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Background and study aim Since its inception in 2007, single-operator cholangioscopy (SOC) has gained popularity for many diagnostically and therapeutically challenging biliary and pancreatic conditions. Many studies have been published to evaluate the feasibility, usefulness, cost-effectiveness, and safety profile of the first generation. This paper is a descriptive study in which we aim to share the experience of two tertiary care centers with the novel version of SOC, SpyGlass DS. Patients and methods We retrospectively reviewed the records of all the patients who went through the procedure from October 2015 - July 2019 to explore the scope of biliary and pancreatic conditions in which SOC was utilized. Technical success was defined as the ability to visualize the lesion and complete the procedure as planned, whereas clinical success was determined by the ability to achieve the desired diagnostic/therapeutic outcome. Results During the period of interest, 66 patients (34 males) went through 84 cholangioscopy procedures. Forty-four patients failed the conventional extraction methods and needed the intervention for the treatment of difficult stones, 24 patients needed a diagnostic evaluation of biliary strictures, and 3 needed an intervention to remove migrated stents. Technical success was achieved in 98.8% (83/84) of the procedures (95% CI: 96–100%). Regarding clinical success, stone breakdown and removal was achieved in 92% of the procedures (49/53; 95% CI: 85–100%). Tissue samples were successfully obtained in 95.8% (23/24) of patients with strictures (95% CI: 88–100%). The biopsy was appropriate to make a histological diagnosis in 83.3% of cases (20/24; 95% CI: 68–98%). The median number of sessions needed to achieve the deisred outcome was one (ranging between 1 and 6 sessions). Conclusion The new version of SOC, SpyGlass DS, provides a feasible and an effective option for the management of difficult cholelithiasis, as well as visually evaluating and obtaining histological samples for indeterminate biliary strictures. However, data from more extensive studies are needed to establish its non-inferiority to the fiberoptic version in terms of short- and long-term outcomes, cost-effectiveness, and complications.

Objectives: Cisplatin (CISP) is an effective chemotherapy used in the treatment of various types of cancer, but it causes nephrotoxicity and other adverse effects. Thymoquinone (THY) is an effective anti-inflammatory and antioxidant compound, which might protects against many chemotherapies associated toxicities. However, THY applications are hindered by its poor solubility and low bioavailability. This study evaluated the efficacy of a novel nanoparticle (NP) encapsulting THY to overcome its poor solubility, enhance its bioavilability, efficacy for the protection against CISP-induced nephrotoxicity in an Ehrlich solid carcinoma (ESC) mice model. Methods: Four treatment groups were included: 1) control, 2) tumour, 3) CISP, and 4) CISP + NP THY. Results: The results showed that NP THY was effective in preventing CISP-induced kidney toxicity in ESC mice and improved its function and pathology. NP THY effectively ameliorated CISP-induced oxidative stress conditions in the kidney tissue via increasing the levels of antioxidants both non-enzymatic (GSH) and enzymatic (SOD and CAT). NP THY, also, significantly reduced CISP-induced kidney inflammation by reducing TNF-α, IL-1β, and NF-kB levels. NP THY didn’t hinder the antitumor activity of CISP as shown by tumour weight and histological examination data. Conclusions: In conclusion, NP THY could be an adjuvant therapy to CISP cancer treatment to prevent associated nephrotoxicity and other adverse effects without compromising CISP antitumor efficacy.

Background and Aims: Complications such as need for bowel resections and hospitalization due to Crohn's disease (CD) occur when disease activity persists due to ineffective therapy. Certain “high-risk” features require an early introduction of anti-tumor necrosis factor-α therapy to prevent such complications. We aim to evaluate the prevalence of “high-risk” features among a cohort of patients with CD and examine the association between discordance of early therapy with baseline risk stratification and disease outcome. Patients and Methods: All adult patients with CD were retrospectively identified and their medical records were reviewed. Clinical, endoscopic, laboratory, and radiological data were collected. Patients were divided into “low” and “high” risk groups according to the presence or absence of penetrating disease, perianal involvement, foregut involvement, extensive disease seen on endoscopy or cross-sectional imaging, young age at the time of diagnosis (Results: Eighty-five CD patients were included. The median age and duration of disease were 25 (interquartile range [IQR] 19-32) and 5 (IQR 4-6) years, respectively. Sixty five percent were females and 66% were native Saudis. Smoking was reported in 12% of patients and perianal disease in 18%. “High-risk” features were identified in 43 (51%) patients, of which only 6 (14%) were treated with “top-down” therapy and 7 (16%) with “accelerated step-up” care. The risk of requiring a bowel resection, and hospitalization was higher for “high-risk” patients compared to “low-risk” patients (risk ratio [RR] 13.67, 95% CI 1.88-99.41; p = 0.003, and RR 1.86, 95% CI 0.03-0.43; p = 0.0312, respectively). “Discordance” occurred in 34% of cases. Bowel resection was required in 15/85 (18%) patients and 32/85 (38%) required at least one hospitalization within 5 years of diagnosis. Logistic regression analysis identified a statistically significant association between “discordance” and need for bowel resections (OR 6.50, 95% CI 1.59-26.27, p = 0.009), and hospitalizations (OR 3.01, 95% CI 1.08-8.39, p = 0.035) within 5 years of diagnosis. Conclusions: “Discordance” between patient risk-profile and treatment selection early in the course of CD has a significant impact on disease outcome, specifically need for bowel resection and hospitalization, which are more likely to occur in the presence of “high-risk” features. Early identification of “high-risk” features could help prevent long-term complications.