Erratum: Endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis in patients receiving fully covered self-expandable metal stents for benign biliary stricture.

[This corrects the article DOI: 10.1055/a-1500-8028.].

Endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis in patients receiving FCEMS for benign biliary stricture.

Background and study aims Fully covered self-expanding metal stents (FCSEMS) are being increasingly used for benign biliary strictures (BBS); however, they are associated with risk of acute cholecystitis. Prophylactic endoscopic transpapillary gallbladder stenting (ETPGBS) can facilitate continuous gallbladder drainage and prevent acute cholecystitis from occlusion of cystic duct orifice by the FCSEMS. The aim of this study was to assess the technical feasibility, efficacy, and safety of ETPGBS to prevent acute cholecystitis in patients receiving FCSEMS for BBS. Patients and methods This was a retrospective analysis of a prospectively collected database at a single center of all patients who underwent prophylactic ETPGBS with FCSEMS for BBS between December 1, 2016 and November 30, 2020. Results A total of 71 ETPGBS were placed during the study period. Sixteen patients (mean age: 66.4 ±â€Š19.8 years; 81 % male) underwent ETPGBS prior to biliary FCSEMS during the same endoscopic session. FCSEMS were left in place (stent dwell time) for a median of 173 days (range: 69-473; mean 196 ±â€Š121) with resolution of BBS and successful removal of ETPGBS and FCSEMS in 12 patients. There was significant improvement in total bilirubin level (5.25 ±â€Š5.53 vs 0.94 ±â€Š0.85 gm/dL; P  = 0.008). No episodes of acute cholecystitis or any other post-procedural complications were noted during the median follow-up of 337 days (range: 150-856; mean 394 ±â€Š236). Conclusions ETPGBS prevented stent-related acute cholecystitis with continued efficacy of FCSEMS for BBS.

Evolving role of artificial intelligence in gastrointestinal endoscopy.

Artificial intelligence (AI) is a combination of different technologies that enable machines to sense, comprehend, and learn with human-like levels of intelligence. AI technology will eventually enhance human capability, provide machines genuine autonomy, and reduce errors, and increase productivity and efficiency. AI seems promising, and the field is full of invention, novel applications; however, the limitation of machine learning suggests a cautious optimism as the right strategy. AI is also becoming incorporated into medicine to improve patient care by speeding up processes and achieving greater accuracy for optimal patient care. AI using deep learning technology has been used to identify, differentiate catalog images in several medical fields including gastrointestinal endoscopy. The gastrointestinal endoscopy field involves endoscopic diagnoses and prognostication of various digestive diseases using image analysis with the help of various gastrointestinal endoscopic device systems. AI-based endoscopic systems can reliably detect and provide crucial information on gastrointestinal pathology based on their training and validation. These systems can make gastroenterology practice easier, faster, more reliable, and reduce inter-observer variability in the coming years. However, the thought that these systems will replace human decision making replace gastrointestinal endoscopists does not seem plausible in the near future. In this review, we discuss AI and associated various technological terminologies, evolving role in gastrointestinal endoscopy, and future possibilities.

Bleeding From Buried Cholecystogastrostomy Lumen-Apposing Metal Stent: The Double Pigtail Catheter Rescue Treatment.

Lumen-apposing metal stents (LAMS) allow transmural drainage of the gallbladder for endoscopic management of acute cholecystitis in nonsurgical candidates. Delayed bleeding from cholecystogastrostomy or gallbladder after the LAMS placement has not been reported. There are no data for the replacement of LAMS with plastic stents to prevent recurrent delayed bleeding. We present a case to describe an alternative treatment approach for cholecystogastrostomy bleeding related to a buried LAMS.

Intestinal epithelial tight junction barrier regulation by autophagy-related protein ATG6/beclin 1.

A defective tight junction (TJ) barrier is a key pathogenic factor for inflammatory bowel disease. Previously, we have shown that autophagy, a cell survival mechanism, enhances intestinal epithelial TJ barrier function. Autophagy-related protein-6 (ATG6/beclin 1), a key protein in the autophagy pathway, also plays a role in the endocytic pathway. The constitutive role of beclin 1 in the intestinal TJ barrier is not known. In Caco-2 cells, beclin 1 was found to be coimmunoprecipitated with the TJ protein occludin and colocalized with occludin on the membrane. Treatment of Caco-2 cells with beclin 1 peptide [transactivating regulatory protein (Tat)-beclin 1] reduced TJ barrier function. Activation of beclin 1 increased occludin endocytosis and reduced total occludin protein level. In contrast, beclin 1 siRNA transfection enhanced Caco-2 TJ barrier function. In pharmacologic and genetic autophagy inhibition studies, the constitutive function of beclin 1 in the TJ barrier was found to be autophagy independent. However, de novo induction of autophagy with starvation or rapamycin prevented Tat-beclin 1-induced increase in TJ permeability and reduction in occludin level. Induction of autophagy also resulted in reduced beclin 1-occludin association. In mouse colon, beclin 1 colocalized with occludin on the epithelial membrane. Perfusion of mouse colon with beclin 1 peptide caused an increase in colonic TJ permeability that was prevented by in vivo induction of autophagy. These findings show that beclin 1 plays a constitutive, autophagy-independent role in the regulation of intestinal TJ barrier function via endocytosis of occludin. Autophagy terminates constitutive beclin 1 function in the TJ barrier and enhances the TJ barrier.

Hemophagocytosis lymphocytosis presenting as pulmonary-renal syndrome: a case report and literature review.

Hemophagocytosis Lymphocytosis (HLH) is a rare and life-threatening illness that is more commonly seen in infants; however, its incidence in adults is becoming more common. Recognizing HLH in a complicated clinical scenario is key to early recognition, treatment, as well as improved morbidity and mortality.

Rectal Mass in a Pregnant Patient: How Come?

A 23-year-old pregnant Native American woman was initially evaluated at the onset of labor with the additional complaint of severe constipation and the finding of iron deficiency anemia. Immediately following manual disimpaction of feces, her rectum prolapsed revealing a 4 cm 9 4 cm bleeding mass. Following a successful Cesarean section, colonoscopy later revealed a 10 cm circumferential, necrotic mass with histologic characteristics of a moderately differentiated, invasive adenocarcinoma with IHC staining characteristic of LS. She left without resolving this problem. Because LS is a common cause of hereditary CRC, screening for LS and MSI is now increasingly being advocated. Early identification of those affected can reduce mortality from colon and a number of other cancers, particularly in females. Awareness of the issue is particularly important in Native American communities where screening rates are low and death rates from CRC are high, particularly in the western USA and in Alaska.

FTO, RNA epigenetics and epilepsy.

Several recent landmark papers describing N(6) -methyladenosine (m(6) A) RNA modifications have provided valuable new insights as to the importance of m(6) A in the RNA transcriptome and in furthering the understanding of RNA epigenetics. One endogenous enzyme responsible for demethylating RNA m(6) A, FTO, is highly expressed in the CNS and is likely involved in mRNA metabolism, splicing or other nuclear RNA processing events. microRNAs (miRNAs), a family of small, non-coding transcripts that bind to target mRNAs and inhibit subsequent translation, are highly expressed in the CNS and are associated with several neurological disorders, including epilepsy. miRNAs frequently bind to recognition sequences in the 3'UTR, a region that is also enriched for m(6) A. Certain specific miRNAs are upregulated by neuronal activity and are coupled to epileptogenesis; these miRNAs contain a consensus m(6) A site that if methylated could possibly regulate miRNA processing or function. This commentary highlights aspects from recent papers to propose a functional association between FTO, RNA epigenetics and epilepsy.