Endoscopic treatment for patients with gastric outlet stricture and biliary obstruction in the absence of endoscopic ultrasound: a retrospective study.

BACKGROUND AND AIM: Endoscopic biliary drainage is difficult in patients with biliary obstruction combined with gastric outlet stricture (GOS). Endoscopic ultrasound is useful for such patients, but needs advanced technique and sophisticated equipment. This study aimed to evaluate the efficacy and safety of conventional endoscopic retrograde cholangiopancreatography (ERCP) in patients with GOS and biliary obstruction without the assistance of endoscopic ultrasound. PATIENTS AND METHODS: Seventy-four patients with GOS proximal to the ampulla and biliary obstruction, including 27 with benign GOS and 47 with malignant GOS, were retrospectively enrolled. Three conventional methods were used to pass through the stricture and allow the duodenoscope to reach the papilla: adjusting the endoscope, balloon dilation, and metal stent insertion. The uncovered metal stent insertion was applied only in patients with malignant GOS. The primary outcome evaluated was successful biliary drainage. RESULTS: No serious complications occurred during or after ERCP. The overall success rate of biliary drainage in the patients was 81.1%. The success rate of duodenoscopy insertion by endoscope adjustment, balloon dilation, and stent insertion was 44.6, 68.9, and 71.4%, respectively. Endoscope adjustment was more successful in the patients in the benign group compared with the patients in the malignant group (60.9 vs. 35.7%). Similar findings were obtained for balloon dilation (92.3 vs. 59.4%). CONCLUSION: Most GOS, encountered during ERCP, can be safely dealt with using conventional endoscopic approaches in patients with biliary obstruction. However, the efficacy of endoscope adjustment or balloon dilation is better for benign GOS than for malignant GOS.

Effect of Metal Stents Combined With Nasobiliary Drainage on Preventing post-ERCP Cholangitis in Patients With Cholangiocarcinoma / 胃肠病学

Background:Cholangitis is common in patients with advanced cholangiocarcinoma after endoscopic metal biliary endoprothesis (EMBE). Aims:To explore the effect of EMBE combined with endoscopic nasobiliary drainage (ENBD)on preventing post-ERCP cholangitis in patients with cholangiocarcinoma. Methods: A total of 263 advanced cholangiocarcinoma patients underwent EMBE were enrolled and divided into EMBE group and EMBE plus ENBD group. Incidence of post-ERCP cholangitis,adverse event rate and hospital stay were evaluated between the two groups. Results:Compared with EMBE group,incidence of post-ERCP cholangitis (2. 3% vs. 10. 8%,P ＝0. 032 )and hospital stay [(4. 68 ± 1. 43)days vs. (5. 18 ± 1. 45 )days,P ＝0. 011 ]were significantly lower in EMBE plus ENBD group, especially in patients with hilar cholangiocarcinoma [incidence of post-ERCP cholangitis:3. 5% vs. 15. 0%,P＝0. 045;hospital stay:(5. 18 ± 1. 44)days vs. (5. 68 ± 1. 39)days,P＝0. 033]. C-reactive protein,white blood cell count, percentage of neutrophil after 3,24,72 hours were significantly decreased in EMBE plus ENBD group than in EMBE group (P＜0. 05). No significant difference in procedure-related adverse event was found between the two groups (P＞0. 05). Conclusions:The combination of EMBE with ENBD is safe and effective in preventing post-ERCP cholangitis,especially in patients with hilar cholangiocarcinoma.

Role of MicroRNA-21 in Pathogenesis,Diagnosis and Treatment of Pancreatic Cancer / 胃肠病学

Pancreatic cancer is characterized by high invasiveness,high malignancy and poor prognosis. Therefore,it is urgent to find biomarkers for early diagnosis and to develop targeting drugs for treatment of pancreatic cancer. MicroRNAs (miRNAs)are single-stranded,non-coding small RNA molecules with a length of 18-25 nucleotides and are highly expressed in pancreatic cancer. MiRNAs play important roles in cell proliferation,differentiation,apoptosis,invasion and metastasis,and are associated with adverse prognosis and resistance to chemotherapy in pancreatic cancer. As a new target for diagnosis and treatment of pancreatic cancer,miRNA-21 has become the hot spot of clinical research. This article reviewed the advances in studies on miRNA-21 in the pathogenesis,diagnosis and treatment of pancreatic cancer.

Diagnostic Value of Endoscopic Ultrasonography-guided Fine Needle Aspiration for Digestive System Neoplasms / 胃肠病学

Imaging examinations such as CT,MRI and ultrasonography are of great importance for the diagnosis of digestive system neoplasms. However,some digestive system neoplasms are difficult to be detected at early stage and make qualitative diagnosis by conventional imaging techniques because of their unique clinical characteristics. Compared with conventional imaging techniques,endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA)can not only detect the early lesions,but also make accurate qualitative diagnosis. The development and improvement of EUS-FNA greatly improve the diagnostic level of digestive system neoplasms. In this paper,the diagnostic value of EUS-FNA in digestive system neoplasms was reviewed.

Detection of miR-2 1 expression levels in carcinoma tissue and serum of patients with papillary thyroid carcinoma and its significance / 吉林大学学报(医学版)

Objective To investigate the expressions of miR-21 in carcinoma tissue and serum of the patients with papillary thyroid carcinoma (PTC), and to clarify its clinical significance.Methods Real-time PCR was used to detect the expression levels of miR-21 in carcinoma tissue and serum of 46 PTC patients,thyroid tissue and serum of 35 cases of nodular goiter and 18 healthy people. The correlations of miR-21 expression level with the clinicopathological features of PTC patients were analyzed.Results The relative expression levels of miR-21 in carcinoma tissue and serum of the PTC patients were 2.74±1.53 and 0.21±0.08,and they were 0.92±0.81 and 0.08±0.05 in carcinoma tissue and serum of the patients with nodular goiter,0.86 ± 0.39 and 0.07 ± 0.03 in normal papillary thyroid tissue and serum of 18 healthy people.The expression levels of miR-21 in carcinoma tissue and serum of the patients with PTC were higher than those of the patients with nodular goiter and healthy people (P<0.05).The expression level of miR-21 in serum and carcinoma tissue of PTC patients had a positive correlation with the extraglandular invasion,distant metastasis,lymph node metastasis,and TNM stages (P<0.05);and it had no correlation with gender and tumor sizes.Conclusion The expression levels of miR-21 in carcinoma tissue and serum of the PTC patients are increased. The up-regulated expression of serum miR-2 1 is correlated with the clinicopathological features of PTC patients, which indicates that miR-2 1 could be used as a potential marker for early detection of PTC.

New model of biliary perfusion systemin vitro / 中华消化内镜杂志

ObjectiveTo establish a new model of biliary peffusion in vitro,and to explore the feasibility of comparative biliary studies with the model.MethodsA set of ten-text-area model of biliary peffusion was designed in vitro.Saline,glycerol and pig bile were put into this model.The outflow of the first tube was set at 8 drops/min,and these liquids were collected through the ten sample test areas and measured at 0.5 hour,1.0 hour,1.5 hours,2.0 hours,12.0 hours and 24.0 hours.Equality of liquid amount was evaluated from each sample test area.Rods containing delayed release EDTA of ten different levels were placed in the test areas.The liquid was collected and EDTA concentrations were evaluated from the ten tubes at 24.0 hours.EDTA concentrations of the same rod in the three liquids were compared.ResultsA(1) the same time point,the amounts of saline,glycerol,pig bile flowing through the ten sample test areas showed no significant difference (P ＞ 0.01 ) ; but EDTA concentrations of the same liquid at 24.0 hours were significantly different (P ＜ 0.01 ) ; and EDTA concentrations of the same rod in the three liquids were also obviously different ( P ＜ 0.01 ).ConclusionThe same liquid flow rates and the same experimental environment can be achieved.Different test results can be obtained from different test areas in different experiments.The test results of the same kind of sample change with the changes of experimental conditions,which simulates biliary duct.

Therapeutic effect of endoscopy for anastomotic and nonanastomotic biliary strictures after liver transplantation / 中华消化内镜杂志

Objective To evaluate the therapeutic effect of endoscopy for patients with anastomotic or nonanastomotic biliary strictures after liver transplantation.Methods Clinical and follow-up data of 56 patients,38 (67.9％) with anastomotic strictures (AS),and 18 (32.1％) with nonanastomotic strictures (NAS) after liver transplantation,who underwent endoscopic therapy were collected and analyzed.Results Compared to AS patients,NAS patients showed shorter time from liver transplantation to initial presentation (4.45 ± 1.47 vs.8.00 ±2.31 months,P =0.000),underwent more ERCP procedures (6.20 ±1.28 vs.4.11 ± 1.51,P =0.000) and received more stents (10.20 ±3.59 vs.7.53 ±2.12,P =0.001).Although the success rate was not statistically different,patients with NAS needed longer treatment duration and had higher recurrence rate (50.0％ vs.18.2％,P =0.033) as well as shorter duration from treatment to recurrence.Among patients with AS,the treatment failure group had longer stricture length (13.00 ±3.61 vs.6.63 ±2.09,P =0.000) than the success group and the patients who experienced recurrence had longer stricture length (10.48 ± 1.07 vs.5.86 ± 1.55,P =0.000) and narrower stricture diameter (1.52 ± 0.38 vs.1.94 ± 0.32,P =0.001).Among NAS patients,the multiple biliary strictures group had lower success rate and higher recurrence rate,but with no statistical significance (62.5％ vs.90.0％,P =0.275 and 66.7％ vs.37.5％,P =0.592,recpectively).Conclusion NAS patients have lower response to endoscopic treatment than AS patients.The length and diameter of biliary stricture in AS as well as the number of stricture in NAS may influent the effect of endoscopic treatment.

The effect of ternary complex factor Net on the proliferation of human pancreatic carcinoma cell line BxPC3 / 中华胰腺病杂志

Objective To investigate the expression of the ternary complex factor Net in human pancreatic carcinoma cell line BxPC3 and its effect on cell proliferation and the expression of c-fos.Methods pEGFP-Net prokaryotic expression plasmid and empty vector pEGFP were transfed into BxPC3 cens by using lipofectamine 2000,then monoclonal cell which stably expressing Net was established.Human pancreatic carcinoma cells proliferation was detected by MTT and flow cytometry.The tuRNA and protein expression of Net and c-fos in BxPC3 cells were detected by real.time PCR and Western blot.Results Net was low expressed in BxPC3 cells.After pEGFP-Net transfection,Net wag stably expressed and the expression of c-fos was inhibited,cell proliferation was also inhibited after pEGFP-Net transfection,the inhibitory rates at the 3rd, 5th,7th day was 38.81%,55.34%and 56.92%respectively,which were significantly higher than those in the empty vector group(5.09%,12.42%,8.6%,P<0.05).G_0/G_1 phase cell was(61.79±5.67)%,which were significantly higher than(45.14±3.37)%in the empty vector group(P<0.05).Conclusions The ternary complex factor Net could inhibit pancreatic carcinoma cell line BxPC3 proliferation.Its mechanism was possibly repressing expression of oncogene c-fos.

Effects of EEFIA2 gene on the invasion and migration of pancreatic neoplasms / 中华消化杂志

Objective To observe the change of invasion and migration of the pancreatic carcinoma cell line SW1990 transfeeted with EEF1A2 gene.Methods Pancreatic carcinoma cell line SW1990 was transfected with EEF1A2 by recombinant adenovirus vector.The alteration of motility、invasion and adhesion property of SW1990 was evaluated by wound healing assay,transwell With or without Matrigel basement membrane and adhesion assay.Results Wound healing assay revealed that EEF1A2 enhanced cell motility and transwell assay with Matrigel indicated that the average numbers of transwell cells with EEFlA2 was increased from 23.25±5.23 to 65.42±8.24(P＜0.05).The adhesive rate was substantially increased in EEF1A2 transfected SW1990 cells compared with control cells.Conclusions EEF1A2 gene can promote the migration.invasion and adhesion ability of pancreatic cancer cell in vitro.It is indicated that EEF1A2 may involve in the development of human pancreatic cancer by influencing cell biological characteristics.