Hypoxia in solid tumors is known to confer treatment resistance and lead to rapid progression and poor prognosis. As a novel cancer drug-delivery candidate, Lactobacillus casei KJ686 (L.casei KJ686) is a mutant strain of the facultatively anaerobic L.casei ATCC393 that was transformed into an obligate anaerobe to suit the hypoxic conditions within solid tumors. In the present study, we intravenously administered L.casei KJ686 to treat tumor-bearing mice and investigated the in vitro cytotoxicity of L.casei KJ686 and its culture medium containing bacterial excretion products. We discovered that L.casei KJ686 localized exclusively in tumor tissues and suppressed tumor growth in our animal experiments. Furthermore, the culture supernatant of L.casei KJ686 exhibited a strong cytotoxic effect in vitro. The specific cytotoxic substances presented in its culture supernatant may have a pivotal role in direct anti-tumor effect in solid tumors.

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Aims : We assessed the success rate at our endoscopic center in patients with a Billroth I gastrectomy and compared it to the rate in patients without a gastrectomy, retrospectively, and assessed the clinical utility of a multi-bending duodenoscope for bile duct cannulation in patients with a Billroth I gastrectomy.
Patients and Methods : Six-hundred and twenty patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with the use of a conventional single-bending duodenoscope and 26 patients who underwent ERCP with a multi-bending duodenoscope were enrolled. Of the 620 patients, 560 had no history of gastrectomy and the remaining 60 had had a Billroth I gastrectomy. The latter 26 patients included six patients whose bile duct cannulation was unsuccessful by conventional endoscope (three of whom were without gastrectomy and the other three had had a Billroth I gastrectomy).
Results : The success rate of bile duct cannulation in the patients who underwent ERCP with the conventional duodenoscope was higher in those without gastrectomy (89%) than in those with a Billroth I gastrectomy (85%), but the difference was not significant. Bile duct cannulation was successful with the multi-bending duodenoscope in all three patients with a Billroth I gastrectomy whose previous cannulation by conventional endoscopy was unsuccessful. In contrast, the cannulation was not successful in all three patients without gastrectomy whose previous cannulation was unsuccessful by conventional endoscopy. The success rate in the 20 naive patients without gastrectomy was 95% by multi-bending duodenoscope. The incidence of post-ERCP pancreatitis was similar between the patients with the use of the single- (7.6%) and multi-bending (7.7%) duodenoscopes.
Conclusion : Our preliminary data suggest that the success rate of bile duct cannulation in the patients who underwent ERCP with the single-bending duodenoscope (TJF-260V) was higher in those without gastrectomy (89%) than in those with a Billroth I gastrectomy and a multi-bending duodenoscope might be beneficial for bile duct cannulation in patients with a Billroth I gastrectomy.

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