A prospective cross-over study using a sphincterotome and a guidewire to increase the success rate of common bile duct cannulation

AIM: During endoscopic retrograde cholangiopancreatography (ERCP), selective cannulation of the common bile duct (CBD) is required in most of the cases.METHODS: From June 2001 till December 2002, all patients referred to our unit for ERCP were considered for entry into the study. Selective CBD cannulation was first attempted with a standard catheter with or without the use of a guidewire. In cases, where CBD cannulation was considered unsuccessful, patients were crossed over to a double-lumen sphincterotome and a guidewire. All patients were hospitalized for 24 h after the procedure in order to assess the incidence of post-ERCP complications.RESULTS: The study sample consisted of 158 patients.Selective CBD cannulation using a standard ERCP catheter with or without the assistance of a guidewire, was accomplished in 129 patients (success rate: 81.65%).From the 29 patients who were crossed over to a sphincterotome and a guidewire, selective CBD cannulation was achieved in 24; the overall success rate rising to 96.8%. Meanwhile, the use of this technique did not increase the incidence of post-ERCP complications.CONCLUSION: The use of a sphincterotome and a guidewire increases the success rate of selective bile duct cannulation in cases that this has not been accomplished with a standard catheter.

Vedolizumab in the treatment of immune checkpoint inhibitorinduced colitis:Two case reports

BACKGROUND Immune check-point inhibitors-induced colitis(ICPIs-induced colitis) is one of the immune-related side effects.Steroids and Infliximab are commonly used to treat it.The patients of our report were treated by Vedolizumab.CASE SUMMARY The two patients went to the doctor with bloody stools and were treated by Sintilimab and Camrelizumab,respectively,for their malignant tumors.They were diagnosed as ICPIs-induced colitis based on endoscopic and histologic examination.The original immunotherapy was ceased while the anti-inflammatory therapy was introduced.The patients’ colitis symptoms disappeared after the treatment and no recurrence was found during the follow-up period.The unique feature about the case reports is that Vedolizumab combined with short-term corticosteroids had achieved good therapeutic effects.CONCLUSION For the symptoms of bloody diarrhea after the ICPIs treatment of cancer,the possibility of ICPIs-induced colitis should be considered.Vedolizumab combined with short-term corticosteroids may be appropriate for the treatment.

Long noncoding RNA TMEM147-AS1 serves as a microRNA-326 sponge to aggravate the malignancy of gastric cancer by upregulating SMAD5

The abnormal expression of long noncoding RNAs(lncRNAs)is frequently observed in gastric cancer(GC)and considered an important driving force in GC progression.However,little is known regarding the involvement of TMEM147-AS1 in GC.Therefore,we examined TMEM147-AS1 expression in GC and determined its prognostic value.In addition,TMEM147-AS1 expression was depleted to identify the functional changes in response to TMEM147-AS1 deficiency.Using the cancer genome atlas dataset and our own cohort,we identified a strong expression of TMEM147-AS1 in GC.Increased TMEM147-AS1 levels in GC showed a significant association with poor prognosis.TMEM147-AS1 interference resulted in the inhibition of GC cell proliferation,colony-forming,migration,and invasion in vitro.Additionally,depletion of TMEM147-AS1 restricted the growth of GC cells in vivo.Mechanistically,TMEM147-AS1 functioned as a microRNA-326(miR-326)sponge.Furthermore,SMAD family member 5(SMAD5)was experimentally validated as the functional effector of miR-326.TMEM147-AS1 was demonstrated to sequester miR-326 away from SMAD5;consequently,knocking down TMEM147-AS1 downregulated SMAD5 levels in GC cells.The functional suppression of miR-326 or reintroduction of SMAD5 effectively reversed the attenuated behavior of GC cells caused by TMEM147-AS1 downregulation.In summary,TMEM147-AS1 exhibits tumorigenic activities in GC,which is likely the result of an altered miR-326/SMAD5 axis.Therefore,targeting TMEM147-AS1/miR-326/SMAD5 may represent a target for the treatment of GC.