Background Hands-on endoscopy workshops are popular and valuable sources for the continuing medical education of endoscopists. Concerns, however, exist regarding clinical outcomes of procedures ...performed during hands-on training of ERCP. Objective We compared the success rates and complications between patients in the hands-on training courses and matched control patients. Design A retrospective, multicenter study. Setting Seven endoscopy centers in mainland China. Patients All patients who underwent ERCP during hands-on training courses at GI endoscopy conferences in China between January 2002 and December 2006 were included. Main Outcome Measurements Clinical and endoscopic characteristics, including age, sex, indication, therapeutic intervention, success rate, and complication, were collected. Differences in ERCP outcomes between domestic and foreign mentors were also compared. Conference, patient, and endoscopist-related variables were analyzed for potential risk factors associated with post-ERCP complications. Results Nine conferences with hands-on ERCP training, including 124 patients, were held at 7 endoscopy centers. There were no significant differences in the sex ratio, age, indication, and therapeutic intervention between patients for hands-on training (n = 124) and controls (n = 124). The success rates and overall complication rates were similar between the 2 groups (91.9% vs 92.7%, respectively, P = .811; 12.9% vs 9.7%, respectively, P = .422). Domestic mentors encountered more post-ERCP complications than foreign mentors (18.0% vs 0%, respectively, P = .001). Univariate analyses showed that a large-scale conference ( P = .004), first-time mentorship ( P = .015), and small case volume for the mentor ( P = .015) were significantly associated with post-ERCP complications. Nominal significance in univariate testing was removed when analyzed in a comprehensive multivariate setting. Limitations A nonrandomized retrospective trial with only 7 centers (9 conferences). Conclusions The success rate and overall complication rate were similar between patients in the hands-on training and those who had routine ERCP procedures. A large-scale conference, first-time mentorship, and small case volume for the mentor may be associated with post-ERCP complications.
Actual behaviors of drugs in the upper GI tract are not well elucidated. We assess the feasibility of magnetically controlled capsule endoscopy (MCE) in direct and real-time visualization of oral ...drug behaviors in the stomach.
From November 2019 to December 2019, 9 patients with a recent history of upper GI symptoms and 10 healthy volunteers were enrolled in this study. Participants swallowed magnetically controlled capsules to examine the whole stomach. After baseline examination, participants ingested dyed sucralfate gel, and MCE recorded the adhesion time, retention time, and distribution area of sucralfate gel. Outcomes included behaviors of sucralfate gel, safety, and satisfaction assessment of the procedures.
Adhesion time of sucralfate gel in the abdominal symptoms group was significantly shorter than in the healthy control group (23.76 ± 1.37 minutes vs 31.96 ± 3.09 minutes; P = .032), whereas retention time was longer (98.85 ± 13.94 minutes vs 63.93 ± 8.57 minutes; P = .043). The distribution area of sucralfate gel in the abdominal symptoms group was significantly larger than in healthy control group in cardia (24.29 ± 7.39 vs 9.18 ± 4.06; P < .0001), fundus (18.90 ± 7.08 vs 8.49 ± 4.10; P = .0015), and pylorus (4.64 ± 2.72 vs 0.94 ± 0.90; P = .0019). No adverse events were observed. All participants had a high degree of satisfaction.
MCE is a feasible and noninvasive tool for direct and real-time visualization of drug behaviors (eg, sucralfate gel) in the stomach. (ClinicalTrials.gov. ID: NCT04327869.)
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Background & Aims: A hybrid allele that originated from homologous recombination between CEL and its pseudogene (CELP), CEL-HYB1 increases the risk of chronic pancreatitis (CP). Although suggested to ...cause digestive enzyme misfolding, definitive in vivo evidence for this postulate has been lacking. Methods: CRISPR-Cas9 was used to generate humanized mice harboring the CEL-HYB1 allele on a C57BL/6J background. Humanized CEL mice and C57BL/6J mice were used as controls. Pancreata were collected and analyzed by histology, immunohistochemistry, immunoblotting, and transcriptomics. Isolated pancreatic acini were cultured in vitro to measure the secretion and aggregation of CEL-HYB1 protein. Mice were given caerulein injections to induce acute pancreatitis (AP) and CP. Results: Pancreata from mice expressing CEL-HYB1 developed pathological features characteristic of focal pancreatitis that included acinar atrophy and vacuolization, inflammatory infiltrates, and fibrosis in a time-dependent manner. CEL-HYB1 expression in pancreatic acini led to decreased secretion and increased intracellular aggregation and triggered endoplasmic reticulum stress compared with CEL. The autophagy levels of pancreata from mice expressing CEL-HYB1 changed at different developmental stages; some aged CEL-HYB1 mice exhibited an accumulation of large autophagic vesicles and impaired autophagy in acinar cells. Administration of caerulein increased the severity of AP/CP in mice expressing CEL-HYB1 compared with control mice, accompanied by higher levels of endoplasmic reticulum stress. Conclusions: Expression of a humanized form of CEL-HYB1 in mice promotes endoplasmic reticulum stress and pancreatitis through a misfolding-dependent pathway. Impaired autophagy appears to be involved in the pancreatic injury in aged CEL-HYB1 mice. These mice have the potential to be used as a model to identify therapeutic targets for CP.
Background Reports on endoscopic management of ingested foreign bodies of the upper-GI tract in China are scarce. Objective To report our experience and outcome in the management of ingestion of ...foreign bodies in Chinese patients. Setting and Patients Between January 1980 and January 2005, a total of 1088 patients (685 men and 403 women; age range, 1 day to 96 years old) with suspected foreign bodies were admitted to our endoscopy center. Interventions All patients underwent endoscopic procedure after admission. Main Outcome Measurements Demographic and endoscopic data, including age, sex, and referral sources of patients, types, number and location of foreign bodies, associated upper-GI diseases, endoscopic methods, and accessory devices for removal of foreign bodies were collected and analyzed. Results A total of 1090 foreign bodies were found in 988 (90.8%) patients. The types of foreign bodies varied greatly: mainly food boluses, coins, fish bones, dental prostheses, or chicken bones. The foreign bodies were located in the pharynx (n = 12), the esophagus (n = 577), the stomach (n = 441), the duodenum (n = 50), and the surgical anastomosis (n = 10). The associated GI diseases (n = 88) included esophageal carcinoma (33.0%), stricture (23.9%), diverticulum (15.9%), after gastrectomy (11.4%), hiatal hernia (10.2%), and achalasia (5.7%). A rat-tooth forceps and a snare were the most frequently used accessory devices. The success rate for foreign-body removal was 94.1% (930/988). Conclusions Ingestion of foreign bodies is a common clinic problem in China. Also in China, an endoscopy procedure is frequently performed, and a high proportion of patients with foreign bodies require endoscopic intervention.
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