Double-balloon enteroscopy for retrieving retained small-bowel video capsule endoscopes: a systematic review

Abstract

Background and aim: Capsule retention is the most common adverse event associated with video capsule endoscopy. The use of double-balloon enteroscopy-assisted capsule endoscope retrieval has been increasingly reported in recent years. However, evidence is limited regarding its success rate, associated factors, and subsequent clinical outcomes.

Methods: A systematic review of relevant studies published before January 2019 was performed. Successful retrieval rate and associated factors, rate of endoscopic balloon dilation, and outcomes after double-balloon enteroscopy were summarized and pooled.

Results: Within 154 associated original articles, 12 including 150 cases of capsule retrieval by double-balloon enteroscopy were included. The estimated pooled successful retrieval rate was 86.5% (95% confidence interval, 75.6–95.1%). Anterograde approach and capsules retained in the jejunum or trapped by malignant strictures were associated with a higher successful retrieval rate than the retrograde approach (62/83 [74.7%] vs. 10/38 [26.3%], p?<?.001) and capsules retained in the ileum (41/41 [100.0%] vs. 43/58 [74.1%], p?<?.001) or trapped by benign strictures (21/21 [100.0%] vs. 65/83 [78.3%], p?=?.043). Endoscopic balloon dilation was performed in 38.8% (95% confidence interval, 22.3–56.3%) of patients with benign strictures. Two perforations (1.3%) were reported as severe adverse events after double-balloon enteroscopy. A significantly lower surgery rate was found among cases with successful video capsule removal compared with unsuccessful cases (7.2% vs. 38.5%, p?=?.002).

Conclusions: Double-balloon enteroscopy is feasible and safe for removing retained video capsule endoscopes, and its use could decrease the need for surgery in patients with benign strictures and facilitate subsequent surgery in patients with malignant strictures.     

Successful treatment of advanced ovarian cancer with anlotinib: a case report

Ovarian cancer remains the most lethal gynecological malignant tumor, with relapse occurring in approximately 70% of advanced cases. Anlotinib is an oral small-molecule multi-targeted tyrosine kinase inhibitor that can resist neoangiogenesis and inhibit tumor growth. Previous research demonstrated clinical antitumor activity of anlotinib in various cancers. We report the case of an elderly woman with advanced ovarian cancer who received anlotinib after failure of multiple-line chemotherapy. A partial response was observed after six cycles of anlotinib monotherapy, with a reduction in the size of the metastases and significantly decreased serum CA125 levels from 1832.7 U/mL to 118.7 U/mL. She continued to take anlotinib, with a progression-free survival time of more than 4 months. Only mild hypertension was observed during the treatment. Anlotinib monotherapy may be a novel therapeutic option for patients with advanced ovarian cancer.     

GPER-mediated,oestrogen-dependent visceral hypersensitivity in stressed rats is associated with mast cell tryptase and histamine expression

Visceral hypersensitivity (VH) is common in irritable bowel syndrome (IBS), and female patients are more likely to seek healthcare services for IBS-related abdominal pain. Oestrogen has been reported to mediate pain modulation via its receptor, and mast cells are known to participate in the development of visceral hypersensitivity. Our previous studies showed that the G-protein-coupled oestrogen receptor (GPER, also known as GPR30) was expressed by mast cells in human colonic tissues and was associated with IBS type and severity of visceral pain. However, whether GPER is involved in oestrogen-dependent visceral hypersensitivity via mast cell degranulation is still unknown. Rats were subjected to wrap partial restraint stress to induce visceral hypersensitivity and were ovariectomized (OVX) to eliminate the effects of oestrogen on visceral hypersensitivity. OVX rats were treated with oestrogen, an oestrogen receptor α and β antagonist (ICI 182.780), a GPER antagonist (G15) or a GPER agonist (G1), to evaluate the effects of oestrogen via its receptor. The colorectal distention test was performed to assess visceral sensitivity. Immunofluorescence studies were performed to evaluate GPER and mast cell tryptase co-expression. Mast cell number with degranulation was detected by specific staining. Mast cell tryptase expression in rat colon was also investigated by Western blot and immunohistochemistry. Substance P and histamine expression were examined by ELISA. GPER was expressed by the majority of tryptase-positive mast cells in the colonic mucosa. Stressed rats showed increased visceral sensitivity, increased mast cell degranulation, mast cell tryptase expression, and increased colon histamine levels. Ovariectomy reduced stress-induced VH in female rats and decreased mast cell degranulation, mast cell tryptase expression, and histamine levels, whereas oestrogen replacement reversed these effects. In OVX rats, the GPER antagonist G15 counteracted the enhancing effects of oestrogen on stress-induced VH, mast cell degranulation, mast cell tryptase, and histamine expression, whereas VH was preserved after treatment with ICI 182.780. On the other hand, pretreatment with the selective GPER agonist G1 at doses between 1 and 20 μg/kg significantly increased VH, mast cell tryptase, and histamine expression in OVX-stressed rats, mimicking the effects of oestrogen. GPER plays a pivotal role in the regulation of mast cell degranulation, mast cell tryptase expression, and histamine levels and contributes to the development of colonic hypersensitivity in a female rat model of IBS.     

脑白质疏松与卒中复发相关性的meta分析

目的系统评价脑白质疏松在卒中复发风险预测中的价值。方法计算机检索Pub Med、Web of science、Embase及维普、中国生物医学文献数据库、中国知网等数据库截止2019年3月15日收录的关于脑白质疏松及卒中复发关系的文献。提取资料进行质量评价并进行meta分析,利用Begg’s漏斗图和Egger’s检验评估发表偏倚。结果最终纳入33篇文献,共34444例。meta分析显示,当结局指标为任何类型复发性卒中时,中重度组与轻度或无组比较(RR=1. 71,95%CI:1. 44～2. 04),I~2=55. 69%;有脑白质疏松组与无脑白质疏松组比较(RR=1. 79,95%CI:1. 43～2. 25),I~2=56. 26%;连续性分析组(RR=1. 81,95%CI:1. 47～2. 23),I~2=34. 63%。当结局指标为缺血性卒中时,中重度组与轻度或无脑白质疏松组比较(RR=1. 82,95%CI:1. 36～2. 42),I~2=48. 43%;有脑白质疏松组与无脑白质疏松组比较(RR=2. 13,95%CI:1. 37～3. 32),I~2=70. 64%;连续性分析组(RR=2. 01,95%CI:1. 13～3. 58),I~2=69. 78%。亚组分析结果显示脑白质疏松对于远期复发性卒中的预测价值更高。通过Begg’s漏斗图和Egger’s检验,仅当结局指标为任何类型复发性卒中时,中重度组与轻度或无脑白质疏松组比较有显著性发表偏倚,经剪补法校正后仍提示相关性。结论脑白质疏松对于复发性卒中具有预测价值。     

经皮肺动脉瓣植入术在肺动脉瓣反流患者中的临床应用

经皮肺动脉瓣植入术(PPVI)在我国作为一种新兴的技术,开展相对较晚,但随着我国医疗水平的不断提高以及临床对于右心室流出道梗阻的先天性心脏病患者术后出现重度肺动脉瓣反流的不断重视,PPVI在我国得到了飞速发展。近十几年来,欧美国家已在临床成熟应用PPVI,相对于传统外科手术而言其具有微创、可重复性、术后疗效好等优点。现对PPVI在肺动脉瓣反流患者中的临床应用进行叙述。     

帕瑞昔布钠联合羟考酮对胸腔镜下肺叶切除术后患者的疗效分析

正胸腔镜在胸外科肺叶切除手术中应用日益广泛,但术后患者仍存在明显疼痛,影响患者康复,良好的术后镇痛能使能减少患者术后卧床时间,利于肠功能的恢复,减少其术后肺部并发症,因此,术后镇痛仍是医护人员急需解决的问题[1-3]。研究表明,帕瑞昔布钠的超前镇痛在缓解术后疼痛方面有着显著效果,它可以提高患者术后的舒适程度,且不增加术后不良反应[4-6]。但帕瑞昔布钠联合羟考酮在胸腔镜肺叶切除术中的应用还没有报道。本文探讨了帕瑞昔布钠联合羟考酮对胸腔镜下肺叶切除术后患者的疗效,现报道如下。