Postoperative anastomotic stenosis is a common complication after biliary, pancreatic and gastrointestinal surgery, which may be caused by multiple factors such as tissue proliferation and cancer recurrence. Endoscopic therapy is often hampered when the lens is difficult to pass through. A patient with intestinal stricture complicated by bilioenterostomy stenosis was treated by superselection of guide wire and stent.

Background Acid-suppressing drugs affect intestinal microbes by inhibiting the secretion of stomach acid. However, it is not clear whether acid suppressive drugs affect the microorganisms in the peripancreatic effusion and affect the postoperative complications. Methods This study was a prospective randomized controlled trial. A total of 45 patients were enrolled in the trial, and all patients were divided into acid-inhibited and non-inhibited groups. The primary endpoint of our study was to observe the difference of microbiota in the two groups of cyst fluid. Results A total of 25 patients were included in the acid-inhibited group and 20 patients were included in the non-acid-inhibited group. There were no significant differences between the two groups in terms of postoperative infection, bleeding, and recurrence rates (p > 0.05). In terms of postoperative C-reactive protein levels, the acid-suppressing group was significantly higher than the non-acid-suppressing group (p < 0.05). In the 16S microbial sequencing analysis, we found no significant difference in α diversity between the antibiotic group and the non-antibiotic group, but there was a statistically significant difference in β diversity between the two groups Conclusion Acid-suppressing drugs can change the microbial composition of pancreatic effusions and increase markers of postoperative inflammation. Acid-suppressive drugs may increase the potential infection after endoscopic drainage.

Background Endoscopic ultrasonography(EUS) guided transmural drainage has become a first-line treatment for peripancreatic fluid collections(PFCs). Postoperative bleeding may lead to severe clinical outcomes. The purpose of this study was to explore thepatient-related and surgery-related factors associtated with postoperative bleeding. Methods This is an observational cohort study. A total of 181 patients who underwent EUS drainage at our center between June 2019 and May 2023 were enrolled analyzed in the study. Postoperative bleeding complications were observed, and patient and operation-related data were collected. Univariate and multifactorial logistics regression were performed for the risk factors that may affect postoperative bleeding. Determine the risk factors affecting postoperative bleeding. Results We achieved a 100% technical success rate. A total of 14 cases(7.7%) of bleeding occurred. All bleeding patients were successfully treated by conservative, endoscopic, interventional and other treatments. Logistic regression analysis showed that cyst size was an independent risk factor for bleeding after EUS-guided transmural drainage (P = 0.006; OR,2.722; 95%CI,1.327–5.587). conclusion The cyst size was an independent risk factor for bleeding after PFC drainage. Slowing the rate of decline in intracystic pressure may reduce the risk of bleeding.

Background:Endoscopic ultrasound (EUS)-guided transhepatic antegrade stone removal (TASR) has been reserved for choledocholithiasis after failed endoscopic retrograde cholangiopancreatography (ERCP) in recent years. The aim of this study was to evaluate the techniques, feasibility, and safety of simplified single-session EUS-TASR for choledocholithiasis in patients with surgically altered anatomy (SAA). Methods:A retrospective database of patients with SAA and choledocholithiasis from the Second Hospital of Hebei Medical University (Shijiazhuang, China) between August 2020 and February 2023 was performed. They all underwent single-session EUS-TASR after ERCP failure. Basic characteristics of the patients and details of the procedures were collected. The success rates and adverse events were evaluated and discussed. Results:During the study period, 13 patients underwent simplified single-session EUS-TASR as a rescue procedure (8 males, median age, 64.0 [IQR, 48.5-69.5] years). SAA consisted of four Whipple procedures, one Billroth II gastrectomy, four gastrectomy with Roux-en-Y anastomoses, and four hepaticojejunostomy with Roux-en-Y anastomoses. The technical success rate was 100% and successful bile duct stone removal was achieved in 12 of the patients (92.3%). Adverse events occurred in two patients (15.4%), while one turned to laparoscopic surgery and the other was managed conservatively. Conclusions:Simplified single-session EUS-TASR as a rescue procedure after ERCP failure appeared to be effective and safe in the management of choledocholithiasis in patients with SAA. But further evaluation of this technique is still needed, preferably through prospective multicenter trials.

Background Endoscopic ultrasound (EUS)- guided transhepatic antegrade stone removal (TASR) for choledocholithiasis has been developed in recent years. The aim of this study was to compare the techniques, feasibility, and safety of traditional endoscopic retrograde cholangiopancreatography (ERCP) and single-session EUS-TASR for choledocholithiasis in patients with surgically altered anatomy (SAA). Methods A retrospective database review of patients with SAA and choledocholithiasis undergoing ERCP or single-session TASR was performed. The success rates and adverse events were evaluated and compared. Results A total of 38 patients (22 males, median age, 69 years) with SAA underwent primary ERCP with 25 successful ERCP, and 13 patients underwent single-session EUS-TASR as a rescue procedure. Technical success was achieved in 100% in TASR compared with 65.8% in primary ERCP (p<0.05). Multivariate analysis showed Roux-en-Y anatomy reduced the technical success rate of primary ERCP (OR 0.032, 95% CI 0.004~0.265, p <0.05). Clinical success rates of TASR and primary ERCP were 92.3% and 63.2%, respectively (p=0.076). The rates of adverse events of TASR and successful ERCP were 15.4% and 4%, respectively (p= 0.265). Otherwise, operation time was significantly shorter in the TASR group (60 min vs. 79 min, p<0.05). Conclusions Single-session EUS-TASR as a rescue procedure after ERCP failure, appeared to be effective and safe in the management of choledocholithiasis in patients with SAA, especially in Roux-en-Y anastomosis. However, further evaluation of this technique is still needed, preferably through prospective multicenter trials.

BACKGROUND:LncRNA is an important regulatory factor in the human genome. We aim to explore the roles of LncFALEC and miR-20a-5p/SHOC2 axis on the proliferation, migration, and Fluorouracil (5-FU) resistance of cholangiocarcinoma (CCA).METHODS:In this study, the expression of FALEC and miR-20a-5p in CCA tissues and cell lines (HuCCT1, QBC939, and Huh-28) was detected by RT-qPCR. The FALEC in 5-FU-resistant CCA cell lines (QBC939-R, Huh-28-R) was knocked down to evaluate its effects on cell proliferation, migration, invasion, and drug resistance.RESULTS:Our analysis showed that compared with the adjacent non-tumor tissues, FALEC was significantly higher in the CCA tissues and even higher in the samples from 5-FU-resistant patients. Knockdown FALEC increased the sensitivity of 5-FU and decreased migration and invasion of CCA cells. Dual luciferase reporter confirmed that FALEC sponges miR-20a-5p and down-regulated its expression. Moreover, SHOC2 leucine-rich repeat scaffold protein (SHOC2) was the target gene of miR-20a-5p. We found overexpression of FALEC (FALEC-OE) increased resistance of CCA cells to 5-FU significantly, which might contribute to increased SHOC2 expression and activation of the ERK1/2 signaling pathway.CONCLUSIONS:In summary, our study revealed that down-regulation of FALEC could inhibit the proliferation, migration, and invasion of CCA cells in vitro by regulating the miR-20a-5p/SHOC2 axis and participating in 5-FU resistance by mediating the ERK1/2 signaling pathway.

Aims To investigate the function and probable mechanism of Clostridium butyricum in the development of choledocholithiasis. Methods and results The lithogenic diet group and the lithogenic diet + C. butyricum group were used to develop the choledocholithiasis model. During the experiment, C. butyricum suspension was administered to the rats in the lithogenic diet + C. butyricum group. The findings demonstrated that the C. butyricum intervention decreased the Firmicutes/Bacteroidetes ratio in the colon of experimental animals given a lithogenic diet. The relative levels of Desulfovibrio (0.93%) and Streptococcus (0.38%) fell, whereas Lactobacillus (22.36%), Prevotella (14.09%), and bacteria that produce short-chain fatty acids increased. Finally, 68 distinct metabolic products were found based on nontargeted metabonomics, and 42 metabolic pathways associated to the various metabolites were enriched. Conclusions We found that C. butyricum decreased the development of choledocholithiasis. It keeps the equilibrium of the rat's gut microbiome intact and lowers the danger of bacterial infections of the gastrointestinal and biliary systems. It is hypothesized that by controlling lipid metabolism, it may also have an impact on the development of cholelithiasis.

Abstract Background To explore the use of a digestive endoscopy professional online platform by domestic endoscopists and its application effect on endoscopists’ continuing medical education, analyse the related problems of continuing medical education using this method, and propose targeted improvement suggestions. Methods Based on the “Doctor’s Circle” app, a questionnaire was sent to all members who successfully registered on the Hebei Biliary and Pancreatic Endoscopy Diagnosis and Treatment Alliance online platform. The questionnaire was available for 30 days. The questionnaire survey results were collected and counted for a grouping comparison. Results By the deadline, 703 completed questionnaires had been received. After the registered doctors joined the platform, 469 (66.7%) experienced a significant influence on their own endoscopic operation ability level, and 354 (50.3%) felt a significant improvement in their ability to diagnose biliary- and pancreatic-related diseases. The application effect of the platform on members’ continuing medical education was affirmed by the vast majority of registered doctors. The clinical specialty of registered doctors, the length of time they joined the platform, the length of time they participated in the platform activities each time, and whether they played back course videos after the live broadcast of the course on the platform were the main factors affecting the application effect on continuing medical education (P < 0.05). Registered doctors who benefited significantly from the platform used it for 6–12 months, participated in activities for 1–2 hours each time, and often played back course videos. Conclusion The new model of continuing medical education based on an online platform breaks through the constraints of traditional models and meets the individualized needs of every medical worker to improve their comprehension level. At present, the global outbreak of COVID-19 makes this learning mode increasingly popular among medical workers. We should constantly improve the organization of the content and methods of continuing medical education courses, make the online platform better serve the majority of medical workers, and effectively improve the comprehension levels of clinicians.

Accumulating evidence has indicated the crucial role of microRNA-196 in mediating tumor progression, while its significance in cholangiocarcinoma (CCA) remains unclear. In this study, we provided the first evidence that the expression level of miR-196-5p is elevated in both CCA cell lines and clinic specimen. MiR-196-5p inhibition notably suppressed cell proliferation as well as metastasis in CCA cell line HuCCT1. Furthermore, the interaction between miR-196-5p and its downstream molecule HAND1 was verified. Moreover, a series of rescue assay verified that both HAND1 and β-catenin silencing could reverse the abnormal elevated cell proliferation and migration brought by miR-196-5p elevation, indicating that HAND1/Wnt/β-catenin signaling pathway activation is essential for miR-196-5p to exert its roles. In summary, we successfully depict the oncogenic role of miR-196-5p in promoting cell proliferation and migration in CCA via HAND1/Wnt/β-catenin axis.

Abstract Background To explore the use of digestive endoscopy professional Internet platform by domestic endoscopists and its application effect on endoscopists' continuing medical education, analyze the related problems of continuing medical education under this mode, and put forward targeted improvement suggestions. Methods Based on the doctor circle app platform, a questionnaire was sent to all members who successfully registered on the Internet platform of Hebei biliary and pancreatic endoscopy diagnosis and treatment alliance. The questionnaire lasted 30 days from the beginning to the end. The questionnaire survey results were collected and counted for grouping comparison. Results By the deadline, 703 completed questionnaires had been received. After the registered doctors joined the platform, 469 (66.7%) had a significant impact on their own endoscopic operation level, and 354 (50.3%) felt a significant improvement in the diagnosis level of biliary and pancreatic related diseases. The application effect of the platform on students' continuing medical education was affirmed by the vast majority of registered doctors; The clinical specialty of registered doctors, the length of time they joined the platform, the time they participated in the platform activities each time, and whether they watched the course playback after the platform live broadcast course were the main factors affecting the application effect of continuing medical education (P < 0.05). The time they joined the platform was 6–12 months, and the time they participated in the platform activities each time lasted 1–2 hours, and registered doctors who often watch course playback benefit significantly. Conclusion The new model of continuing medical education based on the Internet platform breaks through the constraints of the traditional model and meets the individualized needs of every medical worker to improve their comprehensive level; At present, the outbreak of global COVID-19 makes this learning mode more and more popular among medical workers. We should constantly improve the arrangement of the contents and forms of continuing medical education courses, make the Internet platform better serve the majority of medical workers, and effectively improve the comprehensive quality level of clinicians.

1Biliopancreatic Endoscopic Surgery Department, 2nd Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. Correspondence: Senlin Hou, MD. E-mail: [email protected].