KIAA1429 promotes gastric cancer progression by destabilizing RASD1 mRNA in an m6A-YTHDF2-dependent manner.

BACKGROUND: KIAA1429, a regulatory subunit of the N6-methyladenosine (m6A) methyltransferase complex, has been implicated in the progression of various cancers. However, the role of KIAA1429 in gastric cancer (GC) and its underlying mechanisms remain elusive. This study aimed to investigate the role of KIAA1429 in GC and to elucidate the underlying mechanisms. METHODS: The expression patterns and clinical relevance of KIAA1429 in GC were assessed using quantitative real-time PCR (qRT-PCR), Western blotting, immunohistochemistry (IHC), and bioinformatic analysis. In vitro and in vivo loss- and gain-of-function assays, m6A dot blot assays, methylated RNA immunoprecipitation sequencing (MeRIP-seq), RNA-seq, MeRIP-qPCR, dual luciferase reporter assays, RNA stability assays, RNA immunoprecipitation (RIP) assays, and RNA pull-down assays were performed to investigate the biological functions and underlying molecular mechanisms of KIAA1429 in GC. RESULTS: Both the mRNA and protein expression of KIAA1429 were greater in GC tissues than in normal gastric tissues. High KIAA1429 expression correlated positively with poor prognosis in GC patients. KIAA1429 not only promoted GC cell proliferation, colony formation, G2/M cell cycle transition, migration, and invasion in vitro but also enhanced GC tumor growth and metastasis in vivo. Mechanistically, KIAA1429 increased the m6A level of RASD1 mRNA and enhanced its stability in an m6A-YTHDF2-dependent manner, thereby upregulating its expression. RASD1 knockdown partially rescued the KIAA1429 knockdown-induced impairment of pro­oncogenic ability in GC cells. The expression levels of KIAA1429 and RASD1 were negatively correlated in GC tissues. CONCLUSIONS: KIAA1429 plays a pro­oncogenic role in GC by downregulating RASD1 expression through destabilizing RASD1 mRNA in an m6A-YTHDF2-dependent manner. KIAA1429 may serve as a prognostic biomarker and therapeutic target for GC.

Alterations of the duodenal mucosal microbiome in patients with metabolic dysfunction-associated steatotic liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is associated with altered gut microbiota; however, there has been a focus on fecal samples, which are not representative of the entire digestive tract. Mucosal biopsies of the descending duodenum were collected. Five regions of the 16S rRNA gene were amplified and sequenced. Other assessments conducted on the study subjects included body mass index, transient elastography, liver enzymes, and lipid profile. Fifty-one subjects (36 with MASLD and 15 controls) were evaluated. There was no significant difference between the two groups regarding alpha- or beta-diversity of the duodenal mucosal microbiota. Linear discriminant analysis effect size (LEfSe) analysis showed that the genera Serratia and Aggregatibacter were more abundant in the duodenal mucosa of patients with MASLD, whereas the duodenal mucosal microbiota of the healthy controls was enriched with the genus Petrobacter. PICRUSt2 analysis revealed that genes associated with amino acid degradation and carboxylate degradation were significantly enriched in the duodenal mucosal microbiota of patients with MASLD. Our findings reveal the duodenal mucosal microbiota in patients with MASLD, which could contribute to future studies investigating the causal relationship between duodenal microbiota and MASLD.

Bypassing large submucosal vessels during peroral endoscopic myotomy reduces operative time and intraoperative blood loss in patients with achalasia.

OBJECTIVE: Peroral endoscopic myotomy (POEM), a relatively, minimally invasive endoscopic procedure, is the first-line treatment for achalasia. The aim of this study is to compare procedure-related parameters and clinical outcomes between bypassing and performing prophylactic electrocoagulation of large submucosal vessels during POEM. METHODS: We retrospectively enrolled 112 patients with achalasia who had undergone POEM at our hospital between April 2017 and March 2023. Large submucosal vessels were bypassed to avoid injury during submucosal tunneling in the bypass group; whereas, large submucosal vessels were prophylactically treated by electrocoagulation in prophylactic electrocoagulation group. Procedure-related parameters, Eckardt score, and complications were compared between the two groups. RESULTS: The bypass group showed a significant reduction in the operative time and amount of intraoperative blood loss than prophylactic electrocoagulation group (37.11 ± 9.96 min vs. 58.80 ± 17.90 min, and 1 [interquartile range: 1-2] mL vs. 5 [interquartile range: 3-8] mL; P < 0.001). Eleven (17.5%) and 44 (89.8%) patients in the bypass and prophylactic electrocoagulation groups, respectively, required hemostatic forceps (P < 0.001). Furthermore, lower operative and hospitalization costs were recorded in the bypass group than those in prophylactic electrocoagulation group (P < 0.05). No statistically significant difference was found between the two groups in terms of submucosal tunnel length, myotomy length, clinical efficacy, or complications. CONCLUSIONS: Bypassing large submucosal vessels during POEM can reduce the operative duration and intraoperative blood loss, with no difference in clinical outcomes than the prophylactic electrocoagulation treatment.

Incidence of colorectal cancer at different screening intervals after index colonoscopy and post-polypectomy: a meta-analysis of 811,181 participants.

OBJECTIVES: To examine the evidence on the incidence of colorectal cancers (CRCs) at a follow-up screening colonoscopy (after index colonoscopy and post-polypectomy) in individuals with no adenoma, low-risk adenomas, and high-risk adenomas. METHODS: We included studies reporting the incidence of CRCs at different screening intervals after index colonoscopy and post-polypectomy. The main outcome was pooled cumulative incidence rate of CRCs stratified by intervals of 3, 5, 10, and >10 years. RESULTS: Fourteen studies with 811,181 participants were analyzed, including 10 multicenter studies and 3 national CRC screening programs. The cumulative incidence of CRCs was 0.63% (95% confidence interval [CI]: 0.30, 0.97) in the high-risk-adenoma group at 3 years, 0.37% (95% CI: 0.13, 0.61) and 0.67% (95% CI: 0.36, 0.99) in the low-risk-adenoma group at 5 and 10 years, respectively, and 0.32% (95% CI: 0.20, 0.45) and 0.50% (95% CI: 0.30, 0.69) in the no-adenoma-group at 10 and >10 years, respectively. CONCLUSION: This meta-analysis summarizes the results of colonoscopy surveillance programs with detailed data support for different screening intervals. The data on date suggest that reasonable surveillance intervals are within 3 years for the high-risk-adenoma group, 5-10 years for the low-risk-adenoma group, and ≥10 years for the no-adenoma group.

NF-κB-upregulated miR-155-5p promotes hepatocyte mitochondrial dysfunction to accelerate the development of nonalcoholic fatty liver disease through downregulation of STC1.

Previous studies have highlighted the involvement of nuclear factor kappa B (NF-κB) in the development of nonalcoholic fatty liver disease (NAFLD). The purpose of our investigation is to explore the interaction among NF-κB, microRNA-155-5p (miR-155-5p), and Stanniocalcin 1 (STC1), and its effects on NAFLD by establishing a NAFLD model in Sprague Dawley rats. A highly-expressed miR-155-5p and NF-κB was revealed in the liver tissues of NAFLD rats, and a positive correlation was identified between miR-155-5p and NF-κB. Next, the expression of NF-κB and STC1 was altered in the modeled rats through lentivirus injection, followed by determination on the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol, triglycerides, and low-density lipoprotein cholesterol. Furthermore, the hepatocyte mitochondria were separated to measure the activities of adenosine triphosphate (ATP), reactive oxygen species (ROS), mitochondrial membrane potential (MMP), and mitochondrial respiratory chain complex, and to observe the number, length and ultrastructural length of mitochondrial cristae. The results demonstrated that NF-κB overexpression induced mitochondrial dysfunction, increased ROS level, decreased ATP and MMP contents, as well as inhibited the number and length of mitochondrial cristae in the hepatocyte mitochondria of NAFLD rats. Besides, miR-155-5p was found to negatively regulate STC1 expression based on dual luciferase reporter gene assay, which exert inhibition on mitochondrial activity of hepatocytes in NAFLD rats. These results uncover the possible involvement of NF-κB/miR-155-5p/STC1 axis in NAFLD progression, that NF-κB could increase miR-155-5p expression to inhibit STC1 expression, thus inducing hepatic mitochondrial dysfunction and promoting the occurrence and development of NAFLD.

Synergistic effects of ISL1 and KDM6B on non-alcoholic fatty liver disease through the regulation of SNAI1.

BACKGROUND: The increasing incidence of non-alcoholic fatty liver disease (NAFLD) has been reported worldwide, which urges understanding of its pathogenesis and development of more effective therapeutical methods for this chronic disease. In this study, we aimed to investigate the effects of a LIM homeodomain transcription factor, islet1 (ISL1) on NAFLD. METHODS: Male C57BL/6J mice were fed with a diet high in fat content to produce NAFLD models. These models were then treated with overexpressed ISL1 (oe-ISL1), oe-Lysine-specific demethylase 6B (KDM6B), oe-SNAI1, or short hairpin RNA against SNAI1. We assessed triglyceride and cholesterol contents in the plasma and liver tissues and determined the expressions of ISL1, KDM6B and SNAI1 in liver tissues. Moreover, the in vitro model of lipid accumulation was constructed using fatty acids to explore the in vitro effect of ISL1/KDM6B/SNAI1 in NAFLD. RESULTS: The results showed that the expressions of ISL1, KDM6B, and SNAI1 where decreased, but contents of triglyceride and cholesterol increased in mice exposed to high-fat diet. ISL1 inhibited lipogenesis and promoted lipolysis and exhibited a synergizing effect with KDM6B to upregulate the expression of SNAI1. Moreover, both KDM6B and SNAI1 could inhibit lipogenesis and induce lipolysis. Importantly, the therapeutic effects of ISL1 on in vitro model of lipid accumulations was also confirmed through the modulation of KDM6B and SNAI1. CONCLUSIONS: Taken together, these findings highlighted that ISL1 effectively ameliorated NAFLD by inducing the expressions of KDM6B and SNAI1, which might be a promising drug for the treatment of NAFLD.

Curcumin Improves Epithelial Barrier Integrity of Caco-2 Monolayers by Inhibiting Endoplasmic Reticulum Stress and Subsequent Apoptosis.

Curcumin is a natural polyphenol and is supposed to possess antioxidant, anti-inflammatory, anticancer, and antiapoptotic properties. Although some studies have reported the therapeutic effects of curcumin on ulcerative colitis (UC), the specific mechanism remains unclear. An in vitro coculture model of Caco-2 and differentiated THP-1 cells was established. After administration of curcumin (10 µM), Western blot analysis was performed to evaluate the protein levels of tight junction (TJ) proteins zonula occludens- (ZO-) 1 and claudin-1. Annexin V-APC/7-AAD assays and flow cytometry were conducted to assess Caco-2 cell apoptosis. The expression levels of oxidative stress and endoplasmic reticulum stress- (ERS-) related molecules were determined by Western blot analysis. Curcumin administration significantly upregulated ZO-1 and claudin-1 protein levels and reduced Caco-2 cell apoptosis. The protein levels of oxidative stress markers inducible nitric oxide synthase (iNOS) and γH2AX and ERS-induced apoptosis-related molecules C/EBP homologous protein (CHOP) and cleaved caspase-12 were significantly downregulated upon curcumin treatment. Furthermore, curcumin administration greatly blocked the protein kinase-like endoplasmic reticulum kinase- (PERK-) eukaryotic translation initiation factor 2α- (eIF2α-) activating transcription factor 4- (ATF4-) CHOP signaling pathway. Curcumin enhanced intestinal epithelial barrier integrity in the in vitro coculture model by upregulating TJ protein expressions and reducing intestinal epithelial cell apoptosis. The potential mechanisms may be suppression of ERS and subsequent apoptosis.

Diagnostic efficacy of the Japan Narrow-band-imaging Expert Team and Pit pattern classifications for colorectal lesions: A meta-analysis.

BACKGROUND: Pit pattern classification using magnifying chromoendoscopy is the established method for diagnosing colorectal lesions. The Japan Narrow-band-imaging (NBI) Expert Team (JNET) classification is a novel NBI magnifying endoscopic classification that focuses on the vessel, and surface patterns. AIM: To determine the diagnostic efficacy of each category of the JNET and Pit pattern classifications for colorectal lesions. METHODS: A systematic literature search was performed using PubMed, Embase, the Cochrane Library, and Web of Science databases. The pooled sensitivity, specificity, diagnostic odds ratio, and area under the summary receiver operating characteristic curve of each category of the JNET and Pit pattern classifications were calculated. RESULTS: A total of 19227 colorectal lesions in 31 studies were included. The diagnostic performance of the JNET classification was equivalent to the Pit pattern classification in each corresponding category. The pooled sensitivity, specificity, and area under the curve (AUC) for each category of the JNET classification were as follows: 0.73 (95%CI: 0.55-0.85), 0.99 (95%CI: 0.97-1.00), and 0.97 (95%CI: 0.95-0.98), respectively, for Type 1; 0.88 (95%CI: 0.78-0.94), 0.72 (95%CI: 0.64-0.79), and 0.84 (95%CI: 0.81-0.87), respectively, for Type 2A; 0.56 (95%CI: 0.47-0.64), 0.91 (95%CI: 0.79-0.96), and 0.72 (95%CI: 0.68-0.76), respectively, for Type 2B; 0.51 (95%CI: 0.42-0.61), 1.00 (95%CI: 1.00-1.00), and 0.90 (95%CI: 0.87-0.93), respectively, for Type 3. CONCLUSION: This meta-analysis suggests that the diagnostic efficacy of the JNET classification may be equivalent to that of the Pit pattern classification. However, due to its simpler and clearer clinical application, the JNET classification should be promoted for the classification of colorectal lesions, and to guide the treatment strategy.

Angiosarcoma characterized by colonic polyps: A case report.

RATIONALE: Angiosarcoma is a highly invasive tumour with a low incidence rate but high rates of local recurrence and distant metastasis and a poor prognosis. Understanding the endoscopic characteristics of angiosarcoma will help with early diagnosis and treatment of this disease. PATIENT CONCERNS: The patient was a 77-year-old female who was admitted to the hospital due to recurring melena for 3 months. Outpatient gastroscopy showed that the patient had multiple gastric erosions. Colonoscopy revealed the presence of multiple protruding lesions in the colon and multiple rectal polyps. Pathological biopsy indicated that the patient had a tubular adenoma, which was removed by endoscopic resection. DIAGNOSES: Postsurgical pathologic assessment suggested that the histological subtype was epithelioid angiosarcoma. Positron emission tomography-computed tomography (PET-CT) revealed multiple metastases in the lymph nodes and bone. INTERVENTIONS: The patient underwent acid suppression to protect the stomach, fluid supplementation and red blood cell infusion, and subsequently, surgery, radiotherapy and chemotherapy were recommended. The patient's family refused further treatments for the patient and requested discharge. OUTCOMES: The patient refused further treatment and was not followed-up. LESSONS: Colorectal angiosarcoma is an extremely rare and highly malignant tumour, and understanding its endoscopic morphology will help aid in its diagnosis.

Resveratrol alleviates intestinal mucosal barrier dysfunction in dextran sulfate sodium-induced colitis mice by enhancing autophagy.

BACKGROUND: Intestinal mucosal barrier dysfunction plays an important role in the pathogenesis of ulcerative colitis (UC). Recent studies have revealed that impaired autophagy is associated with intestinal mucosal dysfunction in the mucosa of colitis mice. Resveratrol exerts anti-inflammatory functions by regulating autophagy. AIM: To investigate the effect and mechanism of resveratrol on protecting the integrity of the intestinal mucosal barrier and anti-inflammation in dextran sulfate sodium (DSS)-induced ulcerative colitis mice. METHODS: Male C57BL/6 mice were divided into four groups: negative control group, DSS model group, DSS + resveratrol group, and DSS + 5-aminosalicylic acid group. The severity of colitis was assessed by the disease activity index, serum inflammatory cytokines were detected by enzyme-linked immunosorbent assay. Colon tissues were stained with haematoxylin and eosin, and mucosal damage was evaluated by mean histological score. The expression of occludin and ZO-1 in colon tissue was evaluated using immunohistochemical analysis. In addition, the expression of autophagy-related genes was determined using reverse transcription-polymerase chain reaction and Western-blot, and morphology of autophagy was observed by transmission electron microscopy. RESULTS: The resveratrol treatment group showed a 1.72-fold decrease in disease activity index scores and 1.42, 3.81, and 1.65-fold decrease in the production of the inflammatory cytokine tumor necrosis factor-α, interleukin-6 and interleukin-1ß, respectively, in DSS-induced colitis mice compared with DSS group (P < 0.05). The expressions of the tight junction proteins occludin and ZO-1 in DSS model group were decreased, and were increased in resveratrol-treated colitis group. Resveratrol also increased the levels of LC3B (by 1.39-fold compared with DSS group) and Beclin-1 (by 1.49-fold compared with DSS group) (P < 0.05), as well as the number of autophagosomes, which implies that the resveratrol may alleviate intestinal mucosal barrier dysfunction in DSS-induced UC mice by enhancing autophagy. CONCLUSION: Resveratrol treatment decreased the expression of inflammatory factors, increased the expression of tight junction proteins and alleviated UC intestinal mucosal barrier dysfunction; this effect may be achieved by enhancing autophagy in intestinal epithelial cells.

Diagnostic value of liquid-based cytology and smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration: A meta-analysis.

BACKGROUND: Smear cytology (SC) using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the established and traditional choice for diagnosing pancreatic lesions. Liquid-based cytology (LBC) is a novel alternative cytological method, however, the comparative diagnostic efficacy of LBC remains inconclusive. AIM: To examine the diagnostic efficacy of LBC and SC for pancreatic specimens obtained through EUS-FNA via a systematic review and meta-analysis. METHODS: A systematic literature search was performed using PubMed, EMBASE, the Cochrane Library, and Web of Science. The numbers of true positives, false positives, true negatives, and false negatives for each cytological test (LBC and CS) were extracted from the included studies. The pooled sensitivity and specificity and the area under the summary receiver operating characteristic curve (AUC) were calculated, and the AUC was compared by Tukey's multiple comparisons test. The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies II tool. RESULTS: A total of 1656 patients in eight studies were included. The pooled sensitivity and specificity and the AUC for LBC were 0.76 (95%CI: 0.72-0.79), 1.00 (95%CI: 0.98-1.00), and 0.9174, respectively, for diagnosing pancreatic lesions. The pooled estimates for SC were as follows: Sensitivity, 0.68 (95%CI: 0.64-0.71); specificity, 0.99 (95%CI: 0.96-100.00); and AUC, 0.9714. Similarly, the corresponding values for LBC combined with SC were 0.87 (95%CI: 0.84-0.90), 0.99 (95%CI: 0.96-1.00), and 0.9894. Tukey's multiple comparisons test was used to compare the sensitivities and AUCs of the three diagnostic methods; statistically significant differences were found between the three methods, and LBC combined with SC was superior to both LBC (P < 0.05) and SC (P < 0.05). The pooled sensitivity and AUC did not change significantly in the sensitivity analysis. CONCLUSION: LBC may be sensitive than SC in the cytological diagnosis of pancreatic lesions, however, the superior diagnostic performance of their combination emphasizes their integrated usage in the clinical evaluation of pancreatic lesions.

The diagnosis of intramural esophageal squamous cell carcinoma without mucosal invasion using endoscopic ultrasound-guided fine needle aspiration biopsy: A case report.

RATIONALE: Intramural esophageal squamous cell carcinoma (ESCC) without mucosal invasion is extremely rare. Endoscopic mucosal biopsy results are often negative, making diagnosis difficult. In these cases, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy is a useful diagnostic method. PATIENT CONCERNS: A 78-year-old female was admitted to hospital due to dysphagia, and gastroscopy showed a concentric narrowing of the esophageal lumen with a smooth and undamaged esophageal mucosa. DIAGNOSES: Endoscopic ultrasound (EUS) revealed that the esophageal mucosa was thickened with a low echo, and the layers of the esophageal wall could not be clearly distinguished. Cytologic and pathologic diagnoses were obtained through EUS-FNA, which suggested ESCC. INTERVENTIONS: According to the pathologic diagnosis obtained by EUS-FNA, surgery or radiotherapy were recommended for this patient. Eventually, this patient elected to seek treatment at another medical institution. OUTCOMES: This type of disease cannot be diagnosed according to gastroscopic biopsy alone, and the diagnosis was eventually confirmed through EUS-FNA. LESSONS: When an imaging examination suggests a possible malignant lesion of the oesophagus, EUS-FNA may be considered if the surface mucosa contains no endoscopic damage. EUS-FNA has high diagnostic value with high sensitivity, minimal invasiveness, and high safety.

Sirtuin 1 alleviates endoplasmic reticulum stress-mediated apoptosis of intestinal epithelial cells in ulcerative colitis.

BACKGROUND: Sirtuin 1 (SIRT1) is a nicotinamide adenine dinucleotide (NAD+)-dependent protein deacetylase that is involved in various diseases, including cancers, metabolic diseases, and inflammation-associated diseases. However, the role of SIRT1 in ulcerative colitis (UC) is still confusing. AIM: To investigate the role of SIRT1 in intestinal epithelial cells (IECs) in UC and further explore the underlying mechanisms. METHODS: We developed a coculture model using macrophages and Caco-2 cells. After treatment with the SIRT1 activator SRT1720 or inhibitor nicotinamide (NAM), the expression of occludin and zona occludens 1 (ZO-1) was assessed by Western blot analysis. Annexin V-APC/7-AAD assays were performed to evaluate Caco-2 apoptosis. Dextran sodium sulfate (DSS)-induced colitis mice were exposed to SRT1720 or NAM for 7 d. Transferase-mediated dUTP nick-end labeling (TUNEL) assays were conducted to assess apoptosis in colon tissues. The expression levels of glucose-regulated protein 78 (GRP78), CCAAT/enhancer-binding protein homologous protein (CHOP), caspase-12, caspase-9, and caspase-3 in Caco-2 cells and the colon tissues of treated mice were examined by quantitative real-time PCR and Western blot. RESULTS: SRT1720 treatment increased the protein levels of occludin and ZO-1 and inhibited Caco-2 apoptosis, whereas NAM administration caused the opposite effects. DSS-induced colitis mice treated with SRT1720 had a lower disease activity index (P < 0.01), histological score (P < 0.001), inflammatory cytokine levels (P < 0.01), and apoptotic cell rate (P < 0.01), while exposure to NAM caused the opposite effects. Moreover, SIRT1 activation reduced the expression levels of GRP78, CHOP, cleaved caspase-12, cleaved caspase-9, and cleaved caspase-3 in Caco-2 cells and the colon tissues of treated mice. CONCLUSION: SIRT1 activation reduces apoptosis of IECs via the suppression of endoplasmic reticulum stress-mediated apoptosis-associated molecules CHOP and caspase-12. SIRT1 activation may be a potential therapeutic strategy for UC.

Long non-coding RNA NEAT1 modulates hypoxia/reoxygenation-induced cardiomyocyte injury via targeting microRNA-520a.

In the present study, a hypoxia/reoxygenation (H/R) model of cardiomyocytes was established to investigate the effects of long non-coding RNA (LncRNA) Nuclear Enriched Abundant Transcript 1 (NEAT1) and microRNA (miR)-520a on H/R-induced cardiomyocyte apoptosis. Flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labeling staining were used to evaluate cell apoptosis. Luciferase activity assay was used to investigate whether miR-520a targets NEAT1. Results revealed that NEAT1 was significantly upregulated and miR-520a was downregulated in the ischemia/reperfusion myocardium and the cardiomyocytes that received H/R treatment. Further study demonstrated that knockdown of NEAT1 and overexpression of miR-520a serves a protective role against H/R-induced cardiomyocyte apoptosis. miR-520a directly targets NEAT1 and its expression level is negatively correlated with that of NEAT1. The findings suggested that NEAT1 and miR-520a may protect cardiomyocytes from apoptosis through regulating apoptotic proteins B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein, and altering cleaved caspase3 expression levels.

Sigmoid colon translocation of an intrauterine device misdiagnosed as a colonic polyp: A case report.

RATIONALE: Intrauterine contraceptive devices (IUDs) are recommended as a means of contraception. Translocation of IUD is a rare and serious complication. Colonic inflammatory mass caused by translocated IUD initially misdiagnosed as a colonic polyp is extremely rare and has not been reported yet. PATIENT CONCERNS: This report presents a case of sigmoid colon translocation of intrauterine device on a 37-year-old female patient. Colonoscopy was performed due to her complain of repeated blood in stools and subsequently the patient was misdiagnosed as a sigmoid colon polyp. Nonetheless, the "polyp" was not able to be removed endoscopically. DIAGNOSES: Sigmoid colon translocation of an intrauterine device. INTERVENTIONS: To further clarify the diagnosis, computed tomography (CT) scan was performed and the "polyp" was confirmed to be caused by a translocated IUD. OUTCOMES: The translocated IUD was removed easily by surgery, and the patient recovered soon after the operation. LESSONS: The present case indicates that an annual gynaecologic examination is necessary to determine the position of the IUD, and a CT examination may help confirm an ectopic IUD.

Endoscopic ultrasound-guided deep and large biopsy for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies.

AIM: To assess the diagnostic yield and safety of a deep and large biopsy technique under the guidance of endoscopic ultrasound (EUS) for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies. METHODS: From January 2009 to March 2014, 36 patients in whom gastric infiltrating tumors had been diagnosed by EUS received negative results for malignancy after endoscopic biopsies. The deep and large biopsy technique combined bite-on-bite technique with or without endoscopic mucosal resection (EMR) to obtain submucosal tissue from lesions. EUS was used to select the appropriate biopsy sites. If the lesion protruded into the cavity, EMR was performed for removal of the overlying mucosa and then bite-on-bite technique was conducted in the resected area to obtain submucosal tissue. If the lesion appeared to be flat or was difficult to lift by injection, the bite-on-bite technique was directly used. RESULTS: Twenty-eight of the 36 patients were treated by EMR followed by bite-on-bite technique, while 8 patients only underwent bite-on-bite technique. Histological results showed 23 of the 36 lesions were poorly differentiated adenocarcinomas, 2 diffuse large B cell lymphomas, 4 mucosa-associated lymphoid tissue-type lymphomas, and 7 undiagnosed. The deep and large biopsy technique provided a definitive and conclusive diagnosis in 29 (80.6%) of the 36 patients. The 12 gastric linitis plastica and 6 lymphoma patients received chemotherapy and avoided surgery. Minor oozing of blood in 2 mucosal resection wounds was managed by argon plasma coagulation and in 5 cases after deep biopsies by epinephrine (0.001%). Neither severe hemorrhage nor perforation occurred in any patient. CONCLUSION: The deep and large biopsy technique is superior to ordinary endoscopic biopsy for achieving an accurate diagnosis of gastric infiltrating tumors. This procedure guided by EUS is an effective and safe diagnostic method for gastric infiltrating tumors in which endoscopic biopsy results were negative for malignancy.