Globally, cancer claims nearly 10 million lives annually, where tumor heterogeneity, the immunosuppressive microenvironment, and therapeutic resistance constitute fundamental clinical challenges. In recent years, immunometabolic reprogramming has emerged as a cutting-edge research frontier, revealing novel mechanisms by which metabolites orchestrate immune responses. Itaconate—an immunometabolite primarily synthesized by macrophages—serves as a pivotal molecular hub bridging metabolic stress and anti-tumor immunity. This review systematically traces the evolution of itaconate from an industrial chemical to a key immunometabolite; comprehensively elucidates its dual roles (pro-tumorigenic vs. anti-tumorigenic) within the tumor microenvironment; synthesizes preclinical evidence of itaconate and its derivatives across diverse tumor systems; and consolidates emerging adjuvant therapeutic strategies targeting the Acod1/itaconate pathway. Collectively, this work aims to provide innovative immunometabolic perspectives for overcoming current barriers in cancer therapy.

Annually, approximately 3.5 % of the world's population dies of cirrhosis or liver cancer, and the burden of liver disease is steadily expanding owing to multiple factors such as alcohol consumption, irrational diets, viral transmission, and exposure to drugs and toxins. However, the lack of effective therapies and the adverse effects of some medications remain a threat to the management of liver disease. Recently, immunometabolism, as an emerging discipline, appears to be the focus of unprecedented research. As a natural metabolite that regulates cellular functions, itaconate is a crucial bridge connecting metabolism and immune response. Remodeling immune function through metabolic modulation may be a promising alternative for disease intervention strategies. In this review, we first briefly describe the historical origin of itaconate and the development of its derivatives. This was followed by a review of the molecular mechanisms by which itaconate regulated immune-metabolic responses. Furthermore, we analyzed the effects of itaconate regulation on immune cells of the hepatic system. Finally, we summarized the experimental evidence for itaconate and its derivatives in the therapeutic application of liver diseases. Itaconate is potentially an invaluable component of emerging therapeutic strategies for liver disease.

OBJECTIVE:Gallstones have gradually become a highly prevalent digestive disease worldwide. This study aimed to investigate the association of nine different obesity-related indicators (BRI, RFM, BMI, WC, LAP, CMI, VAI, AIP, TyG) with gallstones and to compare their predictive properties for screening gallstones. METHODS:Data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) for the 2017-2020 cycle, and weighted logistic regression analyses with multi-model adjustment were conducted to explore the association of the nine indicators with gallstones. Subject working curves were analyzed to assess the screening ability of the nine indicators. In addition, the association between the most predictive indicator and gallstones was investigated with smooth curve fitting, and differences in risk across populations were explored with subgroup analyses. RESULTS:In total, 3654 participants were involved in the final analysis and 383 (10.48%) carried gallstones. The results of weighted multifactorial logistic regression analysis indicated that BRI, RFM, BMI, WC, LAP, and CMI were independent risk factors for gallstones. The ORs for the highest quartile were 4.13 for RFM, 3.13 for BRI, 2.85 for BMI, 2.86 for WC, 2.45 for LAP, and 1.49 for CMI. The area under the ROC curve for RFM was 0.70. The Delong test compared the performance of different ROCs and revealed that the difference between the area under the curve of RFM and the other metrics was significant ( P < 0.05). Smooth curve fitting suggested a linear positive correlation between RFM and gallstones (LLR > 0.05), especially in women, non-Hispanic White, insufficient physical activity, hypertensive, and diabetic populations. CONCLUSION:RFM, BRI, BMI, WC, LAP, and CMI were essential indicators for recognizing gallstones. By comparison, we realized that RFM was a better predictor of gallstones.

Cholesterol gallstone disease (CGD) is one of the most common digestive diseases, and it is closely associated with hepatic cholesterol metabolism. Cholesterol gallstones may be caused by abnormal hepatic cholesterol metabolism, such as excessive cholesterol biosynthesis within the liver, interfering with the uptake or export of cholesterol in the liver, and abnormal hepatic cholesterol esterification. In this review, we begin with a brief overview of the clinical diagnosis and treatment of gallstone disease (GSD). Then, we briefly describe the major processes of hepatic cholesterol metabolism and summarize the key molecular expression changes of hepatic cholesterol metabolism in patients with gallstones. We review and analyze the recent advances in elucidating the relationships between these key molecules and CGD, and some targets significantly impacting on CGD via hepatic cholesterol metabolism are also listed. We also provide a significant discussion on the relationship between CGD and nonalcoholic fatty liver disease (NAFLD). Finally, the new discoveries of some therapeutic strategies associated with hepatic cholesterol metabolism to prevent and treat CGD are summarized.

BACKGROUND AND AIMS:The secretion of bile salts transported by the bile salt export pump (BSEP) is the primary driving force for the generation of bile flow; thus, it is closely related to the formation of cholesterol stones. Caveolin-1 (Cav-1), an essential player in cell signalling and endocytosis, is known to co-localize with cholesterol-rich membrane domains. This study illustrates the role of Cav-1 and BSEP in cholesterol stone formation. METHODS:Adult male C57BL/6 mice were used as an animal model. HepG2 cells were cultured under different cholesterol concentrations and BSEP, Cav-1, p-PKCα and Hax-1 expression levels were determined via Western blotting. Expression levels of BSEP and Cav-1 mRNA were detected using real-time PCR. Immunofluorescence and immunoprecipitation assays were performed to study BSEP and Hax-1 distribution. Finally, an ATPase activity assay was performed to detect BSEP transport activity under different cholesterol concentrations in cells. RESULTS:Under low-concentration stimulation with cholesterol, Cav-1 and BSEP protein and mRNA expression levels significantly increased, PKCα phosphorylation significantly decreased, BSEP binding capacity to Hax-1 weakened, and BSEP function increased. Under high-concentration stimulation with cholesterol, Cav-1 and BSEP protein and mRNA expression levels decreased, PKCα phosphorylation increased, BSEP binding capacity to Hax-1 rose, and BSEP function decreased. CONCLUSION:Cav-1 regulates the bile salt export pump on the canalicular membrane of hepatocytes via PKCα-associated signalling under cholesterol stimulation.

Cholelithiasis is a common biliary tract disease. However, the exact mechanism underlying gallstone formation remains unclear. Mucin plays a vital role in the nuclear formation and growth of cholesterol and pigment stones. Excessive mucin secretion can result in cholestasis and decreased gallbladder activity, further facilitating stone formation and growth. Moreover, gallstones may result in inflammation and the secretion of inflammatory factors, which can further increase mucin expression and secretion to promote the growth of gallstones. This review systematically summarises and analyses the role of mucins in gallstone occurrence and development and its related mechanisms to explore new ideas for interventions in stone formation or recurrence.

A high recurrence rate is undesirable after treatment of common bile duct (CBD) stones. A major risk factor identified for recurrence is that invasive techniques, including surgical or endoscopic treatments, will impair the biliary tract system either by direct incision of the CBD or by cutting or dilating the ampulla of Vater. During endoscopic treatment, two main assisted methods for lithotomy, sphincterotomy and papillary balloon dilation, can result in different degrees of damage to the structure and function of the sphincter of Oddi (SO), contributing to slowing of biliary excretion, cholestasis, biliary bacterial infection, and promotion of bile duct stone recurrence. In this review, the relationship between endoscopic lithotomy and structural impairment or functional abnormality of the SO will be summarized, and their relationship with the recurrence of CBD stones will also be analyzed. Further improvement of these endoscopic methods or exploration of some novel methods, such as endoscopic endoclip papilloplasty, temporary insertion of a self-expandable metal stent, and combined application of peroral cholangioscopy, may aid in providing more appropriate treatment for patients with choledocholithiasis, repair or protect the function and structure of SO, reduce or prevent the recurrence of bile duct stones, and improve patient outcomes.

Background and Objective:From the 1980s and continuing into the 21st century, percutaneous transhepatic choledoscopy (PTCS) has been increasingly used in the clinical management of cholelithiasis. However, when compared to conventional minimally invasive techniques such as endoscopic retrograde cholangiopancreatography (ERCP), PTCS is characterized by greater invasiveness and a higher rate of complications. As a result, PTCS is frequently used as a supplementary treatment option. Nevertheless, it plays a unique and indispensable role in addressing hepatolithiasis. In this study, to facilitate safer clinical applications and gain a deeper understanding of PTCS-related complications, we conducted a comprehensive examination of these complications. Methods:Research studies related to PTCS were reviewed in PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) (year range, 1952-2024). There was no restriction on language. The occurrence and management of complications at various steps of PTCS were examined and compared with those of first-line minimally invasive treatments via a tabular method. Additionally, we evaluated the feasibility of using PTCS in the context of intrahepatic bile duct stones. Key Content and Findings:Information on the types, incidence, and treatment of complications of PTCS was extracted in this review. A total of 5,923 results were retrieved, of which 41 were excluded. The reason for exclusion was that the article was a meeting comment. The findings indicate that PTCS plays an important role in the treatment of biliary tract diseases. Conclusions:Although PTCS is frequently used as an adjunctive therapeutic approach, its distinct utility in treating intrahepatic bile duct stones remains difficult to replace. Thus, a deeper understanding of PTCS-related complications, coupled with ongoing advancements in instrumentation, could significantly enhance the efficiency of minimally invasive gallstone management.

Charged multivesicular body protein 3 (CHMP3) is an elemental constituent of the endosomal sorting complex required for transport (ESCRT) III, whose function as a tumor susceptibility gene in the development of liver cancer remains unclear. CHMP3 was found to be associated with pyroptosis by bioinformatics analysis of data from patients with hepatocellular carcinoma (HCC) in The Cancer Genome Atlas database. It was aimed to explore the role and potential mechanisms of CHMP3 in the development of liver cancer. The expression of CHMP3 at the tissue level was examined using immunohistochemistry and western blot analysis. Subsequently, HepG2 and Huh-7 cells were transfected with small interfering RNA and overexpression plasmids to change CHMP3 expression. The proliferative capacity of cells was examined using colony formation and Cell Counting Kit-8 assays. Wound healing and Transwell assays were used to examine the migratory and invasive abilities of the cells. Transmission electron microscopy was used to observe changes in cell morphology. Western blotting was used to examine the expression of caspase-1 signaling pathway related proteins, a classic pathway of pyroptosis. In addition, a xenograft tumor model was used to examine the tumorigenic ability of CHMP3 in vivo. The results demonstrated that CHMP3 expression was upregulated in HCC and was associated with poor prognosis. Knockdown or overexpression of CHMP3 inhibited or promoted the proliferation, migration and invasion of liver cancer cells. Knockdown of Huh-7 showed changes in cell membrane integrity as well as cytoplasmic leakage. Furthermore, knockdown of CHMP3 may activate the caspase-1 pyroptosis signaling pathway which in turn inhibits the progression of liver cancer, and this effect can be reversed by the caspase-1 inhibitor AYC. In conclusion, CHMP3 may affect the development of liver cancer through the caspase-1-mediated pyroptosis pathway.

Increasingly, emerging research evidence has demonstrated that nonalcoholic fatty liver disease (NAFLD) is a disease closely associated with systemic inflammation. However, the specific upstream inflammatory factors engaged in the pathogenesis of NAFLD remain unclear. Our study aimed to identify the inflammatory regulators causally associated with NAFLD pathogenesis through Mendelian randomisation. A two-sample Mendelian randomisation method was applied to analyse the causal association between 91 circulating inflammatory proteins and NAFLD. Data on circulating inflammatory proteins were derived from samples of European ancestry (14,824 samples) and NAFLD data were obtained from the FinnGen consortium (2025 cases and 284,826 controls). Instrumental variables were selected from the genetic variance and F-statistics were calculated to avoid bias. We adopted the random-effects inverse variance weighting (IVW) method as our primary analytical approach. Supplementary analyses were also implemented, including weighted median, MR-Egger and weighted mode. Moreover, we conducted pleiotropy and heterogeneity analyses to validate the accuracy of the findings. The application of Mendelian randomisation analysis identified four inflammatory factors that might be causally associated with NAFLD at the genetic level. Elevated levels of eotaxin (or = 1.27, 95% CI: 1.05-1.53, p = 0.014), osteoprotegerin (OPG) (or = 1.29, 1.03-1.60, p = 0.023) and TNFRSF9 (or = 1.32, 95% CI: 1.06-1.64, p = 0.014) may be causally related to an increasing risk of NAFLD. Conversely, heightened leukaemia inhibitory factor (LIF) levels (or = 0.63, 0.44-0.92, p = 0.016) were linked to a lower risk of NAFLD onset. There was no causal relationship between levels of other circulating inflammatory proteins and NAFLD. Our analysis uncovered four upstream inflammatory factors genetically associated with the pathogenesis of NAFLD. These results highlight the potential involvement of inflammation in NAFLD, which provides partial insights for further research in this field in the future.

Objective: Gallstones have gradually become a highly prevalent digestive disease worldwide. This study aimed to investigate the association of nine different obesity-related indicators (BRI, WWI, BMI, WC, LAP, CMI, VAI, AIP, TyG) with gallstones and to compare their predictive properties for screening gallstones. Methods: Data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) for the 2017-2020 cycle, and weighted logistic regression analyses with multi-model adjustment were conducted to explore the association of the 9 indicators with gallstones. Subject working curves were analyzed to assess the screening ability of the 9 indicators. In addition, variation in the relationship between the two indicators with the most predictive power and gallstones was described by restricted cubic spline. Results: In total, 3698 participants were involved in the final analysis and 392 (10.6%) carried gallstones. The results of weighted multifactorial logistic regression analysis indicated that BRI, WWI, BMI, WC, LAP, and CMI were independent risk factors for gallstones. The ORs and confidence intervals for the highest quartile were 3.21 (1.55-6.28) for BRI, 2.26 (1.01-5.05) for WWI, 2.83 (1.48-5.39) for BMI, 2.83 (1.54-5.22) for WC, 2.39 (1.22-4.69) for LAP, 2.03 (1.19-3.46) for CMI. The area under the ROC curve for BRI was 0.67. The Delong test compared the performance of different ROCs and revealed that the difference between the area under the curve of BRI and the other metrics was significant (P<0.05), except for WWI. Conclusion: BRI, WWI, BMI, WC, LAP, and CMI were essential indicators for recognizing gallstones. By comparison, we realized that BRI was a better predictor of gallstones.

The etiology of congenital biliary dilatation(CBD)is still unclear.Currently,abnormal pancreatico-bile duct confluence is the mainstream theory.In terms of classification,Todani classification is the most widely used.On the other hand,Dong′s classification which proposed by Dong Jiahong and his colleagues has guiding significance for the selection of surgical methods.CBD is difficult to detect and diagnose because of the poor specificity of clinical symptoms,and it is often necessary to make a preliminary diagnosis based on the medical history,and it is also quite dependent on the assistance of imaging.Serological examination also plays a key role in the diagnosis of CBD because of its convenience and high acceptance.This article reviewed the etiology,classification and diagnosis of CBD.

Background:The best approach for treating benign or low-grade malignant lesions localized in the pancreatic neck or body remains debatable. Conventional pancreatoduodenectomy and distal pancreatectomy (DP) are associated with a risk of impairment of pancreatic function at long-term follow-up. With advances in technology and surgical skills, the use of central pancreatectomy (CP) has gradually increased. Objectives:The objective was to compare the safety, feasibility, and short-term and long-term clinical benefits of CP and DP in matched cases. Methods:The PubMed, MEDLINE, Web of Science, Cochrane, and EMBASE databases were systematically searched to identify studies published from database inception to February 2022 that compared CP and DP. This meta-analysis was performed using R software. Results:Twenty-six studies matched the selection criteria, including 774 CP and 1713 DP cases. CP was significantly associated with longer operative time (P<0.0001), less blood loss (P<0.01), overall and clinically relevant pancreatic fistula (P<0.0001), postoperative hemorrhage (P<0.0001), reoperation (P=0.0196), delayed gastric emptying (P=0.0096), increased hospital stay (P=0.0002), intra-abdominal abscess or effusion (P=0.0161), higher morbidity (P<0.0001) and severe morbidity (P<0.0001) but with a significantly lower incidence of overall endocrine and exocrine insufficiency (P<0.01), and new-onset and worsening diabetes mellitus (P<0.0001) than DP. Conclusions:CP should be considered as an alternative to DP in selected cases such as without pancreatic disease, length of the residual distal pancreas is more than 5 cm, branch-duct intraductal papillary mucinous neoplasms, and a low risk of postoperative pancreatic fistula after adequate evaluation.

BackgroundObservational studies about the association between serum total bilirubin and cholelithiasis are inconsistent. Hence, it is essential to reevaluate the association between serum total bilirubin and cholelithiasis and to verify whether such association is causal or not.MethodsWe selected single-nucleotide polymorphisms (SNPs) that are strongly associated with exposure as instrumental variable and conducted a bidirectional two-sample Mendelian randomization (MR) study to explore the causal association between serum total bilirubin and cholelithiasis. We implemented the inverse-variance weighted approach as a primary analysis to combine the Wald ratio estimates. Four additional analyses, namely, MR-Egger regression, weighted median, weighted mode, and MR–pleiotropy residual sum and outlier (PRESSO), were utilized to investigate the causal association and the influence of potential pleiotropy.ResultsA total of 116 SNPs were selected as valid instrumental variables to estimate the causal association of serum total bilirubin on cholelithiasis, and causal association between genetically determined serum total bilirubin and cholelithiasis was demonstrated [beta = 0.10; 95% confident interval (CI), 0.07 to 0.14; p < 0.001]. Likewise, the other methods, namely, the weighted median (beta = 0.12; 95% CI, 0.08 to 0.15; p < 0.001), MR-Egger (beta = 0.11; 95% CI, 0.08 to 0.15; p < 0.001), weighted mode (beta = 0.11; 95% CI, 0.08 to 0.15; p < 0.001), and MR-PRESSO approaches, further confirmed that this result (p = 0.054) indicates similar results. In addition, seven SNPs were selected as instrumental variable to estimate causal association of cholelithiasis on serum total bilirubin, and the result supported the causal effect of cholelithiasis to serum total bilirubin (beta = 0.12; 95% CI, 0.09 to 0.15; p < 0.001). At the same time, the other methods, namely, the weighted median (beta = 0.10; 95% CI, 0.06 to 0.13; p < 0.001), MR-Egger (beta = 0.12; 95% CI, 0.07 to 0.18; p = 0.007), weighted mode (beta = 0.09; 95% CI, 0.03 to 0.14, p = 0.019), and MR-PRESSO methods, further confirmed this result (p < 0.001).ConclusionOur MR study revealed that the serum total bilirubin was causally associated with the risk of cholelithiasis, and the genetic predisposition to cholelithiasis was causally associated with the increased serum total bilirubin levels.

Background: Hepatolithiasis is prevalent in Southeast Asian regions, and the role of endogenous b-glucuronidase (b-GD) in the formation of hepatolithiasis is being gradually recognised. Reveal-ing the regulation mechanism of the expression of endogenous b-GD will provide new therapeu-tic strategies for intervening in the formation of hepatolithiasis.Methods: Liver specimens from patients with hepatolithiasis were examined by immunohis-tochemistry to assess the expression of macrophage markers including CD68, CD80, and CD206, as well as that of TNF-a and endogenous b-GD, compared with that in normal liver samples. HiBEpiC cells were co-cultured directly or indirectly with induced M2 macrophages or directly stimulated with TNF-a, and the expression of the endogenous b-GD was examined. A PKC inhibi-tor, chelerythrine, and an NF-kB inhibitor, pyrrolidine dithiocarbamate (PDTC), were used to elu-cidate the possible regulation mechanism.Results: The expression of macrophage markers including CD68 and CD206, as well as that of TNF-a and endogenous b-GD significantly increased in liver specimens from patients with hepato-lithiasis compared with that in normal liver samples. The expression of CD68, CD206 and TNF-a was positively correlated with that of endogenous b-GD. When HiBEpiC cells were co-cultured directly or indirectly with M2 macrophages, following stimulation with lipopolysaccharide (LPS), the expression of endogenous b-GD was significantly higher in the indirect co-culture group than that in the direct co-culture group, or in HiBEpiC cells or M2 macrophages cultured alone. Further experiments revealed that following stimulation with LPS, TNF-a secretion increased in both the indirect and direct co-culture groups compared with that in HiBEpiC cells cultured alone. TNF-a increased the expression of endogenous fi-GD in HiBEpiC cells, in a dose-and time -dependent manner. In addition, TNF-a significantly increased the expression levels of p-P65 and proliferating cell nuclear antigen (PCNA), and PDTC effectively inhibited the TNF-a-induced expression of PCNA and fi-GD.Conclusions: Infiltration of macrophages, especially M2 macrophages, may be involved in the hepatolithiasis formation. LPS activates the macrophages, inducing the secretion of TNF-a, which can further increase the expression of endogenous fi-GD in the epithelial cells of the bile duct, possibly via the NF-kB/PCNA signalling cascade.(c) 2022 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objective To evaluate retrospectively the clinical efficacy of percutaneous transhepatic gallbladder drainage (PTGBD) in the patients with acute biliary pancreatitis (ABP). Methods A total of 244 patients with ABP recei-ving treatment in our department from January 2014 to November 2021 were included in this study. There were 76 cases in study group using PTGBD treatment, among them, 41 cases with performed endoscopic retrograde cholangiopancreatography (ERCP) after symptoms remission, and 168 cases without PTGBD in control group with 49 cases using ERCP and 119 cases with conservative treatment. The rate of post-ERCP pancreatitis (PEP) and postoperative adverse events were compared between two groups. Results The rate of PEP was significantly lower in study group (11/41) than in control group (23/49), 26.8% vs.46.9%, P=0.008. The patients in both groups were performed cholecystectomy or cholecystectomy with bile duct drainage in late stage (73 cases in study group and 152 cases in control group). The shorter operative time [(76.3±28.3) min vs.(121.6±34.9) min, P=0.011], less intraoperative blood loss [(65.7±27.6) mL vs. (99.2±60.3) mL, P=0.028], shorter abdominal drainage duration [(3.6±2.5) d vs. (8.9±4.9) d, P=0.016] in study group than in control group. The rate of postoperative sepsis [2.7% (2 cases) vs. 5.3% (8 cases), P=0.003], rate of reoperation [1.4%(1 case) vs. 3.9%(6 cases), P<0.001], rate of admission to intensive care unit [4.1%(3 cases) vs. 7.2%(11 cases), P=0.028], and mortality [0 vs. 1.3% (2 cases), P<0.001] in study group were lower than those in control group. Conclusions PTGBD could be simple and effective in the treatment of ABP and consistent with treatment of damage control surgery which should be worthy clinical application.

The study investigated the clinical value of fluorescence cholangiography using indocyanine green (ICG) in laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in preventing bile duct injury (BDI) and detecting bile leakage. A total of 300 patients who underwent fluorescent navigation LC and LCBDE in the Second Department of General Surgery, Shengjing Hospital Affiliated to China Medical University from June 2020 to September 2022 were selected as the research objects for observation and analysis. There were 114 males and 186 females, and aged (50.7±14.0) years with the body mass index (BMI) of (23.6±1.6) kg/m². All 300 cases of fluorescence navigation surgery were successfully completed, of which 5 patients received fluorescence-guided LCBDE and primary suture. The results showed that the application of fluorescence cholangiography with ICG can effectively avoid and detect the occurrence of BDI and bile leakage. Meanwhile, it is reasonable to hypothesize that ICG can be used for rapid localization and the final check to prevent the recurrence of bile leakage when bile leakage is suspected in the second operation.

吲哚菁绿(indocyanine green,ICG)荧光胆道造影是可以无创显示肝外胆道并能提示胆漏[1].笔者参与完成1例胆囊结石合并胆道解剖异常的腹腔镜胆囊切除术(LC),术前经静脉注射联合术中经引流管注射ICG荧光胆道造影,有效避免术中胆道损伤,总结报告如下.

Background: At present, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) are frequently used for reducing malignant obstructive jaundice (MOJ). However, it is controversial as to which method is superior in terms of efficacy and safety. Objectives: The aim of this study was to compare the safety, feasibility, and clinical benefits of ERCP and PTCD in matched cases of MOJ. Methods: The Web of Science, Cochrane, PubMed, and CNKI databases were searched systematically to identify studies published between January 2000 and December 2019, without language restrictions, that compared ERCP and PTCD in patients with MOJ. The primary outcome was the success rate for each procedure. The secondary outcomes were the technical success rate, serum total bilirubin level, length of hospital stay, hospital expense, complication rate, and survival. This meta-analysis was performed using Review Manager 5.3. Results: Sixteen studies met the inclusion criteria, including 1,143 cases of ERCP and 854 cases of PTCD. The analysis demonstrated that jaundice remission in PTCD was equal to that in ERCP (mean difference [MD], 1.19; 95% confidence interval [CI]: -0.56 to -2.93; p = 0.18). However, the length of hospital stay in the ERCP group was 3.03 days shorter than that in the PTCD group (MD, -2.41; 95% CI: -4.61 to -0.22; p = 0.03). ERCP had a lower rate of postoperative complications (odds ratio, 0.66; 95% CI: 0.42-1.05); however, the difference was not significant (p = 0.08). ERCP was also more cost-efficient (MD, -5.42; 95% CI: -5.52 to -5.32; p < 0.01). Further, we calculated the absolute mean of hospital stay (ERCP:PTCD = 8.73:12.95 days), hospital expenses (ERCP:PTCD = 5,104.13:5,866.75 RMB), and postoperative complications (ERCP:PTCD = 11.2%:9.1%) in both groups. Conclusion: For remission of MOJ, PTCD and ERCP had similar clinical efficacy. Each method has its own strengths and weaknesses. Considering that ERCP had a lower rate of postoperative complications, shorter hospital stay, and higher cost efficiency, ERCP may be a superior initial treatment choice for MOJ.

Acute biliary tract disease has serious threat for the patient life. Emergency surgery for critical patients tends to poor prognosis. Multidisciplinary advantages were integrated and the experiences were summarized in our department which showed that staged treatment of patients with biliary emergency would improve the prognosis greatly. For the patients with acute severe cholecystitis, percutaneous transhepatic gallbladder drainage (PTGBD) was performed first to relieve obstruction and elective surgical treatment was done then, which could reduce significantly the rates of biliary tract injury and postoperative mortality and the rate of intensive care unit admission. It was safer for patients with biliary pancreatitis that firstly PTGBD was performed to relieve the symptoms of pancreatitis, and elective endoscopic sphincterotomy or laparoscopic common bile duct exploration was performed. It is the first to relieve biliary obstruction for the patients of intrahepatic and extrahepatic bile duct stones with bile duct dilatation using endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic cholangiodrainage (PTCD), which would improve the survival rate greatly. PTCD or ENBD could be used for the patients with malignant tumor in biliary tract to reduce jaundice as early as possible. And then, stent was implanted through PTCD to prolong life.