Biliary Tract
11 cases spanning cholangiocarcinoma targeted therapy, gallstone and choledocholithiasis management, sphincter of Oddi dysfunction, and post-transplant biliary complications — choose a case below to open its full multi-voice debate.
A newly diagnosed FGFR2 fusion-positive cholangiocarcinoma, and whether real trial evidence for first-line targeted therapy is reachable before her insurer has had a chance to say no.
Progression after first-line gemcitabine-cisplatin-durvalumab in IDH1-mutant cholangiocarcinoma, and whether a better-tolerated targeted drug or a survival-proven chemotherapy regimen goes first.
A newly diagnosed unresectable cholangiocarcinoma with no actionable mutation, and two real, FDA-approved immunotherapy combinations with no head-to-head trial to choose between them.
Acute cholangitis, cleared endoscopically and clinically improving by hospital day three — and whether the antibiotic course a procedure note actually documents, not a fixed number of days, should decide when to stop.
Acute cholangitis at 28 weeks, hours before ERCP achieves real source control — and choosing antibiotic coverage that protects both the mother's actual severity and the fetus at the same time.
Symptomatic cholesterol gallstones in a patient anesthesia and cardiology both flag as prohibitive surgical risk, and whether oral dissolution therapy is a real alternative or just a slower version of the same eventual conversation.
A patient about to start high-dose tirzepatide, asking whether the gallstone-prophylaxis logic built for bariatric surgery actually applies to incretin-driven weight loss too.
A young patient with a borderline gallbladder ejection fraction but pain reproduced during the scan itself, and whether a time-limited medical trial or proceeding straight to cholecystectomy better fits what the test actually showed.
Recurrent biliary-type pain more than a year after cholecystectomy, with one real objective finding that places her outside the population a landmark negative trial actually studied.
Acute calculous cholecystitis in an 84-year-old ruled unsafe for general anesthesia, and whether a time-limited antibiotics-alone trial or percutaneous drainage is the right first move.
A rising cholestatic picture from a mechanical anastomotic stricture, a three-week wait for the ERCP slot that actually fixes it, and whether starting a bridge therapy risks the fix being forgotten. ---