Objective To study microcirculation of acute pancreatitis(AP)in vivo with confocal la-ser endoscopy(CLE).Methods Thirty-two SD rats were randomly divided into 2 groups，I.e.control(n=8)and experiment group(n=24).In the control group，pancreas were identified，the blood was collectedfrom the inferior vena cava,0.5％uranin was administered at 4 ml/kg intravenously,and the pancreas were observed through CLE.In the experiment group,AP model was established by ligation of the end of common bile duct.The abdomen was opened to observe the pancreas at 12 h(n=8)，24 h(n=8)and 48 h(n=8)， uranin was administered intravenously，and the pancreatic tissue was observed through CLE.Pancreatic tis- sue in each group was sent for pathological study.Results Both healthy and affected pancreatic microcircu- lation can be viewed through CLE.The number of red blood cells can be counted within certain period of time cross-sectionally.In 12 h group，the construction of pancreatic acini was normal，and the flow of red blood cells could be seen in the capillary，but quite slow.In 24 h group，the structure was vague，but there were still normal pancreatic acini less visible capillaries and less and slower red blood cells flow were ob- served.In 48 h group，some pancreatic acini were not visible，normal pancreatic acinar structure and micro- circulation could not be observed，neither could red blood cells.Insulin tissue，white blood cells and micro- thrombosis could not be observed through CLE.ConclusionCLE is distinctly valuable for pancreatic mi- crocirculation study，especially for AP microcirculation in vivo.However，color developing agents and image processing techniques should be improved to ensure better images and better application.

Objective To assess the efficacy and safety of over-the-scope clip(OTSC) system in treatment of the perforation ,fistula and bleeding of the digestive tract .Methods The data of 33 patients who were treated with OTSC in our department were analyzed retrospective-ly,and the technical success rate ,clinical success rate and complications were statistically analyzed .Among the 33 patients,there were 14 pa-tients with upper gastrointestinal bleeding , 8 patients with postoperative fistula , and 11 patients with endoscopic full-thickness resection (EFTR) of gastric or duodenal bulb.Results The technical success rate and clinical success rate of 33 cases were 96.97% and 93.94%respectively,and there was no complication in all patients .Among them,the clinical success rate of the upper gastrointestinal bleeding was 92.85%,the anastomotic fistula was 75.00%,and the EFTR was 100%.Conclusion As a new type of clinical endoscopic suture system , OTSC is safe and effective in gastrointestinal bleeding ,perforation and fistula .

Objective To evaluate the diagnostic yield and the etiological accuracy of double balloon endoscopy and capsule endoscopy in patients with.Methods Seventy-three patients with OGIB received double balloon endoscopy.The route of enteroscopy could be either via mouth or via anus.Negative result of initial route was required afterwards for another via mouth or via anus examination.Sixty-one patients with OGIB received capsule endoscopy.Results The overall diagnostic yield for double balloon enteroscopy was 94.5%,and for capsule endoscopy it was 81.8%.The etiological diagnostic accuracy of double-balloon enteroscopy was 80.8%,and for capsule endoscopy,50.0%.Double-balloon enteroscopy and capsule endoscopy were both well tolerated.Conclusion Double balloon enteroscopy is superior to capsule endoscopy in the diagnostic yield and the etiological diagnosis of obscure gastrointestinal bleeding.

Objective To evaluate the efficacy and safety of clip traction in endoscopic submucosal dissection (ESD) for heterotopic pancreas in stomach.Methods Data of 62 patients with pathologically confirmed heterotopic pancreas treated by ESD between May 2013 and February 2016 were retrospectively studied in Department of Gastroenterology of Xinqiao Hospital,whose lesions were single and origins were submucosal.Thirty-six cases underwent ESD with clip traction (clip group,n=36),and 26 cases underwent ESD without clip traction (non-clip group,n =26).The procedure time,visualization of the submucosal during dissection,complications and the result of follow-up were evaluated between the two groups.Results ESD was successful in all cases.The procedure time was significantly shorter in the clip group than in the non-clip group (19.35±10.34 min VS 27.02± 14.27 min,t'=2.333,P=0.023),and good visualization was obtained by applying clip traction.The rate of bleeding in the clip group was 55.6％ (20/36),and that in the non-clip group was 61.5％ (16/26).There was no significant difference between the two groups(x2 =0.222,P =0.638).Moreover,perforation did not occur in the clip group,but occurred in one patient in the non-clip group (3.8％,1/26).There was no significant difference between the two groups (P =0.419).All patients were followed up,there was no recurrence.Conclusion ESD is effective and safe for heterotopic pancreas in stomach.Clip traction can shorten the operation time and reduce complications of ESD.

Objective To study the diagnostic and therapeutic value of 1.4-metre colonoscope for upper jejunum lesions. Methods From 2008 to 2009, patients with suspected upper jejunum lesions, who presented as obscure gastrointestinal bleeding or other digestive symptoms and got no definite diagnosis from gastroscopy and entire digestive tract barium meal, were recruited as experimental group (n = 115) and underwent an examination with 1.4-metre endoscope. The endoscope was inserted into proximal jejunum, biopsy or treatment was performed according to the found lesions. Another 115 patients from 2004 to 2007, who presented with similar situation but were examined with gastroscope, were recruited as control group. Results Descending duodenum was accessed successfully in all cases from 2 groups. Horizontal duodenum was accessed in 112 and 107 cases of experimental group and control, respectively (97. 39% vs. 93.04%, P ＞0. 05), while the ascending part was accessed in 109 and 72 cases, respectively (94.78% vs. 62.61%, P＜0.005), and the proximal jejunum was accessed in 102 and 35 cases, respectively (88.70% vs. 30. 43%, P ＜ 0. 005). A total of 31 (26. 96%) lesions were found in experimental group, which was significantly higher than that in control group (6/115, 5.22%, P ＜0.005). Biopsy or endoscopic management was performed in 20 cases from experimental group, in which 12 occupying lesions were confirmed by pathology and surgery. In control group, 1 case of stromal tumor, 1 adenocarcinma, 1 P-J syndrome and 3 ancylostomiasis at horizontal duodenum were confirmed. Conclusion 1.4-metre endoscope can be inserted deeper than gastroscope, and is of better diagnostic value for bleeding in descending duodenum, especially in upper jejunum.

Objective To explore the feasibility ,effectiveness ,recurrence rate and complications ,etc .of endoscopic retrograde stenting in treating acute appendicitis .Methods A retrospective analysis was conducted on seven patients with the clinical diagnosis of acute appendicitis ,complying with the following treatment steps :(1) normal saline for high cleansing enema in 2-3 times ;(2) en-doscopically douching ileocecal junction and observing the opening of appendix ;(3) placing the guide wire into the opening of appen-dix under the guidance of imaging tube ,and then conducting angiography imaging ;(4) repeatedly douching with metronidazole;(5) implant the appendix stent ,draining the inflammatory secretions out and then douching ;(6 ) observing postoperative abdominal pain ,fever ,bowel and other conditions;(7) reviewing with the enteroscopy and removing the stent 2 weeks later .At 2 before the surgery and 48 after it ,all patients were administrated with antibiotics for anti-infective treatment .The follow-up was made from 8-15 months after the surgery .Results Among these 7 patients ,4 patients had successful appendix stenting :the abdominal pain sig-nificantly alleviated after the surgery ;the proportional level of white blood cells(WBC)recovered during 24-48 after the surgery .15 after discharge ,two patients returned to hospital and their appendix stent removal was successful;during the operation ,smooth mu-cosa at the opening of appendix was observed .The stents of two patients spontaneously fell off ,and normal morphology of the ap-pendix opening was observed at review .During the postoperative follow-up of 8-15 months ,one patient relapsed and underwent sur-gical treatment in the general surgery department .The other three patients did not undergo appendix stenting due to the unsuccess-ful intubation .Conclusion The treatment of acute appendicitis with endoscopic stenting has the advantages of little trauma ,high safety and significant efficacy .However ,this method still requires large-scale and multicenter randomized controlled clinical trials to evaluate its feasibility and long-term efficacy .

ObjectiveTo investigate the clinical value of transgastrie endoscopic surgery for the treatment of pancreatic abscess or pancreatic cyst and infection.MethodsThe clinical data of 22 patients with pancreatic abscess or pancreatic cyst and infection who underwent transgastric puncture and drainage or transgastric debridement under the guidance of endoscopic ultrasonography (EUS) at the Xinqiao Hospital of Third Military Medical University from July 2008 to August 2011 were retrospectively analyzed.All patients were comfirmed with bacteria infection after liquid aspiration culture. Patients with pancreatic abscess underwent endoscopic transgastric debridement,and for patients with pancreatic cyst and infection,10 F double pigtail stent and 8.5 F nasal bile duct were placed for drainage.ResultsThe results of liquid aspiration culture confirmed that 2 patients were infected by staphylococcus aureus,3 by proteus mirabilis,4 by pseudomonas aeruginosa,4 by klebsiella and 9 by escherichia coli bacilli.The double pigtail stent and nasal bile duct were installed under EUS (16 patients) or duodenoscope (6 patients).The lesions of 9 patients with pancreatic abscess were healed after endoscopic transgastric debridement with an average period of (6.5 + 1.8 )weeks,and the lesions of 13 patients with pancreatic cyst and infection were healed after transgastric puncture and drainage under the guidance of EUS with an average period of ( 8.3 ± 2.1 ) weeks.All patients were followed up for 2 years,and no recurrence of pancreatic abscess or pancreatic cyst was observed.ConclusionThe effect of transgastric endoscopic surgery for the treatment of pancreatic abscess or pancreatic cyst and infection is satisfactory.

Objective To evaluate the feasibility of endoscopic resection and closure for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.Methods Included in the study were 46 patients with gastric submucosal lesions originating from the muscularis propria layer, detected by gastroscopy and endoscopic ultrasonography.The lesions were removed by endoscopic resection and closure, which were further diagnosed as stromal tumor by means of pathologic and immunohistochemical examinations.The patients were followed up with endoscopy for evaluation of therapeutic effect and complications.Results All lesions were successfully removed, with serosa layer remained in 2 cases and full layer resection in other 44, which were all closed by endoscopic clips.Combination managements of acid suppression,gastrointestinal decompression and intravenous antibiotics were applied in all patients.Pathology reports confirmed complete resection of all lesions, with 0.5 to 3.7 cm in diameter.Normal diet was restored in 44 patients 48 ～ 72 h after the procedure.Pneumoperitoneum and focal peritonitis occurred in 2 cases, one of which underwent rupture and was clamped again.The 2 patients recovered after 10-12 days of conservative treatments.Follow-up endoscopy revealed white ulcerous scar in all cases.Conclusion Endoscopic resection and closure therapy is a safe, economic and less invasive treatment for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.

Objective To explore the long-term outcomes of endoscopic submucosal dissection (ESD) of gastric GISTs.Methods Data of 25 patients with gastric stromal tumors,who underwent ESD,were reviewed in terms of clinical characteristics,histopathologic results,complications and long-term outcomes.Results Twenty-five patients underwent one-time complete removal of lesion, with a average tumor size of 3.0 cm (range,0.6 to 7.6 cm).The average time of operation was 65 minutes (range,15 to 154 minutes).one case was observed with intraoperative hemor-rhage of 200 mL blood,which was successfully managed by hemostatic forceps.Perforation with incidence rate of 16%occurred in 4 cases and was closed well with clips.Mucosal mechanical laceration of esophagus occurred in 1 case when the big tumor was taken out.The average length of hospi-talization was 7.3 days (range,4 to 21 days).A follow-up for 30 months (range,13 to 54 months) showed no tumor recurrence or metastasis. Conclusion ESD is an effective and safe endoscopic procedure to remove gastric GISTs for long-term outcomes in patients with no metastasis.

Objective:To investigate the characteristics and influencing factors of esophageal stenosis after endoscopic submucosal dissection (ESD) for early esophageal carcinoma.Methods:Patients who underwent ESD in the Digestive Endoscopy Center of the Second Affiliated Hospital of Army Medical University from January 2011 to December 2018 were included. The data were obtained from medical records and follow-up. The influencing factors of stenosis were determined by single factor and Cox regression analysis.Results:A total of 654 patients underwent ESD and 79 (12.1%) of them developed postoperative esophageal stenosis. The median time of stenosis development was 27 (17, 43) days. The morphology and lesion circumferential proportion were independent factors for the occurrence of stenosis after ESD. The stenosis incidence of type Ⅱa was 6.601 times (95% CI: 1.518-28.709, P=0.012) compared with that of type Ⅱc. The incidence of stenosis in lesions with 75%-<100% and 100% circumference was 17.408 times (95% CI: 8.009-37.839, P<0.001)and 52.439 times (95% CI: 23.905-115.029, P<0.001) respectively compared with that of patients <75%. Among the 79 patients, 27 had severe stenosis, and the lesion circumferential proportion was an independent factor for stenosis. Compared with the group of lesion circumferential proportion of less than 75%, the incidences of stenosis of lesion circumferential proportion of 75%-<100% and 100% were 7.775 (95% CI: 1.977-30.577, P=0.003) and 70.062 (95% CI: 19.879-246.926, P<0.001) times respectively. Conclusion:The morphology and lesion circumferential proportion are two independent factors for the occurrence of esophageal stenosis after ESD. Additionally, lesion circumferential proportion is an independent factor for the occurrence of severe esophageal stenosis after ESD.