A snare-assisted peroral direct choledochoscopy and pancreatoscopy using an ultra-slim upper endoscope: A case series study.

OBJECTIVE: To evaluate the feasibility, effectiveness and safety of a new snare-assisted peroral direct choledochoscopy/pancreatoscopy (PDCPS) technique. METHODS: From November 2014 through December 2016, 20 consecutive patients with indications for PDCPS were enrolled in this observational study. Endoscopic retrograde cholangiography was initially performed using a conventional duodenoscope, and endoscopic papillary balloon dilation was performed. Next, an ultra-slim endoscope was inserted to perform the PDCPS; a snare tightened around the end of the scope's bending section facilitated its entry into the common bile duct (CBD). The primary endpoint was the overall success rate of the PDCPS procedure (successful biliary intubation and visualization of the area of interest) and the time for biliary intubation with the ultra-slim upper endoscope. RESULTS: Participants (11 men and 9 women; mean age, 72.2 years [range, 41-93 years]) had CBD adenoma (n=1), large CBD stones after failed extraction/lithotripsy treatment (n=13), CBD strictures (n=4), pancreatic duct tumor (n=1) or pancreatic duct dilation (n=1). The success rate was 95%. The mean intubation time was 18min (range, 4-57min). No adverse events were reported. CONCLUSIONS: A snare-assisted PDCPS technique appears to be technically feasible, effective and safe for both diagnostic and therapeutic applications.

Tissue performance of bladder following stretched electrospun silk fibroin matrix and bladder acellular matrix implantation in a rabbit model.

The goal of this study was to investigate the tissue performance of bladder following stretched electrospun silk fibroin matrix (SESFM) implantation compared with bladder acellular matrix (BAM). We compared SESFM with BAM based on porosity and pore size. Scaffolds were separately transplanted into opposite walls of the bladder of 30 rabbits after stripping the bladder mucosa and smooth muscle (1.5 × 2.0 cm(2)). Gross anatomical observation, histological analysis and muscle contractility studies were performed at 2, 4, and 8 weeks post-op. SESFM has higher porosity and larger pore size compared with BAM (p < 0.05). At 2 weeks, the presence of vesical calculus was evident in 7/10 rabbits. Histological analysis showed that SESFM and BAM promoted similar degree of urothelium regeneration (p > 0.05). However, SESFM promoted a higher degree of smooth muscle and vessel regeneration compared to BAM (p < 0.05). In addition, muscle strips supported by SESFM displayed higher contractile responses to carbachol, KCl, and phenylephrine compared with BAM. At 8 weeks, both matrices elicited similar mild acute and chronic inflammatory reactions. Our results demonstrated that SESFM has greater ability to promote bladder tissue regeneration with structural and functional properties compared to BAM, and with similar biocompatibility.

[Diagnostic value of selective small bowel enteroclysis in imageology of intestinal obstruction: clinical analysis of 98 cases].

OBJECTIVE: To improve the diagnosticability of selective enteroclysis in the area of intestinal obstruction, by reviewing the cases of selective intestinal enteroclysis through a naso-intestinal decompression tube, and evaluating its diagnostic concordance level and the influence factors. METHODS: The selective enteroclysis was different from traditional enteroclysis; it utilized a naso-intestinal decompression long tube to perform local intestinal opacification. In the four years between Apr. 2008 and Apr. 2012, 98 cases of selective intestinal enteroclysis were analyzed retrospectively, and diagnostic concordance value was made between the radiologic diagnosis and the final clinical diagnosis recorded in the medical history according to an evaluating criterion. Five scores were used in the evaluating system: 0 meant that the enteroclysis had no valuable information to provide; 0.25 meant that the enteroclysis could prompt the occurring of obstruction, but could not provide the information of location and cause; 0.50 meant that the enteroclysis could find the location of obstruction, but could not determine the cause; 0.75 meant that the enteroclysis could provide some valuable analysis of the causes of the obstruction, and very close to the final clinical diagnosis; 1.00 meant that the complete concordance between the enteroclysis diagnosis and the final clinical diagnosis. The influence factors would also be considered to improve the competence of the selective enteroclysis in the diagnosis of intestinal obstruction. RESULTS: In the 98 cases, 53.1% had definite abdominal operative history. The most common cause of obstruction was conglutination between intestinal loops when discharged from hospital, almost occupying 50%. In this group of cases, the most common types were ileum obstruction (47.6%), multiple location obstruction (41.7%) and incomplete obstruction (59.5%). Conglutination and stricture of the intestinal was the common radiologic appearance (61.9%). There were 50 cases with higher concordance scoring 0.75 or 1.00, in comparison, there were 25 cases with lower concordance scoring 0 or 0.25. The difference between the two groups had statistical significance. CONCLUSION: As a combination of traditional enteroclysis and naso-intestinal decompression tube, selective intestinal enteroclysis could exert higher diagnostic ability than that of traditional enteroclysis and also could break through the limitations of traditional enteroclysis in the condition of intestinal obstruction. This method has higher diagnostic concordance and could provide valuable information in obstruction location, extent, severity and possible causes. The main factor influencing the effectiveness of the examination is the location of the decompression tube and dynamic observation would be very helpful and important.

Adult colonoscopy or single-balloon enteroscopy-assisted ERCP in long-limb surgical bypass patients.

OBJECTIVE: The aim of this study was to evaluate the usefulness of adult colonoscopy or single-balloon enteroscopy (SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) in long-limb surgical bypass patients. METHODS: Retrospective analysis of 16 patients with long-limb surgical bypasses who underwent therapeutic ERCP because of suspected pancreaticobiliary diseases. Small-bowel intubation was performed by peroral adult colonoscopy or SBE. If colonoscopy success was achieved, ERCP was performed subsequently. But in patients using SBE, a small-caliber colonoscope would be used to replace enteroscope if the SBE success was achieved. ERCP was then performed with the conventional accessories. RESULTS: A total of 21 ERCP procedures were performed. Adult colonoscope was used for ERCP in 8 patients with standard Whipple resection consecutively. Colonoscopy success was achieved in 8 of 8 patients (100%), of whom 7 of 8 (87.5%) achieved ERCP success. SBE-assisted ERCP was attempted in other 8 patients with different types of Roux-en-Y anatomy. SBE success was achieved in 7 of 8 patients (87.5%), of whom 4 of 7 (57.1%) achieved ERCP success. The overall success rate of endoscopy and ERCP was 93.8% (15/16) and 68.8% (11/16), respectively. CONCLUSIONS: Adult colonoscopy has high success rate for performing ERCP after Whipple resection and should be selected for such patient preferentially. By using the facilitated method for endoscopic interventions at pancreaticobiliary disease after Roux-en-Y reconstruction, SBE-assisted ERCP can be attempted when it is difficult to gain access to the papilla of Vater or bilioenteric/pancreaticoenteric anastomosis and long length ERCP accessories cannot be available.

[Role of peroxisome proliferators-activated receptor-gamma in the chemical prevention therapy of sulindac for precancerous lesions of rats].

OBJECTIVE: To understand whether peroxisome proliferators-activated receptor-gamma (PPAR-gamma) plays an important role in the chemopreventive effect of sulindac on precancerous lesions (aberrant crypt foci, ACF) of rats. METHODS: Male Sprague-Dawley rats were used in this study and raised in Special Pathogen Free room. Sulindac was the main research object. Carcinogenic agent, 1, 2-dimethylhydrazine (DMH), was used to induce colonic precancerous lesions. Pioglitazone was chosen as agonist of PPAR-gamma and GW9662 used as a specific complete antagonist of PPAR-gamma. ACFs were induced according to the protocol certified in prior experiments. There were 7 groups, named as Negative control group, DMH group, Sulindac group, Sulindac+GW9662 group, Pioglitazone group, Pioglitazone+GW9662 group and GW9662 group. The experiment period was 12 weeks. At the end of the experiment, all rats were sacrificed by euthanasia. Half of the colon including the rectum was taken and immersed in formalin at 4 degrees Celsius overnight, and then recorded the number and size of ACF with the help of anatomic microscope stained by methylene blue. RESULTS: (1) Sulindac and agonist of PPAR-gamma could significantly inhibit DMH-induced ACFs of rats from 137.8+/-59.4 to 73.9+/-32.1 and 96.4+/-32.6 with a decrease of 45.7% (P<0.01) and 30.0%(P<0.05) compared with DMH group. Antagonist of PPAR-gamma could counteract the chemopreventive effect of sulindac with an increase from 73.9+/-32.1 to 106.3+/-33.9; (2) The expression of PPAR-gamma in colorectal mucosa increased significantly during the DMH induction period compared with negative control group, the relative values of gray were 0.304+/-0.288 and 2.292+/-1.380 (P<0.01), sulindac and pioglitazone could decrease the expression of PPAR-gamma remarkably compared with DMH group, the relative values of gray were 1.023+/-1.115 and 0.352+/-0.187 (P<0.01), and the application of GW9662, antagonist of PPAR-gamma could promote the expression of PPAR-gamma in some degree, and the relative values of gray were 1.279+/-0.303 and 0.998+/-0.295 (P>0.05). CONCLUSION: The expression of PPAR-gamma had risen in DMH-induced ACFs of rats significantly. Sulindac and agonist of PPAR-Gamma (pioglitazone) could inhibit the formation of ACF, and followed by a decrease of PPAR-gamma. Antagonist of PPAR-gamma could interfere with the effect of sulindac. PPAR-gamma might play an important role in the chemopreventive effect of sulindac on colorectal pre-cancerous lesions of rats and activation of PPAR-gamma pathway could inhibit the initiation and evolvement of ACF induced by DMH.