Ping Yue

Double pigtail stents healed acute pancreatitis resulting from afferent loop obstruction

Ping Yue1,2 , Wenbo Meng1,2 , Zhiwen Luo3 , Bing Bai1,2 , Xun Li2,4 1Department of Special Minimally Invasive Surgery, The Frist Hospital of Lanzhou University, Lanzhou, China 2Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China 3The First Clinical Medical College of Lanzhou University, Lanzhou, China 4The Fifth General Surgery Department, The First Hospital of Lanzhou University, Lanzhou, China

Unusual self-healing of a traumatic pancreatic fistula that persisted for 16 months

1Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Gansu, China 2Department of Hepatopancreatobiliary Surgery, Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Gansu, China 3The First Clinical Medical College of Lanzhou University, Gansu, China 4Department of The Fifth General Surgery, The First Hospital of Lanzhou University, Gansu, China

Curcumol Exerts Anticancer Effect in Cholangiocarcinoma Cells via Down-Regulating CDKL3

Curcumol is the major component extracted from root of Rhizoma Curcumae. Recent studies have shown that curcumol exerts therapeutic effects against multiple conditions, particularly cancers. However, the therapeutic role and mechanism of curcumol against cholangiocarcinoma cells are still unclear. In our current research, we tested the effect of curcumol in cholangiocarcinoma cells, and using two-dimensional electrophoresis, proteomics and bioinformatics, we identified cyclin-dependent kinase like 3 (CDKL3) as a potential target for curcumol. We have demonstrated that curcumol can evidently suppress growth and migration of cholangiocarcinoma cells. Furthermore, curcumol could significantly block the cell cycle progression of the cholangiocarcinoma cells. These effects could be largely attributed to the inhibition of CDKL3 by curcumol. Further studies have recapitulated the oncogenic role of CDKL3 in that knockdown of CDKL3 by lentiviral mediated transfection of shRNA against CDKL3 also led to a significant inhibition on cell proliferation, migration, invasion, and cell cycle progression. Given the high level of CDKL3 expression in human cholangiocarcinoma tissues and cell lines, we speculated that CDKL3 may constitute a potential biological target for curcumol in cholangiocarcinoma.

Emergent Endoscopic Retrograde Cholangiopancreatography with Placement of Biliary Double Stents to Salvage Endoscopic Retrograde Cholangiopancreatography-Induced Stapfer's Type II Perforation

To the Editor: Endoscopic retrograde cholangiopancreatography (ERCP) plays a vital role in the management of pancreaticobiliary diseases in recent years and it concomitantly carries a risk of complications including post‐ERCP pancreatitis, cholangitis, bleeding, and perforation. The incidence of primary post‐ERCP complications ranges from 5.4% to 23.0%, and ERCP‐induced perforation can occur in 0.3–1.0% of cases, but the associated mortality is high ranging from 8% to 23%.[1] Because of the confluence of the bile duct and pancreatic duct meet at the papilla in proximity to the site of perforation in the duodenum, there is a potential risk of leakage of bile and pancreatic juice into the retroperitoneal space or peritoneum. Patients with Stapfer’s Type II perforation (perivaterian perforation) generally suffered from systemic inflammatory response syndrome, which could progress rapidly to acute lung injury and acute renal insufficiency and even multiple organ failure. All of these contribute to the significantly high mortality. A timely recognition and appropriate treatment are crucial to the management of ERCP‐induced perforation to reduce the overall mortality. Conventionally, surgery remains the primary treatment for iatrogenic perforations. With the improvement in endoscopic technique and development of new accessories, nonsurgical management with endoscopic treatment of perforation is increasingly being reported.[2] We report a retrospective analysis of ERCP‐induced Stapfer’s Type II perforations over a 5‐year period managed with nonsurgical approach combined with salvage ERCP.

Re: Forceps-related endoscopic transpapillary biliary biopsy programmes, reply: endoscopic biopsy techniques for proximal biliary strictures

We read the paper by Meng et al. (1) entitled “Accurate biopsy of bile duct without destroying duodenal papilla” with great interest. They described a new technique to perform endoscopic biopsy in a 75-year-old male with a biliary stricture, which was presumed to be a malignancy, in the hilar region. They used a 7-Fr dilatation catheter (COOK, Winston-Salem, North Carolina, USA) and inserted it into the bile duct and across the stenosis along a guidewire. The withdrawal of the guidewire was followed by the insertion of a 1-mm SpyBiteTM forceps (Boston Scientific, EI Coyol, Alajuela, Costa Rica) through a dilatation catheter. When the tip of SpyBiteTM passed the top, the tissue was grasped. We believe that this technique is highly effective to make a histopathological diagnosis.

Narrow band imaging helps identify the ectopic opening of the common bile duct during endoscopic retrograde cholangiopancreatography

The ectopic opening of the common bile duct (CBD) into the stomach and pyloric canal is extremely rare, and it accounts for a mere 0.43% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) (1); however, when present, it often makes it difficult to recognize the papilla during endoscopy. Here we present a case where narrow band imaging (NBI) was used to discover an ectopic opening of the CBD.

Accurate biopsy of bile duct without destroying duodenal papilla.

Although surgeons can distinguish between benign and malignant stricture in the proximal region of the bile duct, resolution in most cases still depends on surgical procedures (1). Severe edema of the hepatoduodenal ligament after endoscopic retrograde cholangiopancreatography (ERCP) traumatic movements, such as endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) (2), leads to increase in the level of anxiety in surgeons, which would render the resection difficult. Here we present a novel and easier technique of transpapillary bile duct biopsy under fluoroscopy. It can get equal volume of tissue to usual forceps (1.8 mm) and Spyglass (3,4) as well as decreases edema of the hepatoduodenal ligament without destroying major papilla.

Identification and Comparison of Differentiation-Related Proteins in Hepatocellular Carcinoma Tissues by Proteomics

Histological differentiation is a major pathological criterion indicating the risk of tumor invasion and metastasis in patients with hepatocellular carcinoma. The degree of tumor differentiation is controlled by a complex interacting network of associated proteins. The principal aim of the present study is to identify the possible differentiation-related proteins which may be used for early diagnosis and more effective therapies. We compared poorly differentiated and well-differentiated hepatocellular carcinoma tissues by using 2-dimensional gel electrophoresis and matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Among the 11 identified protein spots, 6 were found to be upregulated in poorly differentiated hepatocellular carcinoma tissues and 5 were correspondingly downregulated. Immunohistochemistry was performed on 106 hepatocellular carcinoma tissues to confirm the results of the proteomic analysis. By using bioinformatic tools GO and STRING, these proteins were found to be related to catalytic activity, binding, and antioxidant activity. In particular, our data suggest that overexpression of peroxiredoxin-2, annexin A2, and heat shock protein β-1 was correlated with tumor invasion, metastasis, and poor prognosis, and therefore, these proteins may serve as potential diagnostic and therapeutic biomarkers.