interventions and comprehensive patient care. This editorial emphasizes the need for a paradigm shift in AH management, where prognostic models are complemented by a deeper understanding of patient-specific factors. Such an approach can guide clinicians in tailoring therapies and improving outcomes for this high-risk population.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 5","pages":"105769"},"PeriodicalIF":2.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstructive surgery and percutaneous balloon dilation for the treatment of benign biliary strictures: A retrospective study.","authors":"Sergei Trifonov, Yury Kovalenko, Beslan Gurmikov, Aleksey Varava, Valeria Vodeiko, Evgeniy Pakhtushkin, Vladimir Vishnevsky, Yury Zharikov","doi":"10.4254/wjh.v17.i5.104646","DOIUrl":"10.4254/wjh.v17.i5.104646","url":null,"abstract":"<p><strong>Background: </strong>It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements, often involved in rough scarring, and with a significant risk of stricture recurrence.</p><p><strong>Aim: </strong>To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.</p><p><strong>Methods: </strong>From 2012 to 2022, 193 patients were treated at the A.V. Vishnevsky Surgical Center. All of them had different levels of strictures according to Bismuth-Strasberg classification: Type E1-2 in 32 patients, type E3 - 99, type E4 - 62.123 patients underwent open reconstructive interventions, 70 percutaneous endobiliary interventions.</p><p><strong>Results: </strong>Long-term results were available for 192 (99%) patients with a follow-up of 4.7 ± 1.6 years after reconstructive surgery; 3.0 ± 1.4 years after percutaneous interventions. Excellent and good results (according to Terblanche classification) were achieved in 35% (42/122) of patients after open reconstructive surgery and in 13% (9/70) of patients after percutaneous transhepatic interventions (<i>P</i>-value < 0.05).</p><p><strong>Conclusion: </strong>Technically, the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5. The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 5","pages":"104646"},"PeriodicalIF":2.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}