Objective To explore the clinical value of endoscopic ultrasonography (EUS) examination before esophageal achalasia (EA) patients treated by peroral endoscopic myotomy (POEM).Methods From August 2011 to November 2011,esophageal EUS examination was conducted in 34 EA patients scheduled for POEM treatment (EA group) and 30 cases accepted gastric EUS examination (control group) at endoscopic center,Zhongshan Hospital,Fudan University.The thickness of muscularis propria layer and the circular muscle layer was measured at cardia,5 cm,10 cm and 15 cm above cardia,and the proportion of circular muscle layer was calculated.The differences in groups and between groups were compared.The correlation between muscle thickness and complication after POEM treatment was analyzed.The data were analyzed by t test.Results There was no difference between EA group and control group in the thickness of the muscularis propria layer at same part (at cardia,5 cm,10 cm and 15 cm above cardia,t=1.210,1.116,0 and 0.292respectively; all P＞0.05 respectively).The thickness of the circular muscle layer of EA group at cardia,5 cm,10 cm and 15 cm above cardia was (1.72±0.49) mm,(1.86±0.81) mm,(1.56±0.47) mm and (1.41±0.48) mm respectively,those of control group was (1.06±0.50) mm,(1.40±0.33) mm,(1.05±0.37) mm and (0.78±0.12) mm respectively.At same part,the thickness of the circular muscle layer of EA group was significantly thicker than that of the control group (t =5.326,2.903,4.778 and 6.993 respectively,all P＜0.05).After POEM treatment,complication was high in EA cases with the thickness of muscularis propria layer less than 2 mm.Conclusion Before POEM treatment,EUS examination for EA patients has certain guiding significance.

To investigate the feasibility and safety of endoscopic trans-gastric cholecystolithotomy(ETGC) combined with endoscopic retrograde cholangiopancreatography (ERCP) for cholecystolithiasis and choledocholithiasis. Data of patients with cholecystolithiasis and choledocholithiasis who underwent ETGC after ERCP in Zhongshan Hospital Affiliated to Fudan University from November 2018 to April 2019 were analyzed. Six patients with cholecystolithiasis and choledocholithiasis, 4 males and 2 females, were included in this study.The interval between ERCP and ETGC ranged from 1 to 77 days (median 5 days). All the 6 patients successfully completed ETGC after ERCP, with a surgical success rate of 100%. All the patients had multiple cholecystolithiasis and one patient was complicated with gallbladder polyps.The ETGC operation time was 22-100 min (median 65 min), and the length of hospital stay was 3-9 d (median 6.5 d). Two patients had dull pain in the upper abdomen and increased body temperature after surgery. Abdominal ultrasound in one patient suggested local effusion in the right upper abdomen.Both patients improved after conservative treatment.None of the patients had cholecystitis and cholangitis related symptoms such as right upper abdominal pain or fever during postoperative follow-up, and the follow-up rate was 100%with median follow-up time of 18 month.All the 6 patients underwent abdominal ultrasound examination after surgery. No recurrence occurred in 5 patients. One of the patients showed cholesterol crystals in the gallbladder wall and bile mud deposition.ETGC combined with ERCP is safe and feasible for cholecystolithiasis and choledocholithiasis.

Objective: To investigate the feasibility and safety of endoscopic trans-gastric gallbladder-preserving cholecystolithotomy (ETGC) for gallstones. Methods: The clinical data of 84 cholecystolithiasis patients, who received ETGC at Endoscopic Center of Zhongshan Hospital from March 2017 to May 2019 were analyzed retrospectively. The operation completion rate, operation time, complications and recurrence of calculus were summarized. Results: In the 84 cases of cholecystolithiasis, there were 19 cases (22.6%) of single stone, 53 cases (63.1%) of multiple stones, and 12 cases (14.3%) of gallstones with gallbladder polyps. A total of 82 patients (97.6%) successfully completed ETGC with median operation time of 88 min. Ten patients (12.2%) suffered from abdominal pain after operation, of which 6 patients relieved after conservative treatments. The other 4 cases, including 2 cases of hemoperitoneum, 1 case of biliary fistula, and 1 case of choledocholithiasis with obstructive jaundice, were recovered after corresponding interventions. As of June 14, 2019, 5 cases were lost to follow-up (follow-up rate was 93.9%, 77/82). Residual stones were found in 2 cases (2.6%, 2/77). Stone recurrence was discovered in 4 cases (5.2%, 4/7), and 2 cases (2.6%, 2/77) had cholesterol crystallization in gallbladder. Conclusion ETGC is minimally invasive, feasible and safe in treatment of cholecystolithiasis, and can retain the function of gallbladder. However, how to completely remove the stones and avoid residue by ETGC still needs further exploration, and its long-term efficacy still needs further observation.