Duodenal ulcer caused by coil wiggle after digital subtraction angiography-guided embolization: A case report.

BACKGROUND: Acute gastrointestinal bleeding (GIB) is a life-threatening medical emergency with high morbidity and mortality. Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates. Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery, which is a rare complication, have not previously been reported in a patient with right intrathoracic stomach. CASE SUMMARY: A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago, resulting in right intrathoracic stomach. He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay. Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils. After 15 mo, the patient was re-admitted with a chief complaint of melena for 2 d, esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb, leading to a deep ulcer. Bleeding was controlled after conservative treatment. Seven months later, duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils, and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding. Mild melena recurred once during the long-term follow-up. CONCLUSION: Although rare, coil wiggle after interventional therapy requires careful attention, effective precautionary measures, and more secure alternative treatment methods.

Overexpression of calpain­1 predicts poor outcome in patients with colorectal cancer and promotes tumor cell progression associated with downregulation of FLNA.

Several studies have demonstrated that calpain­1 is involved in a variety of pathophysiological processes, including tumorigenesis. However, the clinical relevance and role of calpain­1 in colorectal cancer (CRC) are unclear. Filamin A (FLNA) is an actin­binding protein that participates in cancer progression and can be cleaved by calpain­1. In the present study, the protein expression levels of calpain­1 and FLNA were detected by immunohistochemistry in 467 matched cancerous and paracancerous tissues from patients with CRC. The staining results and the clinicopathological characteristics of the patients were comprehensively analyzed. A high expression level of calpain­1 was strongly associated with age, metastasis, Dukes stage and survival time but not with sex, histologic grade, tumour location or tumor size. By contrast, a low expression level of FLNA was significantly associated with tumor size, histological grade, metastasis, Dukes stage and survival time, but not with age, sex, or tumor location. Kaplan­Meier survival analysis demonstrated that patients with calpain­1 overexpression had a shorter mean overall survival (OS) than patients with lower levels of calpain­1 expression. Unlike high levels of calpain­1, high levels of FLNA were associated with longer OS than lower levels of FLNA expression. Furthermore, calpain­1 expression was inversely correlated with FLNA expression. The relationship between calpain­1 and FLNA was further confirmed using CRC cell lines in vitro. When calpain­1 expression decreased in CRC cells, FLNA expression increased. Furthermore, calpain­1 knockdown in CRC cells resulted in decreased proliferation, colony formation, migration and invasion. The present findings suggest that calpain­1 overexpression predicted a poor outcome in patients with CRC and promoted tumor progression, possibly via FLNA downregulation.