Objective To evaluate the feasibility and safety of peroral direct cholangioscopy (PDCS) by freehand intubation using routine straight-view endoscope for diagnosis and therapy of biliary diseases.Methods Patients with bile duct dilation underwent standard ERCP and native papilla was dilated using EST and/or endoscopic papillary large balloon dilation,according to the size of the papilla.Then peroral direct cholangioscopy was performed by freehand intubation using routine straight-view endoscope.General data of patients,procedure of ERCP,diagnosis of PDCS and complications were recorded.Results A total of 5 patients underwent PDCS.Indications included common bile duct stones (n =2),intraductal papillary neoplasm of bile buct (n =2) and benign biliary stricture after removable metal stent placement (n =1).The diameter of common bile duct ranges from 1.2 cm to 2.4 cm.EST or/and EPLBD was required in 3/5 patients to facilitate PDCS.Freehand PDCS intubation of the bile duct was successful in all procedures (1 case into distal common bile duct,4 cases into proximal common bile duct).Complications were cholangitis managed with intavenous antibiotics (n =1).No procedure related death occurred.Conclusion Freehand PDCS is technically feasible and safe,and may be clinically useful for diagnostic and therapeutic purposes in managing select biliary tract diseases.

Objective To investigate the risk factors of death in patients with severe acute pancreatitis within 24 hours after admission. Methods Sixty patients with severe acute pancreatitis admitted from Jan. 2000 to Dec. 2003 were divided into two groups , death group 21 cases and survival group 39 cases. Clinical and laboratory data within 24 hours after admission of those patients were analyzed retrospectively, and Logistic regression analysis was performed. Results The average age in death group was (66.6?16.1)years,breath rate in admission (29?9)/min, urine volume within 24 hours(1062?815) ml,serum creatinine(190.6?120.1) ?mol/L, arterial pressure of O2 (58.5?17.3) mm Hg, APACHE Ⅱ score 19.3?7.5;while correspondent data in survival group were (52.4?13.1) years,(20?2)/min, (1648?575) ml, (94.4?56.0) ?mol/L,(78.8?18.0) mm Hg and 9.1?2.0,respectively. Significant differences were existed between two groups(P

Objective To investigate the methods and strategies of therapeutic ERCP in patients with duodenum stricture.Methods Endoscopic procedure,success rate and complications in patients with duodenum stricture who underwent ERCP were retrospectively analyzed.Results In 7276 patients who underwent therapeutic ERCP,duodenum stricture was found in 158 (2.17％),patients with malignant tumor infiltration in 120 and benign stricture in 38.The total success rate of ERCP and biliary drainage was 84.2％,with posture change or guidewire leading method in 96 patients,stylolitic water sac dilation in 33and duodenum metal stent placement before biliary drainage in 4.The procedure was failed in 25 patients.Minor bleeding occurred in 5 patients and no major complication including massive bleeding or perforation was observed.Conclusion ERCP is safe,effective and feasible for patients with duodenum stricture,which can be performed by posture change or guidewire leading method in mild stricture,and stylolitic water sac dilation or duodenum metal stent placement in severe stricture.

Objective To evaluate modified shortened scope for ERCP procedure in swine animal model.Methods A total of 17 male pigs were divided into the conventional endoscope group (shortened scope used on human,n =8) and the modified endoscope group (modified shortened scope,n =9).The success rates,time of access to the pylorus,biliary or pancreatic orifice,the cannulation time of biliary or pancreatic duct,the stenting time of biliary or pancreatic duct,the total time of procedure and the X-ray exposure time were compared between the two groups.Results The success rates were 2/8 and 9/9 in the conventional endoscope group and the modified endoscope group,respectively(P =0.002).There were significantly differences of the cannulation time of biliary duct(180.00 ± 37.89 s VS 55.22 ± 11.56 s,P =0.000),cannulation time of pancreatic duct(55.22 ± 11.56 s VS 56.56 ±29.19 s,P =0.015),the time of access to pancreatic orifice(21.50 ±7.33 min VS4.67 ±2.63 min,P =0.000) and the total time of procedure(55.13 ±5.64 min VS 31.67 ±8.25 min,P =0.000) between the two groups.There were no significant differences in the time of passing through the pylorus,the time of finding biliary orifice,the stenting time of biliary or pancreatic duct or the X-ray exposure time between the two groups.Conclusion The modified shortened scope can improve the success rate of short scope position,facilitate locating biliary or pancreatic orifice,improve the success rate of pancreatic duct cannulation and shorten the cannulation time of biliary or pancreatic duct and the total operation time.

Objective To investigate the effects of trichostatin A (TSA) on cell proliferation and cell cycle in human gastric cancer cell line SGC-7901 in vitro and its mechanism. Methods SGC-7901 cells were treated with 0.1, 0.5 and 2.0 μmol/L of TSA for 24 hrs. Growth inhibition rates of cells were measured by MTT assay and cell cycles were detected by flow cytometery (FCM). Expressions of cyclin D1 and p21 mRNA were measured by real-time PCR. Results The proliferations of SGC-7901 cells were inhibited when treated with TSA for 24 hrs. The inhibition rates in groups treat with 0.1, 0.5 or 2.0 μmol/L of TSA were 3.52%±6.11%, 13.29%±4.13% or 14.24%±2.80% ,respectively. The cell percentage of G0/G1 phase were higher in 0. 5 pznol/L group (71.26%±0.51%) and 2.0 μmol/L group (71.03%±0.12%) compared with control group (51.12%±1.17%). The cell percentage of S phase were lower in 0.5 μmol/L group (13.55%±0.44%) and 2.0 μmol/L group (10.63%±0.63%) compared with control group (34.60%±0.60%). The expression of cyclin D1 mRNA was down-regulated, whereas p21 mRNA expression was up-regulated. Conclusions TSA inhibits SCG-7901 gastric cancer cell proliferation by affecting the cell cycle control gene eyclin D1 and p21 mRNA expressions, which induce G0/G1 cell phase cycle arrest and ultimately impact on the growth of tumor cells.

Objective To investigate the clinical value of KL-6 mucin in differential diagnosis of benign and malignant obstructive jaundice.Methods A total of 41 patients with malignant tumors and 15 with benign lesions were recruited in the study.KL-6 mucin levels of bile and serum were measured using enzyme-linked immunosorbent assay (ELISA).The serum alpha-fetoprotein (AFP),carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels were also measured using radioimmunoassay (RIA).All data were analyzed by Mann-Whitney U test and Receiver Operating Characteristics (ROC)curves.Results CEA,CA19-9,and KL-6 mucin in serum and KL-6 mucin in bile in patients with malignant tumors were significantly higher than those in patients with benign lesions (P ＜ 0.001).There were no significant differences in serum AFP between the two groups.An receiver operating characteristic (ROC)curves analysis revealed that the detection of KL-6 mucin in bile was reasonably accurate in differentiating malignant obstructive jaundice from benign (area under curve [AUC] 0.954).While the AUC of the ROC curves for serum AFP,CEA,CA19-9,KL-6 mucin and KL-6 in bile and 0.954 were 0.657,0.753,0.894,0.846 and 0.954 respectively.Using the ideal threshold as the cut-off point,the sensitivity and specificity of KL-6 mucin for differential diagnosis of benign and malignant obstructive jaundice was 90.24％and 93.33％.Conclusion As a tumor marker,KL-6 mucin in bile is valuable in differential diagnosis of benign and malignant obstructive jaundice.

Objective To evaluate the effectiveness of mouth care combined with intestinal and endoscopic working channel washing for ERCP related cholangitis.Methods A total of 573 patients diagnosed as having obstructive jaundice were randomized into three groups,190 cases in the control group,192 in the saline group and 191 in the amikacin group.Clinical and laboratory data were collected before ERCP and ERCP related cholangitis were recorded.Results There were no significant differences among the three groups in sex,age,the level of obstruction,the category of obstruction,total bilirubin or WBC counting.The incidences of ERCP related cholangitis were 21.1％ (40/190),13.5％ (26/192) and 4.7％ (9/191)in control group,saline group and amikacin group respectively,which was significantly different (x2 =22.409,P =0.000 ).The incidences of ERCP related cholangitis were 19.5％ ( 65/333 ) and 4.2％(10/240) in patients diagnosed as having hilar duct obstruction and low positioned biliary obstruction respectively (x2 =27.175,P =0.000).There was no significant difference in ERCP related cholangitis between benign and malignant biliary obstruction.Subgroup of hilar duct obstruction showed the incidences of ERCP related cholangitis were 29.7％ (33/111 ),20.5％ (24/117)and 7.6％ (8/105)in the control group,the saline group and the amikacin group,respectively (x2 =16.905,P =0.000).Conclusion The incidence of ERCP related cholangitis is relatively higher in patients with hilar duct obstruction.Mouth care combined with intestinal and endoscopic working channel washing can effectively reduce the incidence of ERCP related cholangitis,especially in the amikacin group.

ObjectiveTo evaluate the feasibility and safety of endoscopic intraductal radiofrequency ablation (RFA) for unresectable malignant biliary strictures.MethodsA total of 12 patients with malignant biliary obstructions,who were unsuitable for surgical resection,were prospectively selected for this study.During ERCP,when successful biliary cannulation achieved,a bipolar radiofrequency probe was introduced into bile duct over a guidewire.RFA was given to the tumor lesion under fluoroscopy,followed by stent placement.The patients were closely observed and followed up after the procedure.ResultsSuccessful RFA was achieved in all patients before stents insertion ( plastic and metal stents in 6 respectively,additional pancreatic stents were given to 3).Mild complications of cholangitis and pancreatitis occurred in 1 patient respectively,which were cured with short-term management.Jaundice was promptly controlled in 7 patients (58.3％ ).During the mean follow-up duration of 3.4 (range 0.5-5.5) months,one patient died of cardiocerebral accident and others survived without obvious disconffort.The 1- month and 3- month stent patency was 100％ (12/12) and 80％ (8/10),respectively.ConclusionIt is technically feasible and safe to perform endoscopic intraductal RFA for the palliation of biliary malignancies.The short-term outcome is satisfying,however,long-term result and the better therapeutic schedule need further evaluation.

Objective To investigate the efficacy of pancreatic duct guidewire pre-occupying in ERCP with difficult biliary cannulation.Methods During a four-year study period from June 2008 to June 2012,a total of 3505 patients were included in this retrospective analysis.Initial biliary cannulation method consisted of single-guidewire technique for up to 5 attempts,followed by double-guidewire technique when repeated unintentional pancreatic duct cannulation had taken place.Pre-cut papillotomy technique was reserved for when double-guidewire technique had failed or no pancreatic duct cannulation had been previously achieved.Biliary cannulation success and post-ERCP complication rate were compared.Results Single-guidewire technique was characterized by statistically significant higher success rate (93.4％),compared with the double-guidewire technique (54.8％,P ＜0.001),pre-cut failed double-guidewire technique (81.3％,P ＜0.001) or precut as first step method (84.6％,P =0.011).Pre-cut failed double-guidewire technique and pre-cut as first step method offered a statistically significantly more favorable outcome compared with the double-guidewire technique (both P ＜ 0.001).The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner among the four methods.Numbers of patients who got bleeding in pre-cut papillotomy technique and sphincterotomy after successful single-guidewire technique were 5 and 2 respectively.One case of perforation was recorded using pre-cut papillotomy technique.There was no procedure-related mortality within 30 days.Conclusion Although double-guidewire technique success rate proved not to be superior to singleguidewire technique or pre-cut papillotomy,it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.

Objective To evaluate the effectiveness of mouth care combined with intestinal and endoscopic working channel flushing for ERCP related cholangitis and to investigate the mechanisms.Methods A total of 284 patients who underwent ERCP were divided into the amikacin group (n =96),the saline group (n =95) and the control group (n =93).Specimens were collected before cannulation (Sample 1),the first access to the bile duct (Sample 2) and at the end of ERCP (Sample 3).All the samples underwent bacterial culture and colony counting.Incidence of ERCP related cholangitis and bacterial results were recorded.Results The incidences of ERCP related cholangitis were 7.3％ (7/96),8.4％ (8/95)and 18.3％ (17/93)in amikacin group,saline group and control group respectively,with significant differences among three groups (x2 =6.861,P =0.032).The positive rate of bacterial culture of Sample 1 in the amikacin group,saline group and control group were 6.3％ (6/96),25.3％ (24/95) and 28.0％ (26/93) (x2 =16.833,P =0.000),respectively.The positive rate of bacterial culture of Sample 2 in amikacin group,saline group and control group were 6.3％ (6/96),16.8％ (16/95) and 24.7％ (23/93)(x2 =12.206,P =0.002),respectively.The positive rate of bacterial culture of Sample 3 in amikacin group,saline group and control group were 7.3％ (7/96),17.9％ (17/95) and 33.3％ (31/93) (x2 =20.713,P =0.000),respectively.Conclusion The procedure of ERCP can bring the intestinal bacteria into the bile duct,which could be reduced by mouth care combined with intestinal and endoscopic working channel flushing.And the incidence of ERCP related cholangitis can be effectively reduced.