ABSTRACT
BACKGROUND: Endoscopic papillary large balloon dilatation (EPLBD) without endoscopic sphincterotomy (EST) is an accepted, simplified endoscopic technique for large common bile duct (CBD) stone removal. However, little is known about the long-term outcomes of this technique. The purpose of this study was to evaluate the long-term outcomes of EPLBD without EST for the treatment of large CBD stones. METHODS: This retrospective study of EPLBD without EST for a large CBD stone was conducted between June 2005 and October 2010. A total of 128 patients with a large CBD stone were included. The primary outcome measurement was complete CBD stone removal after EPLBD. Clinical data obtained from medical records were analyzed. RESULTS: The overall complete stone removal rate was 94.5 %. Mechanical lithotripsy was needed in 18 (14.1 %) patients. Post-procedural pancreatitis and asymptomatic hyperamylasemia occurred in 1 (0.8 %) and 11 (8.6 %) patients, respectively. One (0.8 %) patient experienced minor bleeding. The rate of stone recurrence was 13.1 %, and median time to stone recurrence was 600 days (range 144-2284 days). Over a half (64.3 %) of stone recurrences occurred during the 2 years following stone removal. Recurrence tended to be more frequent in patients with a large CBD diameter and in patients requiring multiple endoscopic sessions for complete CBD stone retrieval. CONCLUSION: EPLBD without EST may be safe and effective in patients with a large bile duct stone.
Subject(s)
Ampulla of Vater/surgery , Choledocholithiasis/surgery , Dilatation/methods , Endoscopy, Digestive System/methods , Aged , Aged, 80 and over , Female , Humans , Hyperamylasemia/epidemiology , Male , Middle Aged , Pancreatitis/epidemiology , Postoperative Complications/epidemiology , Postoperative Hemorrhage/epidemiology , Recurrence , Retrospective Studies , Sphincterotomy, Endoscopic , Treatment OutcomeABSTRACT
PURPOSE: To investigate the effect of alendronate on the expression of Id genes in osteoblast differentiation. METHODS: C2C12 cells were treated with alendronate for various concentrations and time periods. For evaluation of alendronate-induced osteoblast differentiation in C2C12 cells, alkaline phosphatase (ALP) activity was measured. The expression of osteoblast differentiation markers such as ALP, type-1 collagen (Col 1), and osteocalcin (OCN), and the expression of Id-1 and Id-2 were measured by RT-PCR. In order to understand the mechanism underlying the regulation of Id genes, the promoter region of the Id-1 gene was identified. Database analysis of the promoter region for Id-1 using known consensus sequences identified several putative response elements, including CCAAT/enhancer-binding protein beta (C/EBPß). RESULTS: Alendronate treatment significantly increased not only ALP activity but also the expression of ALP, Col 1, and OCN, Id-1 and Id-2. C/EBPß and alendronate cooperatively increased the promoter activity and expression of Id-1. CONCLUSIONS: These results suggest that C/EBPß-mediated Id-1 transcriptional activation may regulate alendronate-induced osteoblast differentiation of C2C12 cells.
