anyong Li

Endoscopic ultrasound-guided fine needle core biopsy for the diagnosis of pancreatic malignant lesions: a systematic review and Meta-Analysis

Endoscopic ultrasound-guided fine needle core biopsy (EUS-FNB) has been used as an effective method of diagnosing pancreatic malignant lesions. It has the advantage of providing well preserved tissue for histologic grading and subsequent molecular biological analysis. In order to estimate the diagnostic accuracy of EUS-FNB for pancreatic malignant lesions, studies assessing EUS-FNB to diagnose solid pancreatic masses were selected via Medline. Sixteen articles published between 2005 and 2015, covering 828 patients, met the inclusion criteria. The summary estimates for EUS-FNB differentiating malignant from benign solid pancreatic masses were: sensitivity 0.84 (95% confidence interval (CI), 0.82–0.87); specificity 0.98 (95% CI, 0.93–1.00); positive likelihood ratio 8.0 (95% CI 4.5–14.4); negative likelihood ratio 0.17 (95% CI 0.10–0.26); and DOR 64 (95% CI 30.4–134.8). The area under the sROC curve was 0.96. Subgroup analysis did not identify other factors that could substantially affect the diagnostic accuracy, such as the study design, location of study, number of centers, location of lesion, whether or not a cytopathologist was present, and so on. EUS-FNB is a reliable diagnostic tool for solid pancreatic masses and should be especially considered for pathology where histologic morphology is preferred for diagnosis.

Diagnostic Accuracy of Serum Procalcitonin for Spontaneous Bacterial Peritonitis Due to End-stage Liver Disease: A Meta-analysis

AbstractEarly diagnosis and prompt treatment of spontaneous bacterial peritonitis (SBP) due to end-stage liver disease is vital to shorten hospital stays and reduce mortality. Many studies have explored the potential usefulness of serum procalcitonin (PCT) in predicting SBP. The aim of this study is to evaluate the overall diagnostic accuracy of PCT levels for identifying SBP due to end-stage liver disease.After performing a systematic search of the Medline, Embase, and Cochrane databases for studies that evaluated the diagnostic role of PCT for SBP, sensitivity, specificity, and other measures of accuracy of PCT concentrations in serum for SBP diagnosis were pooled using random-effects models. A summary receiver operating characteristic curve was used to summarize overall test performance.Seven publications met the inclusion criteria covering 742 episodes of suspected SBP along with 339 confirmed cases. The summary estimates for serum PCT in the diagnosis of SBP attributable to end-stage liver disease were: sensitivity 0.82 (95% CI 0.79–0.87), specificity 0.86 (95% CI 0.82–0.89), positive likelihood ratio 4.94 (95% CI 2.28–10.70), negative likelihood ratio 0.22 (95% CI 0.10–0.52), and diagnostic OR 22.55 (95% CI 7.01–108.30). The area under the curve was 0.92. There was evidence of significant heterogeneity but no evidence of publication bias.Serum PCT is a relatively sensitive and specific test for the identification of SBP. However, due to the limited high-quality studies available, medical decisions should be carefully made in the context of both PCT test results and other clinical findings.

Endoscopic treatment of Zenker's diverticulum: a simplified needle-knife technique

Flexible endoscopic diverticulostomy (septotomy) with the assistance of a guidewire, a nasogastric tube, a plastic overtube, or a diverticuloscope seems to be a safe and effective treatment of symptomatic Zenker’s diverticulum (ZD) in the esophagus. The purpose of the assistance is to make the operative field clearer. However, those assisted devices can cause trauma in the diverticulum and unnecessarily increase operation time. This video demonstrates that a simplified needle-knife technique can be easily and safely performed without the aforementioned assistance devices. A 62-year-old man with ZD underwent endoscopic septotomy for dysphagia and weight loss. To protect the airway, he was intubated. A ZD was found in the proximal esophagus, 17 cm from the entry site (Fig. 1A). Using a high-resolution Olympus gastroscope

EUS-guided drainage of pancreatic fluid collection with a Hot AXIOS stent in a patient with pancreatitis following distal pancreatectomy (with video)

The Hot AXIOS lumen-apposing stent (Xlumena Inc., Mountain View, CA, USA) is a novel double-flanged or “barbell‐shaped,” covered, self‐expanding metal stent that can be an efficient tool for the drainage of pancreatic f luid collection (PFC), which is mostly caused by gallstone disease, or alcoholic, idiopathic, or chronic pancreatitis.[1-5] Herein, we present a case of successful PFC drainage in a patient with pancreatitis following distal pancreatectomy [Video 1].

Endoscopic Submucosal Resection: A Novel Technique for Resection of a Small Gastric Stromal Tumor from the Muscularis Propria

Endoscopic Submucosal Resection: A Novel Technique for Resection of a Small Gastric Stromal Tumor from the Muscularis Propria

Estrogen inhibits the overgrowth of Escherichia coli in the rat intestine under simulated microgravity

Microgravity can affect many aspects of intestinal homeostasis, leading to an increased risk of colitis. Estrogen, the most frequently affected hormone when under simulated microgravity, regulates the permeability of the colonic mucosa barrier. The associations between alterations in intestinal microbiota and increased susceptibility under microgravity have not been thoroughly elucidated. The aim of the present study was to evaluate the changes in intestinal microbiota under simulated microgravity and to investigate the protective effect of estrogen against those changes. The hindlimb unweighting (HU) model was used to simulate microgravity in rats. Estrogen was administered via intramuscular injection. Amplicons of the V3 variable regions of bacterial 16S rDNA were analyzed using denaturing gradient gel electrophoresis (DGGE), cloning and sequencing. Several specific bacterial groups were assayed using quantitative-polymerase chain reaction. Bacterial translocation was evaluated by detecting serum lipopolysaccharide (LPS) and LPS binding protein (LBP) levels. DGGE profiles generated by universal primers revealed minor, though specific, changes in bacterial communities under simulated microgravity, particularly the band matching the sequence of Escherichia coli (E. coli). The quantification of 16S RNA revealed increased numbers of Bacteroides fragilis, E. coli and Fusobacterium nucleatum; however, Bifidobacteria longum significantly decreased under microgravity. Estrogen inhibited the overgrowth of E. coli, and decreased the levels of LBS and LBP under simulated microgravity. These results demonstrated that simulated microgravity alters the intestinal microflora and may contribute to bacterial translocation in the gut mucosa. The data also suggested that further investigations evaluating the administration of estrogen to protect against microgravity-associated diseases may be required.