Fecal microbiota transplantation and prednisone for severe eosinophilic gastroenteritis

Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations. We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man. The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital. Then he was misdiagnosed as having Crohn’s disease in another university teaching hospital. Finally, the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn’s disease by fecal microbiota transplantation. Physical examination revealed a slight distended abdomen with diffuse tenderness. Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%, as well as eosinopenia, monocytopenia and lymphocytopenia. Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon. We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations. The patient was treated by fecal microbiota transplantation combined with oral prednisone, and was free from gastrointestinal symptoms at the time when we reported his disease. This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis.

Fecal microbiota transplantation for severe enterocolonic fistulizing Crohn's disease

The concept of fecal microbiota transplantation(FMT)has been used in traditional Chinese medicine at least since the 4thcentury.Evidence from recent human studies strongly supports the link between intestinal bacteria and inflammatory bowel disease.We proposed that standardized FMT might be a promising rescue therapy for refractory inflammatory bowel disease.However,there were no reports of FMT used in patients with severe Crohn’s disease(CD).Here,we report the successful treatment of standardized FMT as a rescue therapy for a case of refractory CD complicated with fistula,residual Barium sulfate and formation of intraperitoneal large inflammatory mass.As far as we know,this is the first case of severe CD treated using FMT through mid-gut.

Endoscopic transpancreatic septotomy as a precutting technique for difficult bile duct cannulation

AIM: To evaluate the technique of transpancreatic septotomy(TS) for cannulating inaccessible common bile ducts in endoscopic retrograde cholangiopancreatography(ERCP).METHODS: Between May 2012 and April 2013, 1074 patients were referred to our department for ERCP. We excluded 15 patients with previous Billroth Ⅱ gastrectomy, Roux-en-Y anastomosis, duodenal stenosis, or duodenal papilla tumor. Among 1059 patients who underwent ERCP, there were 163 patients with difficult bile duct cannulation. Pancreatic guidewire or pancreatic duct plastic stent assistance allowed for successful ERCP completion in 94 patients. We retrospectively analyzed clinical data from 69 failed patients(36 transpancreatic septotomies and 33 needle-knife sphincterotomies). RESULTS: Of the 69 patients who underwent precut papillotomy, common bile duct cannulation was successfully achieved in 67. The success rates in the TS and needle knife sphincterotomy(NKS) groups were 97.2%(35/36) and 96.9%(32/33), respectively, which were not significantly different(P > 0.05). Complications occurred in 11 cases, including acute pancreatitis(n = 6), bleeding(n = 2), and cholangitis(n = 3). The total frequency of complications in the TS group was lower than that in the NKS group(8.3% vs 24.2%, P < 0.05).CONCLUSION: Pancreatic guidewire or pancreatic duct plastic stent assistance improves the success rate of selective bile duct cannulation in ERCP. TS and NKS markedly improve the success rate of selective bile duct cannulation in ERCP. TS precut is safer as compared with NKS.

Endoscopic retrieval of 28 foreign bodies in a 100-year-old female after attempted suicide

Foreign body ingestion is a common emergency situation in children with one or a few objects having been ingested. Here we report our experience using endo-scopic retrieval in a female centenarian with dyspnea and foreign bodies in the esophagus. She attempted suicide by swallowing 26 coins and two other foreign bodies. A gastroscope was used to remove all foreign bodies in the lower esophagus. In total, 26 coins, one ferrous ring and one cylindrical plastic object were retrieved. To our knowledge, this is the first clinical report on retrieval of so many foreign bodies in a single case.

Establishment and validation of a computer-assisted colonic polyp localization system based on deep learning

BACKGROUND Artificial intelligence in colonoscopy is an emerging field,and its application may help colonoscopists improve inspection quality and reduce the rate of missed polyps and adenomas.Several deep learning-based computer-assisted detection(CADe)techniques were established from small single-center datasets,and unrepresentative learning materials might confine their application and generalization in wide practice.Although CADes have been reported to identify polyps in colonoscopic images and videos in real time,their diagnostic performance deserves to be further validated in clinical practice.AIM To train and test a CADe based on multicenter high-quality images of polyps and preliminarily validate it in clinical colonoscopies.METHODS With high-quality screening and labeling from 55 qualified colonoscopists,a dataset consisting of over 71000 images from 20 centers was used to train and test a deep learning-based CADe.In addition,the real-time diagnostic performance of CADe was tested frame by frame in 47 unaltered full-ranged videos that contained 86 histologically confirmed polyps.Finally,we conducted a selfcontrolled observational study to validate the diagnostic performance of CADe in real-world colonoscopy with the main outcome measure of polyps per colonoscopy in Changhai Hospital.RESULTS The CADe was able to identify polyps in the test dataset with 95.0%sensitivity and 99.1%specificity.For colonoscopy videos,all 86 polyps were detected with 92.2%sensitivity and 93.6%specificity in frame-by-frame analysis.In the prospective validation,the sensitivity of CAD in identifying polyps was 98.4%(185/188).Folds,reflections of light and fecal fluid were the main causes of false positives in both the test dataset and clinical colonoscopies.Colonoscopists can detect more polyps(0.90 vs 0.82,P<0.001)and adenomas(0.32 vs 0.30,P=0.045)with the aid of CADe,particularly polyps<5 mm and flat polyps(0.65 vs 0.57,P<0.001;0.74 vs 0.67,P=0.001,respectively).However,high efficacy is not realized in colonoscopies with inadequate bowel preparation and withdrawal time(P=0.32;P=0.16,respectively).CONCLUSION CADe is feasible in the clinical setting and might help endoscopists detect more polyps and adenomas,and further confirmation is warranted.

Gastrotracheal fistula:Treatment with a covered self-expanding Y-shaped metallic stent

A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously.After admission to our hospital,gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wallnear the carina and the upper residual stomach.We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy.A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus.Subsequently,the fistula was closed completely.The patient tolerated the stent well and had good palliation of his symptoms.

Genetic variants in pseudogene E2F3P1 confer risk for HBV-related hepatocellular carcinoma in a Chinese population

Recent studies showed that pseudogenes can regulate the expression of their coding gene partners by competing for miRNAs. The E2F family plays a crucial role in the control of cell cycle checkpoint. E2F3P1 is a pseudogene of E2F3. Few studies focused on genetic variations on pseudogenes. In this study, we performed a case-control study to assess the association between single nucleotide polymorphisms （SNPs） in E2F3P1 and hepatocellular carcinoma （HCC） risk in 1050 hepatitis B virus （HBV）-positive HCC cases and 1050 chronic HBV carders. Logistic regres- sion analysis was applied to estimate odds ratios （ORs） and 95% confidence intervals （CIs） for the associations between genotypes and HCC risk. We found that the variant CT/TT genotypes of rs1838149 were associated with a significantly decreased risk of HCC （adjusted OR = 0,66, 95% CIs = 0.51-0.86, P = 0.002） compared to those with wildtype CC homozygote. Furthermore, the AA genotype of rs9909601 had an increased HCC risk with an adjusted OR of 1.41 （95% CIs = 1.07-1.86）, and the A allele of rs9909601 was significantly associated with HCC risk com- pared to those with the G allele （adjusted OR = 1.17, 95% CIs = 1.03-1.33, P = 0.017）. These results indicate that genetic variations in the pseudogene E2F3P1 may confer HCC risk.

Association between body mass index and erosive esophagitis:A meta-analysis

AIM:To conduct a meta-analysis to estimate the determinants of the association between erosive esophagitis (EE)and body mass index(BMI). METHODS:We identified the studies using PubMed. Studies were selected for analysis based on certain inclusion and exclusion criteria.Data were extracted from each study on the basis of predefined items.Metaanalyses were performed to verify the risk factors,such as obesity and gender. RESULTS:Twenty-one studies were included in this systematic review.These studies demonstrated an association between increasing BMI and the presence of EE[95%confidence interval(CI):1.35-1.88,overweight,odds ratio(OR)=1.60,P value homogeneity =0.003,95%CI:1.65-2.55,obese,OR=2.05,P< 0.01].The heterogeneity disappeared by stratifying for gender.No publication bias was observed in this metaanalysis by the Egger method. CONCLUSION:This analysis demonstrates a positive association between BMI and the presence of EE,especially in males.The risk seems to progressively increase with increasing weight.

Cholecystectomy does not significantly increase the risk of fatty liver disease

AIM: To investigate the relationship between cholecystectomy and fatty liver disease(FLD) in a Chinese population.METHODS: A total of 32428 subjects who had voluntarily undergone annual health checkups in the Second Affiliated Hospital of Nanjing Medical University from January 2011 to May 2013 were included in this study. Basic data collection, physical examination, laboratory examination, and abdominal ultrasound examination were performed.RESULTS: Subjects undergoing cholecystectomy were associated with greater age, female sex, higher body mass index, and higher levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, and triglycerides. However, no significant differences were found in high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, gammaglutamyl transpeptidase, albumin, and serum uric acid. The overall prevalence of FLD diagnosed by ultrasonography was high at 38.4%. The prevalence of FLD was significantly higher for subjects who had undergone cholecystectomy(46.9%) than those who had not undergone cholecystectomy(38.1%; χ2 test, P < 0.001). Cholecystectomy was positively associated with FLD(OR = 1.433, 95%CI: 1.259-1.631). However, after adjusting for possible factors associated withFLD, multivariate regression analysis showed that the association between cholecystectomy and FLD was not statistically significant(OR = 1.096; 95%CI: 0.939-1.279). CONCLUSION: According to our study results, cholecystectomy may not be a significant risk factor for FLD.

Emerging roles of long noncoding RNAs in cholangiocarcinoma:Advances and challenges

Cholangiocarcinoma(CCA),a cancer with a relatively low incidence rate,is usually associated with poor prognosis.Current modalities for the diagnosis and treatment of CCA patients are still far from satisfactory.In recent years,numerous long noncoding RNAs(lncRNAs)have been identified as crucial players in the development of various cancers,including CCA.Abnormally expressed lncRNAs in CCA,regulated by some upstream molecules,significantly influence the biological behavior of tumor cells and are involved in tumor development through various mechanisms,including interactions with functional proteins,participation in competing for endogenous RNA(ceRNA)regulatory networks,activation of cancer-related signaling pathways and epigenetic modification of gene expression.Furthermore,several lncRNAs are closely associated with the clinicopathological features of CCA patients,and are promising biomarkers for diagnosing and prognostication of CCA.Some of these lncRNAs play an important role in chemotherapy drug resistance.In addition,lncRNAs have also been shown to be involved in the inflammation microenvironment of CCA and malignant outcome of CCA risk factors,such as cholestatic liver diseases.In view of the difficulty of diagnosing CCA,more attention should be paid to detectable lncRNAs in the serum or bile.This review summarizes the recent knowledge on lncRNAs in CCA and provides a new outlook on the molecular mechanisms of CCA development from the perspective of lncRNAs.Moreover,we also discussed the limitations of the current studies and differential expression of lncRNAs in different types of CCA.