Yonghui Huang

Autoimmune metaplastic atrophic gastritis in chinese: a study of 320 patients at a large tertiary medical center

Abstract Objectives: Autoimmune metaplastic atrophic gastritis (AMAG) is an uncommon disease worldwide and may predispose to gastric carcinoid tumors or adenocarcinomas. The aims of this study were to outline the clinical characteristics of Chinese AMAG patients, including demographic pattern, hematologic features, and gastroscopic and histopathologic findings. Patients and methods: A total of 320 Chinese patients with AMAG, from January 2007 to December 2014, were reviewed in a regional hospital of China. Results: Of the 320 AMAG patients, the mean age was 60.6 ± 12.3 years [range 26–86; 206 (64.4%) women]. The coarse annual detection rate was 0.9%. Anemia was present in only 19.3% patients (53/275) and 3.5% (11/315) AMAG patients also had primary biliary cirrhosis. One hundred and thirty-six had endoscopically identifiable lesions. These lesions consisted of 130 polypoid lesions (63 hyperplastic polyps, 2 oxyntic mucosa pseudopolyps, 2 intestinal-type gastric adenomas, 2 fundic gland polyps, 5 concurrent polyps, 14 well-differentiated neuroendocrine neoplasms, 7 submucosal tumors and 35 chronic gastritis), 6 adenocarcinomas. The detection rate of atrophy and intestinal metaplasia in antral mucosa were 47.2 and 37.5%, respectively. Conclusions: AMAG is more frequent than expected in China and display a female predominance, accompanied with other autoimmune disorders. AMAG should be paid more attention by clinicians through a multidisciplinary team approach.

Haemophagocytic lymphohistiocytosis in inflammatory bowel disease with virus infection

Patients with inflammatory bowel disease (IBD) are at risk of developing haemophagocytic lymphohistiocytosis (HLH) because of chronic systemic inflammation as well as exposure to immunosuppressive medications. The two main causes of HLH in IBD patients are infection with cytomegalovirus and Epstein-Barr virus. Patients with Crohns disease are more susceptible to HLH than those with ulcerative colitis. The majority of cases are seen in people receiving an immunosuppressive regimen that included thiopurines.

Adult colonoscopy or single-balloon enteroscopy-assisted ERCP in long-limb surgical bypass patients.

OBJECTIVE The aim of this study was to evaluate the usefulness of adult colonoscopy or single-balloon enteroscopy (SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) in long-limb surgical bypass patients. METHODS Retrospective analysis of 16 patients with long-limb surgical bypasses who underwent therapeutic ERCP because of suspected pancreaticobiliary diseases. Small-bowel intubation was performed by peroral adult colonoscopy or SBE. If colonoscopy success was achieved, ERCP was performed subsequently. But in patients using SBE, a small-caliber colonoscope would be used to replace enteroscope if the SBE success was achieved. ERCP was then performed with the conventional accessories. RESULTS A total of 21 ERCP procedures were performed. Adult colonoscope was used for ERCP in 8 patients with standard Whipple resection consecutively. Colonoscopy success was achieved in 8 of 8 patients (100%), of whom 7 of 8 (87.5%) achieved ERCP success. SBE-assisted ERCP was attempted in other 8 patients with different types of Roux-en-Y anatomy. SBE success was achieved in 7 of 8 patients (87.5%), of whom 4 of 7 (57.1%) achieved ERCP success. The overall success rate of endoscopy and ERCP was 93.8% (15/16) and 68.8% (11/16), respectively. CONCLUSIONS Adult colonoscopy has high success rate for performing ERCP after Whipple resection and should be selected for such patient preferentially. By using the facilitated method for endoscopic interventions at pancreaticobiliary disease after Roux-en-Y reconstruction, SBE-assisted ERCP can be attempted when it is difficult to gain access to the papilla of Vater or bilioenteric/pancreaticoenteric anastomosis and long length ERCP accessories cannot be available.

Endoscopic Retrograde Cholangiopancreatography Using a Dual-Lumen Endogastroscope for Patients with Billroth II Gastrectomy

Objective. To evaluate the safety and efficacy of a dual-lumen forward-viewing endoscope for ERCP in patients with prior Billroth II gastrectomy. Methods. The records of 46 patients treated with ERCP by a dual-lumen forward-viewing endoscope after Billroth II gastrectomy from 2007 to 2012 were reviewed. Results. The success rate of selective cannulation was 82.6% (38/46). Of the 38 cases with successful selective cannulation, endoscopic sphincterotomy was achieved in 23 cases by placing the needle knife through the 2nd lumen, while endoscopic papillary balloon dilatation was conducted in the other 15 cases. Of the 8 failed cases of selective cannulation, 6 had failed afferent loop intubation, and 3 of these 6 patients had Brauns anastomosis. The safety and efficacy of catheter-assisted endoscopic sphincterotomy were increased by placing the needle knife through the 2nd lumen without altering the conventional endoscopic sphincterotomy procedure. Conclusions. A dual-lumen forward-viewing endoscope can be safely and effectively used to perform ERCP in patients with a Billroth II gastrectomy, except for patients with additional Brauns anastomosis.

Clinical Applicability of Various Treatment Approaches for Upper Gastrointestinal Submucosal Tumors

Submucosal tumor (SMT) is a disease that is commonly discovered during endoscopic examination. With advances in endoscopic ultrasonography (EUS) technology, this technique has become the primary screening method for the diagnosis of upper gastrointestinal SMTs. The present study summarized the clinical data of patients who were examined and diagnosed with upper gastrointestinal SMTs by EUS, underwent endoscopic therapy or surgical treatment, and received final pathological results in our hospital between January 2011 and September 2014. Our results show that endoscopic therapy has become the main approach for the treatment of upper gastrointestinal SMTs with the development and maturation of endoscopic technology in recent years. Our conclusion suggests that the selection of endoscopic methods, such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and peroral submucosal tunneling endoscopic resection (STER), under the guidance of EUS is safe and effective for the treatment of upper gastrointestinal SMTs.

Endoscopic retrieval of a migrated pancreatic stent under direct pancreatoscopy by use of a “snare over in-stent wire guide” method

GIE Volume 3, No. 9 : 2018 scopic retrieval of a migrated, double-flanged, pancreatic stent (5F 7 cm) under direct pancreatoscopy by use of a “snare over in-stent wire guide” method (Video 1, available online at www.VideoGIE.org). Five years previously, a 46-year-old man with recurrent pancreatitis had undergone ERCP. The main pancreatic duct (PD) was dilated throughout. After a pancreatic sphincterotomy, a 5F 7-cm double-flanged straight pancreatic stent was inserted for post-ERCP pancreatitis prophylaxis. One month later, the patient underwent an upper endoscopy for stent removal. The endoscopist did not visualize the stent endoscopically and thought it had dislodged. However, the stent had migrated into the pancreas. The patient did well for 5 years without a further attack of pancreatitis. Unfortunately, the migrated stent was seen inside the pancreas on CT scan (Fig. 1) after the patient

A snare-assisted peroral direct choledochoscopy and pancreatoscopy using an ultra-slim upper endoscope: A case series study

OBJECTIVE To evaluate the feasibility, effectiveness and safety of a new snare-assisted peroral direct choledochoscopy/pancreatoscopy (PDCPS) technique. METHODS From November 2014 through December 2016, 20 consecutive patients with indications for PDCPS were enrolled in this observational study. Endoscopic retrograde cholangiography was initially performed using a conventional duodenoscope, and endoscopic papillary balloon dilation was performed. Next, an ultra-slim endoscope was inserted to perform the PDCPS; a snare tightened around the end of the scopes bending section facilitated its entry into the common bile duct (CBD). The primary endpoint was the overall success rate of the PDCPS procedure (successful biliary intubation and visualization of the area of interest) and the time for biliary intubation with the ultra-slim upper endoscope. RESULTS Participants (11 men and 9 women; mean age, 72.2 years [range, 41-93 years]) had CBD adenoma (n=1), large CBD stones after failed extraction/lithotripsy treatment (n=13), CBD strictures (n=4), pancreatic duct tumor (n=1) or pancreatic duct dilation (n=1). The success rate was 95%. The mean intubation time was 18min (range, 4-57min). No adverse events were reported. CONCLUSIONS A snare-assisted PDCPS technique appears to be technically feasible, effective and safe for both diagnostic and therapeutic applications.

Features of patients with inflammatory bowel diseases who develop hemophagocytic lymphohistiocytosis

Dear Editor: Hemophagocytic lymphohistiocytosis (HLH) is a serious hyperinflammatory condition that develops sporadically in patients undergoing treatment for inflammatory bowel disease (IBD). We collected data from a patient who developed HLH while undergoing treatment for IBD, as well as from 21 other cases through a literature search.We summarized clinical data, laboratory test results, imaging findings, and information on treatments and outcomes, and compared with the general IBD patients in two hospitals. Altogether, 16 papers were collected.Most patients (20/22) were less than 45 years old, the male to female ratio was 12:10, and Crohn’s disease (CD):ulcerative colitis (UC) was 18:4. As for immunosuppressive regimen, nine patients were under thiopurines in monotherapy, in combination with steroids (n=4) and infliximab (n=4); three patients was on steroids monotherapy and one patient in combination with infliximab. Effectiveness of the immunosuppressive regimen was described in nine patients, and among these, eight had a positive clinical response. The interval from prescription of immunosuppressive regimen to the onset of HLH was 4 months to 6 years. Of the 22 patients who developed HLH, 12 (54.5 %) had cytomegalovirus virus (CMV) infection and 8 (36.4 %) had Epstein-Barr virus (EBV) infection. One case had acute pancreatitis and toxic megacolon, the other had no cause identified. (Virological tests were not mentioned in these two cases). Five patients died; three from EBV infection, one from CMV infection and one from an unknown cause. The most common symptoms of HLH were fever (22/22), fatigue (9/22) and abdominal pain (7/22). There were also some flu-like symptoms, such as sore throat (5/22), cough (5/22), rhinorrhoea (3/22), headache (3/22) and myalgia (2/22). Six patients presented with severe hematochezia. On chest X-ray, six patients had multiple bilateral alveolar opacities. Ultrasonography showed splenomegaly and/or hepatomegaly in 13 patients, enlargement of lymph nodes in seven patients, and multiple hypoechoenic nodules of the spleen or liver in two patients. Hemophagocytosis was observed on bone marrow aspiration in 11 patients. Other abnormities included respiratory failure in three patients, coagulopathy or DIC in eight patients. The data source of the control group was a two-institutional cohort of patients with IBD from January, 2013 to December, 2014. Eighty-seven patients with IBD were enrolled in the control group. We compared the proportion of CD patients, viral infection rate, mortality, and usage of immunosuppressive agents including thiopurines between HLH group and the control group. Comparing with the control group, the prevalence of EBVand CMVwere higher in HLH group than those in control group (P=0.000 and P=0.001, respectively); proportion of CD patients was higher in HLH group than that in * Y. Li leeeyuan@aliyun.com

Improved method of gastrostomy tube replacement using a small-caliber transnasal endoscope

Abstract Conclusion: Gastrostomy tube replacement using a new approach through the abdominal-wall stoma with a small-caliber trans-nasal endoscope is feasible, fast, and safe compared with the trans-oral approach. Objectives: To evaluate the feasibility of a new technique using a trans-nasal endoscope for gastrostomy tube replacement. Methods: Between June 2005 and December 2013 in the Peking University Third Hospital, 69 patients underwent gastrostomy tube replacement using the trans-oral approach (conventional method) or a small-caliber trans-nasal endoscope inserted through the abdominal-wall stoma (new method). A retrospective review was performed of the medical records of those patients, including demography and information about the surgical procedure and any complications. Patients were classified into the conventional group and the new method group. Descriptive statistics for all continuous variables were mean ± standard deviation and for categorical variables were number and percentage. Results: Gastrostomy tube replacement was achieved in 69 of 69 cases (100%); 23 of these procedures were performed using the new method. The surgery time with the conventional method (8.3 ± 2.0 min) was significantly longer than with the new method (6.0 ± 0.9 min, p < 0.001). With the conventional method, there was one patient (2%) with post-operative fever and skin infection; no complications occurred with the new method.