Carbon dioxide insufflation improves the intubation depth and total enteroscopy rate in single-balloon enteroscopy: a randomised, controlled, double-blind trial.

OBJECTIVE: The total enteroscopy rate of single-balloon enteroscopy (SBE) using air insufflation is not satisfactory, and whether carbon dioxide (CO2) insufflation increases the total enteroscopy rate of SBE is unknown. This randomised controlled trial aimed to determine whether CO2 insufflation facilitates the intubation depth and total enteroscopy rate of SBE. DESIGN: A total of 214 eligible patients referred for SBE were randomised to receive either air or CO2 insufflation, and included in the intention-to-test (ITT) analysis. In addition, 199 patients in whom enteroscopy was completed were included in the per-protocol (PP) analysis. Both the patients and endoscopists were blinded, and the intubation depth and total enteroscopy rate were defined as the primary outcomes. RESULTS: The CO2 group showed a superiority of intubation in the ITT analysis (oral route: 323.8±64.2 vs 238.3±68.6 cm; anal route: 261.6±74.2 vs 174.7±62.1 cm, both p<0.001), and the total enteroscopy rate (34.9% vs 17.6%, p=0.006). Similar results were obtained in a PP analysis for both outcomes. In addition, in the PP analysis, the addition of circumference after the procedure was less in the CO2 group (0.8±0.6 vs 3.3±1.8 cm, p=0.005) for the oral route. No serious complications were reported. The overall percentage of procedures with significant pathological findings was 52.8%; the rates were 58.5% and 47.2% (p=0.100, ITT analysis) in the CO2 and air groups, respectively. CONCLUSIONS: CO2 insufflation improves the intubation depth and total enteroscopy rate in SBE with a good safety profile and acceptability compared with that of air, and thus is recommended for clinical utilisation. TRIAL REGISTRATION NUMBER: ClinicalTrial.gov identifier: NCT01758900.

Is obesity an indicator of complications and mortality in acute pancreatitis? An updated meta-analysis.

OBJECTIVE: To provide a meta-analyisis on whether obesity could be a prognostic indicator on the severity, development of complications and mortality of acute pancreatitis (AP). METHODS: Eligible articles were retrieved using electronic databases. Clinical studies evaluating the association between obesity and disease course of patients with AP were included. Weighted mean difference (WMD) and 95% confidence interval (CI) were estimated and pooled using RevMan 4.2.8. RESULTS: In all, 12 clinical studies with a total of 1483 patients were included in the analysis. Obese patients had a significantly increased risk of severe acute pancreatitis (SAP; RR=2.20, 95% CI 1.82-2.66, P<0.05), local complication (RR=2.68, 95% CI 2.09-3.43, P<0.05), systemic complication (RR=2.14, 95% CI 1.42-3.21, P<0.05) and in-hospital mortality (RR=2.59, 95% CI 1.66-4.03, P<0.05) compared with non-obese patients. CONCLUSIONS: Obesity is a definite risk factor of morbidity and in-hospital mortality for AP and may serve as a prognostic indicator.

Small interfering RNA against the apurinic or apyrimidinic endonuclease enhances the sensitivity of human pancreatic cancer cells to gemcitabine in vitro.

OBJECTIVE: To investigate whether the downregulation of human apurinic or apyrimidinic endonuclease/redox factor-1 gene (APE1/Ref-1) expression by ribonucleic acid interference (RNAi) would increase the sensitivity of SW1990 cells to gemcitabine. METHODS: Chemically synthesized small interfering RNA (siRNA) directed against human APE1/Ref-1 (si-APE1) was transfected into SW1990 cells through transfection reagents. The mRNA expression of APE1/Ref-1 was detected by semi-quantitative RT-PCR and the protein expression of APE1/Ref-1 was detected by Western blot; cell proliferation and apoptosis were studied by a Cell Counting Kit 8 (CCK-8) and flow cytometry (FCM) and fluorescence microscopy. RESULTS: After transfecting the SW1990 cells with siRNA directed against human APE1/Ref-1, the mRNA expression of APE1/Ref-1 of these cells was reduced, and its protein expression was reduced by 55.41 +/- 3.58%. The CCK-8 assay showed that the absorbance and the inhibition of cell growth transfected with si-APE1 were significantly different from the blank (cultured with Dulbecco's modified Eagle's medium) and negative control (given 50 nmol/L scrambled control siRNA). The inhibition rates of cell growth of the si-APE1 group at 24, 48, 72 h were 41.69 +/- 2.78%, 24.83 +/- 3.70% and 21.27 +/- 9.82%, respectively. A FCM analysis and cell morphology study showed that the apoptotic rate of SW1990 cells transfected with si-APE1 combined with gemcitabine treatment was significantly different from the blank control and others. CONCLUSION: To knock down APE1/Ref-1 gene expression may significantly sensitize the SW1990 cells to gemcitabine and enhance cell apoptosis.

Effects of thalidomide in experimental models of post-endoscopic retrograde cholangiopancreatography pancreatitis.

BACKGROUND: Tumor necrosis factor-alpha (TNF-alpha) plays a central role in the pathogenesis of acute pancreatitis and related systemic complications. The authors hypothesized that it may also play an important role in the development of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). The aim of the study was to evaluate the effectiveness of thalidomide, an immunomodulator that exerts an inhibitory action on TNF-alpha by enhancing mRNA degradation, in reducing post-ERCP pancreatitis in a rat model. METHODS: A total of 200 mg/kg thalidomide was given intragastric once a day (total 8 days) before the experimental models of post-ERCP pancreatitis were established. After 24 h, histology and edema of pancreas, serum amylase, and TNF-alpha mRNA in the pancreatic tissue were evaluated. RESULTS: Intraductal contrast infusion caused increases in serum amylase, edema, histological grade, and TNF-alpha mRNA of pancreas. The prophylactic use of thalidomide significantly reduced serum amylase, pancreatic edema and the histologic grade of pancreatitis accompanied by a decrease in mRNA expression of TNF-alpha in the pancreatic tissue. CONCLUSIONS: Prophylactic intragastric administration of thalidomide provides a protective effect in post-ERCP pancreatitis. The mechanism of the protective effects of thalidomide seems to be the reduction of expression of TNF-alpha mRNA in pancreatic tissue.

Role of prophylactic antibiotic administration in severe acute pancreatitis: a meta-analysis.

OBJECTIVE: To carry out a meta-analysis of published studies in order to evaluate the clinical efficacy of prophylactic antibiotics in severe acute pancreatitis (SAP). MATERIAL AND METHODS: MEDLINE, China Biological Medicine, Embase and Cochrane Data Base for Systematic Reviews were searched for randomized controlled trials on the efficacy of prophylactic antibiotics in patients with SAP from 1966 to 2004. Six studies met our inclusion criteria. Two authors (G.S.X. and Z.H.W.) independently extracted the following data from these studies: trial design, characteristics of participants and outcomes. Data were analyzed by Revman 4.2 software. RESULTS: In patients with SAP, prophylactic antibiotics, including broad-spectrum antibiotics that usually achieve therapeutic pancreatic tissue levels, did not reduce pancreatic infection (relative risk, RR, 0.77, 95% confidence interval 0.48-1.24, p = 0.28), surgical intervention (RR 0.84, 95% confidence interval 0.40-1.74, p = 0.64) and mortality rate (RR 0.54, 95% confidence interval 0.28-1.04, p = 0.07). CONCLUSIONS: Prophylactic antibiotic administration is not an appropriate treatment strategy in patients with SAP, it should be limited in patients with pancreatic necrosis, as demonstrated by computerized tomography.