Cholangiocarcinoma consists of a heterogeneous group of aggressive and rare malignancies that arise from the bile ducts outside or inside the liver. Although surgical resection remains the only potential curative treatment option for patients with cholangiocarcinoma, curative surgery is only possible in a small number of cases. Furthermore, recurrence rates are high even among patients who undergo surgical resection. Unfortunately, a significant proportion of patients present with locally advanced, unresectable disease. Recently, neoadjuvant chemotherapy has emerged as a promising method to identify patients with poor prognosis, avoiding pathological and non-therapeutic resection, as well as potentially downstaging tumors which cannot be resected initially. This therapeutic strategy has the potential to improve local and distant control, to achieve R0 resection and to prevent distant metastasis. However, few data are currently available supporting neoadjuvant chemotherapy in cholangiocarcinoma and several questions remains unanswered. Adjuvant chemotherapy is administered after surgery to eradicate any remaining cancer cells with the goal of reducing the chances of recurrence. And chemotherapy is also frequently used in cholangiocarcinoma as an adjunct to surgical resection, but the appropriate sequence of chemotherapy with surgery is unclear.

Pancreatic cancer can arise in the background of chronic pancreatitis (CP). The relative risks for pancreatic cancer in CP vary considerably according to other contributing factors such as disease duration, excess alcohol consumption, tobacco consumption, eating habits, physical activity, and late-onset diabetes. The incidence of pancreatic cancer is estimated to be about 10 per 105 per year, and the incidence and prevalence of CP are estimated to be 5-12 per 105 and 50 per 105 per year, respectively. The pooled relative risk estimates for pancreatic cancer in CP patients range from 2.7 to 13.3. Subsets of CP subjects with a family history of pancreatic cancer or those with newly developed diabetes over the age of 50 have a higher risk for pancreatic cancer. However, the prevalence of pancreatic cancer is not high enough to justify general screening of the adult CP population. Thus, it is necessary to select subsets of CP cohorts with a significantly high risk of pancreatic cancer. We need a better overall disease model that can define the interaction of multiple risk factors and their cumulative or potential effects on pancreatic cancer.

Background/Aim: In gallbladder cancer (GBC), gender differences in incidence and mortality rates have been reported with geographic variation. However, there is little known about sex-related difference in GBC prognosis. This study compares prognostic factors according to gender for GBC. Methods: We searched clinicopathological factors in all stages of 952 GBC patients from seven medical centers in Korea. A total of 927 patients were enrolled and surgery with curative resection was performed in 499 patients. Results: Carbohydrate antigen (≥37 U/mL) was a significant prognostic factor in both females and males (odd ratio [OR], 4.30; 95% confidence interval [CI], 3.13-5.89; p<0.001). Age was a significant factor only in female patients, elderly patients were associated with low resectability and the likelihood of T-stage >2; an independent predictor of poor prognosis via multivariate analysis (OR, 1.03; 95% CI, 1.01-1.05; p=0.005, OR, 1.05; 95% CI, 1.02-1.08; p=0.002). Body mass index (BMI) also showed gender difference, and lower BMI (≤25 kg/m2) was the significant good indicator of multivariate analysis for lymph node metastasis in female patients (OR, 0.42; 95% CI, 0.23-0.77; p=0.005) but, the significant poor indicator of univariate analysis for advanced T-stage in male (OR, 2.79; 95% CI, 1.40-5.54; p=0.003). Conclusions: These results suggest that there is a possibility of gender difference in GBC prognosis. Age and high BMI were poor prognostic factors for curative resection for female GBC patients.

Percutaneous balloon dilation with or without placement of an external biliary drain is a nonoperative alternative method for treating benign bilioenteric anastomotic strictures. Although this procedure has a high technical success rate, outcomes are less optimal when attempting to dilate refractory tight strictures. For the stricture, cutting balloon can be an option. We present four patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation. To the patients, a peripheral cutting balloon over-the-wire system was inflated, following subsequent conventional non-compliant balloon dilation. After the balloon dilation treatment, an external drainage catheter was placed through the stricture site and maintained for up to 30 days. Technical and end-treatment success was achieved in all four patients. In conclusion, the use of cutting balloon dilation may appear to be a safe and effective alternative method of treatment in patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation.

Biliary stent migration is one of the late complications of endoscopic retrograde cholangiopancreatography. Most of the biliary stent migration is asymptomatic and successfully managed by stent removal. A 66-year-old man with unresectable pancreatic cancer, common bile duct obstruction, and duodenal third portion obstruction underwent endoscopic plastic biliary stent placement and duodenal uncovered metallic stent placement in two separate sessions. After 3 weeks from the duodenal stenting, he presented with hematemesis. Urgent esophagogastroduodenoscopy and magnetic resonance imaging showed hemobilia. The patient recovered with conservative managements. Cross-sectional imagings done 2 months later demonstrated the penetration of the biliary stent into portal vein. Here, we present a case of delayed hemobilia caused by penetration of biliary plastic stent into the portal vein.