Bowel preparation efficacy and safety of compound polyethylene glycol electrolyte powder combined with linaclotide for colonoscopy: A randomized controlled trial.

Background and Aim: Adequate bowel preparation is essential for colonoscopy, which is important for detecting colon polyps and preventing colorectal cancer. Linaclotide is approved for irritable bowel syndrome with predominant constipation (IBS-C) symptoms. The main objective of this study was to explore the quality of bowel preparation by low-volume compound polyethylene glycol (PEG) combined with linaclotide. Methods: A total of 266 patients who underwent colonoscopy in Shangrao People's Hospital from June 2021 to June 2022 were randomized to 1 of 3 split PEG regimens: 4LPEG, 2LPEG, and 2LPEG + L (linaclotide). The primary end point was adequate bowel preparation (Boston Bowel Preparation Scale [BBPS] total score of ≥6, with each of three colonic segments subscores ≥2). Secondary outcomes were polyp detection rates and the incidence of adverse reactions. Results: Over 12 months, 266 subjects were randomized into 2LPEG (n = 12), 4LPEG (n = 112), or 2LPEG + L (n = 142). There were no significant differences between the 4LPEG and 2LPEG + L groups in achieving adequate bowel preparation (P > 0.05). The mean BBPS score of the total colon, left hemi-colon, right hemi-colon, and transverse in the 2LPEG + L group was higher than that in the 2LPEG group (P < 0.001). Patient's sleeping quality and the incidence of adverse reactions of 2LPEG + L group were compatible with 2LPEG group, but it was significantly lower than that in 4LPEG group. There was no statistically significant difference in the detection rate of colon polyps between each group. Conclusion: The quality of bowel preparation of the compound polyethylene glycol electrolyte powder combined with linaclotide is approximately the same as that of 4LPEG, and it can reduce the adverse reactions in the process of bowel preparation, and its intestinal cleansing effect is also better than that of 2LPEG.

Comparison of percutaneous vs endoscopic drainage in the management of pancreatic fluid collections: A prospective cohort study.

BACKGROUND AND AIM: Currently, endoscopic drainage (ED) and percutaneous drainage (PD) are both widely used effective interventions in the management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare the clinical effectiveness and safety of ED to those of PD in the treatment of PFCs. METHODS: A prospective cohort study of PFC patients who underwent ED or PD was conducted between January 2009 and December 2017. In this study, the initial success rate, adverse events, intervention, requirement of surgical treatment, hospital mortality within 30 days, length of hospital stay, and expenses during hospitalization were monitored, and a follow-up investigation of treatment outcome was conducted. Long-term recovery, recurrence, and mortality were determined according to telephone follow up. RESULTS: In total, 129 patients were included in the study; 62 patients underwent ED, and 67 patients underwent PD during the 8-year study period. Initial treatment success was considerably higher in patients whose PFCs were managed by ED than in patients whose PFCs were managed by PD (94.9% vs 65.0%, P = 0.003). The rate of procedural adverse events, reintervention, length of hospitalization, and expense were all higher in the PD group than in the ED group, but the long-term recovery rate and requirement of surgical intervention were not clearly different between patients who underwent the two treatment measures. CONCLUSION: ED of symptomatic PFCs was associated with higher rates of initial treatment success, lower rates of reintervention and adverse events, and a shorter hospital stay than PD of symptomatic PFCs.

Regulation of Autophagy Affects the Prognosis of Mice with Severe Acute Pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a common inflammatory disease that may develop to severe AP (SAP), resulting in life-threatening complications. Impaired autophagic flux is a characteristic of early AP, and its accumulation could activate oxidative stress and nuclear factor κB (NF-κB) pathways, which aggravate the disease process. AIM: To explore the therapeutic effects of regulating autophagy after the onset of AP. METHODS: In this study, intraperitoneal injections of 3-methyladenine (3-MA) and rapamycin (RAPA) in the L-arginine or cerulein plus lipopolysaccharide (LPS) Balb/C mouse model. At 24 h after the last injection, pulmonary, intestinal, renal and pancreatic tissues were analyzed. RESULTS: We found that 3-MA ameliorated systemic organ injury in two SAP models. 3-MA treatment impaired autophagic flux and alleviated inflammatory activation by modulating the NF-κB signaling pathway and the caspase-1-IL-1ß pathway, thus decreasing the injuries to the organs and the levels of inflammatory cytokines. CONCLUSION: Our study found that the regulation of autophagy could alter the progression of AP induced by L-arginine or cerulein plus LPS in mice.

The Efficiency of Aggressive Hydration With Lactated Ringer Solution for the Prevention of Post-ERCP Pancreatitis: A Systematic Review and Meta-analysis.

BACKGROUND: As shown in studies, aggressive hydration during the perioperative period of endoscopic retrograde cholangiopancreatography (ERCP) effectively prevents post-ERCP pancreatitis (PEP). We conducted a systematic review and meta-analysis to evaluate the clinical effectiveness and safety of aggressive hydration with lactated Ringer solution at preventing PEP. MATERIALS AND METHODS: We searched all relevant research from PubMed, the Cochrane Library, Embase, the Web of Science, ClinicalTrial.gov, and Scopus database for randomized controlled trials (RCTs) published before March 2017. Reference lists from reviews or relevant articles were screened for RCTs. The primary outcomes were the incidence of PEP and the incidence of moderate to severe pancreatitis. The secondary outcomes were the incidence of hyperamylasemia and pain and the length of hospital stay. The meta-analysis was conducted using the Cochrane Program Review Manager. RESULTS: Three RCTs were included in our study. On the basis of the results of the meta-analysis, the aggressive hydration group had a lower incidence of pancreatitis after ERCP [odds ratio (OR)=0.29; 95% confidence interval (CI), 0.16-0.53]; a lower incidence of moderate to severe PEP (OR=0.16; 95% CI, 0.03-0.96); lower incidence of hyperamylasemia (OR=0.38; 95% CI, 0.25-0.59); lower risk of pain (OR=0.17; 95% CI, 0.08-0.38); and a shorter duration of hospital stay (standardized mean difference=-0.41; 95% CI, -0.69 to -0.14). CONCLUSIONS: Aggressive hydration with lactated Ringer solution can reduce the overall incidence of PEP, moderate to severe pancreatitis and hyperamylasemia, shorten the length of hospitalization and reduce pain.