Qingshan Pei

Rectal anastomotic atresia is rare in clinical practice and is challenging to manage using traditional approaches [1] [2] [3] [4]. Here, we report successful recanalization utilizing a forward-viewing echoendoscope and endoscopic radial incision and cutting (ERIC) technique. A 61-year-old man who had undergone laparoscopy-assisted radical resection combined with protective ileostomy and post-surgical chemoradiotherapy for rectal carcinoma was admitted to our hospital. Colonoscopy revealed a completely occluded anastomosis 10 cm from the anus, characterized by surgical staples and white scar ([Fig. 1]). To recanalize the lumen, the colonoscope was first inserted through a temporary stoma ([Video 1]). A mixed solution of contrast medium and methylene blue was injected and revealed by X-ray fluoroscopy ([Fig. 2]). Second, a forward-viewing echoendoscope (Olympus, Tokyo, Japan) was advanced to the obstruction site through the anus. The distal intestinal lumen was punctured with a 19-gauge needle (Cook Medical Inc., Bloomington, Indiana, USA) under the guidance of X-ray and endoscopic ultrasound (EUS) ([Fig. 3]), which was confirmed by successfully withdrawing the mixed solution. Then, a 0.035-inch guidewire was inserted and retained, and the puncture needle was retrieved. Unfortunately, dilation using an 8.5-Fr bougie (Cook Medical Inc.) failed due to the staples and severe fibrosis. Alternatively, a 10-Fr cystotome (Cook Medical Inc.) was used to incise the occlusion, and then the ERIC technique was meticulously executed using a Multi-Function Knife (Anrui Medicine Co., Ltd., Hangzhou, China), allowing the passage of the colonoscope. The anastomotic stenosis was sequentially dilated to 15 mm with a balloon (Micro-Tech [Nanjing] Co., Ltd., Nanjing, China) ([Fig. 4]). No severe immediate or delayed complications were observed during the procedure. Four more balloon dilation procedures were performed, and no progressive stenosis was revealed ([Fig. 5]). Eventually, the ileostomy was successfully reversed. This case highlights the utility of EUS-guided recanalization plus ERIC technique, providing a safe, effective, and less invasive option than surgery. Endoscopy_UCTN_Code_TTT_1AQ_2AF Article published online: 13 November 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Objective: There are no guidelines or consensus on the optimal treatment measures for small rectal neuroendocrine tumors (NETs) at present. This meta-analysis was conducted to compare the efficacy and safety of endoscopic mucosal resection (EMR) with suction and endoscopic submucosal dissection (ESD) for the small rectal NETs. Methods: The literature searches were conducted using Pubmed and Embase databases, and then a meta-analysis was performed. The primary outcome was complete resection rate, and the secondary outcomes were complication rate, procedure time, and recurrence rate. Results: Fourteen studies with 823 patients were included in our meta-analysis. The overall complete resection rates in EMR with suction and ESD procedure were 93.65% (472/504) and 84.08% (243/289), respectively. The pooled analysis showed that EMR with suction could achieve a higher complete resection rate than ESD with significance (OR: 4.08, 95% CI: 2.42–6.88, p < .00001) when the outlier study was excluded, and procedure time was significantly shorter in the EMR with suction group than in the ESD group (SMD: −1.59, 95% CI: −2.27 to −0.90, p < .00001). Moreover, there was no significant difference in overall complication rate (OR: 0.56, 95% CI: 0.28–1.14, p = .11) and overall recurrence rate (OR: 0.76, 95% CI: 0.11–5.07, I²=48%) between EMR with suction and ESD group. Conclusions: The present meta-analysis mostly based on retrospective studies show that EMR with suction is superior to ESD for small rectal NETs (≤10 mm) with higher complete resection rate, shorter procedure time, and similar overall complication rate and recurrence.

Cholangiocarcinoma (CCA), a devastating neoplasm, is highly resistant to current chemotherapies. CCA cells frequently overexpress the antiapoptotic protein myeloid cell leukemia-1(Mcl-1), which is responsible for its extraordinary ability to evade cell death. Triptolide, a bioactive ingredient extracted from Chinese medicinal plant, has been shown to inhibit cell proliferation and induce apoptosis in several cancers.