Current treatment of biliary Sphincter of Oddi Dysfunction.

The sphincter of Oddi is a delicate neuromuscular structure located at the junction of the biliary-pancreatic system and the duodenum. Sphincter of Oddi Dysfunction (SOD) can result in various clinical manifestations, including biliary-type pain and recurrent idiopathic pancreatitis. The management of SOD has been challenging. With the publication of the landmark Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction (EPISOD) trial and the Rome IV consensus, our clinical practice in the treatment of SOD has changed significantly in recent years. Currently, the management of type II SOD remains controversial and there is a lack of non-invasive therapy options, particularly for patients not responding to endoscopic treatment. In this mini review, we aimed to discuss the current knowledge on the treatment of biliary SOD.

Short-term effect of a negative colonoscopy in patients with functional constipation.

The yield of colonoscopy for neoplasia among patients with chronic constipation is very low. However, a negative colonoscopy may benefit these patients by decreasing anxiety and thereby alleviating constipation symptoms. We performed a prospective study to characterize the effect of a negative colonoscopy in patients with functional constipation. Seventy-five patients with chronic constipation were enrolled, and 69 patients were diagnosed with functional constipation through the Rome III criteria. After excluding patients whose constipation symptoms were affected by medications (e.g., laxatives, prokinetics), 45 patients were included in the study. Among the 45 patients, the average health-related anxiety score decreased from 21.0 to 15.6 at 1 week after colonoscopy (P < 0.01). Sustained improvement was observed in anxiety scores at 1 month (14.0), 2 months (12.4), and 6 months (11.2). Mean constipation symptom score was also decreased at 1 week (8.7), 1 month (8.0), 2 months (7.6), and 6 months (6.8) compared with the precolonoscopy period (11.5; P < 0.01). These results suggest that a negative colonoscopy in patients with functional constipation is associated with a decline in health-related anxiety and constipation symptom scores. (Registration number: ChiCTR-OOh-16008488).

A pilot single-center prospective randomized trial to assess the short-term effect of a flashing warning light on reducing fluoroscopy time and radiation exposure during ERCP.

BACKGROUND AND AIMS: ERCP has the risk of exposure to ionizing radiation. Performers may unconsciously increase fluoroscopy time (FT) because of a lack of radiation protection awareness. This study investigates whether a flashing warning light adopted as a behavioral intervention for performers reduces FT and radiation exposure during ERCP. METHODS: We conducted a prospective randomized trial of 200 therapeutic ERCPs. A flashing warning light was placed on top of the endoscopy monitor. Cases were consecutively enrolled and randomly assigned to 2 groups in a 1:1 ratio. In the warning light group, the light was on when the fluoroscopy foot pedal was depressed; in the control group, the light was off. Fluoroscopy and procedure-related data were recorded. RESULTS: The median FT and dose-area product (DAP) for the warning light group versus the control group were 142.5 seconds versus 175.0 seconds (P = .045) and 856.8 µGy∙m2 versus 1054.4 µGy∙m2 (P = .043). In a multivariable analysis, the use of the warning light was found to reduce FT by 15.4% (-27.0 seconds; P = .042). DAP reduction because of the decreased FT was 15.2% (160.3 µGy∙m2). The reduction in patient effective dose per case was .42 mSv, equivalent to 21 chest radiographs. No adverse events or interference with the procedures because of the warning light were noted. CONCLUSIONS: The use of a flashing warning light is a feasible way to reduce FT and radiation exposure during ERCP. (Clinical trial registration number: ChiCTR-IPR-14005349.).

"Post-cut": An endoscopic technique for managing impacted biliary stone within an entrapped extraction basket.

BACKGROUND AND STUDY AIMS: Ampullary impaction of an entrapped stone-basket complex is not an infrequent yet challenging event during endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study is to evaluate the feasibility, safety, and efficacy of "post-cut" for the management of such scenarios. PATIENTS AND METHODS: Patients with impacted biliary stone with an entrapped basket during ERCP at West China Hospital, Chengdu, China, from October 2004 to August 2014 were included in this retrospective study. Adequate biliary sphincterotomy was performed in all cases before attempted stone basket removal. Using free hand needle knife techniques, the authors extended the sphincterotomy along the long axis of the distal common bile duct to manage the biliary stone-basket impaction. In comparison with "pre-cut", the authors coined the term "post-cut" referring to this technique. The feasibility, safety, and potential complications of post-cut were analysed. RESULTS: "Post-cut" was performed in consecutive 10 cases of impacted biliary stone within an entrapped extraction basket. The size of the removed stone ranged from 6 mm to 13 mm. The length of post-cut is 2 mm to 4 mm. The impacted basket was easily retrieved in all patients without complications, including bleeding, perforation, and pancreatitis. CONCLUSION: "Post-cut" is a feasible, effective, and safe endoscopic technique when impaction of a biliary stone with an entrapped extraction basket develops.

Schistosomiasis combined with colorectal carcinoma diagnosed based on endoscopic findings and clinicopathological characteristics: a report on 32 cases.

AIMS AND BACKGROUND: To improve understanding of the relationship between schistosome-related enteropathy and colorectal carcinoma with particular focus on endoscopic findings and clinicopathological characteristics of colonic schistosomiasis. MATERIALS AND METHODS: All cases of intestinal schistosomiasis diagnosed at West China Hospital, Chengdu, China, between October 2006 and October 2012 were included in this study. A total of 179 cases of colonic schistosomiasis diagnosed through colonoscopy and pathological examinations were collected for analysis and the demographics, symptoms, endoscopic findings and clinicopathological characteristics were retrospectively evaluated. RESULTS: Of the 179 colonic schistosomiasis patients, 32 combined with colorectal cancer (CRC) were found, between the ages of 44 and 85 years (24 males, 75%). These 32 lesions were classified as 12 endophytic/ulcerative (37.5%), 10 exophytic/fungating (31.2%), 4 annular (12.5%), 3 giant polypus (9.4%), and 3 IIc (superficial depressed type) (9.4%). The segments of rectum and sigmoid colon were involved in 19 patients (59.4%) and 6 patients (18.8%), respectively. The histopathologic types were classified as follows: 30 well- differentiated adenocarcinomas, one mucinous adenocarcinoma and one poorly differentiated adenocarcinoma. The pathological findings suggest colorectal malignancy with deposited schistosome ova. CONCLUSIONS: Chronic schistosomal infestation has a probable etiological role in promoting genesis of colorectal neoplasms.