Surveillance colonoscopy after endoscopic resection of colorectal adenomas is a crucial step in colorectal cancer screening. After identifying the patients at risk,a tailored follow-up colonoscopy surveillance strategy should be formulated. The follow up colonoscopy time interval after endoscopic resection of colorectal adenomas should be scheduled on the basis of past history,family history,and results of initial high quality colonoscopy examination. By reviewing the American and European guidelines for surveillance after polypectomy,a follow-up colonoscopy time interval schedule matched with the risk stratification is suggested for discussion.

5-aminosalicylic acid(5-ASA)is a first-line drug in the treatment of inflammatory bowel disease(IBD). It is a highly effective,safe,and well-tolerated drug for treatment of mild to moderate ulcerative colitis. As the emerging of new formulations of 5-ASA in recent years,the clinical indication has been extended. This article reviewed the characteristics of various formulations and clinical application of 5-ASA.

Objective To study the correlativity of laser-induced fluorescence (LIF) spectrum on the same specimen of colorectal carcinoma both in vivo and in vitro and to obtain the best diagnostic parameter in detecting colorectal carcinoma. Methods LIF spectra were analyzed from 10 patients with colorectal carcinoma during colonoscopy, and then analyzed again after resection. The cancer foci and normal mucosa more than 5 cm apart from the foci were excited by a nitrogen laser (337 nm)using a quartz optical fiber in gentle contact with the area of interest, and then the fluorescence emission was collected by the same quartz optical fiber. The LIF spectrum was analyzed using an optical multichannel analyzer (OMAⅢ). Results (1)The LIF spectrum from cancer tissues was same as that of normal tissues, both showed the main and the second peak respectively located at about 460 nm and 390 nm in vivo and in vitro. The main peak intensities in vivo from both cancer and normal tissue were significantly lower than these in vitro. The main peak intensities in vivo and in vitro from cancer tissue were decreased about 1 time to those from normal tissue.(2) The integrated spectral intensity in vivo and in vitro of cancer tissue from each patient was significantly lower than that from the corresponding normal tissue respectively, P

Objective Laser induced fluorescence spectroscopy have been used in early diagnosis of GI cancer, but the device is expensive and inconvenient. The purpose of this study was to test the effectiveness and feasibility of a new device designed by the authors. Methods Two formulas were set up based on the analysis of OMA data and a new system was established. Fifteen samples of normal tissue and 40 cases of endoscopic diagnosed cancer were tested. Results (1) First formula: general energy of fluorescence was W 359～659 nm . (2) The second: the ratio of energy integral was W 359～460 nm /W 460～659 nm . (3) The sensitivity and specificity were 93.3% and 100.0% for 15 samples of gastro intestinal cancer in vitro and were 90.0% and 92.5% respectively for gastrointestinal cancer endoscopically. Conclusions (1) The deviec may help doctors to determine the characteristics of lesion in endoscopy and the efficacy of the instrument was the same as OMA system. (2) The cost was about one tenth of that for OMA system.

Objective To study the relationship between gastric mucosa associated lymphoid tissue (MALT) lymphoma and Helicobacter pylori (H.pyori) infection retrospectively. Methods The paraffin embedded samples of the tumors in gastric intestinal tract and its corresponding normal tissues from 35 patients with non Hondgkin's lymphomas in gastric intestinal tract were sectioned. The slides, except routine histopathologic study, were submitted to immuno histochemical staining (CD 3,CD 5,CD 10 ,CD 20 ,C 23 ,CD 45 RO, kappa, lamda, cyclin, Ki67, TUNEL) and to HE staining for the detection of H. pylori infection. Results ①Twenty one cases were identified to be MALT lymphomas according to the results of immunohistochemical staining, of them 16 cases were gastric MALT lymphomas, 1 case of intestinal MALT lymphoma, and 4 cases of colonic MALT lymphomas. ② H. pylori infection in gastric MALT lymphoma was 100% except in 3 cases who had only tumor tissues, which could not be evaluated. ③ Two cases were stage Ⅰ 1 gastric MALT lymphomas, 5 were stage Ⅱ 1,and 9 were stage Ⅱ E. ④ Only 6 cases had recognized as gastric MALT lymphomas by endoscopy and biopsy. Three patients were misdiagnosed as gastric cancer, 1 as M?n?trier disease, 1 as atrophic gastritis, and 5 as chronic gastritis endoscopiclly. ⑤ One patient got a complete regression after 3 courses of anti H. pylori therapy and was in good health after 3 years of the treatment. Conclusions ① A close relation was present between H.pyloi infection and gastric MALT lymphoma. ② Early gastric MALT lymphoma may regress after eradication of H.pylori.

Background:Ulcerative colitis(UC)is often accompanied by a variety of extraintestinal manifestations. Recently, the role of extraintestinal manifestations in diagnosis and treatment of UC has aroused widespread concern in clinical practice. Aims:To study the extraintestinal manifestations of patients with UC in order to elevate diagnosis level of UC. Methods:A total of 208 inpatients from June 2008 to September 2011 at Beijing Military General Hospital were enrolled. The extraintestinal manifestations of UC were retrospectively analyzed. Results:The ratio of male to female was 1. 14: 1, mean age was(41. 17 ± 13. 57)years,mean disease duration was(62. 6 ± 79. 4)months. Thirty-three patients had proctitis,52 had left-sided colitis,and 123 had extensive colitis. Forty-nine patients were mild UC,80 were moderate UC, and 79 were severe UC. The incidence of extraintestinal manifestations was 28. 8%(60 / 208);13 patients(6. 3% )had more than one extraintestinal manifestation. The main extraintestinal manifestations were oral ulcer(13. 0% ),arthropathy (11. 1% ),hepatobiliary disease( 3. 8% ) and skin lesion( 1. 4% ). The trend of incidence of extraintestinal manifestations increased from patients with proctitis,left-sided colitis to extensive colitis(21. 2% ,28. 8% ,30. 9% , respectively),however,the difference was not statistically significant(P > 0. 05). No significant difference in incidence of extraintestinal manifestations in patients with mild UC,moderate UC and severe UC was found(22. 4% ,33. 8% ,27. 8% , respectively)(P > 0. 05). Conclusions:Patients with UC are often accompanied by extraintestinal manifestations,and the recognition of extraintestinal manifestations is helpful for improving diagnosis and treatment level of UC.

Objective To investigate the value and safety of colonoscopy in patients aged 80 years and over.Methods Clinical and endoscopic data of 1 249 patients aged 80 years and over collected from December 2005 to December 2015 at PLA army General Hospital were analyzed retrospectively.Results The average age was 83.03 years.Reasons for receiving colonoscopy included constipation with abdominal distension(19.38 ％)and hematochezia(10.57％).The completion rate of colonoscopy for the entire length was 94.50 ％.There were no abnormal findings in 492 cases (39.39 ％).Colonic polyps (31.62 ％) and colorectal cancer (14.25 ％) were among the major lesions detected with colonoscopy.Colorectal neoplasms were found in 58.33％ of the 132 patients with hematochezia.The total complication rate from colonoscopy and treatment was 0.72％,with the complication rate from treatment at 1.32％.Conclusions Constipation with abdominal distension and hematoehezia are the main reasons for undergoing colonoscopy for very elderly patients.Colon polyps and colorectal cancer are common disorders in elderly patients over 80 years of age and people with hematochezia in this age group are at high risk of having colorectal cancer.Colonoscopy is a safe and effective procedure and an important examination method for very elderly patients with hematochezia.

Background:Clinical and epidemiological studies revealed that estrogen replacement therapy was associated with a significant reduction in risk of colorectal cancer in postmenopausal women.In our previous studies,estrogen increased the expression of mismatch repair (MMR)gene MLH1 in colonic cancer cells,and re-expression of MLH1 in MLH-deficient colonic cancer cells significantly increased the estrogen-induced apoptosis.Aims:To investigate the signaling pathway implicated in the MLH1-mediated apoptosis in colonic cancer cells induced by estrogen and the roles of p53 and its related genes in this apoptotic pathway.Methods:Plasmid containing wild type human MLH1 (hMLH1)full length cDNA was transfected into MLH1-deficient human colonic cancer cell line HCT116.By using HCT116 cells transfected with empty plasmid as controls,the apoptotic DNA ladder was determined by electrophoresis and the expressions of p53 and other apoptosis-related proteins were assessed by Western blotting under the condition with or without estrogen stimulation. Results:17β-estradiol (E2 )at the concentration of 10 -8 mol/L induced significant apoptosis in HCT116 cells transfected with hMLH1.In HCT116 cells transfected with hMLH1 and stimulated with E2 (group D),the protein expressions of caspase-3,caspase-9,p53,Bax and cytoplasmic cytochrome C increased significantly when compared with HCT116 cells stimulated with E2 only (group B);expressions of the abovementioned proteins were also higher in group D than in group C (transfected with hMLH1 only).Conclusions:MMR gene MLH1 is involved in estrogen-induced apoptosis of human colonic cancer cell line HCT116 by activating p53 signaling and mitochondrial apoptotic pathway.

Objective To evaluate the efficacy of premedication of pronase and simethicone before upper gastrointestinal endoscopy. Methods A total of 4 690 patients undergoing upper gastrointestinal en?doscopy from January 2014 to November 2014 were recruited at gastrointestinal endoscopy center in Beijing Military General Hospital. All patients were randomized into 3 groups. The pronase plus simethicone group( n=1 602) took 40 ml mixed solution of pronase, sodium bicarbonate and simethicone orally 20 minutes before endoscopy. The simethicone group( n=1 548) took 40 ml simethicone orally 20 minutes before endoscopy. And the control group( n=1 540) took 10 ml lidocaine hydrochloride mucilage orally 5 minutes before endos?copy. The visibility during gastroscopy was observed. Results Each patient underwent gastroscopy, and no severe adverse event occurred during the procedure. The visibility of 82?3%( n=1 318) of the pronase plus simethicone group, 67?7%( n=1 048) of the simethicone group and 28?1% patients( n=432) of the control group respectively reached grade A or B. The visibility during gastroscopy in the pronase plus simethicone group was higher than that in the simethicone group(χ2=89?42, P=0?000) , while that in the simethicone group was higher than that of the control group(χ2=486?30, P=0?000). Conclusion Premedication of pronase and simethicone can improve the visibility during gastroscopy.

Objective To analyze the miss rates of colorectal adenomas during colonoscopy as well as risk factors influencing the adenoma miss rates and to take corresponding measures. Methods A total of 432 patients who underwent index and follow-up colonoscopy in 18 months were randomized and investigated. The results of two colonoscopies were compared and the missed adenomas were defined as the adenomas de-tected only during the second colonoscopy. Miss rates were calculated according to patient-based methods. Chi-square test was used to analyze the relative factors influencing the adenoma miss rate of per-patient. Then the meaningful factors were chosen into the logistic regression model for multiple factors analysis. Results Of 432 patients,116(26. 9%)had missed adenomas on first colonoscopy. Single factor analysis found that the size of adenoma( χ2 = 89. 686,P = 0. 000),the shape of adenoma( χ2 = 68. 488,P = 0. 000),the location of adenoma(χ2 = 77. 055,P = 0. 000)and adenoma tissue types(χ2 = 417. 000,P = 0. 000)were the risk factors for miss rates of colorectal adenomas. Number of polyps(χ2 = 8. 450,P= 0. 038),the organi-zation type of polyp(χ2 = 10. 718,P= 0. 013)and proficiency of colonoscopists(χ2 = 56. 069,P= 0. 000), the quality of bowel preparation(χ2 = 39. 195,P = 0. 000),insertion time(χ2 = 13. 133,P = 0. 001)were also the risk factors for miss rates of colorectal adenomas. Logistic regression analysis showed that the bigger the adenoma size,the less missed adenomas(OR= 0. 341,95%CI:0. 173-0. 671). Also,the longer insertion time took,the lower the adenoma miss rate(OR = 0. 987,95% CI:0. 981-0. 994). Per-patient miss rates were lower for high-risk adenomas compared with low-risk adenomas(OR = 0. 324,95%CI:0. 154-0. 680). Adenomas happening in multiple parts of bowel easily leads to missing(OR= 3. 791,95%CI:1. 505-9. 546). Conclusion The missed diagnosis of adenomas is not only significantly associated with features of missed adenomas,but also with skills of colonoscopists,insertion time,and bowel preparation. The key is high-quality index colonoscopy to avoid adenomas missing.