Formalin-fixed, paraffin-embedded liver sections were stained with hematoxylin and eosin (H&E) or Reticulin by the University of Pittsburgh Research Histology services.

An experienced pathologist (E.S.) evaluated liver histology while blinded to the treatment groups. Sections were stained for F-actin with TRITC-phalloidin (Sigma-Aldrich, St. Louis, MO) or claudin-2 antibody. Fluorescence (Eclipse E600, Nikon) or confocal (LSM-510) microscopes were used to capture digital images. Navitoclax mw Liver tissue was fixed with 2.5% glutaraldehyde in phosphate-buffered saline by perfusion via the inferior vena cava. Transmission and scanning electron microscopy were performed as described previously by Wack et al.12 The common bile duct was ligated and the gallbladder was cannulated after a midline laparotomy with a polyethylene (PE-10) tube. Bile was collected for 20 minutes to obtain the flow rate and for analysis of bile composition. Excretion rates of bile components were calculated by measuring the concentration of each component by biochemical assay as described below and adjusting for bile flow rate and body weight. Functional integrity of hepatic tight junctions was measured as described by Han et al. using fluorescein isothiocyanate (FITC)-conjugated

dextran, molecular weight 40 kDa (FD-40).13 Glutathione, phospholipids, total bile acids, and total cholesterol levels in bile were determined selleck chemicals llc using commercially available kits from Biovision (Mountain View, CA), Wako Chemicals medchemexpress (Richmond, VA), Diazyme (Poway, CA), and Stanbio (Boerne, TX), respectively, according to the manufacturer’s instructions. Serum bilirubin, alkaline phosphatase, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were determined using automated methods in the University

of Pittsburgh clinical chemistry laboratory. Hepatic total bile acid levels was determined by homogenizing 100 mg minced frozen liver tissue in 0.5 mL ice-cold phosphate-buffered saline with Halt protease and phosphatase inhibitor cocktail (Pierce, Rockford, IL). Cellular debris was removed by centrifuging at 600g for 10 minutes at 4°C, and the supernatant centrifuged at 105,000g at 4°C to recover purified cytosol. Cytosolic total bile acid levels were measured using a total bile acids kit from Diazyme and normalized to protein concentration for each sample. RNA extraction and real-time PCR (RT-PCR) were performed as previously described using proprietary TaqMan primers from Applied Biosystems (Foster City, CA).14 The list of primers is provided in Supporting Table 1. The results are expressed as relative to that in WT mice on chow diet (set at 1). Crude liver membrane extracts were prepared by homogenizing minced tissue in 100 volumes of ice-cold homogenizing buffer (0.25 M sucrose, 10 mM Tris-HCl [pH 7.4]) containing protease and phosphatase inhibitor cocktail (Pierce).

For each primary and secondary variable, comparisons between treatment groups were made by analysis of covariance of change from baseline, with the same variable’s baseline value as a covariate, with main effects of treatment group and acute pain

medication overuse strata. The baseline covariate adjustment was prespecified as the primary analysis. Missing data were imputed using Gamma-secretase inhibitor a prespecified modified last-observation carried forward methodology (mLOCF) previously described.32,33 For binomial variables, the between-group comparisons were performed with Pearson’s chi-square or Fisher’s exact tests, except that logistic regression with baseline covariate was used for variables with baseline imbalance. This a priori planned analysis corrected for the baseline imbalance. A 2-sided test with P ≤ .05 was considered to be statistically significant. Safety analyses were performed on all randomized patients who received at least 1 dose of study medication at day 0. Contributors.— All authors formed the core writing team for the manuscript and contributed to study conception, design, data analysis, and interpretation. C.C.T., R.E.D., and M.F.B. also provided administrative support and were involved in the collection and/or assembly of data for the PREEMPT trials. S.K.A., S.D.S., Veliparib R.B.L., and H.C.D. provided patients

for the PREEMPT trials. All authors contributed to and commented on the manuscript draft and gave their final approval to submit for publication. Demographic and Baseline Headache Characteristics.— A total of 3333 patients were screened for the PREEMPT studies, with 1384 patients randomized and thus included in

the pooled analyses (n = 688 onabotulinumtoxinA; n = 696 placebo). At baseline, there were no notable differences between the pooled treatment groups for most of the important demographic characteristics (Table 1). However, at baseline the onabotulinumtoxinA group compared with the placebo group on average had significantly medchemexpress fewer headache episodes (12.2 vs 13.0; P = .004) and migraine episodes (11.4 vs 12.2; P = .004), and significantly more total cumulative hours of headache occurring on headache days (295.9 vs 281.2; P = .021) (Table 1). Most patients overused acute pain medications during the 28-day baseline; however, very few (1.7%) had opioid overuse. The rate of patient compliance in reporting diary data was high both at baseline (>99%) and throughout the 24-week double-blind phases (>93%). There was no difference in diary compliance between treatment groups. Primary Variable: Frequency of Headache Days.— There was a large mean reduction from baseline in the frequency of headache days in both treatment groups.

For the detection of persisting HCV-NS3 Ag in the liver, liver tissue samples isolated 21 days post-infection were homogenized in RIPA C buffer (50 mM Tris pH 7.5, 1% Triton X-100, 300 mM NaCl, 5 mM ethylenediaminetetraacetic

acid, 0.02% NaN3) to make 2% (w/v) extract and used for immune precipitation/western blot assay. Liver tissue extracts were incubated with protein-G sepharose beads for 30 min at 4°C to remove non-specifically bound proteins. After centrifugation, supernatants were incubated with anti-Flag-M2 antibody PI3K inhibitor (Sigma-Aldrich) coupled protein-G sepharose beads for 2 h at 4°C. After centrifugation, HCV-NS3-3xFlag fusion protein bound to the beads were dissolved in sample buffer and separated on 10% sodium dodecylsulfate polyacrylamide gel electrophoresis gels (Mini PROTEAN TGX gel; Bio-Rad, Hercules, CA, USA) for immunoblot analysis using anti-Flag-M2 antibody and

goat antimouse Ig horseradish peroxidase (KPL, Gaithersburg, MD, USA). Electrochemiluminescence Prime Western Blotting Detection Reagent (GE Healthcare, Little Chalfont, UK) was used for chemiluminescent detection. Mann–Whitney U-tests were used to evaluate the significance of the differences. Correlations between parameters were tested for statistical selleck significance by Pearson correlation. TO DETERMINE THE effect of the amount of virus dose, we evaluated hepatic inflammation and compared the magnitude of HCV-NS3-specific CD8 T-cell responses and their effector function in the liver of mice infected with 2 × 107, 1 × 109 and 1 × 1010 PFU Ad-HCV-NS3. In histological studies, we observed Ad-infection-mediated hepatic inflammation in mice injected with MCE公司 1 × 109 and 1 × 1010 PFU. Especially, infection with 1 × 1010 PFU caused drastic infiltrations

of inflammatory cells (Fig. 1a). We also observed that CD8 lymphocytes infiltrated into the lobular areas of the infected liver in mice injected with 1 × 1010 PFU (Fig. 1b). At 7 days post-infection, we found by flow cytometric assay that the numbers and the frequencies of CD8 T cells in the liver were markedly increased after infection with 1 × 109 PFU and 1 × 1010 PFU, and the increased CD8 T cells decreased with time (Fig. 1c). We did not find significant differences between the number of CD8 T cells of core (+) and core (−) at each time point and infectious dose. In addition, we evaluated core protein expression in the liver in each infectious dose at 7 and 14 days post-infection; there was no significant difference in core protein expression between Ad-infected and non-infected livers (Fig. 1e). Using major histocompatibility complex (MHC) class I tetramer complexed with the H2-Db-binding HCV-NS3 GAVQNEVTL epitope, we found that i.v. infection with 2 × 107 PFU generally elicited only a weak expansion of HCV-NS3 tet+ CD8+ IHL (Fig. 2a,b) and IFN-γ+ HCV-NS3 tet+ CD8+ IHL (Fig. 2a,c).

Categorical variables were evaluated using a chi-squared test. The Student t test was applied to normally distributed noncategorical variables, and nonparametric statistics, including the Wilcoxon rank sum test, were applied to all others. Differences with two-tailed P ≤ 0.05 were considered significant.

We determined odds ratios (ORs) and their 95% confidence intervals relating HBV or HCV viral dominance LY2606368 to sex, age, ethnicity, and monoinfection versus dual infection status using both uncontrolled univariate logistic regression and adjusted multivariate logistic regression. All statistical analyses were performed using Stata version 10.0 software (StataCorp LP, College Station, TX). A total of 115 consecutive HBV/HCV dual-infected patients with serial HBV DNA, HCV RNA, and ALT test results from January 1994 through March 2009 were included in the data analysis along with an age-, sex-, ethnicity-, and site-matched HBV-monoinfected cohort. Both groups had an identical mean age (52 ± 14 years), sex MK-1775 concentration distribution (68% male), and ethnic distribution (83% Asian versus non-Asian). The HBV-monoinfected control patients had a lower prevalence of smoking

(21% versus 34%; P = 0.09) and alcohol consumption (17% versus 32%; P = 0.03) compared with dual-infected patients. No significant differences were found at the time of presentation when comparing monoinfected patients with dual-infected patients for the following clinical and laboratory characteristics: body mass index (24 ± 5.3 versus 24 ± 3.5; P = 0.89), HBeAg (18%

versus 12%; P = 0.28) or antibody to HBeAg (79% versus 88%; P = 0.08), family history of either HBV or HCV (19% versus 19%; P = 0.99), family history of HCC (9% versus 9%; P = 0.99), and median follow-up duration (38 months versus 33 months; P = 0.85). There was no difference in the rate of preexisting HCC (6% versus 4%; P = 0.36). These data are summarized in Table 1. HBV genotype and the presence of HBV viral mutations were also evaluated, and no significant differences between monoinfected and 上海皓元 dual-infected patients were found at the time of presentation: 78% of monoinfected patients had genotype B and 22% had genotype C, whereas 71% of dual-infected patients had genotype B and 29% had genotype C (n = 32/17; P = 0.66). HBV precore mutations were found in 71% of monoinfected patients and 75% of dual-infected patients (n = 28/16; P = 0.8) and basal core promoter mutations in 46% versus 44%, respectively (P = 0.86). No DNA polymerase mutations were found in either study group. The baseline hepatic inflammation and fibrosis scores were also measured and compared in the two populations. Among HBV-monoinfected patients, 77% had grade 1 or 2 inflammation and 23% had grade 3 or 4 inflammation, whereas dual-infected patients had scores of 66% and 34% for mild to moderate versus more advanced inflammation, respectively (n = 22/30; P = 0.44).

Each partner independently reported time periods of sexual activity and the number of contacts per month during that time period. Since the time periods reported by each partner might not match perfectly, we calculated the number of contacts per time period per partner and summed the estimated number of contacts Vismodegib per each partner over the duration of the relationship. The average of the total number of contacts reported by partner 1 and partner 2 was used as the total number of contacts for the couple. Prevalence of anti-HCV positivity and 95% CIs were calculated for the partners

of index subjects. Incidence of sexually acquired HCV infection was estimated per number of sexual contacts (vaginal intercourse with and without menses and anal intercourse). Incidence density of HCV infection was calculated as the number of potential transmission events per total person-years of sexual relationship reported among partners. Duration of the sexual relationship was summed among the 500 partners to determine the total person-years of

observation. Of the 2,077 couples screened for study inclusion, 672 (32%) were eligible. Reasons for study exclusion occurring in ≥5% of the 1,405 ineligible couples included lack of sexual activity (31%), prior organ transplant (12%), refused study participation (11%), doctor refused (8%), HIV or HBV coinfection (8%), partnership less than 3 years or nonmonogamous (6%), and history of IDU in both partners (6%). Of the 672 eligible couples, 500 (74%) enrolled and completed all the study requirements, at which time study enrollment was halted. The primary reasons Selleckchem Stem Cell Compound Library for failure MCE to participate among the remaining 172 eligible couples were nonresponse (54%) or refusal (29%). Of the 500 enrolled couples, 43% were referred from tertiary referral practices, 34% from community sources, and 21% were blood donors. The 500 couples were predominantly non-Hispanic white, educated, employed, and born in the United

States (Table 1). The median duration of the couples’ sexual relationships was 15 years (range, 2-52 years). The most frequently reported risk factors for HCV infection among index subjects were IDU (53.8%) and blood transfusion before 1992 (31.6%); these risks were infrequently reported by partners. Twenty or more lifetime sex partners prior to the current relationship were reported by 46.2% of index subjects and 26.8% of partners. The median number of sexual contacts per month was highest for vaginal intercourse during the first year of the relationship (12 contacts per month) (Table 2). The frequency of sexual contacts decreased over time for all types of sexual activity. Vaginal intercourse during menses and anal intercourse (≥1 occasion) were reported by 65.2% and 30.4% of couples, respectively. Condom use during vaginal intercourse was reported by 29.9% of couples and condom use decreased over time for vaginal and anal intercourse.

Together with the well-known down-regulation of miR-199a/b-3p in nonasiatic HCC collectives,14 these data highlight the importance of miR-199a/b-3p expression in liver diseases and HCC. In further experiments, the authors explored the functional significance of miR-199a/b-3p down-regulation in HCC. First, restoration of miR-199a/b-3p expression in HCC cell lines inhibited cell growth, induced apoptosis, and inhibited

cell cycle progression, indicating that miR-199a/b-3p selleck chemical may function as a tumor suppressor in vitro. Moreover, infection of a human HCC-bearing nude mouse model (SMMC-LTNM model) with an adeno-associated virus 8 (AAV-8) vector system to overexpress miR-199a/b-3p led to inhibition of tumor growth and reduction of serum alpha-fetoprotein,

even after a single Wnt tumor tail vein injection. As pointed out before, miRNAs can suppress transcription and translation of hundreds of target mRNAs. To identify the relevant targets of miR-199a/b-3p in the context of hepatocarcinogenesis, the authors followed different approaches, including in silico analysis of databases, gene enrichment, and ontology analysis. By combining these respective approaches, the authors could identify the mitogen-activated protein kinase (MAPK) signaling pathway as a potential target of miR-199a/b-3p. Of this pathway, only PAK4 (p21 protein [Cdc42/Rac]-activated kinase 4) contains putative miR-199a/b-3p target sites. Strikingly, expression of PAK4 could not only be down-regulated by miR-199a/b-3p transfection and overexpression, medchemexpress but high PAK4 protein levels also correlated with low miR-199a/b-3p expression in HCC samples. The pathophysiological significance of this finding was highlighted by the fact that intratumoral injection of cholesterol-conjugated small, interfering RNA against PAK4 led to inhibited tumor growth and reduced serum

alpha-fetoprotein levels in the SMMC-LTNM model. On a molecular level, inhibition of miR-199a/b-3p or overexpression of PAK4 inhibited the activation of the Raf/MEK/ERK (extracellular signal-regulated kinase) cascade, which is believed to promote hepatocarcinogenesis in humans.14 Interestingly, besides PAK4, miR-199a/b-3p also targets signaling of c-met and mammalian target of rapamycin, and it seems likely that a deregulation in the whole network of these “pro-oncogenic” pathways rather than a down-regulation of a single gene contribute to the procarcinogenic effects of miR-199a/b-3p silencing in HCC (Fig. 1). HCC represents the fifth most common cause for cancer-related death worldwide, and in some African or Asian countries, HCC is even the leading cause of cancer-related morbidity.

Conclusion: SPRR2a modulates ZEB-1 signaling by way of miR-200c/141-associated EMT through SH3-domain networks and contributes to benign and malignant BEC wound-healing responses. (Hepatology 2014;59:1130–1143) “
“To compare the immunogenicity of two modified hepatitis B virus (HBV) vaccination schedules in liver transplant

recipients. Hepatitis B immunoglobulin (HBIG) in combination with nucleoside/nucleotide buy Daporinad analogs (NUCs) is the recommended prophylaxis for preventing HBV recurrence following liver transplantation (LT). However, HBIG treatment is expensive. Active immunization with hepatitis B vaccine would be a preferable alternative prophylaxis to replace HBIG treatment. However, the overall response rate to standard vaccination (given at months 0, 1 and 6) is relatively low in immune-compromised patients. Two cohorts of 114 subjects were immunized with recombinant HBV vaccine containing S-antigen. The patients in the rapid schedule group were immunized with 40 μg HBV vaccine at months 0, 1, 2 and 3, and with 20 μg at months 4, 5 and 6. The patients in the accelerated schedule group were immunized with 40 μg of HBV vaccine at days 0, 7, 14 and 28, and 20 μg at months 2, 3 and 4. The overall response rate

was 16.7% (19/114) and all responders discontinued HBIG injection and only one patient developed HBV recurrence. The response rate was 24.6% (14/57) and 8.8% (5/57) in the rapid vaccination and the accelerated vaccination http://www.selleckchem.com/products/Staurosporine.html schedules, respectively (P = 0.024). HBV vaccination may induce endogenous anti-HBs 上海皓元 to replace

HBIG in selected patients. Vaccination schedules may influence vaccine response, and individual optimization may improve response rate to HBV vaccination. “
“To evaluate whether hepatitis B virus (HBV) preS/S gene variability has any impact on serum hepatitis B surface antigen (HBsAg) levels and to analyze the replication capacity of naturally occurring preS/S variants, sera from 40 untreated patients with HBV-related chronic liver disease (hepatitis B e antigen [HBeAg]-positive, n = 11; HBeAg-negative, n = 29) were virologically characterized. Additionally, phenotypic analysis of three different preS/S variant isolates (carrying a 183-nucleotide deletion within the preS1 region, the deletion of preS2 start codon, and a stop signal at codon 182 within the S gene, respectively) was performed. HBV infecting 14 (35%) patients had single or multiple preS/S genomic mutations (i.e., preS1 and/or preS2 deletions, preS2 start codon mutations, C-terminally truncated and/or “a” determinant mutated S protein). Presence of preS/S variants negatively correlated with HBsAg titers (r = −0.431; P = 0.

Our data in surgically resected human HCC and a mouse model of Inhibitor Library carcinogen-induced HCC support a potential tumor suppressor function of Col18a1. Further studies are underway to establish what roles Col18a1 may play in controlling the rates of HCC progression. Disclosures: Lewis R. Roberts – Grant/Research Support: Bristol Myers Squibb, ARIAD Pharmaceuticals, BTG, Wako Diagnostics, Inova Diagnostics, Gilead Sciences The following people have nothing to disclose: Michael Duncan, Renumathy Dhanasekaran, Priyanka Thakur Background & Aims: Recent single nucleotide polymorphism (SNP) studies revealed several host genetic risk factors for hepatocellular carcinoma (HCC); however, the majority

of genetic factors remain unclear. MicroRNAs (miRNAs) are small non-coding RNAs that control

gene expression post-transcrip-tionally. As for HCC, two common SNPs in mature miRNAs (rs2910164 in miR-146a and rs11614913 in miR-196a2) have been extensively studied, but published results are inconsistent and inconclusive. Almost all these studies compared hepatitis B virus (HBV)-related HCC patients and healthy controls in China. We aimed to investigate the association between these BVD-523 ic50 SNPs and HBV-related as well as hepatitis C virus (HCV)-related HCC risk in a Japanese population using a large number of patients. Methods: We analyzed the effect of rs2910164 and rs11614913 on HCC development in over 1,500 chronic HBV patients, including 407 with HCC (cases) and 1,141 without HCC (controls), and over 3,300 chronic HCV patients, including 1,026 cases and 2,349 controls, by multiplex-PCR-based Invader assay. Results: According to 1000Genomes database, risk allele frequencies (AFs) of rs2910164 and medchemexpress rs11614913 vary among ethnic groups: 0.22 and 0.41 in Europeans, 0.54 and 0.58 in Han Chinese, and 0.60 and 0.60 in Japanese, respectively. Estimated statistical power is 60% and over 90% for our HBV and HCV studies, respectively. First, we analyzed chronic HBV patients and found that risk AF of rs2910164 was significantly higher in cases than in controls (P = 0.040, odds ratio [OR] = 1.19).

We also found a similar result for rs11614913 (P = 0.017, OR = 1.21). Because both of age and male ratio were significantly higher in cases than controls, we adjusted for age and gender and again found significant associations with HBV-related HCC for both SNPs (P = 0.014 and 0.037, OR = 1.23 and 1.19, respectively). Next, we analyzed chronic HCV patients, but we could not find any significant differences between risk AFs of cases and those of controls for either SNP (P = 0.266 and 0.861, respectively), despite sufficient statistical power. After adjusting for age and gender, we again observed no association. Finally, we investigated the association between these two SNPs and expression of possible target genes using expression quantitative trait loci (eQTL) with public databases, but we failed to find any supporting evidence.

Treatment efficacy at 2 hours posttreatment was compared in patients with and without baseline allodynia. Results.— At the time of treatment, allodynia was present in 216 patients treated with MAP0004 and 202 patients treated with placebo. MAP0004 treatment efficacy was superior

to placebo, as measured by 2-hour pain relief for patients with and without allodynia (P < .0001) and as measured by 2-hour pain freedom for patients with (P < .0001) and without (P < .0002) allodynia. No significant within-treatment differences after treatment with MAP0004 in patients with and without allodynia selleck chemicals at baseline were observed. Patients were more likely to be allodynia-free after treatment with MAP0004 compared with placebo (73% vs 66%, P = .0013). Furthermore, treatment with MAP0004 prevented the development of allodynia in patients not experiencing allodynia at baseline (P = .0057). MAP0004 was generally well tolerated. Conclusions.— This post hoc subanalysis

shows that MAP0004 was similarly effective in patients whether or not allodynia was present at treatment baseline. Patients were also more likely to be allodynia-free learn more following treatment of a migraine with MAP0004. “
“(Headache 2011;51:1202-1211) Objective.— To evaluate patient satisfaction with and confidence in Sumavel® DosePro® (needle-free subcutaneous sumatriptan) among current triptan users administering Sumavel DosePro for up to 4 migraine attacks. Background.— Sumavel DosePro is a needle-free, single-use device that facilitates subcutaneous injection of sumatriptan 6 mg and confers relief as early as 10 minutes after dosing. Design/Methods.— In this open-label, multicenter study, Sumavel DosePro was self-administered for ≤4 migraine attacks (over a ≤60-day period) involving moderate or severe baseline pain by adult migraineurs who currently

were using triptans (any form, any dosage) and reported MCE公司 being less than very satisfied with their current therapy (ie, baseline satisfaction ranging from satisfied to very dissatisfied). Treatment satisfaction was measured via the Patient Perception of Migraine Questionnaire, revised (PPMQ-R). Results.— Among the 212 patients using Sumavel DosePro to treat ≥1 migraine attack, PPMQ-R Overall Satisfaction (primary endpoint) increased significantly from baseline to the end of treatment (mean ± SD 65.7 ± 19.8 vs 73.7 ± 29.1, P = .0007), an improvement that met the criterion for clinical significance. From baseline to the end of treatment, PPMQ-R scores also improved significantly for Efficacy (62.2 ± 17.6 vs 76.2 ± 23.7, P < .0001), Functionality (59.0 ± 22.3 vs 73.8 ± 25.3, P < .0001), and Tolerability (83.9 ± 13.1 vs 86.4 ± 15.0, P = .02), but declined for Ease of Use (82.6 ± 15.3 vs 67.8 ± 27.6, P < .0001). For all global satisfaction domains, the percentage of patients satisfied or very satisfied increased from baseline to the end of treatment (Overall Satisfaction 36.3% vs 64.

Results: The pVM1 group included 14 lesions (2.9%). On univariate analysis, tumor diameter (p < 0.001), pathological invasion depth (pT1b; p < 0.0001) had a significant effect on pVM1. On multivariate analysis of those factors, pT1b was the only factor that had a significant effect on pVM1. The pVM1 rates in pT1a and pT1b lesions were 0.047% and 17.9% (p < 0.0001),

respectively, and the diagnostic rate of invasion depth was 96.1% overall. Conclusion: Submucosal (SM) invasion depth had a significant effect on pVM1. When SM invasive cancer is suspected prior to surgery, it may become incomplete resection when ESD is performed for the primary tumor. In such cases, full-thickness resection is desirable for cT1b gastric cancer. The future development of function-preserving or reductive surgeries that bridge the gap between ESD and standard surgery in such cases of potentially Aloxistatin cost invasive gastric cancer is desired. Key Word(s): 1. ESD Presenting Author: KAZUYUKI MATSUMOTO Additional Authors: KOICHIRO TSUTSUMI, HIRONARI KATO, YUTAKA AKIMOTO, Ku-0059436 clinical trial TAKESHI TOMODA, NAOKI YAMAMOTO, HIROYUKI NOMA, SHIGERU HORIGUCHI, HIROYUKI OKADA, KAZUHIDE YAMAMOTO Corresponding Author: KAZUYUKI MATSUMOTO Affiliations: Okayama University, Okayama University, Okayama University, Okayama University, Okayama University, Okayama University, Okayama

University, Okayama University, Okayama University Objective: Postoperative hepatolithiasis is one of the complications, which often occur in patients who underwent hepaticojejunostomy due to various pancreatobiliary diseases. In treatment for hepatolithiasis, it is important to remove the stones completely. We evaluated the efficacy of peroral direct cholangioscopy (PDCS) using an ultraslim endoscope for treatment of hepatolithiasis in patients hepaticojejunostomy. Methods: Between April 2012 and April 2014, 14 patients with hepatolithiasis, who had undergone bowel reconstruction with hepaticojejunostomy, 上海皓元 were included. Firstly, diagnostic and therapeutic ERC by using a short double-ballon enteroscope (DBE) (EC-450BI5 or EI-530B, Fujifilm,

Tokyo) was performed in all patients. Following removal of hepatolithiasis, the DBE was exchanged for an ultraslim endoscope (EG-530NW; Fujifilm, Tokyo) through the overtube for performing PDCS. Results: The success rate of PDCS was 85.7% (12/14). In 5 of 12 (41.7%) patients with successful PDCS, the residual stones were detected and removed completely by using a 5-Fr basket and/or suction after normal saline irrigation. In the remaining 7 (58.3%) patients, no residual stone was detected. The median PDCS procedure time was 14 min (range, 8–36). No serious procedure-related complications were observed. Median followed up after PDCS was 15.5 month (range, 3–27), and only one patient (8.3%) had recurrence of hepatothiliasis.