Diverticulitis associated pancreatitis: a report of 2 cases and review of the literature

Duodenal diverticula are the second most common type of digestive diverticula after those in the colon. They are present in approximately 27% of patients who undergo upper digestive endoscopy. Most of these diverticula, especially those located near the papilla, are asymptomatic. However, in rare cases, they can be associated with obstructive jaundice (Lemmel Syndrome), bacterial infection, pancreatitis, or bleeding. In this report, we present two cases of acute obstructive pancreatitis caused by duodenal diverticulitis. Both patients were managed conservatively, resulting in a positive outcome.

Motorized spiral enteroscopy: effectiveness when used for new indications

Background and study aims

Motorized spiral enteroscopy is proven to be effective in antegrade and retrograde enteroscopy. Nevertheless, little is known about its use in less common indications. The aim of this study was to identify new indications for the motorized spiral enteroscope.

Methods

Monocentric retrospective analysis of 115 patients who underwent enteroscopy using PSF-1 motorized spiral enteroscope between January 2020 and December 2022.

Results

A total of 115 patients underwent PSF-1 enteroscopy. 44 (38%) were antegrade procedures and 24 (21%) were retrograde procedures in patients with normal gastrointestinal anatomy with conventional enteroscopy indications. The remaining 47 (41%) patients underwent PSF-1 procedures for secondary less conventional indications: n=25 (22%) enteroscopy-assisted ERCP, n=8 (7%) endoscopy of the excluded stomach after Roux-en-Y gastric bypass, n=7 (6%) retrograde enteroscopy after previous incomplete conventional colonoscopy and n=7 (6%) antegrade panenteroscopy of the entire small bowel. In this group of secondary indications, technical success rate was significantly lower (72.5%) as compared to technical success rates in the conventional groups (98-100%, p<0.001 Chi-square). Minor adverse events occurred in 17/115 patients (15%), all treated conservatively (AGREE I and II).

Conclusion

This study demonstrates the capabilities of PSF-1 motorized spiral enteroscope for secondary indications. PSF-1 is useful to complete colonoscopy in case of long redundant colon, to reach the excluded stomach after Roux-en-Y gastric bypass, to perform unidirectional pan-enteroscopy and to perform ERCP in patients with surgically altered anatomy. However, technical success rates are lower as compared to conventional antegrade and retrograde enteroscopy procedures, with only minor adverse events.

Extrapancreatic effects of incretin hormones: evidence for weight-independent changes in morphological aspects and oxidative status in insulin-sensitive organs of the obese nondiabetic Zucker rat (ZFR)

Incretin‐based therapies are widely used to treat type 2 diabetes. Although hypoglycemic actions of incretins are mostly due to their insulinotropic/glucagonostatic effects, they may also influence extrapancreatic metabolism. We administered exendin‐4 (Ex‐4), a long‐acting glucagon‐like peptide receptor agonist, at low dose (0.1 nmol/kg/day) for a short period (10 days), in obese nondiabetic fa/fa Zucker rats (ZFRs). Ex‐4‐treated ZFRs were compared to vehicle (saline)‐treated ZFRs and vehicle‐ and Ex‐4‐treated lean rats (LRs). Blood glucose levels were measured at days 0, 9, and 10. Ingested food and animal weight were recorded daily. On the day of sacrifice (d10), blood was sampled along with liver, epididymal, subcutaneous, brown adipose, and skeletal muscle tissues from animals fasted for 24 h. Plasma insulin and blood glucose levels, food intake, and body and epididymal fat weight were unchanged, but gross morphological changes were observed in insulin‐sensitive tissues. The average size of hepatocytes was significantly lower in Ex‐4‐treated ZFRs, associated with decreased number and size of lipid droplets and 4‐hydroxy‐2‐nonenal (HNE) staining, a marker of oxidative stress (OS). Myocytes, which were smaller in ZFRs than in LRs, were significantly enlarged and depleted of lipid droplets in Ex‐4‐treated ZFRs. Weak HNE staining was increased by Ex‐4. A similar observation was made in brown adipose tissue, whereas the elevated HNE staining observed in epididymal adipocytes of ZFRs, suggestive of strong OS, was decreased by Ex‐4. These results suggest that incretins by acting on OS in insulin‐sensitive tissues may contribute to weight‐independent improvement in insulin sensitivity.

Effect of radial gradient of temperature on the performance of large-diameter high-performance liquid chromatography columns. I. Analytical conditions

The performance of a large-diameter chromatographic column can be drastically reduced when the solvent enters the column at a temperature different from that of the wall of the column. A radial temperature gradient inside the column will affect the physical properties of the solvent and the chromatographic behaviour of the solute resulting in a deformation of the band profile. A mathematical model is proposed to take into account the effect of a radial gradient of temperature in a large-diameter column on the chromatographic peak shape under linear conditions. The model is then compared with experimental results in preparative columns of different sizes. A good agreement between experiment and theory has been found showing a serious effect of thermal conditions on separation quality, depending on the column size. It is also demonstrated that a small difference of temperature can be helpful to compensate practical effect of frits and distribution of the sample at the extremities of the packed bed. Finally, it demonstrates the necessity to perform efficiency measurement under different thermal conditions to have a good comparison between columns.

Serum indole-3-acetic acid in control subjects and newly abstinent alcoholics after an oral loading with L-tryptophan: a preliminary study using liquid chromatography with amperometric detection

Described in this paper is a rapid, isocratic assay for serum indole-3-acetic acid (IAA). The sample preparation involves only protein precipitation using sulfosalicylic acid, and the sensitivity of amperometric detection is in the picogram range. The chromatographic analysis time is approximately 4 min. The devised method was used for a longitudinal study of IAA levels in serum samples from control subjects and newly abstinent alcoholics. Dietary variations were eliminated by administering a 2.0-g loading dose of L-Trp to all subjects investigated. The results are presented in the form of cumulative frequency polygons. Preliminary data indicate no differences in IAA levels between newly abstinent alcoholics and control subjects.

Analytical methodology for assays of serum tryptophan metabolites in control subjects and newly abstinent alcoholics: preliminary investigation by liquid chromatography with amperometric detection

A rapid, isocratic assay for the determination of all major tryptophan metabolites in serum samples from control non-alcoholic subjects, recovered alcoholics and newly abstinent alcoholics is described. The sample preparation involves only precipitation of protein with sulfosalicylic acid. The complete liquid chromatographic analysis is short (25 min) and the sensitivity of amperometric detection permits the routine assessment of catabolites at the picogram level. This preliminary longitudinal study of the basal and post-tryptophan load serum metabolites revealed a considerable scatter of experimental results for kynurenine and serotonin in all groups examined, probably owing to the clinical heterogeneity of the sample populations.