Background Socratic method, which is an educational method to promote critical thinking through a dialogue, has never been practiced in a large number of people at the academic societies. Methods Modified Socratic method was performed for the first time as an educational seminar using an example case of moderate acute cholecystitis based on the evidence described in Tokyo Guidelines 2018. We adopted a method that Takada had been modifying for many years: the instructor first knows the degree of recognition of the audience, then the instructor gives a lecture in an easy-to-understand manner and receives questions from the audience, followed by repeated questions and answers toward a common recognition. Results Using slides, video, and an answer pad, 281 participants including the audience, instructors and moderators came together to repeatedly ask and answer questions in the five sessions related to the case scenario. The recognition rate of the topic of Critical View of Safety increased significantly before vs. after this method (53.0% vs. 90.3%). The seminar had been successfully performed by receiving a lot of praise from the participants. Conclusion This educational method is considered to be adopted by many academic societies in the future as an effective educational method.

The Japanese Biliary Atresia Society (JBAS) prepared for clinical practice guidelines for biliary atresia (BA) according to the Medical Information Network Distribution Service (MINDS) Handbook 2014. Twenty-five clinical questions (CQs) essential for daily clinical practice for BA were grouped into diagnosis, treatment, complications, and prognosis. Systematic literature search performed by the review members and medical evidence was extracted from articles published until July 2014 on PubMed and the Japan medical abstracts society. To reach the guideline consensus, a majority (>70%) adoption was made by the guidelines drafting members according to Delphi procedures. Recommendations for 21 CQs were appropriately provided. However, for 4 CQs (stool color cord, postoperative steroid administration, timing for liver transplantation, and primary liver transplantation), recommendations could not be determined due to a scarcity of evidence. This guideline is the first clinical practice guideline for biliary atresia created by such procedures.

Background/Purpose The biliary atresia (BA) inflammatory process leads to various obstructive patterns of extrahepatic biliary trees. The significance of the various BA obstructive patterns is unclear. This study aimed to determine the relationship between the anatomical patterns of the biliary tract and short- and long-term prognoses in BA. Methods Between 1989 and 2018, 3483 patients were registered in the Japanese Biliary Atresia Registry. For this study, we selected 2649 patients who underwent Kasai portoenterostomy (KP) between the ages of 31 days and 90 days to eliminate the influence of age at KP as much as possible. Results Regarding the main type, there were significant differences in the jaundice clearance rate (JCR) (Type I: 67.9%, Type I-cyst: 79.4%, Type II: 74.5%, Type III: 60.9%) (p<0.0001) and the native liver survival rate (NLSR) (p<0.0001). In subgroups with hepatic radicles in Types I, II and I-cyst, there was a significant difference in JCR (p=0.0004) and NLSR (p=0.0026). In subgroups with hepatic radicles in Type III, there was a significant difference in JCR (p=0.0148) and NLSR (p=0.0421). Conclusions Anatomical patterns of obstruction influenced short- and long-term prognoses in BA. These patterns were suggested to be prognostic factors following Kasai portoenterostomy.

Purpose The purpose of this study was to prepare clinical practice guidelines for biliary atresia according to the Medical Information Network Distribution Service (MINDS) Handbook for Clinical Practice Guideline Development 2014. Methods The guideline drafting group determined 25 clinical questions (CQs) essential for daily clinical practice. These CQs were grouped into the following four major categories: diagnosis, treatment, complications, and prognosis. A systematic literature search was performed by the systematic review team, and medical evidence was extracted from articles published until July 2014 on PubMed and the Japan Medical Abstracts Society. To reach a consensus, majority voting (>70%) of the panel of the guideline drafting group was adopted according to the Delphi technique. Results Recommendations for 21 CQs were appropriately provided. However, for 4 CQs (CQ2, stool color; CQ9, steroid administration; and CQ24 and CQ25, liver transplantation), recommendations could not be determined due to a scarcity of evidence. Conclusions The first clinical practice guidelines for biliary atresia were successfully created using procedures recommended by the MINDS. It is expected that these guidelines will be used worldwide and that the standardization of biliary atresia treatment will improve treatment outcomes.