Hemostatic clips to facilitate intubation during ERCP with ampulla around duodenal diverticulum / 中国内镜杂志

Objective To investigate the effectiveness of hemostatic-clip-assisted method during ERCP with ampulla around duodenal diverticulum. Methods 25 patients with ampulla around duodenal diverticulum encountered cannulation difficulty, 11 cases underwent with clip-assisted method, 14 cases with ordinary ways. Number of successful cases, cannulation time, post-operation complication were analyzed. Results All the 11 cases succeeded in clip group. 12 patients succeeded in none-clip group. Cannulation time between the two groups were discrepant. There was no difference in number of successful cases and post-operation complication rate. Conclusion Successful application of hemostatic clip help to expose and facilitate cannulation of an ampulla around a duodenal diverticulum.

Purse-string suture with single channel gastroscopy for the gastric wall perforation during endoscopic submucosal dissection of gastric fundus / 中国内镜杂志

Objective To evaluate the perforation repair method of purse-string suture with single channel after gastroscopy endoscopic submucosal resection (ESD) in treating gastric submucosalal stromal tumor originating from muscularis propria lay of gastric fundus. Methods 15 patients with GIST from gastric fundus muscularis propria were treated with ESD. The diameters of tumors were from 1.5 ～ 3.5 cm. Purse-string suture with single channel gastroscopy was performed for the gastric wall perforation during ESD. Results All patients underwent repair successfully. The procedure time was 10 ～ 15 min. No severe complications occurred. Conclusion Purse-string suture with single channel gastroscopy is a feasible and effective perforation repair method during ESD of gastric fundus.

The role of double-balloon enteroscopy following capsule endoscopy in diagnosis of obscure Small intestinal diseases.

OBJECTIVE: The aim of this study was to evaluate the detection rate accuracy of Double-balloon Enteroscopy (DBE) after Capsule Endoscopy (CE) in patients with suspected small bowel diseases. METHODOLOGY: From January 2009 to March 2012, sixty-two patients with obscure small bowel diseases who underwent CE followed by DBE were included in this study. Introduction of the endoscope by DBE was either orally or anally according to CE. RESULTS: Sixty-two patients are reported. The overall detection rate of small bowel diseases using CE was 70.9% (44/62). Sixty-eight DBE procedures following capsule endoscopy were carried out, There was no significant difference (χ(2)=0.6739, P>0.05) of Positive findings between CE and CE +DBE. Furthermore, the detection rate of small bowel diseases in patients with obscure small intestinal bleeding using CE +DBE (90.9%, 30/33) was superior to that of CE (78.8%, 26/33); χ(2)=1.8857, P>0.05. CONCLUSIONS: Capsule Endoscopy (CE) can cover the whole GI tract and provide the selection of the route of Double-balloon enteroscopy (DBE). DBE can also serve as a good complementary approach after an initial imaging using CE. It can verify the findings of CE and provide therapeutic intervention. Using of CE followed by DBE is effective in the diagnosis and management of patients with obscure small bowel diseases.

Small Endoscopic Sphincterotomy plus Large-Balloon Dilation for Removal of Large Common Bile Duct Stones during ERCP.

OBJECTIVE: This study compared the therapeutic benefits and complication rates of small endoscopic sphincterotomy plus large-balloon dilation (ESLBD) with those of endoscopic sphincterotomy (EST) alone for large bile duct stones. METHODS: We compared prospectively ESLBD group (n=63) with conventional EST group (n=69) for the treatment of large bile duct stones (≥15mm). Mechanical lithotripsy was performed when the stone could not be removed using a normal basket. We compared the rates of stone removal, frequency of mechanical lithotripsy use, procedure-related complications, and recurrent stones. RESULTS: A total of 132 patients were reviewed in the study. The mean age of the patients was 67.9 years. The two groups showed significant differences in complete stone removal during the first session (80.9 vs. 60.8%; P = 0.046), the use of mechanical lithotripsy (7.94 vs. 24.6%; P = 0.041), and less duration of admission (P =0.045). After ERCP, there were some instances of oozing in both groups, All patients recovered completely, 14 patients had recurrent common bile duct stones among the follow-up duration. CONCLUSION: The ESLBD technique seems to be a feasible and safe alternative technique for conventional EST and EBD and has no more Post-ERCP complications.

Treatment of gastric epithelial tumours by endoscopic submucosal dissection using an insulated-tip diathermic knife.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a promising technique for the treatment of large, pre- and early malignant gastrointestinal lesions. OBJECTIVE: To assess the rates of en bloc resection, incidence of complications, procedure times and therapeutic outcomes of ESD using an insulated-tip diathermic knife; and to investigate predictors of these outcomes based on the final pathological features of biopsy specimens. METHODS: One hundred twenty patients with endoscopically suspected gastric epithelial tumours who were treated with ESD from January 2006 to December 2009 were evaluated. RESULTS: The mean diameter of the gastric epithelial tumours in the present cohort was 1.88 cm. The mean diameter of the resected specimens was 3.33 cm. The en bloc resection rate was 90% (108 of 120). The median length of the operation was 64.6 min. The bleeding and perforation complication rates were 5.0% (six of 120) and 2.5% (three of 120), respectively. Of 10 gastric tumours initially diagnosed as adenocarcinoma on biopsy, four were found to be low-grade dysplasia and six were found to be high-grade dysplasia after resection and final pathological examination. A total of 112 (93.33%) patients underwent curative treatment, eight patients (6.67%) underwent noncurative treatment with ESD, and two patients (1.67%) experienced local recurrence and subsequently underwent surgery. CONCLUSIONS: ESD is a promising local curative treatment option for gastric epithelial tumours, but still carries the risks of bleeding and/or perforation. Differences in the interpretation of histological results among different pathologists and/or between biopsy specimens before ESD and the en bloc tissue specimens after ESD will result in discrepancies.

HCCR-2 enhances the division and proliferation of SMMC 7721 via PI3K/Akt pathway / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To observe the biological changes of SMMC 7721 cell line which was stably transfected with HCCR-2 gene and to study the molecular mechanism of HCCR-2 expression in SMMC 7721 cell line.</p><p><b>METHODS</b>SMMC7721 cells were transfected with HCCR-2-pEGFP-N1 and pEGFP-N1 by lipofectmine 2000 and the transfectants were selected and confirmed using Western-blot technique. Cell cycles were tested by flow cytometry. The reproductive activity was detected by MTT assay. SMMC 7721 cells were routinely cultured with treatment of increasing concentrations (0, 50, 100, 200 ng/ml) of EGF for 24 h. Cells were pretreated with the specific inhibitor of PI3K (LY294002) and then cultured with EGF (100 ng/ml) for 24h and the expression of HCCR protein in these cells were measured by Western blot. Another set of SMMC 7721 cells were transfected with DN-Akt-pcDNA3.1 (dominant negative Akt kinase) and pcDNA3.1 by lipofectmine 2000. The transfectants were selected and confirmed using Western-blot technique as before. HCCR-2 and bcl-2 were measured on protein level by Western blot.</p><p><b>RESULTS</b>SMMC 7721 cells were stably transfected with HCCR-2 gene. HCCR-2 gene transfection can increase the proportion of S-phase cells (21.62%+/-1.33% vs 15.76%+/-0.73%, P<0.01) and decrease the cell apoptosis (1.28%+/-0.16% vs 7.72%+/-0.23%, P<0.01). MTT assay showed the growth of HCCR-2 gene transfected cells was faster than that of empty vecter transfected cells. The HCCR-2 protein was up-regulated in a dose-dependent manner in the cells cultured with different concentrations of EGF for 24 h. Treatment of SMMC 7721 cells with specific inhibitor of PI3K (LY294002) suppressed EGF-induced HCCR-2 expression. HCCR-2 protein was down-regulated in dominant negative Akt transfectants.</p><p><b>CONCLUSIONS</b>EGF upregulated HCCR-2 protein expression in SMMC 7721 cell line via PI3K/Akt pathway. The overexpression of HCCR-2 could enhance the division and proliferation of SMMC 7721.</p>