We aim to evaluate the safety and feasibility of novel elbow biopsy forceps with a prebent head for sampling biliary strictures in our institution. A total of 24 patients (15 males and 9 females) with biliary stricture who underwent biliary biopsy during endoscopic retrograde cholangiopancreatography (ERCP) using novel elbow biopsy forceps from June 2019 to August 2020 were retrospectively included. The novel biopsy forceps had a head angulation of 30 degrees and were able to cannulate the bile duct and approach the biliary strictures easily to obtain adequate samples. The technical success rate, incidence of adverse events, and consistency of pathological and surgical specimens were assessed. This device was used successfully in all patients. A total of 52 biopsy specimens were obtained from 24 patients, and all specimens could be used for histopathological examination. Seventeen patients were diagnosed with malignancy based on biopsies, and all of them underwent surgical treatment. The histopathological findings of the biopsy specimens were in accordance with the postoperative pathology diagnoses. One of the seven patients was diagnosed with a benign lesion that was proven to be malignant during surgical treatment in the follow-up period. Two patients experienced a single episode of acute pancreatitis and recovered shortly after appropriate treatment. No patients experienced biliary perforation or biliary bleeding. Biopsy using novel elbow forceps in patients with biliary stenosis is feasible and safe. The novel device and related biopsy technique may be widely applied for biliary disease differentiation.

Background and aims Stent migration is one of the most common complications during the placement of multiple plastic biliary stents (MPBS) under endoscopy. This study aims to evaluate the feasibility and efficiency of the fishing line assisted (FLA) method for preventing the complication. Methods Patients with unresectable malignant hilar biliary obstruction (MHBO) who undergone endoscopic placement of MPBS using the FLA or conventional method from May 2018 to April 2021 in our center were enrolled in the study. The endpoints of this study were the stent migration rate, technical success rates, adverse events rates, times of stent migration, and the procedure time. Results FLA group (N = 19) and conventional group (N = 22) had similar baseline characteristics of the patients. The technical success rates (100% vs. 95.5%; P > 0.05), ERCP-related adverse events rates (5.3% vs. 4.5%; P > 0.05), and the stent-related adverse events rates (0% vs. 4.5%; P > 0.05) were no significant differences between the FLA and conventional groups. MPBS inserted using the conventional method consumed more time (median, 33.9 min vs. 15.6 min; P < 0.05) method and increased the times of stent migration (median, 3 times vs. 0 times; P < 0.05) than using the FLA method. Even if no statistical difference was detected in the stent migration rate between groups, this rate was lower in the FLA group than the conventional group (0% vs. 13.6%; P > 0.05). Conclusions FLA method is an effective technique for MPBS implantation to prevent stent migration during endoscopic retrograde cholangiography (ERCP). The method should be applied to patients with unresectable MHBO who need to place MPBS.

Objectives: The study aimed to compare the cleansing effect, compliance and adverse of polyethylene glycol 2L with castor oil and polyethylene glycol 4L on bowel preparation prior to colonoscopy in inpatients.Methods: Our study retrospectively analyzed the medical records and colonoscopy reports of inpatients (n=673) who underwent colonoscopy at the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, and the inpatients were divided into two groups according to different bowel preparation protocols. BBPS is used to assess the degree of bowel cleanliness before colonoscopy. We statistically analyzed and compared the degree of bowel cleansing between 2L-PEG-CaO and 4L-PEG group, as well as the compliance and adverse effects of the medication in both groups.Results: Among 673 patients undergoing colonoscopy, 330 were prescribed 4L-PEG and 343 2L-PEG-CAO. Both groups of inpatients were matched for baseline characteristics. In the 4L-PEG and 2L-PEG-CaO groups, adequate bowel preparation rate was 72.4% and 77.3% (P=0.148), BBPS scores was 6.79±1.51 and 7.03±1.71 (P=0.056), and adverse event rate was 68.2% and 30.0% (P<0.001), respectively.Conclusion: The 2L-PEG combined with castor oil is an effective and safe cleansing regimen for bowel preparation and is relatively inexpensive and suitable for wider use.