Endoscopic papillary balloon intermittent dilatation and endoscopic sphincterotomy for bile duct stones

AIM: To compare the effectiveness and safety of endoscopic papillary balloon intermittent dilatation (EPBID) and endoscopic sphincterotomy (EST) in the treatment of common bile duct stones. METHODS: From March 2011 to May 2012, endoscopic retrograde cholangiopancreatography was performed in 560 patients, 262 with common bile duct stones. A total of 206 patients with common bile duct stones were enrolled in the study and randomized to receive either EPBID with a 10-12 mm dilated balloon or EST (103 patients in each group). For both groups a conventional reticular basket or balloon was used to remove the stones. After the procedure, routine endoscopic nasobiliary drainage was performed. RESULTS: First-time stone removal was successfully performed in 94 patients in the EPBID group (91.3%) and 75 patients in the EST group (72.8%). There was no statistically significant difference in terms of operation time between the two groups. The overall incidence of early complications in the EPBID and EST groups was 2.9% and 13.6%, respectively, with no deaths reported during the course of the study and follow-up. Multiple regression analysis showed that the success rate of stone removal was associated with stone removal method [odds ratio (OR): 5.35; 95%CI: 2.24-12.77; P=0.00], the transverse diameter of the stone (OR: 2.63; 95%CI: 1.19-5.80; P=0.02) and the presence or absence of diverticulum (OR: 2.35; 95%CI: 1.03-5.37; P=0.04). Postoperative pancreatitis was associated with the EST method of stone removal (OR: 5.00; 95%CI: 1.23-20.28; P=0.02) and whether or not pancreatography was performed (OR: 0.10; 95%CI: 0.03-0.35; P=0.00). CONCLUSION: The EPBID group had a higher success rate of stone removal with a lower incidence of pancreatitis compared with the EST group.

FXR agonist GW4064 alleviates endotoxin-induced hepatic inflammation by repressing macrophage activation

AIM:To examine the effect of farnesoid X receptor(FXR)activation by GW4064 on endotoxin-induced hepatic inflammation in nonalcoholic fatty liver disease(NAFLD)and the underlying mechanism.METHODS:Six-week-old male C57BL/6 mice were fed a normal diet or a high-fat(HF)diet for 8 wk.HF dietfed mice were intraperitoneally injected with GW4064(30 mg/kg)or DMSO(vehicle)once daily for a week and then sacrificed after lipopolysaccharide(LPS,50μg/mouse)administration.Hepatic inflammation,levels of the macrophage marker F4/80,and apoptosis were measured at the end of the study.Additionally,the expression of proinflammatory genes involved in NAFLD(interleukin-6,interleukin-1β,interferon-γ,MCP-1)were analyzed by real-time PCR in the murine macrophagecell line RAW 264.7 cultured with or without GW4064(2μmol/L)before treatment with LPS.RESULTS:In patients with NAFLD,the expression of FXR was detected by immunohistochemical staining and the relation between FXR expression and NAFLD activity score(NAS)was analyzed.Activation of FXR by GW4064 alleviated hepatic inflammation induced by endotoxin in a murine NAFLD model fed an HF diet as reflected by reduced serum levels of aspartate aminotransferase and alanine aminotransferase.Apoptosis and proinflammatory cytokine levels in liver tissues were also reduced by GW4064,and GW4064 could reduce induction of proinflammatory cytokines by LPS in vitro.FXR levels were reduced in patients with nonalcoholic steatohepatitis compared with healthy controls and were negatively correlated with NAS.CONCLUSION:FXR activation attenuates LPS-induced hepatic inflammation in murine NAFLD by reducing expression of proinflammatory cytokines in macrophages.