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OBJECTIVE: The aim of this study was to evaluate the usefulness of adult colonoscopy or single-balloon enteroscopy (SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) in long-limb surgical bypass patients. METHODS: Retrospective analysis of 16 patients with long-limb surgical bypasses who underwent therapeutic ERCP because of suspected pancreaticobiliary diseases. Small-bowel intubation was performed by peroral adult colonoscopy or SBE. If colonoscopy success was achieved, ERCP was performed subsequently. But in patients using SBE, a small-caliber colonoscope would be used to replace enteroscope if the SBE success was achieved. ERCP was then performed with the conventional accessories. RESULTS: A total of 21 ERCP procedures were performed. Adult colonoscope was used for ERCP in 8 patients with standard Whipple resection consecutively. Colonoscopy success was achieved in 8 of 8 patients (100%), of whom 7 of 8 (87.5%) achieved ERCP success. SBE-assisted ERCP was attempted in other 8 patients with different types of Roux-en-Y anatomy. SBE success was achieved in 7 of 8 patients (87.5%), of whom 4 of 7 (57.1%) achieved ERCP success. The overall success rate of endoscopy and ERCP was 93.8% (15/16) and 68.8% (11/16), respectively. CONCLUSIONS: Adult colonoscopy has high success rate for performing ERCP after Whipple resection and should be selected for such patient preferentially. By using the facilitated method for endoscopic interventions at pancreaticobiliary disease after Roux-en-Y reconstruction, SBE-assisted ERCP can be attempted when it is difficult to gain access to the papilla of Vater or bilioenteric/pancreaticoenteric anastomosis and long length ERCP accessories cannot be available.

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To detect chromosome translocation t(11;18) (q21;q21) and the nuclear expression of bcl-10 in gastrointestinal mucosa-associated lymphoid tissue (MALT) lymphoma in Chinese, a possible API2-MALT fusion transcript specific to t(11; 18) (q21; q21) in tumors from 42 cases of primary gastrointestinal lymphoma (29 cases of low grade MALT lymphoma, 13 cases of transformed MALT lymphoma) and 40 cases of diffuse large B cell lymphoma was examined by means of RT-PCR and proved by DNA-sequencing. Bcl-10 expression was examined by immunohistochemical method. The results showed that t(11;18) (q21;q21) was 14% positive in cases of low grade MALT lymphomas and 46% positive in transformed MALT lymphomas, but none in cases of DLBCL. Bcl-10 nuclear expression was seen 61% in low grade MALT and 69% in transformed MALT lymphoma. It was suggested that t(11;18) (q21;q21) was related to the prognosis and development of highly advanced MALT lymphoma but not relevant to DLBCL. Bcl-10 nuclear expressions were not significantly different between these two groups, which remains to be explained.

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OBJECTIVE: To investigate the relationship between Helicobacter pylori (Hp) infection and gastric cancer through the changes of gastric mucosa histopathology within 5 years after Hp eradication in Hp-positive subjects in the high incidence region of gastric cancer. METHODS: One thousand and six adults were selected from general population in Yantai, Shandong Province, the high incidence region of gastric cancer. Gastroscopy and CLO test were performed in all subjects. Biopsy samples from the gastric antrum and body were obtained for histology and assessment of Hp infection. All the Hp-positive subjects were then randomly divided into two groups: treatment group receiving OAC triple therapy and placebo as controls. These subjects were endoscopically followed up in the second and fifth year. In this article, we compared the endoscopic appearance and histology of the biopsy specimens from the same site obtained at the first and final visit. Statistical analysis was done by chi(2) test. RESULTS: All the 552 Hp-positive subjects were randomly divided into treatment group or control group, 276 in each. During the five-year follow-up, the number of patients who continued to be negative or positive for Hp was 161 and 198, respectively. Statistical analysis revealed that: (1) At the initial visit, there were no significant differences in the severity and activity of inflammation between the biopsy specimens from the antrum (P = 0.105) and body (P = 0.084) in both groups. But the proportion of atrophy and intestinal metaplasia in the antrum was much higher than that in the body (P = 0.000). (2) The severity and activity of inflammation in both the antrum and body were markedly reduced after Hp eradication (P = 0.000). (3) Within the five years after Hp eradication, intestinal metaplasia in the antrum regressed or had no progression, while the proportion of intestinal metaplasia in the Hp-positive group increased significantly (P = 0.032). (4) After Hp eradication, the atrophy in both the antrum and body had no significant regression. P value was 0.223 and 0.402, respectively. CONCLUSIONS: Hp eradication results in remarkable reduction in the severity and activity of chronic gastritis, marked resolution of intestinal metaplasia in the antrum. On the other hand, continued Hp infection leads to progressive aggrevation of atrophy and intestinal metaplasia.

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