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World J Gastroenterol. Oct 21, 2022; 28(39): 5707-5722
Published online Oct 21, 2022. doi: 10.3748/wjg.v28.i39.5707
Pitfalls and promises of bile duct alternatives: A narrative review
Mitsuo Miyazawa, Masayasu Aikawa, Junpei Takashima, Hirotoshi Kobayashi, Shunsuke Ohnishi, Yoshito Ikada
Mitsuo Miyazawa, Junpei Takashima, Hirotoshi Kobayashi, Department of Surgery, Teikyo University Mizonokuch Hospital, Kanagawa 213-8507, Japan
Masayasu Aikawa, Department of Surgery, Saitama Medical University International Medical Center, Saitama 350-1298, Japan
Shunsuke Ohnishi, Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo 060-8638, Japan
Yoshito Ikada, Department of Bioenvironmental Medicine, Nara Medical University, Nara 634-8521, Japan
Author contributions: Miyazawa M designed and carried out the data analyses, prepared the figures, and wrote the manuscript; Aikawa M, Takashima J, and Ohnishi S performed data analysis; Ikada Y contributed to the design of the polymer and supervised the project.
Supported by the Japan Society for the Promotion of Science, No. 21K08786.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mitsuo Miyazawa, FACS, MD, PhD, Professor, Department of Surgery, Teikyo University Mizonokuch Hospital, 5-1-1 Futago, Takatsu-ku, Kawasaki-shi, Kanagawa 213-8507, Japan.
Received: May 24, 2022
Peer-review started: May 24, 2022
First decision: August 1, 2022
Revised: August 18, 2022
Accepted: September 22, 2022
Article in press: September 22, 2022
Published online: October 21, 2022

Biliodigestive anastomosis between the extrahepatic bile duct and the intestine for bile duct disease is a gastrointestinal reconstruction that abolishes duodenal papilla function and frequently causes retrograde cholangitis. This chronic inflammation can cause liver dysfunction, liver abscess, and even bile duct cancer. Although research has been conducted for over 100 years to directly repair bile duct defects with alternatives, no bile duct substitute (BDS) has been developed. This narrative review confirms our understanding of why bile duct alternatives have not been developed and explains the clinical applicability of BDSs in the near future. We searched the PubMed electronic database to identify studies conducted to develop BDSs until December 2021 and identified studies in English. Two independent reviewers reviewed studies on large animals with 8 or more cases. Four types of BDSs prevail: Autologous tissue, non-bioabsorbable material, bioabsorbable material, and others (decellularized tissue, 3D-printed structures, etc.). In most studies, BDSs failed due to obstruction of the lumen or stenosis of the anastomosis with the native bile duct. BDS has not been developed primarily because control of bile duct wound healing and regeneration has not been elucidated. A BDS expected to be clinically applied in the near future incorporates a bioabsorbable material that allows for regeneration of the bile duct outside the BDS.

Keywords: Bile duct alternative, Bile duct substitute, Biliary regeneration, Bile duct reconstruction, Peribiliary gland, Bioabsorbable polymer

Core Tip: The bile duct-intestinal anastomosis eliminating the function of the papilla of Vater causes chronic inflammation due to the reflux of bile and is not an ideal reconstruction method. Bile duct alternatives for bile duct defects have not been developed for over 100 years. In the present situation where the wound healing of the bile duct defect cannot be controlled, only the use of a bioabsorbable material, such as a scaffold, and the regeneration of the bile duct outside the scaffold can be expected as a bile duct substitute.