ObjectiveTo systematically review efficacy of endoscopic ultrasonography guided biliary drainage (EUS-BD) and percutaneous transhepatic biliary drainage (PTBD) on patients with malignant obstructive jaundice.MethodsThe PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, and CNKI were searched online to collect the randomized controlled trials or cohort studies of EUS-BD versus PTBD on the patients with malignant obstructive jaundice from inception to November 30, 2018. Two reviewers independently screened the literatures, extracted the data and assessed the risk of bias of included the studies, then the meta-analysis was performed by using the RevMan 5.3 software.ResultsThree randomized controlled trials and 6 cohort studies involving 496 patients were included. The results of meta-analysis showed that: compared with the PTBD, the EUS-BD had the lower occurrence of complications [OR=0.30, 95% CI (0.20, 0.47), P<0.000 01], lower rate of reintervention [OR=0.11, 95% CI (0.06, 0.22), P<0.000 01], shorter hospital stay [MD=–3.42, 95% CI (–6.72, –0.13), P=0.04], and less hospital costs [SMD=–0.83, 95% CI (–1.16, –0.49), P<0.000 01]. There were no significant differences in the technical success rate [OR=0.88, 95% CI (0.20, 3.85), P=0.86] and clinical effective rate [OR=1.73, 95% CI (0.97, 3.11), P=0.06] between the two groups.ConclusionsCurrent evidence shows that EUS-BD has some advantages of lower occurrence of complications, lower rate of reintervention, shorter hospital stay, and less hospital costs in treatment of patients with malignant obstructive jaundice as compared with PTBD. There are no significant differences between two groups in technical success rate and clinical effective rate. Due to limited quality and quantity of included studies, more high quality studies required to be verified above conclusions.
ObjectiveTo explore the feasibility of organoid culture derived from the patients with gastric cancer by suspension culture. MethodsThe fresh gastric cancer tissues of the 3 patients with gastric cancer were selected, which were digested with mixed enzymes and then made into cell suspensions, and were inoculated into ultra-low attachment plates to culture organoid by suspension. When the organoid growth was dense, the passage and freezing were carried out. The formation process of organoid was observed under the inverted microscope (IM). Further the consistency between the organoid and primary gastric cancer tissue was evaluated by hematoxylin-eosin (HE) and immunohistochemical (IHC) staining. ResultsIn this study, an organoid that could be passaged and frozen was successfully established in one patient. The results under the IM showed that the organoid was initially spherical in shape (cultured on day 5), then gradually became short rod-shaped on day 10, showed a branching like change on day 15, and formed irregular glandular tubular structures on day 20. The structures between the organoids and primary gastric cancer tissues were highly similar by HE staining. The IHC staining results showed that the expressions of low molecular weight cytokeratin (CK-LMW), p53, and Ki67 in the organoid and its corresponding primary gastric cancer tissue were basically the same. That was, the CK-LMW and p53 expressions were positive in the organoid and primary gastric cancer tissue, and the Ki67 was highly expressed (with a positive rate of approximately 70%). ConclusionBased on the preliminary research results of this study, it suggests that the suspension culture can be used to establish organoid derived from patients with gastric cancer, which is in accordance with primary tumor tissue at the tissue and cellular levels.