In this cohort study, body composition profiles did not correlate well with BMI. Myopenia was associated with primary nonresponse with potential implications for dosing and serves as an explanation for pharmacokinetic failure.

Endoscopic balloon dilatation of Crohn's anastomotic strictures is safe and effective in the long term. We demonstrate that active disease predicts for future surgery, while escalation of medical therapy may decrease the need for repeat dilatation.

Cancer patients exhibit an elevated stroke risk (1)(2)(3)(4)(5). In a case-control study examining the epidemiology of cancer in stroke patients and their clinical course, we identified 72 active cancer and 72 control patients from the 1493 stroke admissions to Princess Margaret Hospital, Hong Kong in 2009. The prevalence of cancer among stroke patients was 4·8% (Table 1), and stroke was the first symptom of their cancer in nine patients. The proportions of ischemic stroke (IS) (79·2%) and haemorrhagic stroke (HS) (20·8%) in cancer group were comparable with noncancer group, and vascular risk factors (hypertension, diabetes mellitus, and hyperlipidemia) were less prevalent. The cancers we identified followed the local cancer epidemiology, with lung and colorectal cancer being the two most common types. In HS, both groups had similar proportions of deep parenchymal and lobar haemorrhages, but multiple haemorrhages were only seen in the three cancer patients. Except for the two acute promyelocytic leukaemia patients who bled, the distributions of other cancers among HS patients were similar to those with IS. Among IS, the proportions of patients in the four Oxfordshire-classified syndromes were comparable in the two groups. The etiology of IS was undetermined in half of the cancer patients compared with only 28·3% of the noncancer patients. There was no difference in the severity of neurological impairment [National Institutes of Health Stroke Scale (NIHSS) 10·7 (cancer) and 11·8 (noncancer)], but cancer patients had a higher hospital-acquired pneumonia (11·1% vs. 4·2%) and hospital mortality (31·9% vs. 12·5%) rates. At three-months poststroke, cancer remained the most important independent predictor of mortality [odds ratio 12·4 (3·0-51·4)], and more cancer patients were disabled. We concluded that stroke and cancer, when coinciding, carried a high morbidity and mortality rate. Often, the occurrence of stroke in cancer patients could not be sufficiently explained by conventional etiology, implicating the role of cancer-related factors in their stroke pathophysiology.

To illustrate the efficacy and safety profile of double-balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) using a short enteroscope in patients with surgically altered anatomy.Methods: A retrospective study was performed to review the endoscopic outcomes of patients undergoing DBE-assisted ERCP for biliary diseases in Tuen Mun and Pok Oi hospitals in Hong Kong SAR, China from December 2015 to December 2020.Results: Altogether 46 DBE-assisted ERCP procedures were performed in 37 patients.The enteroscopic success rate, defined as reaching the papilla or bilioenteric anastomosis, was 95.7% (95% confidence interval [CI] 85.2%-99.5%), which was significantly lower in patients with intact stomach than in those who had a previous gastrectomy (67% vs 100%, P = 0.014). The diagnostic ERCP success rate, defined as performance in an informative cholangiogram, was 84.1% (95% CI 69.9%-93.4%) in cases where it was attempted.Intended biliary therapeutic interventions were successfully performed in 76.1% (95% CI 61.2%-87.4%) of all procedures. Adverse events were reported in six (13.0%) procedures (95% CI 4.9%-26.3%), including the micro-perforation of the intestine in two (4.3%) patients with prior Roux-en-Y gastrectomy, three (6.5%) of acute cholangitis and one (2.2%) of acute pancreatitis. All adverse events were managed successfully using conservative methods except in one case of micro-perforation, which required a laparotomy.Conclusions: DBE-assisted ERCP using a short enteroscope is a promising technique for managing biliary diseases in patients with surgically altered anatomy. It must be performed to avoid perforation, particularly in patients with a Roux-en-Y reconstruction.

Endoscopic retrograde cholangiopancreatography (ERCP) is a standard endoscopic technique for treating biliary obstruction and cholangitis. The presence of surgically altered gastrointestinal anatomy, however, poses a major technical difficulty to the procedure due to the long and tortuous access to the small bowel. We report a three-case series with successful attempts at short double-balloon enteroscopy (DBE)-assisted ERCP in patients with postoperative gastrointestinal anatomy. The enteroscope employed was EC-450BI5, Fujifilm endoscopy (Fig 1) and the sedation agents used in all procedures were dexmedetomidine and fentanyl continuous infusion combined with bolus midazolam. Case 1 A 76-year-old man was admitted to our hospital in December 2015 with acute cholangitis that presented as fever and deranged liver function tests (LFT) with predominant elevation of alkaline phosphatase