Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction

AIM:To determine the utility of endoscopic ultrasoundguided biliary drainage(EUS-BD)with a fully covered self-expandable metal stent for managing malignant biliary stricture. METHODS:We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered selfexpandable metal stent when endoscopic retrograde cholangiopancreatography(ERCP)fails.EUS-guided choledochoduodenostomy(EUS-CD)and EUS-guided hepaticogastrostomy(EUS-HG)was performed in 9 patients and 4 patients,respectively. RESULTS:The technical and functional success rate was 92.3%(12/13)and 91.7%(11/12),respectively. Using an intrahepatic approach(EUS-HG,n=4),there was mild peritonitis(n=1)and migration of the metal stent to the stomach(n=1).With an extrahepatic approach(EUS-CD,n=10),there was pneumoperitoneum(n=2),migration(n=2),and mild peritonitis (n=1).All patients were managed conservatively with antibiotics.During follow-up(range,1-12 mo),there was re-intervention(4/13 cases,30.7%)necessitated by stent migration(n=2)and stent occlusion(n=2). CONCLUSION:EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.

Effects of ranitidine for exercise induced gastric mucosal changes and bleeding

瞄准：在胃的粘膜变化上并且在在长距离跑步者的官方补给的流血上评估 ranitidine 的效果。方法：24 个长距离跑步者(M：16， F：8，变老：18.2 +/- 1.5 年) 参予了这研究。一张症状问询表，凳子缝玄术测试，并且上面胃肠(官方补给) 内视镜检查法在学习以前在这些题目上被执行。这些题目拿了口头的 ranitidine (150 mg， b.i.d ) 为二个星期。上面的官方补给的内视镜检查法和凳子 Hemoccult 测试在治疗以后被重复。结果：24 个跑步者中的 22 个在药前有至少一上面的官方补给的粘膜损害。内视镜的改进在腐蚀胃炎的 14 个盒子中的十一个和食道炎的 5 个盒子中的四个中被看见。六个题目是在学习以前积极的血红素玄术，但是仅仅在药以后是积极的。结论：胃的粘膜损害并且在长距离跑步者的官方补给的流血似乎被联系到酸相关的因素由常规跑的高水平调停了。Ranitidine 似乎是并且阻止胃的粘膜损害并且官方补给的流血的有效预防。