Objective To explore the clinical effect of cholangioscopic Holmium laser lithotripsy for bile duct refractory residual stone and orthomorphia for intrahepatic bile duct membranous stenosis. Methods The final diagnosis was established by T tube retrograde cholangiography and cholangioscopy in 12 patients with refractory bile duct residual stone. Twenty-nine stones distribute in extrahepatic and intrahepatic bile duct and 5 intrahepatic bile duct membraneous stenosis were found in 3 cases. All patients underwent Holmium laser lithotripsy and orthomorphia. Results The stone clearance rate was 100% in 12 patients after cholangioscopic holmium laser lithotripsy. No serious complication occurred in patients after 5 membranous stenosis orthomorphia. Follow-up observation on 11 patients shows no obvious recurrence of symptom and stones. Conclusion Holmium laser lithotripsy and orthomorphia are safe and effective in the treatment of bile duct refractory residual stone and stenosis.

Objective To study the relationship of pit pattern in the progress of colorectal and the expression of PCNA and survivin in pit pattern. Methods Chromoendoscopy observation results were recorded according to the pit pattern classification proposed by Kudo. These results were divided into 6 groups according to the pit pattern and the results of histophathology. Expression of PCNA and surviving mRNA was detected by RT-PCR. Statistical analysis was performed using χ2 test , Fisher's exact test or Spearman rank correlation with SPSS 12.0 software package. Results In 6 groups classified according to the pit patterns, the expression rate of PCNA mRNA in type Ⅰ, Ⅱ, Ⅲ L, Ⅳ, V 1 and VN were 0% (0/13), 12.5% (1/8), 38.9% (7/18), 66.7% (12/18), 75.0% (3/4) and 100.0% (9/9), the expression rate of survivin mRNA in type Ⅰ,Ⅱ, Ⅲ L, Ⅳ, V 1 and V N were 0%, (0/13), 12.5% (1/8), 22.2% (4/18), 44.4% (8/18), 50.0% (2/4) and 77.8% (7/9), respectively. Conclusions The expression of survivin and PCNA mRNA had positive correlation in the coloree-tal lesions classified whether by the pit patterns or histophathology. Study of the two genes simultaneously could complement each other and reflect the biological characteristics of colorectal cancer more accurately.

Objective To evaluate the endoscopic precut sphincterotomy for malignant biliary obstruction. Methods Endoscopic precut sphincterotomy was performed in different ways for 46 patients with malignant biliary obstruction and difficult biliary cannulation according to the anatomic structure of the papilla and cannulation. Ways of precut were summarized and complications were analyzed. Results Precut sphincterotomy was performed with bow-like knife in 4 patients, with needle-knife in 24, with trans-pancreatic sphincterotomy in 12 and with combined ways in 6. The procedure succeeded in 35 cases (76. 1%, 35/46). Post-procedure complications included bleeding in 3 patients, pancreatitis in 1, hyper-amylasemia in 2and cholangitis in 1. No perforation was found. Conclusion Endoscopic precut sphincterotomy is not only able to improve the therapeutic endoscopy achievement rate in patients with malignant biliary obstruction, but also to lower the incidence of complications if used adequately.

Objective To explore the application value of the guide-wire for selective biliary cannulation of proximal biliary obstruction.Methods A total of 344 patients with proximal biliary obstruction were treated by endosocopic retrograde cholangio-pancreatography.Various guide-wire skills,were applied to pass through the stricture of bile duct,so as to reach the target bile duct,and analyzed for their therapeutic effects.Results Selective biliary cannulation of proximal biliary obstruction was completed in 336 patients,after successful cholangiography for therapeutic operation.The overall success rate was 97.67％.There was no procedure-related complications,such as hemobilia or perforation.Conclusion The guide-wire for selective biliary cannulation of proximal biliary obstruction not only improves the success rate of therapeutic endoscopy but also reduces the procedure time and the incidence of complications.

Objective To evaluate efficacy and safety of Iodine-125 seeds used in brachytherapy for cholangiocarcinoma.Methods A total of 65 cases of cholangiocarcinoma patients were diagnosed and treated with ERCP.The Iodine-125 seeds were implanted into bile duct cavity by self-made carrier (applicator) in various ways, and Iodine-125 seeds were replaced to improve the local irradiation dose.Follow-up was regularly made through endoscopy and ultrasonography to evaluate feasibility, efficacy and complications.Results Self-expanding metal stents, single or double plastic stents were successfully placed in 65 patients.At first , single row of Iodine-125 seeds were inserted to 59 patients, double row Iodine-125 were inserted to 6 patients , and the average activity of the first irradiation was 5.775 mCi.Iodine-125 were replaced in 4 patients after three months, in 41 patients after six months, in 5 patients after one year.The total dose was up to 14 mCi.In the follow-up of 6-35 months, the longest survival time was 35 months in two patients, where the Iodine-125 seeds were replaced 3 times as a whole and there was no serious complications.Conclusion Iodine-125 brachytherapy on cholangiocarcinoma by ERCP, where biliary stents and Iodine-125 seeds can be replaced at any time , is convenient, less invasive and can obviously prolong survival time.