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Background: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous surgery and reconstruction of gastrointestinal tract is often challenging. Numerous reports of ERCP with short type double balloon enteroscope (DBE) in patients with surgically altered anatomy have been published since 2009 and reported overall ERCP success rates varying widely. The aim of this study was to evaluate the efficacy and safety of ERCP with short type DBE in patients with surgically altered anatomy in a systematic review and meta-analysis. Methods: A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 2001 to December 2018. The following end points were analyzed: enteroscopy success rate, diagnostic ERCP success rate, therapeutic ERCP success rate, overall ERCP success rate, and complications. Data were selected and abstracted from eligible studies and were pooled using a random-effects model. Heterogeneity was assessed using the I2 test. Results: Nine studies involving a total of 1,054 procedures in 890 patients were included in the analysis. The pooled enteroscopy, diagnostic, therapeutic, and overall ERCP success rates were 94.3% [95% confidence interval (CI): 88.9–98.0%], 94.3% (95% CI: 90.8–97.1%), 98.3% (95% CI: 95.5–99.7%) and 85.6% (95% CI: 78.7–91.3%), respectively. Among patients who underwent Roux-en-Y reconstruction, the overall ERCP success rate was 83.8% (95% CI: 75.3–90.8%). In patients who had undergone a pancreatoduodenectomy (PD), the overall ERCP success rate was 92.2% (95% CI: 79.8–99.0%). In patients with Billroth II gastrectomy, the overall ERCP success rate was 92.9% (95% CI: 84.0–98.4%). ERCP with short type DBE-related complications occurred in 38 patients including pancreatitis, perforation, cholangitis, bleeding, and liver graft ischemia. The incidence of ERCP with short type DBE -related complication was 3.8% (95% CI: 2.4–5.5%). Conclusions: Diagnostic and therapeutic ERCP with short type DBE are feasible in patients with altered gastrointestinal anatomy with satisfactory success rate and acceptable complication rate. ERCP with short type DBE may be considered when pancreaticobiliary diseases occur in patients undergoing reconstruction of gastrointestinal tract.

Acute variceal hemorrhage (AVH) is a devastating complication of liver cirrhosis. Endoscopic variceal ligation (EVL) is a useful endoscopic treatment for AVH with few complications. However, the issue regarding management of early re-bleeding after EVL still needs to be concerned. Furthermore, the dietary principle after EVL is unclear. There is no consensus regarding what food should be eaten after EVL. In this paper, we reported a patient who ate a banana after an EVL and then developed early re-bleeding episodes.

Background: Endoscopic treatment is the mainstay treatment option for gastroesophageal varices. A retrospective study was performed to evaluate the risk factors for 5-day bleeding after endoscopic treatments for gastroesophageal varices in liver cirrhosis. Methods: All cirrhotic patients who were consecutively admitted to our department between January and March 2016 and underwent endoscopic treatments for gastroesophageal varices were considered in this study. 5-day bleeding after endoscopic treatments was identified. Receiver operating curve (ROC) analysis was performed to calculate the diagnostic accuracy of baseline factors for predicting the occurrence of 5-day bleeding after endoscopic treatments. The area under curve (AUC) with 95% confidence interval (CI) was calculated. Results: Overall, 95 patients were included. Eight (8.6%) patients developed 5-day bleeding after endoscopic treatments. Patients who developed 5-day bleeding after endoscopic treatments had significantly longer duration of hospitalizations and higher in-hospital mortality than those who did not develop. Five-day bleeding was significantly associated with lower albumin levels and higher prothrombin time, INR, and D-dimer level at baseline. In the ROC analysis, the AUC of albumin level for predicting the risk of being free of 5-day bleeding was 0.750 (95% CI: 0.571–0.929, P=0.020), and the AUCs of prothrombin time, INR, and D-dimer level for predicting the risk of 5-day bleeding were 0.850 (95% CI: 0.761–0.939, P=0.001), 0.790 (95% CI: 0.661–0.918, P=0.007), and 0.833 (95% CI: 0.729–0.938, P=0.002). Conclusions: Albumin, prothrombin time, INR, and D-dimer level should be significant risk factors for 5-day bleeding after endoscopic treatments for gastroesophageal varices in liver cirrhosis.

This paper aims to systematically review the major findings from meta-analyses regarding the impact of hypoxia-inducible factors (HIFs) in various human cancers. A total of 56 eligible meta-analysis papers were identified via the PubMed and EMBASE databases. The associations of HIF-1α gene polymorphism and/or HIF-1α and HIF-2α protein expression with the risk, clinicopathological features, and/or survival were explored in head and neck cancer (n=4), glioma (n=2), oral cancer (n=10), oropharyngeal cancer (n=1), nasopharyngeal cancer (n=1), lung cancer (n=12), breast cancer (n=17), esophageal cancer (n=5), gastric cancer (n=8), colorectal cancer (n=15), pancreatic cancer (n=8), hepatocellular carcinoma (n=5), prostate cancer (n=13), renal cancer (n=13), bladder cancer (n=3), ovarian cancer (n=3), cervical cancer (n=10), endometrial cancer (n=1), and osteosarcoma (n=1). Based on the current evidence, the impact of HIFs should be heterogeneous on various human cancers.

Acute ischemic stroke is one of the leading causes of death in the world. Major risk factors include behavior, metabolism, and environment-related factors. To our knowledge, no study has reported the association between acute ischemic stroke and acute upper gastrointestinal bleeding. Herein, we presented two cases of acute upper gastrointestinal bleeding who developed acute ischemic stroke during their hospitalizations. The potential mechanisms for explaining their association were preliminarily discussed.

Serum carbohydrate antigen 19-9 (CA19-9), a common tumor marker, is frequently increased in bile duct malignancy. We reported a case with an extremely increased CA19-9 level due to benign common bile duct stones and gallstones. A 63-year-old male presented with intermittent right upper quadrant abdominal pain for 1 year. Tumor markers showed that CA19-9 level was more than 1,000.0 U/mL (normal range: 0–37 U/mL), CA-50 level was 466.34 IU/mL (normal range: 0–25 IU/mL), and CA24-2 level was more than 200 IU/mL (normal range: 0–20 IU/mL). Abdominal CT scan and magnetic resonance cholangiopancreatography (MRCP) demonstrated multiple stones located in the lower segment of common bile duct, lower bile duct obstruction, and gallbladder stones. Pancreatic cancer and cholangiocarcinoma were excluded. On the third day after endoscopic retrograde cholangiopancreatography (ERCP), CA19-9 level dropped to 78.62 U/mL. In conclusion, an extremely increased CA19-9 level might be observed in some patients with benign bile duct diseases.

In this paper, we illustrated a very rare type of spontaneous portosystemic shunt originating from main portal vein to right renal vein in a cirrhotic patient. The diagnosis of such a large spontaneous portosystemic shunt was established according to the axial contrast-enhanced computed tomography scans. The cause and outcome were also discussed.