Zelong Han

Association between TLR2 and TLR4 Gene Polymorphisms and the Susceptibility to Inflammatory Bowel Disease: A Meta-Analysis.

Background The associations between toll-like receptor 2 (TLR2) and toll-like receptor 4(TLR4) polymorphisms and inflammatory bowel disease (IBD) susceptibility remain controversial. A meta-analysis was performed to assess these associations. Methods A systematic search was performed to identify all relevant studies relating TLR2 and TLR4 polymorphisms and IBD susceptibility. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed by ethnicity and publication quality. Results Thirty-eight eligible studies, assessing 10970 cases and 7061 controls were included. No TLR2 Arg677Trp polymorphism was found. No significant association was observed between TLR2 Arg753Gln polymorphism and Crohn’s disease (CD) or ulcerative colitis (UC) in all genetic models. Interestingly, TLR4 Asp299Gly polymorphism was significantly associated with increased risk of CD and UC in all genetic models, except for the additive one in CD. In addition, a statistically significant association between TLR4 Asp299Gly polymorphism and IBD was observed among high quality studies evaluating Caucasians, but not Asians. Associations between TLR4 Thr399Ile polymorphisms and CD risk were found only in the allele and dominant models. The TLR4 Thr399Ile polymorphism was associated with UC risk in pooled results as well as subgroup analysis of high quality publications assessing Caucasians, in allele and dominant models. Conclusions The meta-analysis provides evidence that TLR2 Arg753Gln is not associated with CD and UC susceptibility in Asians; TLR4 Asp299Gly is associated with CD and UC susceptibility in Caucasians, but not Asians. TLR4 Thr399Ile may be associated with IBD susceptibility in Caucasians only. Additional well-powered studies of Asp299Gly and other TLR4 variants are warranted.

Successful closure of lateral duodenal perforation by endoscopic band ligation after endoscopic clipping failure.

Successful Closure of Lateral Duodenal Perforation by Endoscopic Band Ligation After Endoscopic Clipping Failure

The evaluation of the OMOM capsule endoscopy with similar pictures elimination mode

BACKGROUND AND OBJECTIVE The reading of capsule endoscopy (CE) is time-consuming. Thus, several time-saving features have been added to the CE software by different CE companies. However, the similar pictures elimination mode in the OMOM capsule endoscopy software has not been evaluated yet. Our aim is to evaluate the sensitivity and specificity of the similar pictures elimination mode. METHODS We retrospectively studied 200 consecutive capsule endoscopy procedures in Nanfang Hospital between April 2012 and July 2012, among which 52 cases were excluded for poor bowel preparation, failure to reach the colon or data missing. All images of the small-bowel were re-evaluated with four different reading modes (conventional mode and three levels of similar pictures elimination mode) by four experienced endoscopists. Then, the reading time, the number of detected lesions, κ value, sensitivity and specificity were compared between 4 methods. RESULTS The mean reading time with levels I to III, respectively, was significantly shorter than with conventional mode (P<0.001, conventional mode 33.25min, level I 24.90min, level II 20.54min, level III 14.96min). The sensitivity between conventional mode and level I were similar (93.8% vs. 87.7%, P=0.073), while the sensitivity of levels II and III was significantly lower than conventional mode (77.8% vs. 93.8%, 70% vs. 93.8%, respectively). The specificity between all 4 modes were similar (100% for conventional mode, 98.5% for levels I to III). CONCLUSIONS Level I reading mode was as efficient as the conventional mode and less time-consuming. Its sensitivity and specificity were similar compared with the conventional mode.

iTRAQ-Based Proteomics Screen identifies LIPOCALIN-2 (LCN-2) as a potential biomarker for colonic lateral-spreading tumors

The improvement and implementation of a colonoscopy technique has led to increased detection of laterally spreading tumors (LSTs), which are presumed to constitute an aggressive type of colonic neoplasm. Early diagnosis and treatment of LSTs is clinically challenging. To overcome this problem, we employed iTRAQ to identify LST-specific protein biomarkers potentially involved in LST progression. In this study, we identified 2,001 differentially expressed proteins in LSTs using iTRAQ-based proteomics technology. Lipocalin-2 (LCN-2) was the most up-regulated protein. LSTs expression levels of LCN-2 and matrix metallopeptidase-9 (MMP-9) showed positive correlation with worse pathological grading, and up-regulation of these proteins in LSTs was also reflected in serum. Furthermore, LCN-2 protein overexpression was positively correlated with MMP-9 protein up-regulation in the tumor tissue and serum of LST patients (former rs = 0.631, P = 0.000; latter rs = 0.815, P = 0.000). Our results suggest that LCN-2 constitutes a potential biomarker for LST disease progression and might be a novel therapeutic target in LSTs.

A case of acute glutaraldehyde-induced colitis following polyps treated by EMR

Dear Editor: We present a case of acute glutaraldehyde-induced colitis following polyps treated by endoscopic mucosal resection (EMR). A previously healthy, 56-year-old man underwent a screening colonoscopy after regular bowel cleansing with macrogol electrolytes powder in Endoscopy Center of Nan Fang Hospital in June 2013. Three polyps 6–8 mm in diameter were found in the transverse colon and descending colon, respectively, and all of which were resected by EMR. After resection of the polyps, the artificial ulcer floors were endoscopically closed with clips to prevent postoperative bleeding and perforation. Ten hours after the procedure, he developed mild left upper abdominal pain, high fever, diarrhea, and progressed into some bloody stools. Physical examination revealed typical signs of peritonitis. A significant amount of erythrocytes and some leucocytes was observed in the stool examination. Stool culture for enteric pathogens including Clostridium difficile antigen and blood cultures were negative. A plain abdominal X-ray showed an increase in bowel gas and no free air. Abdominal computerized tomography (CT) demonstrated diffuse edematous thickening of the colonic wall extending from the descending to midtransverse colon. Then a colonoscopy was performed without bowel preparation in order to evaluate the postpolypectomy bleeding. Colonoscopy showed hyperemia, edema, extensive necrosis of the mucosa, friability, and fibrinous exudates from sigmoid-descending junction to the midtransverse colon, which were multiple and nonconfluent and some small ulcerations in the descending colon. No perforation occurred in the lesions. The rest of the colonic mucosa was completely normal. We found that 2 % of glutaraldehyde disinfectant was retained in the endoscope channels because of inadequate flushing and rinsing of the endoscopy. A diagnosis of glutaraldehyde colitis was made as the patient had no signs of ischemic colitis, and no similar case had occurred after this defect was rectified. The patient’s symptoms resolved 4 days after bowel rest and intravenous fluid supplementation and cefoperazone sodium and sulbactam sodium. Repeat colonoscopy after 6 months was normal. Two percent glutaraldehyde is often used to disinfect endoscopes as its superior germicidal action [1]. But it could induce severe sensitivity reactions on skin, eyes, nose, and respiratory tract due to direct contact [2]. The incidence of glutaraldehyde-induced colitis was reported as 0.1–4.7 %, but this might be an underestimate as most of the cases were not reported [3]. Despite the rate of glutaraldehyde-induced colitis is relatively low, it is an important complication of colonoscopy. The possible mechanisms of mucosal injury might include local activation of arachidonic acid and other inflammatory factors, which leads to colitis and other systemic signs [2]. The patients could recover after the treatment of bowel rest and empiric antibiotics [4]. Xianfei Wang and Zelong Han contributed equally to this work. X. Wang : Z. Han :Y. Li :Y. Guo :W. Xu : S. Liu (*) Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China e-mail: liuside2011@163.com

Effectiveness and safety of endoscopic resection for gastric GISTs: a systematic review

Abstract Aims: To evaluate the effectiveness and safety of endoscopic resection for gastric gastrointestinal stromal tumors (GISTs). Material and methods: The effectiveness and safety of endoscopic resection were mainly assessed by complete resection rate, postoperative adverse event rate, and recurrence rate. Moreover, a comparison of endoscopic with laparoscopic resection for gastric GISTs was made through weighted mean difference by STATA 12.0 with regard to operation time, blood loss, and length of stay after including patients who underwent endoscopic or laparoscopic resection for gastric GISTs in the comparative studies. Results: Eleven studies investigating endoscopic resection for GISTs were included. For stromal tumors <2 cm in average diameters the pooled rates of complete resection, postoperative adverse events and recurrence were 0.97, 0.08, and 0.03, respectively. Only five retrospective studies directly compared endoscopic with laparoscopic resection for gastric GISTs with average diameters from 1.1 cm to 3.8 cm, and endoscopic resection had a shorter operation time than laparoscopic resection, but there were no significant differences in intraoperative blood loss, length of stay, postoperative complications, and postoperative recurrence rates between the two approaches. Conclusions: Endoscopic resection is predominantly tried for gastric GISTs of relatively small size. It seems effective and safe for gastric GISTs <2 cm in average diameter, with relatively short operation times.

Successful closure of esophagomediastinal fistula with endoclips and an endoloop after endoscopic submucosal dissection

Perforation, bleeding, mediastinal emphysema, and postoperative stricture are the most common complications associated with esophageal endoscopic submucosal dissection (ESD) [1]. However, though rare, esophagobronchial fistula or esophagomediastinal fistula can also develop after ESD. Conventional treatments of esophageal fistula include surgery, esophageal covered stent implantation, and other endoscopic methods involving the use of endoclips or fibrin glue [2–5]. A 65-year-old man with esophageal high grade intraepithelial neoplasia underwent ESD at our hospital. Following submucosal dissection, multiple-site damage of the muscular layer was found at the mucosal defect. Endoclips (ROCC-D26-195; Micro-Tech [Nanjing] Co., Ltd., ▶ Fig. 1 Esophagomediastinal fistula following endoscopic submucosal dissection. a Esophagography with a water-soluble contrast agent suggested the presence of an esophagomediastinal fistula. b The orifice of the fistula. c An open endoloop was placed around the orifice of the fistula and anchored into the margin by endoclips. d The endoloop was tightened and the esophagomediastinal fistula was closed. E-Videos

Endoscopic mucosa-sparing lateral dissection for treatment of gastric submucosal tumors: a prospective cohort study

BACKGROUND In our previous work, we developed a modified method for the removal of gastric submucosal tumors (SMTs), called endoscopic mucosa-sparing lateral dissection (EMSLD). This prospective study aimed to evaluate the efficacy and postoperative outcomes of EMSLD. METHODS We prospectively enrolled 25 consecutive patients with gastric SMTs, who received EMSLD treatment. Clinicopathological characteristics and operation-related outcomes were analyzed. RESULTS The mean age of patients was 49.3 ± 9.7 years, and the mean tumor size was 14.6 ± 6.1 mm. En bloc resection was achieved in all cases. The mean procedure time was 47.3 ± 25.9 minutes, and the estimated blood loss was 4.8 ± 3.5 mL. Endoscopic full-thickness resection was performed in six patients (24 %) because the tumors originated from the deep muscularis propria layer. All perforations and resection defects were successfully closed by the retained mucosa and endoclips. No serious complications related to EMSLD were encountered during or after the procedure. CONCLUSIONS EMSLD was reliable and effective for the removal of gastric SMTs. However, large-scale randomized controlled trials are needed.

Endoscopic polypectomy for pacemaker patients: is it safe?

Endoscopic polypectomy is believed to reduce the incidence of colorectal cancer, and it has become a standard practice for the removal of gastrointestinal polyps. However, for patients with implanted cardiac devices, endoscopic polypectomy is thought to be relatively contraindicated. Aside from two case reports from around 10 years ago, few studies have evaluated the safety of endoscopic polypectomy for this population. In this study, polypectomy was performed in 14 consecutive pacemaker patients to determine the safety of endoscopic polypectomy using high‐frequency current in patients with implanted cardiac devices.