Zhou D, Zhang B, Zhang XY, Guan WB, Wang JD, Ma F. Focal intrahepatic strictures: A proposal classification based on diagnosis-treatment experience and systemic review. World J Clin Cases 2020; 8(23): 5902-5917 [PMID: 33344589 DOI: 10.12998/wjcc.v8.i23.5902]
Corresponding Author of This Article
Fei Ma, MD, Doctor, Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. mafei@xinhuamed.com.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 6, 2020; 8(23): 5902-5917 Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.5902
Focal intrahepatic strictures: A proposal classification based on diagnosis-treatment experience and systemic review
Di Zhou, Bo Zhang, Xiao-Yu Zhang, Wen-Bin Guan, Jian-Dong Wang, Fei Ma
Di Zhou, Xiao-Yu Zhang, Jian-Dong Wang, Department of General Surgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China
Bo Zhang, Department of General Surgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University, School of Medicine, Chongming Branch, Shanghai 202150, China
Wen-Bin Guan, Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Fei Ma, Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China
Fei Ma, Shanghai Institute for Pediatric Research, Shanghai 200092, China
Author contributions: Zhou D and Zhang B designed performed the research and wrote the paper; Guan WB contributed to the pathological analysis; Zhang XY and Wang JD performed the follow-up; Ma F designed the research and supervised the report.
Supported bythe National Natural Science Foundation of China, No. 81802337; and Shanghai Jiao Tong University, No. YG2017MS74.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Xinhua Hospital Affiliated with Shanghai Jiao Tong University, School of Medicine.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fei Ma, MD, Doctor, Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. mafei@xinhuamed.com.cn
Received: May 5, 2020 Peer-review started: May 5, 2020 First decision: June 18, 2020 Revised: June 18, 2020 Accepted: September 23, 2020 Article in press: September 23, 2020 Published online: December 6, 2020 Processing time: 213 Days and 2.5 Hours
ARTICLE HIGHLIGHTS
Research background
Focal intrahepatic strictures (FIHS) refer to local strictures of the small and medium intrahepatic bile ducts. FIHS are easily misdiagnosed due to their rare incidence, and few studies have focused on the diagnosis and treatment approaches.
Research motivation
No diagnosis and treatment guideline for FIHS has been published so that misdiagnosed and mistreatment frequently occurs.
Research objectives
This study aims to propose a new classification for FIHS in order to guide its diagnosis and treatment.
Research methods
The symptoms, biochemistry results, imaging results, endoscopic examination results and initial and final diagnoses of 6 patients with FIHS admitted between 2010/01 and 2019/12 were retrospectively analyzed.
Research results
The 6 patients were diagnosed with intratubular growth-type intrahepatic cholangiocarcinoma (IG-ICC), recurrent multiple hepatocellular carcinoma (rmHCC) with bile duct tumor thrombus (BDTT), adenosquamous carcinoma (ASC), hepatolithiasis, small duct primary sclerosing cholangitis (SD-PSC) and autoimmune hepatitis (AIH). The initial and final diagnoses were not consistent in 4 patients. Hepatectomy was performed in patients with IG-ICC, ASC and hepatolithiasis according to the locations of their FIHS. Patients with rmHCC with BDTT received lenvatinib/sintilimab, while patients with SD-PSC and AIH received UDCA. We proposed the following classification system for FIHS: type I: FIHS located within one segment of the liver; type II: FIHS located at the confluence of the bile ducts of one segment or two adjacent segments; type III: FIHS connected to the left or right hepatic duct; and type IV: Multiple FIHS located in both lobes of the liver.
Research conclusions
Our proposed classification system might help to guide the diagnosis and treatment of FIHS. Hepatectomy should be performed not only for malignant FIHS but also for benign strictures with severe secondary damage that cannot be improved by nonsurgical methods.
Research perspectives
The classification system and its guiding significance in the treatment of FIHS.
