Prevention program for the COVID-19 in a children’s digestive endoscopy center

The pneumonia caused by the coronavirus disease-2019(COVID-19)outbreak in Wuhan,China constitutes a public health emergency of international concern.The gastrointestinal symptoms of vomiting,diarrhea and abdominal pain and the detection of COVID-19 nucleic acid from fecal specimens in a small number of patients suggest the possibility of transmission via the gastrointestinal tract.People of all ages are vulnerable to this virus,including children.Digestive endoscopy is an invasive procedure during which children cannot wear masks;therefore,they have higher risks of exposure to COVID-19,and the digestive endoscopy center is a relatively high-risk area for COVID-19 infection.Based on these factors and in combination with related policies and regulations,a prevention and control program for the COVID-19 pneumonia in a children's digestive endoscopy center was established to prevent the COVID-19 nosocomial infection.

Effect of comprehensive management combined with cognitive intervention on patient cooperation and complications during digestive endoscopy

BACKGROUND As lifestyles continue to change worldwide,the incidence of digestive tract carcinoma has gradually increased.Digestive endoscopy is an important tool that can assist in the diagnosis,treatment,and surgical intervention for this disease.However,the examination process is affected by many factors,and patient cooperation is often poor,which can increase the risk of complications.AIM To explore the effects of integrated management and cognitive intervention on cooperation and complications in patients undergoing endoscopy for early gastrointestinal neoplasms.METHODS A total of 354 patients with early stage gastrointestinal cancer who underwent digestive endoscopy procedures between January and December 2023 at our hospital were divided into observation and control groups(177 patients in each group)in a randomized controlled blind trial.The control group received routine interventions,while the observation group received comprehensive integrated management combined with cognitive interventions.We compared the changes in adverse mood,discomfort,examination time,cooperation with the examination,and complications before and after the intervention between the two groups.RESULTS The self-rated anxiety and depression scale scores were lower in the observation group than in the control group(P<0.05).The visual analog scale scores for discomfort during intubation and examination were also lower in the observation group than in the control group(P<0.05).Furthermore,the examination time was shorter in the observation group than in the control group(P<0.05),and the degree of cooperation(94.35%)was higher in the observation group than in the control group(84.75%;P<0.05).Lastly,the incidence rates of gastrointestinal adverse reactions(10.17%vs 20.34%),choking agitation(14.69%vs 24.86%),abdominal pain(8.47%vs 18.08%),and muscle tension(5.08%vs 14.12%)were all lower in the observation group than in the control group(P<0.05).CONCLUSION Integrated management and cognitive intervention in early gastrointestinal neoplasm endoscopy alleviate mood,reduce discomfort,shorten examinations,improve cooperation,and reduce complications.

Effects of exercise by type and duration on quality of life in patients with digestive system cancers:A systematic review and network meta-analysis

Background:There is scant evidence regarding the effects of exercise type and duration on quality of life(QoL)in digestive system cancer(DSC)survivors.We aim to investigate the optimal type and duration of exercise to improve QoL for DSC survivors through a systematic review and network meta-analysis.Methods:A systematic literature search of PubMed,Embase,and Web of Science was performed.Eligibility for study inclusion was limited to studies that were randomized controlled trials involving all kinds of exercise in adult patients with DSCs,and the comparator was in standard care or other types of exercise.The primary outcome was QoL,including general health,physical health,mental health,and role function.Secondary outcomes included cancer-related symptoms such as fatigue,insomnia,depression,anxiety,and duration of hospital stay.The network meta-analyses were performed using a random-effect model.Results:The analysis included 32 eligible articles and a total of 2558 participants.Our primary outcome indicated that short-term aerobic exercise significantly enhanced general health(standardized mean difference(SMD)=0.66,95%credible intervals(Crls):0.05 to 1.30),and also contributed to a better mental health(SMD=0.38,95%CrI:-0.05 to 0.81)and role function(SMD=0.48,95%CrI:-0.27 to 1.20).Although without significant changes,short-term resistance exercise tended to increase the physical health of patients with DSCs(SM=0.69,95%CrI:-0.07 to 1.50)and effective in alleviating fatigue(SMD=-0.77,95%CrI:-1.50 to 0.01).Short-term aerobic exercise was related to a lower score of insomnia(SMD=-1.20,95%CrI:-2.40 to 0.06),depression(SMD=-0.51,95%CrI:-1.50 to 0.45),and anxiety(SMD=-0.45,95%CrI:-1.30 to 0.34).All types of exercise related to a trend of declined hospital stays(-0.87 to-5.00 day).Long-term resistance exercise,however,was negatively associated with general health(SMD=-0.33,95%CrI:-1.70 to 1.00),physical health(SMD=-0.18,95%CrI:-1.30to 0.90),and role function(SMD=-1.20,95%CrI:-2.50 to 0.11).Conclusion:This study suggests that short-term aerobic exercise,with or without resistance exercise programs,enhances QoL(especially for general health)as well as relieves cancer-related symptoms for DSC survivors,while long-term resistance exercise may have negative effects,and thus should be adopted cautiously.These results provide important evidence for the management of DSCs.

Outcomes of colon self-expandable metal stents for malignant vs benign indications at a tertiary care center and review of literature

BACKGROUND Endoscopic placement of a self-expandable metal stent(SEMS)is a minimally invasive treatment for use in malignant and benign colonic obstruction.However,their widespread use is still limited with a nationwide analysis showing only 5.4%of patients with colon obstruction undergoing stent placement.This underutilization could be due to perceived increase risk of complications with stent placement.AIM To review long-and short-term clinical success of SEMS use for colonic obstruction at our center.METHODS We retrospectively reviewed all the patients who underwent colonic SEMS placement over aeighteen year period (August 2004 through August 2022) at our academic center. Demographicsincluding age, gender, indication (malignant and benign), technical success, clinical success,complications (perforation, stent migration), mortality, and outcomes were recorded.RESULTSSixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were formalignant indications, 8 were for benign conditions. The benign strictures included diverticulardisease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemicstricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primaryor recurrent colon cancer;12 were from extrinsic compression. Fifty-four strictures occurred on theleft side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55)procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication ratewas significantly higher for benign group: Four complications were observed in the malignantgroup (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stentmigration) (P = 0.02). When stratifying complications of perforation and stent migration there wasno significant difference between the two groups (P = 0.14, NS).CONCLUSIONColon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has ahigh procedural and clinical success rate. Benign indications for SEMS placement appear to havesimilar success to malignant. While there appears to be a higher overall complication rate inbenign cases, our study is limited by sample size. When evaluating for perforation alone theredoes not appear to be any significant difference between the two groups. SEMS placement may bea practical option for indications other that malignant obstruction. Interventional endoscopistsshould be aware and discuss the risk for complications in setting of benign conditions. Indicationsin these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.

Percutaneous transhepatic cholangioscopy-assisted biliary polypectomy for local palliative treatment of intraductal papillary neoplasm of the bile duct

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a premalignant biliarytype epithelial neoplasm with intraductal papillary or villous growth.Currently reported local palliative therapeutic modalities,including endoscopic nasobiliary drainage,stenting and biliary curettage,endoscopic biliary polypectomy,percutaneous biliary drainage,laser ablation,argon plasma coagulation,photodynamic therapy,and radiofrequency ablation to relieve mechanical obstruction are limited with weaknesses and disadvantages.We have applied percutaneous transhepatic cholangioscopy(PTCS)-assisted biliary polypectomy(PTCS-BP)technique for the management of IPNB including mucin-hypersecreting cast-like and polypoid type tumors since 2010.AIM To assess the technical feasibility,efficacy,and safety of PTCS-BP for local palliative treatment of IPNB.METHODS Patients with mucin-hypersecreting cast-like or polypoid type IPNB and receiving PTCS-BP between September 2010 and December 2019 were included.PTCS-BP was performed by using a half-moon type snare with a soft stainless-steel wire,and the tumor was snared and resected with electrocautery.The primary outcome was its feasibility,indicated by technical success.The secondary outcomes were efficacy,including therapeutic success,curative resection,and clinical success,and safety.RESULTS Five patients(four with mucin-hypersecreting cast-like type and one with polypoid type IPNB)were included.Low-and high-grade intraepithelial neoplasia(HGIN)and recurrent IPNB with invasive carcinoma were observed in one,two,and two patients,respectively.Repeated cholangitis and/or obstructive jaundice were presented in all four patients with mucin-hypersecreting cast-like type IPNB.All five patients achieved technical success of PTCS-BP.Four patients(three with mucin-hypersecreting cast-like type and one with polypoid type IPNB)obtained therapeutic success;one with mucin-hypersecreting cast-like type tumors in the intrahepatic small bile duct and HGIN had residual tumors.All four patients with mucin-hypersecreting IPNB achieved clinical success.The patient with polypoid type IPNB achieved curative resection.There were no PTCS-BP-related serious adverse events.CONCLUSION PTCS-BP appears to be feasible,efficacious,and safe for local palliative treatment of both mucin-hypersecreting cast-like and polypoid type IPNB.

Lactobacillus plantarum AR495 improves stress-induced irritable bowel syndrome in rats by targeting gut microbiota and Mast cell-PAR2-TRPV1 signaling pathway

Probiotics have great potential in regulating intestinal pain.In this study,the effects of Lactobacillus plantarum AR495 on the visceral sensitivity and gut microbiota of irritable bowel syndrome(IBS)rats were studied.The results showed that tryptase released after mast cell activation and degranulation plays a key role in visceral pain,and L.plantarum AR495 reduced the stimulation of colonic mast cells and the expression of protease-activated receptor 2(PAR2)and TRPV1 in dorsal root ganglia.Research further showed that supplementation with L.plantarum AR495 increased the level of short-chain fatty acids(SCFAs)and enhanced the barrier function of the colon.In addition,the microbiota analysis of the colon indicated that L.plantarum AR495 promoted the proliferation of Bifidobacterium and inhibited the proliferation of Lachnospiraceae,which alleviated the imbalance of the intestinal microbiota caused by IBS to a certain extent.In total,L.plantarum AR495 might reduce visceral sensitivity through the Mast cell-PAR2-TRPV1 signaling pathway by maintaining the homeostasis of the intestinal barrier.

Lactobacillus plantarum AR113 attenuates liver injury in D-galactose-induced aging mice via the inhibition of oxidative stress and endoplasmic reticulum stress

Probiotics could effectively eliminate excess reactive oxygen species(ROS)generated during aging or lipid metabolism disorders,but their mechanism is unclear.The major purpose of this study was to investigate the mechanism of Lactiplantibacillus plantarun AR113 alleviating oxidative stress injury in the D-galactose induced aging mice.The result showed that pretreatment with L.plantarun AR113 significantly relieving H_(2)O_(2)induced cytotoxicity in HepG2 cells by maintain cell membrane integrity and increasing antioxidant enzyme activities.In D-galactose induced aging mice,L.plantarun AR113 could significantly attenuate liver damage and inflammatory infiltration by promoting endogenous glutathione(GSH)synthesis and activating the Nrf2/Keap1 signaling pathway in mice,and increasing the expression of regulated phaseⅡdetoxification enzymes and antioxidant enzymes.Further analysis shown that gavage of L.plantarun AR113 could significantly reduce the expression of G protein-coupled receptor 78(GPR78)and C/EBP homologous protein(CHOP)proteins,and promote the restoration of endoplasmic reticulum(ER)homeostasis,thereby activating cell anti-apoptotic pathways.These results were also confirmed in H_(2)O_(2)-treated HepG2 experiments.It indicated that L.plantarun AR113 could inhibit D-galactose-induced liver injury through dual inhibition of ER stress and oxidative stress.L.plantarun AR113 have good application potential in anti-aging and alleviating metabolic disorders.

Serum urate is associated with an increased risk of inflammatory bowel disease: A bidirectional Mendelian randomization study

BACKGROUND Previous studies have indicated bidirectional associations between urate levels and inflammatory bowel disease(IBD),including ulcerative colitis(UC)and Crohn’s disease(CD).However,it remains unclear whether the observations are causal because of confounding factors.AIM To investigate the causal associations between urate levels and IBD using bidirec-tional Mendelian randomization(MR).METHODS Independent genetic variants for urate levels and IBD were selected as instru-mental variables from published genome-wide association studies(GWASs).Summary statistics for instrument-outcome associations were retrieved from three separate databases for IBD(the UK Biobank,the FinnGen database and a large GWAS meta-analysis)and one for urate levels(a large GWAS meta-analysis).MR analyses included the inverse-variance-weighted method,weighted-median estimator,MR-Egger and sensitivity analyses(MR-PRESSO).A meta-analysis was also conducted to merge the data from separate outcome databases using a fixed-effects model.RESULTS Genetically higher serum urate levels were strongly associated with an increased risk of UC[odds ratio(OR):1.95,95%confidence interval(CI):1.86-2.05]after outlier correction,and the ORs(95%CIs)for IBD and CD were 0.94(95%CI:0.86-1.03)and 0.91(95%CI:0.80-1.04),respectively.Animal studies have confirmed the positive association between urate levels and UC.Moreover,genetically predicted IBD was inversely related to urate levels(OR:0.97,95%CI:0.94-0.99).However,no association was observed between genetically influenced UC or CD and urate levels.CONCLUSION Urate levels might be risk factors for UC,whereas genetically predicted IBD was inversely associated with urate levels.These findings provide essential new insight for treating and preventing IBD.

Establishing a model to measure and predict the quality of gastrointestinal endoscopy

BACKGROUND Tens of millions of gastrointestinal endoscopic procedures are performed every year in China,but the quality varies significantly and related factors are complex.Individual endoscopist-and endoscopy division-related factors may be useful to establish a model to measure and predict the quality of endoscopy.AIM To establish a model to measure and predict the quality of gastrointestinal endoscopic procedures in China's Mainland.METHODS Selected data on endoscopy experience,equipment,facility,qualification of endoscopists,and other relevant variables were collected from the National Database of Digestive Endoscopy of China.The multivariable logistic regression analysis was used to identify the potential predictive variables for occurrence of medical malpractice and patient disturbance.Linear and nonlinear regressions were used to establish models to predict incidence of endoscopic complications.RESULTS In 2012,gastroscopy/colonoscopy-related complications in China's Mainland included bleeding in 4,359 cases(0.02%)and perforation in 914(0.003%).Endoscopic-retrograde-cholangiopancreatography-related complications included severe acute pancreatitis in 593 cases(0.3%),bleeding in 2,151(1.10%),perforation in 257(0.13%)and biliary infection in 4,125(2.11%).Moreover,1,313(5.0%)endoscopists encountered with medical malpractice,and 5,243(20.0%)encountered with the disturbance from patients.The length of endoscopy experience,weekly working hours,weekly night shifts,annual vacation days and job satisfaction were predictors for the occurrence of medical malpractice and patient disturbance.However,the length of endoscopy experience and the ratio of endoscopists to nurses were not adequate to establish an effective predictive model for endoscopy complications.CONCLUSION The workload and job satisfaction of endoscopists are valuable predictors for medical malpractice or patient disturbance.More comprehensive data are needed to establish quality-predictive models for endoscopic complications.

Impact of pancreatic and biliary stent on post-endoscopic papillectomy complications:A single-center retrospective study

Background:Endoscopic papillectomy(EP)is recommended as the first-line therapy for ampullary tumors,despite a relatively high incidence of complications.Pancreatic and/or biliary stents are placed at the endoscopist’s discretion to prevent post-EP complications.The present study aimed to evaluate the efficacy of different stents.Methods:A total of 117 patients who underwent EP and met the criteria between June 2006 and October 2022 were enrolled in the study.These patients were divided into a pancreatic stent group(PS group,n=47),a biliary stent group(BS group,n=38),and a two-stent group(PBS[PS and BS]group,n=32).Relevant clinical data were collected and compared among the three groups.Multivariate logistic analyses were performed to explore risk factors for post-EP complications.Results:The incidence of all complications was 37.6%(44/117).Pancreatitis and hemorrhage were the two most common complications with incidence rates of 14.5%(17/117)and 17.9%(21/117).The incidence rates of post-EP pancreatitis were 10.6%(5/47),23.7%(9/38),and 9.4%(3/32)in the PS group,BS group,and PBS group,respectively,with no significant differences.There were also no significant differences in other complications among the three groups.Age(odds ratio[OR]:0.95;95%confidence interval[CI]:0.91-0.99;P=0.022)was independently associated with post-EP pancreatitis while tumor size(OR:1.66;95%CI:1.06-2.60;P=0.028)was independently associated with post-EP hemorrhage.Conclusions:While pancreatic stenting is the first choice to prevent post-EP pancreatitis,biliary stenting could also be considered as a substitute for patients with difficulties in pancreatic cannulation.Two-stent(biliary and pancreatic stent)placement is unnecessary unless it is required due to other concerns.

Burden of digestive system diseases in China and its provinces during 1990-2019:Results of the 2019 Global Disease Burden Study

Background:Evaluating the impact of digestive system diseases is vital for devising effective prevention strategies.However,comprehensive reports on the burden of digestive system diseases in China are lacking.Our study aimed to provide an overview of the burden and trends of digestive system diseases from 1990 to 2019 in China and its provinces.Methods:This cross-sectional study utilized the Global Disease Burden Study 2019 to estimate the incidence,mortality rate,disability-adjusted life years(DALYs),years of life disability,years of life lost,and changes in the burden of digestive diseases across Chinese provinces from 1990 to 2019.The analysis of disease burden primarily examines the characteristics of sub-disease distribution,time trends,age distribution,and sex distribution.Additionally,we compared provincial age-standardized DALYs for digestive diseases with the expected rates based on the socio-demographic index(SDI).Results:In 2019,there were 499.2 million cases of digestive system diseases in China,resulting in 1,557,310 deaths.Stomach cancer,colon and rectal cancer,and esophageal cancer are the top three diseases associated with mortality and DALY related to digestive system diseases.Meanwhile,cirrhosis and other chronic liver diseases,gastroesophageal reflux disease,and gallbladder and biliary diseases are the top three kinds of diseases with the highest prevalence among digestive system diseases.The risk of gastric cancer sharply increases among men after the age of 40 years,leading to a significant disparity in burden between men and women.As the SDI increased,the DALYs associated with digestive system diseases in China and its provinces showed a downward trend.Conclusion:Our study highlights the inverse correlation between DALYs associated with digestive system diseases and the SDI.

Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology

Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.

Antimicrobial prophylaxis in patients with colorectal lesions undergoing endoscopic resection

AIM: To investigate the effect of prophylaxis withantibiotics on clinical adverse events in patients who underwent endoscopic submucosal dissection(ESD) or endoscopic mucosal resection(EMR) for colorectal lesions.METHODS: From June 2011 to December 2013, a total of 428 patients were enrolled into the study, of which 214 patients admitted to hospital underwent EMR or ESD procedures. These patients were randomized to an antibiotic group, in which patients were given cefuroxime 1.5 g iv half an hour before and 6 h after surgery respectively, and a control group, in which patients were not given any antibiotic. A further 214 outpatients with small polyps treated by polypectomy were compared with controls that were matched by age and gender, and operations were performed as outpatient surgery. Recorded patient parameters were demographics, characteristics of lesions and treatment modality, and the size of the wound area. The primary outcome measures were clinical adverse events, including abdominal pain, diarrhea, hemotachezia, and fever. Secondary outcome measures were white blood cell count, C-reactive protein and blood culture. Additionlly, the relationship between the size of the wound area and clinical adverse events was analyzed. RESULTS: A total of 409 patients were enrolled in this study, with 107 patients in the control group, 107 patients in the antibiotic group, and another 195 cases in the follow-up outpatient group. The patients' demographic characteristics, including age, gender, characteristics of lesions, treatment modality, and the size of the wound area were similar between the 2 groups. The rates of adverse events in the antibiotic group were significantly lower than in the control group: abdominal pain(2.8% vs 14.9%, P < 0.01), diarrhea(2.0% vs 9.3%, P < 0.05), and fever(0.9% vs 8.4%, P < 0.05) respectively. The levels of inflammatory markers also decreased significantly in the antibiotic group compared with the control group: leukocytosis(2.0% vs 11.2%, P < 0.01), and C-reactiveprotein(2.0% vs 10.7%, P < 0.05). Additionally, clinica adverse events were related to the size of the surgica wound area. When the surgical wound area was larger than 10 mm × 10 mm, there were more clinica adverse events.CONCLUSION: Clinical adverse events are not uncommon after EMR or ESD procedures. Prophylactic antibiotics can reduce the incidence of clinical adverse events. This should be further explored.

PDCA nursing in improving quality management efficacy in endoscopic submucosal dissection

BACKGROUND Endoscopic submucosal dissection(ESD) is a common surgical strategy for the treatment of early gastrointestinal tumors and precancerous lesions.PDCA nursing can effectively prevent potential risks in the nursing process,protect patient privacy,and improve patient satisfaction,nursing integrity,and service quality.AIM To explore the effects of PDCA nursing model on the quality management of gastrointestinal ESD,the 36-item Shot-Form Health Survey(SF-36) score,and negative emotions.METHODS A total of 178 patients who underwent ESD between January 2020 and January 2021 were divided into two groups.The usual care mode was the control group,with 80 cases from January to July 2020;from July 2020 to January 2021,98 patients were enrolled in the PDCA care mode as the research group.The length of hospital stay and the costs of the two groups were statistically analyzed.The visual analog scale(VAS),SF-36 score,Zung self-rating scale for anxiety and depression,and postoperative complications were also assessed.RESULTS The length of hospitalization and cost in the research group were lower than in the control group(P < 0.05),and the VAS scores were lower than those before care(P < 0.05).Moreover,the VAS score of the research group was lower than that of the control group(P < 0.05).The SF-36 scores for physical function,role status,social function,pain,mental health,and physical strength were higher in the research group than in the control group(P < 0.05).Depression and anxiety scores of the research group were lower than those of the control group(P < 0.05).The postoperative complication rate in the research group(6.12%) was lower than in the control group(32.50%)(P < 0.05).CONCLUSION PDCA nursing can improve the quality of management of ESD surgery,shorten the length of hospital stay and cost,reduce the VAS and Zung scale scores to alleviate adverse emotions,improve the SF-36 score,and reduce postoperative complications.

Co-occurrence of IPMN and malignant IPNB complicated by a pancreatobiliary fistula: A case report and review of the literature

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB) is pathologically similar to intraductal papillary mucinous neoplasm(IPMN). However, there are several significant differences between them. The rate of IPMN associated with extrapancreatic malignancies has been reported to range from 10%-40%, and it may occasionally be complicated with the presence of fistulas. IPMN associated with malignant IPNB is extremely rare and only nine cases have been reported in the literature.CASE SUMMARY We report a 52-year-old man who presented with recurrent cholangitis for nine months. Computed tomography and magnetic resonance cholangiopancreatography showed the common bile duct stricture with dilated pancreatobiliary duct without other abnormal findings. The underlying pathogenesis could not be identified based on the radiologic images. Endoscopic retrograde cholangiopancreatography revealed a pancreatobiliary fistula with dilated main pancreatic duct, biliary stricture with dilated biliary tree, and mucus discharge from the enlarged orifice of the major papilla. The patient underwent SpyGlass cholangiopancreatoscopy due to a suspected mucin-producing biliary neoplasm and indeterminate main pancreatic duct dilatation. Multiple papillary growing neoplasms with vascular images, with the extent of lesions spreading in the biliopancreatic ductal lumens, were identified by SpyGlass. In addition, the presence of a pancreatobiliary fistula was also identified. The patient was diagnosed as having benign IPMN and malignant IPNB with focal invasion by postoperative pathology. Furthermore, varying histological subtypes were present in both IPMN and IPNB. Pylorus-preserving pancreaticoduodenectomy was performed on the patient with excellent results during the 52 month followup period.CONCLUSION We deemed that pancreatography and SpyGlass allowed for an efficient diagnosis of IPMN with pancreatobiliary fistula, whereas the etiology could not be identified by radiologic imaging.

Gastric foreign body granuloma caused by an embedded fishbone:A case report

Fishbones are the most commonly ingested foreign bodies that cause gastrointestinal tract penetration. However, fishbones embedded in the gastrointestinal tract that lead to foreign body granulomas that mimic submucosal tumors are rare. Herein, we describe a 56-year-old woman who presented with a 20-day-history of upper abdominal pain. Endoscopy revealed an elevated lesion in the gastric antrum. An abdominal computed tomography scan showed a mass in the gastric antrum and a linear calcified lesion in the mass. An endoscopic ultrasonography examination revealed a 3.9 cm &#x000d7; 2.2 cm, irregular, hypoechoic mass with indistinct margins in the muscularis propria layer. The patient was initially diagnosed as having a submucosal tumor, and subsequent surgical resection showed that the lesion was a foreign body granuloma caused by an embedded fishbone. Our case indicated that the differential diagnosis of a foreign body granuloma should be considered in cases of elevated lesions in the gastrointestinal tract.

Utilization and quality assessment of digestive endoscopy in China:results from 5-year consecutive nationwide surveys

Background:Worldwide,the volume and availability of digestive endoscopy have undergone dramatic development in recent years,with increasing attention on quality assurance.We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions.Methods:We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually.The questionnaires included the personnel,annual volume,and quality indicators of endoscopy.An endoscopy quality index(EQI)was developed based on recorded quality indicators using principal component analysis to determine the relative weight.Results:From 2015 to 2019,806,1412,2644,2468,and 2541 hospitals were respectively enrolled in this study.The average annual volume of endoscopy increased from 12,445 to 16,206(1.30-fold)and from 2938 to 4255(1.45-fold)in tertiary and secondary hospitals,respectively.The most obvious growth was observed in diagnostic colonoscopy(1.44-fold for all hospitals after standardization).The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3%(55,210/448,861)to 17.7%(85,429/482,647)and from 11.4%(69,411/608,866)to 16.9%(107,192/634,235),respectively.The adenoma detection rate of diagnostic colonoscopy increased from 14.9%(2,118,123/14,215,592)to 19.3%(3,943,203/20,431,104).The EQI model included 12 quality indicators,incorporating 64.9%(7.792/12)of the total variance into one comprehensive index.According to the EQI measurements,the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals.Conclusions:Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality.The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.

Long-term outcomes of endoscopic papillary balloon dilation for removal of bile duct stones in Billroth Ⅱ gastrectomy patients

Background： Endoscopic papillary balloon dilation （EPBD） for common bile duct （CBD） stones removal in Billroth II gastrectomy patients is feasible. However, the long-term outcomes of this technique are notclear. The aim of this study was to evaluate the procedural and long-term outcomes of EPBD for removal of CBD stones in Billroth II gastrectomy patients.

Silver-nanoparticle-coated biliary stent inhibits bacterial adhesion in bacterial cholangitis in swine

BACKGROUND： One of the major limitations of biliary stents is the stent occlusion, which is closely related to the over- growth of bacteria. This study aimed to evaluate the feasibility of a novel silver=nanoparticle-coated polyurethane （Ag/PU） stent in bacterial cholangitis model in swine. METHODS： Ag/PU was designed by coating silver nanopar- tides on polyurethane （PU） stent. Twenty-four healthy pigs with bacterial cholangitis using Ag/PU and PU stents were ran- domly divided into an Ag/PU stent group （n=12） and a PU stem group （n=12）, respectively. The stents were inserted by standard endoscopic retrograde cholangiopancreatography. Laboratory assay was performed for white blood cell （WBC） count, alanine aminotransferase （ALT）, interleukin-1 [l （IL- 1 p）, tumor necrosis factor-a （TNF-~） at baseline time, 8 hours, 1, 2, 3, and 7 days after stent placements. The segment of bile duct containing the stent was examined histologically ex vivo. Implanted bili- ary stents were examined by a scan electron microscope. The amount of silver release was also measured in vitro. RESULTS： The number of inflammatory cells and level of ALT, IL-1β and TNF-α were significantly lower in the Ag/PU stent group than in the PU stent group. Hyperplasia of the mucosa was more severe in the PU stent group than in the Ag/PU stent group. In contrast to the biofilm of bacteria on the PU stent, fewer bacteria adhered to the Ag/PU stent. CONCLUSIONS： PU biliary stents modified with silver nanoparticles are able to alleviate the inflammation of pigs with bacterial cholangitis. Silver-nanoparticle-coated stents are resistant to bacterial adhesion.

Microbiologic risk factors of recurrent choledocholithiasis postendoscopic sphincterotomy

BACKGROUND Choledocholithiasis is a severe disorder that affects a significant portion of the world’s population.Treatment using endoscopic sphincterotomy(EST)has become widespread;however,recurrence post-EST is relatively common.The bile microbiome has a profound influence on the recurrence of choledocholithiasis in patients after EST;however,the key pathogens and their functions in the biliary tract remain unclear.AIM To investigate the biliary microbial characteristics of patients with recurrent choledocholithiasis post-EST,using next-generation sequencing.METHODS This cohort study included 43 patients,who presented with choledocholithiasis at the Guangdong Second Provincial General Hospital between May and June 2020.The patients had undergone EST or endoscopic papillary balloon dilation and were followed up for over a year.They were divided into either the stable or recurrent groups.We collected bile samples and extracted microbial DNA for analysis through next-generation sequencing.Resulting sequences were analyzed for core microbiome and statistical differences between the diagnosis groups;they were examined using the Kyoto Encyclopedia of Genes and Genomes pathway hierarchy level using analysis of variance.Correlation between the key genera and metabolic pathways in bile,were analyzed using Pearson’s correlation test.RESULTS The results revealed distinct clustering of biliary microbiota in recurrent choledocholithiasis.Higher relative abundances(RAs)of Fusobacterium and Neisseria(56.61%±14.81%vs 3.47%±1.10%,8.95%±3.42%vs 0.69%±0.32%,respectively)and the absence of Lactobacillus were observed in the bile of patients with recurrent disease,compared to that in stable patients.Construction of a microbiological co-occurrence network revealed a mutual relationship among Fusobacterium,Neisseria,and Leptotrichia,and an antagonistic relationship among Lactobacillales,Fusobacteriales,and Clostridiales.Functional prediction of biliary microbiome revealed that the loss of transcription and metabolic abilities may lead to recurrent choledocholithiasis.Furthermore,the prediction model based on the RA of Lactobacillales in the bile was effective in identifying the risk of recurrent choledocholithiasis(P=0.03).CONCLUSION We demonstrated differences in the bile microbiome of patients with recurrent choledocholithiasis compared to that in patients with stable disease,thereby adding to the current knowledge on its microbiologic etiology.