Endoscopic Treatment of Duodenocolic Fistula Caused by Migrating Biliary Stents.

BACKGROUND Endoscopic biliary stent implantation is a recognized and effective method for the treatment of benign and malignant diseases of the bile duct and pancreas, ensuring smooth bile drainage. Currently, stent migration is considered a long-term and complex process, and in most cases, stents are removed through endoscopy or expelled from the body through the intestinal cavity. In rare cases, stents lead to formation of duodenocolic fistulas. CASE REPORT We report a case of duodenal colon fistula caused by a biliary stent penetrating the duodenum and entering the ascending colon. We removed the stent through endoscopy and clamped the fistulas of the colon and duodenum separately with titanium clips. Due to the presence of large common bile duct stones, nasobiliary drainage was performed again. Later, laparoscopic choledocholithotomy was performed, and the patient was discharged after rehabilitation. CONCLUSIONS ERCP endoscopy must consider the possibility of stent displacement in patients with biliary stents. In the case of CBD biliary stent dislocation in the patient, continuous abdominal plain films and physical examinations are required until spontaneous discharge is confirmed. In addition, for patients with benign bile duct stenosis undergoing biliary drainage, doctors should urge them to return to the hospital on time to remove the stent. For patients with postoperative abdominal pain or peritonitis symptoms, abdominal CT scan confirmation is required and early intervention should be considered.

Effect of digital three-dimensional reconstruction technique combined with indocyanine green (ICG) excretion test for precision hepatectomy in primary liver cancer.

OBJECTIVE: The aim of this study was to evaluate the residual volume of liver reserve function in liver cancer patients using three-dimensional reconstruction technique (3D technology) and the indocyanine green (ICG) excretion test. METHODS: A retrospective analysis was conducted, and data were collected from 90 liver cancer patients in Ganzhou People's Hospital between January 2017 and December 2021. The control group underwent preoperative resectability evaluation based on traditional two-dimensional images, whereas the experimental group underwent digital three-dimensional reconstruction technique combined with indocyanine green (ICG) excretion test. The intraoperative bleeding volume, accuracy of preoperative surgical planning, operation time, postoperative complication rate, and perioperative mortality were compared between the two groups. RESULTS: The assessment of resected liver volume (resectability) in the experimental group was larger than in the control group (P=0.003). Moreover, the accuracy rate of preoperative surgical planning in the experimental group was higher than in the control group (P=0.014). The intraoperative estimated blood loss favored the experimental group by a mean of 355 ml (P=0.02). Operative time and hospital stay favored the experimental group by a mean time of 204 min (P=0.03). The positive rate of liver resection margin and recurrence rate in the experimental group were lower than in the control group (P=0.021, P=0.004). Moreover, the two groups differed after intervention in terms of AST (P=0.001), ALT (P=0.0001), TBIL (P=0.001), and ALB (P=0.026). CONCLUSION: The combination of three-dimensional reconstruction technique and indocyanine green (ICG) excretion test provides accurate visualization of hepatic anatomy and improves the precision of liver resection surgery, which is of great guiding value. This can optimize the preoperative evaluation and surgical planning for liver resection, shorten the operation time, and reduce intraoperative bleeding volume.

FOXC2 as a prognostic marker and a potential molecular target in patients with human solid tumors.

Background: Forkhead Box Protein C2 (FOXC2) belongs to the Forkhead/Wing-helix family. The regulatory role of this transcription factor in physiological function and carcinogenic activity has been proven in subsequent investigations. However, there is still scarcity of evidence on the relationship between FOXC2 expression and prognosis in human solid tumors. We conducted this meta-analysis to evaluate the role of FOXC2 as a prognosis factor and a possible target marker in human solid tumors. Methods: PubMed, Web of Science, Embase, and the Cochrane library database were all searched methodically. Eligible publications on FOXC2 in human solid tumors were gathered and reviewed. The effect sizes were calculated using pooled hazard ratios (HRs) or odds ratios (ORs) with the corresponding 95% confidence interval (CI). Statistical analysis was conducted with Stata SE12.0. Results: This meta-analysis comprised 3,267 patients from 20 studies covering a variety of solid tumors. Increased FOXC2 expression was related to shorter overall survival (OS) (HR = 2.05, 95% CI: 1.73-2.42). High expression of FOXC2 is associated with lymph node metastases (OR = 3.33, 95% CI: 2.65-4.19), TNM stage (OR = 3.09, 95% CI: 2.00-4.78), and age (OR = 1.26, 95% CI: 1.06-1.50), according to the pooled ORs. However, no significant association was observed between the high expression of FOXC2 and sex, tumor size or tumor differentiation. Conclusion: Increased expression of FOXC2 is associated with unfavored OS, lymph node metastases, TNM stage, and age. FOXC2 is a promising prognostic marker and a novel target marker in human solid tumors.

Effect of modified Blumgart pancreaticojejunostomy on nutritional status in elderly patients after pancreaticoduodenectomy.

OBJECTIVE: To evaluate the effect of modified Blumgart pancreaticojejunostomy on the nutritional status in elderly patients after pancreaticoduodenectomy. METHODS: Fifty-eight elderly patients who underwent pancreaticoduodenectomy in our hospital were evenly divided into the traditional group (receiving traditional Blumgart pancreaticojejunostomy) and the modified group (receiving modified Blumgart pancreaticojejunostomy). RESULTS: In the modified group, intraoperative blood loss and 24-h VAS score were lower and time to off-bed activity and postoperative hospital stay were shorter than those in the traditional group (P<0.05). The levels of d-lactic acid, diamine oxidase, and endotoxin were increased after surgery and were higher in the modified group than those in the traditional group, while the digestive symptoms and cancer pain scores at 6 months after surgery and postoperative complication rate were lower than those of the traditional group (all P<0.05). The nursing satisfaction was higher in the modified group than that in the traditional group (P<0.05). The nutritional status, pancreatic endocrine function and pancreatic exocrine function showed no significant differences between the two groups. CONCLUSION: The modified Blumgart pancreaticojejunostomy can reduce the pain level, expedite postoperative rehabilitation, and improve the intestinal mucosal barrier function and quality of life of patients while not significantly affecting postoperative nutritional status and pancreatic function.

[Evaluation of gastroesophageal varices with three-dimensional visualization technology].

OBJECTIVE: To observe the prognostic value of Medical Image Three-dimensional (3D) Visualization System (MI-3DVS) in evaluation of the distribution and blood supply of gastroesophageal varices (EGV). METHODS: 3D reconstruction was played by MI-3DVS and CT-maximum intensity projection (CT-MIP) respectively on multi slice computed tomography (MSCT) date of 51 patients with EGV from February 2010 to October 2012. The demonstration rate of collateral vessels in spleen and stomach area, EGV typing and the blood supply between the two methods were observed and compared. RESULTS: The demonstration rates of LGV, gastro-renal shunt, splenorenal shunt and PGV showed a high coincidence between the MI-3DVS and CT-MIP (κ = 0.882-1.000), and moderate agreements in SGV and paraesophageal varices (κ = 0.646 and 0.757). The outcome of EGV classification (MI-3DVS vs. CT-MIP) were typeIfor 31 vs. 28 cases, type II for 6 vs. 4 cases, type III for 4 vs. 4 cases and type IV for 6 vs.10 cases, the 2 methods show high agreements (weighted Kappa value of 0.848 and P < 0.01).Significant differences were found in the blood supply distribution among the four types of EGV (χ(2) = 36.647, P < 0.01); and the blood supply of the EGV tended to be a strong correlation with EGV classification (C = 0.769 and 0.744, P = 0.000). There were 12 patients with gastro-renal shunt and 5 patients with Spleno-renal shunt. CONCLUSIONS: MI-3DVS can explicitly determine the location, blood vessel diameter and blood supply of the EGV, which is helpful for us to grab the formation of collateral circulation completely. The 3D reconstruction of MI-3DVS has guidance and current significance in optimizing therapeutic schedule or preoperative planning.