BACKGROUND:Gastric oxyntic gland adenoma is a rare neoplasm often misdiagnosed as a hyperplastic or fundic gland polyp due to nonspecific endoscopic features and the limitations of superficial biopsies, leading to diagnostic delays. CASE SUMMARY:In 2020, a gastroscopy of a 47-year-old man revealed a 0.5 cm lesion that was diagnosed as a hyperplastic polyp by superficial biopsy. By 2022, the lesion had enlarged to 1.0 cm exhibiting firmness, bleeding tendency, and disrupted submucosal layers on endoscopic ultrasound. Repeat biopsies again suggested hyperplasia. Endoscopic submucosal dissection was performed, confirming the diagnosis of gastric oxyntic gland adenoma. Additional surgical resection confirmed negative margins, and no recurrence at the three-year postoperative follow-up. However, endoscopic ultrasound revealed localized thickening (1.2 mm) of the muscularis mucosae at the gastric lesser curvature, likely representing post-procedural fibrosis. The patient was clinically asymptomatic, and was advised to continue annual endoscopic monitoring. CONCLUSION:This case highlights the necessity of deep biopsy or complete resection for diagnosis. We recommend long-term endoscopic surveillance post-resection and heightened clinical vigilance to mitigate misdiagnosis risks.

目的:系统评价中药高位保留灌肠预防内镜逆行胰胆管造影术后胰腺炎(PEP)的疗效和安全性.方法:计算机检索PubMed、The Cochrane Library、EMbase、中国知网、维普数据库、万方数据库、中国生物医学文献服务系统数据库,搜集关于中药高位保留灌肠预防PEP疗效和安全性的随机对照试验(RCT),检索时限均从建库至2022年12月9日.由2名研究者独立进行文献的筛选、资料的提取及偏倚风险的评估,通过Stata 15软件进行数据分析.结果:纳入的6项RCTs共包含样本量579例.Meta分析显示,与西医常规治疗相比,中药高位保留灌肠可以降低PEP发生率(OR=0.27,95％CI[0.13,0.54],P＜0.001)、内镜逆行胰胆管造影术后高淀粉酶血症(PEH)发生率(OR=0.29,95％CI[0.19,0.44],P＜0.001),降低术后3 h(SMD=-0.51,95％CI[-0.85,-0.17],P=0.003)、6 h(SMD=-1.15,95％CI[-1.72,-0.59],P＜0.001)、12 h(SMD=-0.69,95％CI[-0.98,-0.40],P=0.003)、24 h(SMD=-1.91,95％CI[-3.16,-0.66],P=0.003)血清淀粉酶(AMS)水平,降低术后24 h血清白细胞介素-6(IL-6)水平(SMD=-1.26,95％CI[-1.61,-0.91],P＜0.001),缩短住院时间(SMD=-1.13,95％CI[-1.70,-0.56],P＜0.001),节约住院费用(SMD=-0.41,95％CI[-0.75,-0.07],P=0.017).结论:中药高位保留灌肠在预防PEP方面总体疗效显著,具有良好的安全性,同时还能缩短住院时间并减少住院成本.

近年来,胆道子镜直视化系统为诊疗复杂胆胰管疾病打开了新的局面.但其在胆囊疾病诊治方面仍少有报道.现报道 1例通过内镜逆行胰胆管造影(ERCP)联合SpyGlass进入胆囊观察并取活检,从而确诊胆囊黏液腺瘤的患者,并就其临床资料及诊断过程等进行分析讨论.

目的 探讨SpyGlassTM DS在 70 岁以上胆管疾病患者中的诊疗价值及安全性.方法 回顾性分析 2018 年 1 月至 2022 年4 月在北京中医药大学东方医院使用SpyGlassTM DS诊治的 178 例患者临床资料,根据年龄分为≥70 岁组和<70 岁组,观察诊治疾病的有效性,比较两组术中诊断的疾病谱、术中操作、术后并发症的差异性.结果 在不明原因胆道狭窄判断良恶性方面:≥70 岁组内镜下直视敏感度为 93.5%,特异度 83.3%,准确度 89.8%;活检诊断敏感度 94.7%,特异度 100%,准确度 95.7%.<70 岁组中内镜下直视下敏感度 89.3%,特异度 78.6%,准确度 83.9%.活检诊断敏感度 82.4%,特异度 100%,准确度 89.3%.整体内镜下直视敏感度91.5%,特异度 80.4%,准确度 86.7%;整体活检诊断敏感度 88.9%,特异度 100%,准确度 92.2%.在治疗困难性胆总管结石方面:取石成功率为 97.6%.安全性分析方面:≥70 岁组高血压、冠心病检出率高于<70 岁组(P<0.05).≥70 岁组留置支架概率(44.0%)高于<70 岁组(28.7%)(P<0.05),≥70 岁组并发症发生率与<70 岁组比较,差异无统计学意义(P>0.05).结论 SpyGlassTM DS系统能有效、准确地诊断治疗胆管疾病,对 70 岁以上人群术后不会增加并发症发生率,是一项安全、有效的技术.

Objective:To compare the efficacy and safety of stone extraction with a single peroral choledochoscopy system under direct visualization and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) for non-difficult common bile duct stones.Methods:A total of 164 patients with common bile duct stones who underwent stone extraction by using the single peroral choledochoscopy system under direct visualization (the observation group, n=82) and conventional X-ray endoscopic retrograde cholangiopancreatography (ERCP) (the control group, n=82) from January 2018 to April 2022 in Dongfang Hospital, Beijing University of Chinese Medicine were enrolled. The observation group was directly selected from the database, while the control group was randomly matched by age stratification with baseline data validated. The success rates of intubation, stone removal, postoperative complication incidence, and radiation exposure between the two groups were compared. Results:There was no significant difference between the baseline data of the observation group and the control group ( P>0.05). The number of patients with detected stones≥2 in the observation group and the control group were 59 (71.95%) and 37 (45.12%) respectively with significant difference ( χ 2=12.16, P=0.001). The success rates of bile duct intubation in the observation group and the control group were both 100.00% (82/82). The success rates of stone extraction were 98.78% (81/82) and 100.00% (82/82) respectively with no significant difference ( P>0.05). The one-time stone removal rates of the two groups were 93.90% (77/82) and 92.68% (76/82) respectively with no significant difference ( χ2=0.10, P=0.755). There was no significant difference in the incidence of postoperative complications between the observation group and the control group ( P>0.05). The amount of intraoperative ray exposure volume in the observation group was significantly lower than that of the control group [10.20 (6.69, 18.94) mGy VS 15.41 (10.70, 22.77) mGy, U=2 462.00, P=0.003]. Conclusion:The efficacy and safety of stone extraction with single peroral choledochoscopy system under direct visualization are comparable to those of traditional X-ray ERCP for non-difficult common bile duct stones, but it can significantly reduce the intraoperative ray exposure volume during therapeutic ERCP stone extraction.

目的 探讨便秘型与腹泻型结直肠息肉之间的临床特点及上皮内瘤变,以期为临床诊疗提供理论依据.方法 选取 2017 年 1 月—2021 年 12 月于北京中医药大学东方医院消化内镜中心行电子肠镜检查并发现结直肠息肉的 852 例患者的临床资料,利用统计软件分析便秘型(n=412)与腹泻型(n=440)患者的临床特点和上皮内瘤变的合并情况.结果 便秘型结直肠息肉患者以女性居多,腹泻型结直肠息肉患者以男性居多,且年龄多在 50～69 岁之间;便秘型患者易合并结肠黑变病和憩室,腹泻型患者易合并末端回肠炎和内痔;两类型患者息肉分布部位主要集中在左半结肠,以直肠、乙状结肠、横结肠为主;病变部位位于乙状结肠、直肠、升结肠且直径≥1.0 cm 的管状腺瘤和绒毛管状腺瘤更易合并上皮内瘤变.结论 便秘型与腹泻型结直肠息肉患者在年龄、性别、合并疾病存在统计学差异,上皮内瘤变无统计学差异.对于 50 岁以上人群应及早进行正规肠镜检查,不放过任何一个可疑病灶,对于结直肠癌的预防和预后有重要意义.

目的 研究大肠黑变病(melanosis coli,MC)伴发息肉的内镜特点.方法 回顾性分析2014年1月至2021年2月在北京中医药大学东方医院行肠镜检查的患者,根据疾病诊断纳入MC、MC伴息肉、息肉患者,收集三组患者的年龄、黑变部位、息肉大小、息肉部位、息肉类型、息肉病理类型等资料进行统计学分析.结果 研究分别纳入MC组302例、MC+息肉组246例、息肉组333例患者.年龄:MC+息肉组年龄高于MC组和息肉组(P<0.05),MC+息肉组发病人群以60～74岁居多(61.0％)(P<0.05).黑变部位:MC+息肉组黑变累及3个部位以上的发生频率高于MC组(P<0.05).息肉大小:MC+息肉组直径>1 cm的息肉检出率高于息肉组(P<0.05).息肉部位:MC+息肉组右半结肠和盲肠的息肉检出率高于息肉组,病变≥3个部位的频率高于息肉组(P<0.05).息肉类型:MC+息肉组绒毛管状腺瘤、腺瘤样增生的检出率高于息肉组,管状腺瘤、增生性息肉、炎性息肉的检出率低于息肉组(P<0.05).病理类型:MC+息肉组和息肉组的息肉病理类型分布及检出率比较,差异无统计学意义(P>0.05).结论 MC伴发息肉发病年龄较高,黑变范围更广,息肉部位也较多,息肉恶变倾向更明显.

Rationale:Gastric hyperplastic polyp (GHP) commonly arises in the abnormal background mucosa, which makes it easy to be misdiagnosed and missed, and has a potential risk of malignant transformation over time. Here, we present a case of neoplastic transformation of GHP in a context of autoimmune gastritis (AIG). Patient concerns:In 2020, a 67-year-old woman was admitted for endoscopic review 6 years after gastric polyp resection, the histological diagnosis of gastric polyp was neoplastic transformation of GHP as before. The patient had undergone multiple polypectomies at the same part. Then histological examination revealed that partial epithelial hyperplasia and dysplasia, and the neoplastic areas were interlaced with normal mucosa. Diagnoses and interventions:We further found that the background diagnosis was AIG. These results supported the diagnosis of neoplastic transformation of GHP in a context of AIG. With the doubt of missed diagnose, we retrospectively analyzed the medical history in 2014, 2015 and 2016, confirmed the presence of AIG. Unfortunately, serological tests and special treatment were not performed. Outcomes:The correct diagnosis was eventually confirmed in 2020, which enables patients to receive normal treatment and monitoring, and avoids further deterioration of the disease. Lessons:The purpose of this case report is to increase clinical awareness of neoplastic transformation of GHP in a context of AIG, and hope promise for early diagnosis and treatment.

目的 为了探讨大肠进展期腺瘤切除术后与血脂谱相关性及其他危险因素.方法 回顾性分析2018年1月至2020年12月在北京中医药大学东方医院行结肠镜检查患者病历资料及术后回访信息,根据大肠进展期腺瘤性息肉术后复发有无分为复发组和未复发组,分析两组人群的一般资料、血脂谱及大肠息肉的结肠镜下表现的差异.结果 复发组男性、吸烟、饮酒的比率均显著高于未复发组(P<0.05).复发组BMI、甘油三酯水平均显著高于未复发组(P<0.05).复发组HDL-C水平为(1.30±0.38)mmol/L,显著低于未复发组的(1.44±0.31)mmol/L(P<0.05).复发组中直肠部位检出率(12％)未复发组(20％),P<0.05.多因素logistic回归分析:甘油三酯水平升高(OR=1.626;95％CI=1.044～2.533;P=0.032)、年龄(OR=1.087;95％CI=1.043～1.133;P=0.001)、吸烟(OR=5.222;95％CI=1.674～16.289;P=0.004)、息肉数量≥3枚(OR=1.962;95％CI=1.373～2.803;P=0.001)、BMI高(OR=1.147;95％CI=1.020～1.291;P=0.022)是进展期腺瘤性息肉切除术后复发独立危险因素.回归模型预测概率(PRE)曲线=甘油三酯×0.606+数量≥3个×0.649+吸烟×0.663+年龄×0.617+BMI*0.627.最终模型的曲线下面积为0.811(95％CI:0.754～0.868,P<0.001)、最佳预测截断值为0.68、敏感度60.3％、特异性88.4％.结论 甘油三酯含量升高、年龄、吸烟、息肉数量≥3枚、BMI升高是大肠进展期腺瘤性息肉切除复发独立危险因素,且可以进行此类人群术后预测.

BackgroundHepatocellular carcinoma (HCC) is a highly invasive disease with a high mortality rate. Our previous study found that Chenodeoxycholic acid (CDCA) as an endogenous metabolite can enhance the anti-tumor effect. Sorafenib has limited overall efficacy as a first-line agent in HCC, and combined with CDCA may improve its efficacy. MethodsHepG2 cells and Balb/c nude mice were used respectively for in vitro and in vivo experiments. Flow cytometry, Western blotting, HE and immunohistochemical staining and immunofluorescence were used to study the effects of CDCA combined with sorafenib on HepG2 cell growth and apoptosis-related proteins. Magnetic bead coupling, protein profiling and magnetic bead immunoprecipitation were used to find the targets of CDCA action. The effect of CDCA on EGFR/Stat3 signaling pathway was further verified by knocking down Stat3 and EGFR. Finally, fluorescence confocal, and molecular docking were used to study the binding site of CDCA to EGFR. ResultsIn this study, we found that CDCA enhanced the effect of sorafenib in inhibiting the proliferation, migration and invasion of HepG2 cells. Magnetic bead immunoprecipitation and protein profiling revealed that CDCA may enhance the effect of sorafenib by affecting the EGFR/Stat3 signaling pathway. Further results from in vitro and in vivo gene knockdown experiments, confocal experiments and molecular docking showed that CDCA enhances the efficacy of sorafenib by binding to the extracellular structural domain of EGFR. ConclusionThis study reveals the mechanism that CDCA enhances the inhibitory effect of sorafenib on HepG2 cell growth in vitro and in vivo, providing a potential new combination strategy for the treatment of HCC.

Abstract Background: Gastric hyperplastic polyp commonly arises in the abnormal background mucosa, including autoimmune gastritis, also known as type A gastritis. There are no obvious clinical symptoms in the early stages of the disease, which makes it easy to be misdiagnosed and missed, and has a potential risk of malignant transformation over time.Case presentation: In 2020, a 67-year-old woman was admitted for review 6 years after gastric adenoma resection. Upper endoscopy revealed multiple lobulated polyps in the gastric body, which was histologically diagnosed as gastric adenomatous polyp as before. Interestingly, we discovered that the patient had undergone multiple polypectomies at the same part, which was inconsistent with the pathogenesis of adenomatous polyp. Then we did histological examination and revealed that partial epithelial hyperplasia and dysplasia, and the neoplastic areas were interlaced with normal mucosa. We further found that the background diagnosis was autoimmune gastritis. These results supported the diagnosis of neoplastic transformation of gastric hyperplastic polyp, not gastric adenomatous polyp. With the doubt of possible be misdiagnosed, we reviewed the medical history. Retrospective analysis in 2014, 2015 and 2016 confirmed the presence of autoimmune gastritis. Unfortunately, serological tests were not performed and no special treatment was done. Fortunately, the correct diagnosis was eventually confirmed as neoplastic transformation of gastric hyperplastic polyp in a context of autoimmune gastritis in 2020, which enables patients to receive normal treatment and monitoring, and avoids further deterioration of the disease. Conclusions: The purpose of this case report is to increase clinical awareness of neoplastic transformation of gastric hyperplastic polyp in a context of autoimmune gastritis, and hope promise for early diagnosis and treatment.

Significant proof suggests an essential role played by the bile microbiota in biliary diseases. This study retrospectively analyzed the differences in biliary microbes among patients with perihilar cholangiocarcinoma (pCCA), distal cholangiocarcinoma (dCCA), pancreatic cancer (PC), and cholelithiasis (CH). Bile samples were obtained from 53 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP), and the bile microbiota was analyzed through 16S rRNA gene analysis and next-generation sequencing. Based on the results of linear discriminant analysis effect size (LEfSe), the top three biomarkers for pCCA at the genus level were Pseudomonas, Sphingomonas, and Halomonas; for dCCA were Streptococcus, Prevotella, and Halomonas; and for PC were Pseudomonas, Chloroplast, and Acinetobacter. The top five genera in the pCCA, dCCA, and PC groups showed predictive values with areas under the receiver operating characteristic curves of 91.56%, 95.56%, and 96.59%, respectively. The PICRUSt2 analysis outcomes displayed the diversities of fifteen pathways between the CH and pCCA groups, 22 pathways between the CH and dCCA groups, and eighteen pathways between the CH and PC groups. As this pilot study identified specific microbial bile markers for patients with CH, pCCA, dCCA, and PC, the clinical implications are vast. Further study focusing on distinct bacterial populations in bile will help differentiate biliary diseases.

目的 分析经结肠镜检查确诊的6410例结直肠病患者临床资料,为疾病防治提供依据.方法 对6410例结直肠病患者的临床资料作回顾性分析.结果 6410例结直肠病患者均经结肠镜检查确诊,其中结直肠息肉患者5412例、结直肠憩室患者393例、结直肠炎患者356例、溃疡性结肠炎患者294例、结直肠癌患者255例、大肠黑变病患者252例.临床表现主要为腹痛、腹泻、便秘及便血等,其中结直肠息肉、结直肠炎、结直肠憩室患者的临床表现主要为腹痛,结直肠癌患者的临床表现主要为便血,大肠黑变病患者的临床表现主要为便秘,溃疡性结肠炎患者的临床表现主要为便血、黏液脓血便.溃疡性结肠炎患者中男性占比显著高于女性(P<0.05);≤40岁的结直肠病患者中溃疡性结肠炎占比最高,60～70岁间为结直肠息肉、大肠黑变病、结直肠憩室的检出高峰,≥71岁患者中以结直肠癌占比最高.结直肠癌发病部位以直肠为主,溃疡性结肠炎发病部位以直乙状结肠为主,结直肠憩室发病部位以结肠为主,结直肠息肉发病部位以左半结肠为主.结直肠息肉病理类型以管状腺瘤为主,形态以山田Ⅰ型、Ⅱ型为主.5412例结直肠息肉患者中,息肉癌变130例,癌变部位以直肠、乙状结肠为主.结论 结直肠病以结直肠息肉多见,临床表现主要为腹痛、腹泻、便秘及便血,其中≤40岁男性患者中溃疡性结肠炎占比较高,≥71岁患者中结直肠癌占比最高.部分结直肠息肉患者出现息肉癌变,癌变部位以直肠、乙状结肠为主.

Rationale: Gastric hyperplastic polyp (GHP) commonly arises in the abnormal background mucosa, which makes it easy to be misdiagnosed and missed, and has a potential risk of malignant transformation over time. Here, we present a case of neoplastic transformation of GHP in a context of autoimmune gastritis (AIG). Patient concerns: In 2020, a 67-year-old woman was admitted for endoscopic review 6 years after gastric polyp resection, the histological diagnosis of gastric polyp was neoplastic transformation of GHP as before. The patient had undergone multiple polypectomies at the same part. Then histological examination revealed that partial epithelial hyperplasia and dysplasia, and the neoplastic areas were interlaced with normal mucosa. Diagnoses and interventions: We further found that the background diagnosis was AIG. These results supported the diagnosis of neoplastic transformation of GHP in a context of AIG. With the doubt of missed diagnose, we retrospectively analyzed the medical history in 2014, 2015 and 2016, confirmed the presence of AIG. Unfortunately, serological tests and special treatment were not performed. Outcomes: The correct diagnosis was eventually confirmed in 2020, which enables patients to receive normal treatment and monitoring, and avoids further deterioration of the disease. Lessons: The purpose of this case report is to increase clinical awareness of neoplastic transformation of GHP in a context of AIG, and hope promise for early diagnosis and treatment.

ObjectiveTo investigate the value of transient elastography (TE) in the staging of hepatic fibrosis in patients with autoimmune liver disease (ALD). MethodsPubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP databases were searched for English and Chinese articles on TE in the staging of hepatic fibrosis in ALD published from January 2000 to January 2021. Two reviewers independently performed data extraction for the articles included, and QUADAS2 was used for quality assessment. The bivariate mixed effects model in Stata 15.0 software was used to perform the Meta-analysis. ResultsA total of 11 articles were included, with 1041 patients in total. In the diagnosis of significant hepatic fibrosis (F≥2), TE had a pooled sensitivity of 0.81 (95% CI: 0.75-0.86), a specificity of 0.87(95%CI: 0.79-0.92), and an area under the receiver operating characteristic curve (AUC) of 0.91(95%CI: 0.88-0.93); in the diagnosis of advanced hepatic fibrosis (F≥3), TE had a pooled sensitivity of 0.81(95%CI: 0.74-0.87), a sensitivity of 0.90(95%CI: 0.85-0.93), and an AUC of 0.92(95%CI: 0.90-0.94); in the diagnosis of early-stage liver cirrhosis (F4), TE had a pooled sensitivity of 0.87(95%CI: 0.74-0.93), a specificity of 0.93(95%CI: 0.87-0.97), and an AUC of 0.96(95%CI: 0.94-0.97). ConclusionTE has a good diagnostic value in evaluating significant liver fibrosis, advanced liver fibrosis, and early-stage liver cirrhosis in patients with ALD, especially with a relatively high diagnostic accuracy for early-stage liver cirrhosis.

Gastric hyperplastic polyp (GHP) commonly arises in the abnormal background mucosa, which makes it easy to be misdiagnosed and missed, and has a potential risk of malignant transformation over time. Here, we present a case of neoplastic transformation of GHP in a context of autoimmune gastritis (AIG).In 2020, a 67-year-old woman was admitted for endoscopic review 6 years after gastric polyp resection, the histological diagnosis of gastric polyp was neoplastic transformation of GHP as before. The patient had undergone multiple polypectomies at the same part. Then histological examination revealed that partial epithelial hyperplasia and dysplasia, and the neoplastic areas were interlaced with normal mucosa.We further found that the background diagnosis was AIG. These results supported the diagnosis of neoplastic transformation of GHP in a context of AIG. With the doubt of missed diagnose, we retrospectively analyzed the medical history in 2014, 2015 and 2016, confirmed the presence of AIG. Unfortunately, serological tests and special treatment were not performed.The correct diagnosis was eventually confirmed in 2020, which enables patients to receive normal treatment and monitoring, and avoids further deterioration of the disease.The purpose of this case report is to increase clinical awareness of neoplastic transformation of GHP in a context of AIG, and hope promise for early diagnosis and treatment.

Rationale: Gastric hyperplastic polyp (GHP) commonly arises in the abnormal background mucosa, which makes it easy to be misdiagnosed and missed, and has a potential risk of malignant transformation over time. Here, we present a case of neoplastic transformation of GHP in a context of autoimmune gastritis (AIG). Patient concerns: In 2020, a 67-year-old woman was admitted for endoscopic review 6 years after gastric polyp resection, the histological diagnosis of gastric polyp was neoplastic transformation of GHP as before. The patient had undergone multiple polypectomies at the same part. Then histological examination revealed that partial epithelial hyperplasia and dysplasia, and the neoplastic areas were interlaced with normal mucosa. Diagnoses and interventions: We further found that the background diagnosis was AIG. These results supported the diagnosis of neoplastic transformation of GHP in a context of AIG. With the doubt of missed diagnose, we retrospectively analyzed the medical history in 2014, 2015 and 2016, confirmed the presence of AIG. Unfortunately, serological tests and special treatment were not performed. Outcomes: The correct diagnosis was eventually confirmed in 2020, which enables patients to receive normal treatment and monitoring, and avoids further deterioration of the disease. Lessons: The purpose of this case report is to increase clinical awareness of neoplastic transformation of GHP in a context of AIG, and hope promise for early diagnosis and treatment.

RATIONALE:Gastric hyperplastic polyp (GHP) commonly arises in the abnormal background mucosa, which makes it easy to be misdiagnosed and missed, and has a potential risk of malignant transformation over time. Here, we present a case of neoplastic transformation of GHP in a context of autoimmune gastritis (AIG).PATIENT CONCERNS:In 2020, a 67-year-old woman was admitted for endoscopic review 6 years after gastric polyp resection, the histological diagnosis of gastric polyp was neoplastic transformation of GHP as before. The patient had undergone multiple polypectomies at the same part. Then histological examination revealed that partial epithelial hyperplasia and dysplasia, and the neoplastic areas were interlaced with normal mucosa.DIAGNOSES AND INTERVENTIONS:We further found that the background diagnosis was AIG. These results supported the diagnosis of neoplastic transformation of GHP in a context of AIG. With the doubt of missed diagnose, we retrospectively analyzed the medical history in 2014, 2015 and 2016, confirmed the presence of AIG. Unfortunately, serological tests and special treatment were not performed.OUTCOMES:The correct diagnosis was eventually confirmed in 2020, which enables patients to receive normal treatment and monitoring, and avoids further deterioration of the disease.LESSONS:The purpose of this case report is to increase clinical awareness of neoplastic transformation of GHP in a context of AIG, and hope promise for early diagnosis and treatment.

Objective:To systematically evaluate the efficacy of epinephrine in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).Methods:Randomized controlled trials (RCTs) on epinephrine for preventing PEP from inception to October 10, 2020 were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, VIP Information Network, China National Knowledge Infrastructure,WanFang Data,and clinical trial registration platforms including ClinicalTrials.gov,WHO International Clinical Trial Registration Platform. Literature was screened independently by two reviewers, data were extracted and the risk of bias of included studies were assessed. The meta-analysis was performed by RevMan 5.3.Results:A total of 410 papers were retrieved and 8 RCTs involving 4 208 patients were included. The results of meta-analysis showed that compared with the saline group, the epinephrine could reduce the incidence of PEP ( RR=0.29,95% CI:0.16-0.50, P<0.001). There were no significant differences in the therapeutic effect between group epinephrine and group indomethacin ( RR=0.17,95% CI:0.02-1.39, P=0.100) or group indomethacin combined with epinephrine and group indomethacin ( RR=1.15,95% CI:0.61-2.16, P=0.670). Conclusion:Local spraying of epinephrine on the duodenal papilla can reduce the incidence of PEP compared with normal saline. But the epinephrine or combination of indomethacin and epinephrine fails to reveal any benefit over indomethacin alone in preventing PEP.