Objective To compare the effects of intrasphincteric injection of botulinum toxin or pneumatic dilation on the treatment of achalasia. Methods One hundred and eighteen patients with esopha-geal achalasia were randomly assigned into 2 groups. (1) Injection group; botulinum toxin 100iu was injected into the muscular layer around LES under endoscopies with each site 20iu. (2) Dilation group; Dilating the cardiac sphincter with Rigiflex dilation balloon under endoscopies. Esophageal manometry was performed before and one week after treatment. And clinical symptoms were observed. Results Before therapy the 3 kinetic parameters of both groups revealed no significant statistical difference, but after therapy in dilation group LESP decreased to (6.03?3.45) mm Hg, LESRP ( -0. 11 ?2. 34) mm Hg, LESRR increased to 92. 50% ? 13. 86% , with significant statistical difference as compared to the data before treatment. In injection group LESP decreased to (23. 16 ? 16. 17) mm Hg, LESRP and LESRR after therapy showed no statistical difference as compared to the corresponding data before therapy. The improvement of clinical symptoms in dilatation and injection groups graded as prominent effective, improved and failed were 45 ( 80. 36% ) , 11 (19.64% ) ,0 and 15(24.19% ) , 38(61.29% ) , 9( 14.52% ) respectively. Conclusion In the treatment of esophageal achalasia the short term effect of pneumatic dilatation is superior to intrasphincteric injection method, the improvement of clinical symptoms is closely related to the decrease of LESP and LESRP especially the later.

From November 1997 to August 2002, a total of 165 achalasia patients were treated with endoscopic injection of botulinum toxin A into the gastric cardia. The results showed that the lower esophageal sphincter (LES) pressure (41.76?22.00 vs 19.14?11.40 mmHg) and LES relax pressure (14.74?9.41 vs 8.51?7.85mmHg) were decreased significantly (both P

Objective To investigate the indication and therapeutic effect of endoscopic pancreatic stent insertion. Meth-ods 13 procedures of endoscopic sphincter incision,2 procedures of endoscopic pancreatic stone picking,3 procedures ofendoscopic papilla adenoma or carcinoma resection. 10 procedures of endoscopic stenosis dilatation and 20 procedures ofendoscopic pancreatic stent insertion were performed on 9 cases of chronic pancreatis (in which 3 cases had pancreaticstone), 1 case of acute recurrent pancreatis.4 cases of pancreatic cancer and 3 cases of papilla adenoma or carcinoma.The duration of stent preserve was 2 weeks to 8 months, average 3. 43 months. Results Remission of abdominal pain,improvement of appetite and digestive function was found in 16 cases. 12～35 months (average 26. 17 months) of follow-up was performed on patients of pancreatitis after the stents were removed. 7 cases had no recurrence of abdominal pain,3 patients still often had upper abdominal pain. Complications:3 cases had mild elevation of serum amylase and lipase. 1case had obstructive jaundice. Conclusion Endoscopc pancreatic stent insertion and drainage is suitable for pancreaticduct obstruction caused by chronic pancreatitis or cancer. It can alleviate symptoms and has reliable therapeutic effect andgood security.

Objective To evaluate the efficacy of scle rotherapy (EVS) for esophageal variceal bleeding. Methods Retrospective analysis was made in 1 010 patients with es ophageal variceal bleeding who underwent sclerotherapy, among them 850 patie nts were cirrhosis and 160 patients were hepatocellular carcinoma. The total num ber of procedures of sclerotherapy were 3 203, including 602 for emergency scler otherapy and 2 601 for selective sclerotherapy. Supplementary sclerotherapy was performed in 502 cases. Average procedures of sclerotherapy for initial treatme nt were 3.18?1.1 in 710 cirrhotic patients. Follow-up was made in 579 cirrhosi s patients for 3-157 months, with an average follow-up period of (42.47?32.78) months. Results 1. The hemostasis rate in the whole group was 97.0%, the c omplication rate was 13.4%, and the mortality was 1.8%. 2. Rate of complete and nearly complete elimination of esophageal varices in cirrhotic patients was 84 .1 %, and long term rebleeding rate was 23.7%. Survival rates were (95.8?0.8)% 、(86.1?1.6)%、(74.5?2.4)%、(53.6?3.8)% at 1,3,5 and 10 year according to t he Kaplan-Meier analysis. Conclusions EVS is an important method of treatment for esophageal variceal bleeding.

0.05). 7 cases were complicated with early rebleeding in each group, 3 cases died in the EVL group, and no patient died in the EVS group. During the follow up period of 1 year, the rate of recurrent varices was 39.4%(26/66) in the EVL group, versus 21.3% (13/61) in the EVS group, showing statistically significant difference between the two groups ( P 0.05).

Objective To study the feasibility and effect of implantation of the biliary stent for treatment of biliary obstruction.Methods A retrospective analysis of the diagnostic and therapeutic procedure was done in 131 cases of the inpatients from Apr.2006 to Feb.2007.The 131 patients with biliary obstruction underwent successfully 138 cases/times implantation of biliary stent.The results of recession of jaudince and the rate of complication were evaluated.Results All patients were implanted biliary stent successfully.The serum total bilirubin,direct bilirubin,alkaline phosphatase,?-glutamyl transpeptidase decreased obviously in three days,and the difference was remarkable.The main complication was infection of biliary tract and pancreatitis.Conclusion Implantation of biliary stent is an effective management for biliary obstruction,especially for patients who have lost the chance of operation.

Objective To evaluate and analyse the efficacy and safety of endoscopic papillectomy for tumors of major duodenal papilla.Methods The clinical data of thirty-four patients with tumors of major duodenal papilla who were treated by endoscopic papillectomy were retrospectively reviewed,and the clinical outcome was summarized.Results The success rate of endoscopic papillectomy was 94.12％ (32/34),and the complete resection was 66.67％ (20/30).Short-term complications occurred in 10 cases,including postoperative gastrointestinal bleeding in 7cases and postoperative pancreatitis in 3 cases.Five cases need further surgical intervention for the reason that tumor was too deep in 2 cases,bile duct was invaded in 2 cases and conservational medication was unsuccessful in 1 case.Thirty-three cases were pathologically diagnosed as low grade intraepithelial neoplasia (LGIN),17 cases high grade intraepithelial neoplasia (HGIN),1 case carcinoid and 3 cases adenocarcinoma.The recurrence rate was 23.33 (7/33).tumor recurrence rate of HGIN was higher than that of LGIN(42.86％ VS10％,P =0.078).Conclusion Endoscopic papillectomy is an effective method for treating tumors of major duodenal papilla,however,hemorrhage is the main postoperative complication,the recurrence rate is higher in HGIN group.

Objective To summarize and analyze the clinical characteristic of blue rubber bleb nevus syndrome (BRBNS).Methods The clinical data of four cases treated since 2001 and 30 BRBNS cases reported by domestic literature were retrospectively analyzed.The clinical manifestation,family history,endoscopy and imageology examination,site of lesions,treatment and follow up were analyzed.Results The male to female ratio was 1.8∶1 and median age was 19.5 years.A total of 33 cases (97.1％) presented with gastrointestinal bleeding,median age of gastrointestinal bleeding detected was 9.0 years.Among the 33 cases,anemiawas found as the primary symptom in nine cases (27.3％),and one case complicated with intussusception and intestinal necrosis accompanied with abdominal pain.Two cases have family history.Gastroscopy (85.3 ％) and colonoscopy(73.5 ％) were mainly examinations for detection.Lesions mainly involved skin (100.0％) and digestive tract (97.1％),and the locations of the lesion in digestive tract was stomach (64.7％),small intestine (64.7％),colon (58.8％),esophagus (29.4％).Treatment methods included symptomatic treatment,endoscopic therapy and surgery.Banding ligation and polypectomy resection were common endoscopic therapies.Gastrointestinal bleeding did not recur in six cases with endoscopic therapy and four cases receiving surgery during short-term follow up.Conclusions BRBNS lesions mainly involve skin and digestive tract,mostly complicated with gastrointestinal bleeding.For gastrointestinal bleeding,so far endoscopic therapy and surgery are the effective therapies.

Objective To explore the effectiveness and safety of limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD)for patients with large common duct stones and periampul-lary diverticula (PAD).Methods Data of 40 patients with large common duct stones (diameter ≥10 mm) and PAD who underwent ESBD were retrospectively reviewed.The clinical feature,operation method,suc-cess rates of stone removal and early complications rates during hospitalization were evaluated according to PAD subtypes.Results The stone removal rate in first session was 90.0%(36 /40,with a median time of 29 minutes per procedure.Three patients underwent a second procedure to remove residual stones.The over-all stone removal rate was 97.5% (39 /40).The early complications rate was 15%(6 /40),including mild pancreatitis in two cases(5%),hyperamylasemia in two (5%),postoperative late bleeding in two (5%), which were cured with conservative treatment.No perforation,massive hemorrhage or death occurred.No significant differences in success stone removal rate and early complication rate were found between PAD sub-types.Conclusion ESBD is an effective and safe procedure for removing choledocholithiasis in patients with PAD,regardless of PAD subtypes.

Objective To evaluate the technique of transpancreatic septum precut for cannulation of inaccessible common bile duct in endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of 109 patients with difficult biliary cannulation in ERCP, of whom 56 underwent transpancreatic septum precut and 53 had needle-knife sphincterotomy from January 2006 to July 2008, were analyzed retrospectively, and the success rate of cannulation and the occurrence of complications were compared between the two methods. Results Of 109 patients accepted precut papillotomy, common bile duct cannulation was successfully achieved in 97. The success rates of transpancreatic septum precut group and needle-knife sphincterotomy group were 96.4% (54/56) and 81.1% (43/53) respectively, which was significantly different (P<0.05). Complications occurred in 11 cases, including bleeding(n =4), acute pancreatitis(n=5), cholangitis(n=2). The tolal frequency of complications of the transpancreatic septum pre-cut papillotomy group was lower than that of needle-knife sphincterotomy group(3.6% vs. 17.0%, P<0.05). Conclusion In patients with inaccessible bile ducts, transpancreatic septum precut is a safe and effective procedure in cannulation, exhibiting a higher success rate and lower occurrence of complication when compared with needle-knife sphincterotomy.