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Gallbladder, Bile Duct and Pancreas Disorders: Current Challenges, New Perspectives...
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Gallbladder, Bile Duct and Pancreas Disorders: Current Challenges, New Perspectives and Innovative Techniques

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 15 October 2025 | Viewed by 6165

Special Issue Editors

Prof. Dr. Daniel Paramythiotis

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Guest Editor
First Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
Interests: pancreas; surgery
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Prof. Dr. Robert Grützmann

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Guest Editor
Department of Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
Interests: pancreatic cancer; surgery; oncology
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Prof. Dr. Vasileios Papaziogas

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Guest Editor
Surgical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: laparoscopic surgery; hernia; gastrectomy
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Dr. Dimitrios Raptis

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Guest Editor
2nd Surgical Department, Aristotle University of Thessaloniki, “G. Gennimatas” Hospital, Thessaloniki, Greece
Interests: gastroenterology
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Dr. Eleni Karlafti

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Guest Editor
Emergency Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
Interests: emergency medicine; internal medicine; diabetes; hypertension
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Gallbladder, bile duct and pancreas disorders are highly frequent and characterized by heterogeneity. Innovate technologies are used for the diagnosis and management of these disorders, allowing for the medical community to identify, locate and treat them. Entering this field, artificial intelligence is offering solutions to difficult cases of clinical practice. Additionally, minimally invasive surgical and endoscopic procedures, as well as robotic surgery, render higher chances for the successful management of the patients of these disorders. Moreover, oncology treatments are evolving, employing a wide range of biological medicines and opening a new era in therapy for gallbladder, bile duct and pancreas disorders.

The aim of this Special Issue is to evaluate and discuss current challenges, new perspectives and innovative techniques for gallbladder, bile duct and pancreas disorders, including differential diagnosis, pharmacotherapy, treatment, final outcome and prognosis.

We invite colleagues around the world to report their experience and knowledge with original studies, reviews, case reports or communications in current challenges, new perspectives and innovative techniques relating disorders of the gallbladder, bile ducts and pancreas for this Special Issue of our journal, in order to support this dominant research area.

You may choose our Joint Special Issue in Medicina.

Dr. Daniel Paramythiotis
Prof. Dr. Robert Grützmann
Prof. Dr. Vasileios Papaziogas
Dr. Dimitrios Raptis
Dr. Eleni Karlafti
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreas
  • biliary tract
  • pancreatobiliary diseases
  • pancreas neoplasm
  • tumor
  • ERCP
  • EUS
  • management
  • therapy
  • technique
  • surgery

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Published Papers (4 papers)

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14 pages, 1355 KiB  
Article
Apigenin Attenuates Hepatic Ischemia–Reperfusion-Induced Lung Injury via Downregulation of MMP-3 and MCP-1: An Experimental Study in Rats
by Chrysovalantis Mariorakis, Maria Lambropoulou, Panagoula Oikonomou, Christos Tsalikidis, Michail Pitiakoudis, Elissavet Anestiadou, Orestis Ioannidis and Alexandra K. Tsaroucha
J. Clin. Med. 2025, 14(10), 3530; https://doi.org/10.3390/jcm14103530 - 18 May 2025
Viewed by 141
Abstract
Background/Objectives: In liver transplant surgery, ischemia–reperfusion (I-R) maneuvers are frequently employed to control bleeding; however, such interventions can result in injury not only to the liver but also to remote organs. The lungs, in particular, are highly susceptible due to their extensive [...] Read more.
Background/Objectives: In liver transplant surgery, ischemia–reperfusion (I-R) maneuvers are frequently employed to control bleeding; however, such interventions can result in injury not only to the liver but also to remote organs. The lungs, in particular, are highly susceptible due to their extensive vascularization and inflammatory response. While pulmonary injury secondary to hepatic I-R is recognized, and despite the fact that various antioxidant compounds have been investigated for their potential to mitigate I-R-induced damage to hepatic tissue, few studies have focused on evaluating therapeutic agents aimed at mitigating lung damage in this setting. This study aimed to evaluate the protective effect of apigenin on pulmonary tissue following liver I-R injury using an experimental rat model. Methods: Sixty-three male albino Wistar rats (approximately 15 weeks old, weighing 220–350 g) were randomly allocated into three groups: a sham group (open–close surgery; n = 7), a control (C) group subjected to liver I-R injury only (n = 28), and an apigenin (Ap) group receiving intraperitoneal apigenin administration immediately after liver ischemia and prior to reperfusion (n = 28). Both the C and Ap groups were subdivided into four equal subgroups corresponding to euthanasia at 60-, 120-, 180-, and 240 min post-reperfusion. Lung tissues were harvested for immunohistochemical analysis targeting the expression of matrix metalloproteinase-3 (MMP-3) and monocyte chemoattractant protein-1 (MCP-1). Results: The apigenin-treated groups exhibited significantly reduced expression levels of MMP-3 and MCP-1 across all time points when compared to the control groups. In contrast, no expression of MMP-3 or MCP-1 was observed in the sham group. Conclusions: The findings support the protective role of the antioxidant apigenin in reducing pulmonary injury following liver I-R. The diminished expression of MMP-3 and MCP-1 in the apigenin-treated rats provides compelling evidence for its protective effects on remote organs. Full article
(This article belongs to the Special Issue Gallbladder, Bile Duct and Pancreas Disorders: Current Challenges, New Perspectives and Innovative Techniques)
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11 pages, 362 KiB  
Article
Positive Intraoperative Bile Culture and Antibiotic Resistance Increase the Risk of Pancreatic Fistula in Patients After Pancreatoduodenectomy
by Michael Hoffmann, Lena Anthuber, Matthias Anthuber, David Pinto and Matthias Schrempf
J. Clin. Med. 2025, 14(2), 455; https://doi.org/10.3390/jcm14020455 - 12 Jan 2025
Viewed by 925
Abstract
Background/Objectives: A positive intraoperative bile culture (bacterobilia) is considered to be a risk factor for increased morbidity after pancreatoduodenectomy. The aim of our study was to describe the frequency of bacterobilia with a special emphasis on antibiotic resistance and to analyze the [...] Read more.
Background/Objectives: A positive intraoperative bile culture (bacterobilia) is considered to be a risk factor for increased morbidity after pancreatoduodenectomy. The aim of our study was to describe the frequency of bacterobilia with a special emphasis on antibiotic resistance and to analyze the association of these findings with postoperative complications, in particular with postoperative pancreatic fistula. Methods: From a prospective database, patients with available intraoperative bile cultures (n = 95) were selected and analyzed. Microbiological test results reported the type of bacteria as well as sensitivity and resistance patterns. Associations between culture results, antibiotic resistance, and postoperative outcomes were assessed. Results: Among 95 patients that were included in this trial, 71 (74.7%) had a positive bile culture. A total of 29.6% (21/71) of patients with positive bile cultures developed POPF grade B/C compared to 8.3% (2/24) of patients with negative bile cultures (p = 0.052). The difference in CR-POPF became statistically significant when at least one of the isolated microorganisms was resistant to ampicillin/sulbactam, the perioperative antibiotic administered for prophylaxis. CR-POPF was diagnosed in 38.5% (15/39) of patients with antibiotic resistance vs. 14.3% (8/56) of patients without resistant microorganisms (p = 0.007). We also identified the isolation of Enterococcus spp. (p = 0.006), resistant Enterobacter (p = 0.031), or resistant Escherichia coli (p = 0.027) as risk factors for pancreatic fistula. Conclusions: The isolation of antibiotic-resistant strains in a positive bile culture is a major risk factor for the development of pancreatic fistula after pancreatoduodenectomy. The most relevant bacteria in our study were Enterococcus spp., Enterobacter cloacae, and Escherichia coli. Thus, broad-spectrum antimicrobial prophylaxis with efficacy against these microorganisms and with low resistance rates should be routinely administered perioperatively. Full article
(This article belongs to the Special Issue Gallbladder, Bile Duct and Pancreas Disorders: Current Challenges, New Perspectives and Innovative Techniques)
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12 pages, 4290 KiB  
Article
The Catheter Flushing Method Shows a Similar Diagnostic Yield to the Conventional Method in Brushing Cytology for Biliary Strictures
by Sung Ill Jang, Ji Hae Nahm, See Young Lee, Seok Jeong, Tae Hoon Lee, Dong Uk Kim, Chang-Il Kwon, Jae Hee Cho and Min Je Sung
J. Clin. Med. 2024, 13(22), 6741; https://doi.org/10.3390/jcm13226741 - 8 Nov 2024
Viewed by 1059
Abstract
Background/Objectives: Endobiliary brushing is usually performed in the diagnosis of indeterminate biliary strictures; however, in this setting, brush cytology is limited by a low diagnostic yield and sensitivity. Here, we compared the catheter flushing method (CFM) with the conventional cytologic method (CCM) [...] Read more.
Background/Objectives: Endobiliary brushing is usually performed in the diagnosis of indeterminate biliary strictures; however, in this setting, brush cytology is limited by a low diagnostic yield and sensitivity. Here, we compared the catheter flushing method (CFM) with the conventional cytologic method (CCM) in terms of cellularity and diagnostic performance. Methods: Endobiliary brushings were obtained during endoscopic retrograde cholangiopancreatography (ERCP) from patients with biliary strictures enrolled at six tertiary hospitals. Additionally, the CFM was performed after brushing. Using liquid-based cytologic preparations of samples, we assessed the diagnostic performance of the CCM using Pap staining and the CFM using methionyl-transfer RNA synthetase 1 (MARS1) immunofluorescence staining. Results: From a total of 399 patients (malignant, 253; benign, 146), 374 CCM samples and 361 CFM samples contained adequate cells, with no significant difference in diagnostic yield (93.7% vs. 90.5%, respectively; p = 0.088). The sensitivity of the CFM (90.3%) was significantly higher than that of the CCM (75.1%; p < 0.001), with no significant difference in accuracy between methods (81.2% vs. 82.6%, respectively; p = 0.608). Conclusions: The diagnostic yield of the CFM was comparable to that of the CCM. Additionally, the diagnostic performance of the CFM was comparable to that of the CCM. These findings indicate that the CFM could be an additional brush cytology method for sample collection in patients with indeterminate biliary strictures. Incorporating both the CCM and CFM might be expected to improve the diagnostic yield of brush cytology in the biliary strictures. Further prospective comparative studies between the CCM and CFM using the same staining method are needed to validate these findings. Full article
(This article belongs to the Special Issue Gallbladder, Bile Duct and Pancreas Disorders: Current Challenges, New Perspectives and Innovative Techniques)
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22 pages, 3683 KiB  
Systematic Review
Comparative Assessment of Endoscopic Ultrasound-Guided Biopsies vs. Percutaneous Biopsies of Pancreatic Lesions: A Systematic Review and Meta-Analysis of Diagnostic Performance
by Daniel Paramythiotis, Eleni Karlafti, Dimitrios Tsavdaris, Konstantinos Arvanitakis, Adonis A. Protopapas, Georgios Germanidis, Leonidas Kougias, Adam Hatzidakis, Christos Savopoulos and Antonios Michalopoulos
J. Clin. Med. 2024, 13(11), 3108; https://doi.org/10.3390/jcm13113108 - 25 May 2024
Cited by 2 | Viewed by 2282
Abstract
Introduction: Pancreatic cancer ranks as the fourth deadliest form of cancer. However, it is essential to note that not all pancreatic masses signal primary malignancy. Therefore, it is imperative to establish the correct differential diagnosis, a process further supported by pre-operative biopsy procedures. [...] Read more.
Introduction: Pancreatic cancer ranks as the fourth deadliest form of cancer. However, it is essential to note that not all pancreatic masses signal primary malignancy. Therefore, it is imperative to establish the correct differential diagnosis, a process further supported by pre-operative biopsy procedures. This meta-analysis aims to compare the diagnostic performance of two minimally invasive biopsy approaches for pancreatic tissue sampling: percutaneous biopsies guided by computed tomography or ultrasound, and transduodenal biopsies guided by endoscopic ultrasound (EUS). Methods: A systematic literature search was conducted in the MEDLINE and Scopus databases. The included studies analyzed the diagnostic performance of the two biopsy methods, and they were assessed for risk of bias using the Quality Assessment of Diagnostic Accuracy Studies–2 tool. Statistical analysis was carried out using the RevMan and MetaDisc software packages. Results: The statistical analysis of the results demonstrated the superiority of the percutaneous approach. Specifically, the pooled sensitivity, specificity, LR+, LR−and DOR for the percutaneous approach were 0.896 [95% CI: 0.878–0.913], 0.949 [95% CI: 0.892–0.981], 9.70 [95% CI: 5.20–18.09], 0.20 [95% CI: 0.12–0.32] and 68.55 [95% CI: 32.63–143.98], respectively. The corresponding values for EUS-guided biopsies were 0.806 [95% CI: 0.775–0.834], 0.955 [95% CI: 0.926–0.974], 12.04 [95% CI: 2.67–54.17], 0.24 [95% CI: 0.15–0.39] and 52.56 [95% CI: 13.81–200.09], respectively. Nevertheless, it appears that this statistical superiority is also linked to the selection bias favoring larger and hence more readily accessible tumors during percutaneous biopsy procedures. Conclusions: Concisely, our meta-analysis indicates the statistical superiority of the percutaneous approach. However, selecting the optimal biopsy method is complex, influenced by factors like patient and tumor characteristics, clinical resources, and other relevant considerations. Full article
(This article belongs to the Special Issue Gallbladder, Bile Duct and Pancreas Disorders: Current Challenges, New Perspectives and Innovative Techniques)
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