Objective To study the clinical application of endoscopic retrograde cholangiopancre-atography(ERCP)combined with biliary microlithiasis exploration in acute cholangitis.Methods The clinical data of consecutive 54 cases of acute cholangitis were analyzed.Before ERCP,all cases were examined by routine examinations,including abdominal uhrasonography,CT or magnetic resonance cholangiopancre atography(MRCP).The bile Was collected through ERCP or endoscopic mtsobiliary drainage(ENBD),then all the samples were choked by polarization microscope.Results Thirty-six cases(66.67%)out of 54 patients with common bile duct(CBD)stones or dilation of common bile duct were diagnosed by routine examination.ERCP Was performed in all patients,only 3 cases failed,and the rest were successful.Through ERCP,39 cases with CBD stones(76.47%),4 cases with CBD inflamnmtory smcmre were diagnosed,and 12 cases were normal.Among the 12 cases,9 cages were found with biliary microlithiasis by polarization microscope.The diagnostic effectiveness of ERCP combined with biliary microlithiasis exploration was highest(94.12%),and there Was significant difference between them(P＜0.05).Conclusions It may improve the diagnostic accuracy to combine ERCP with biliary microlithiasis exploration in CBD stones.Biliary microlithiasis may play an important role in the pathogenesis in unknown aetiology acute unexplained cholangitis.

Objective To study the diagnostic value of NBI combined with magnification endoscopy using VS classification standard for early gastric carcinoma lesions.Methods A total of 100 patients with suspected early gastric cancer whose gastric mucosa showed roughness,erosion,abnormal colour or ulcer were collected from January 2013 to June 2014.The lesions were observed under white light endoscopy and then underwent biopsy.Observation and biopsy were conducted in the same location by NBI-ME with self contrast method 2 weeks later.Patients in group A underwent NBI-ME,then were diagnosed by VS classifi-cation standard.Patients in group B were diagnosed with white light endoscopy.The sensitivity,specificity, positive predictive value,negative predictive value and accuracy between group A and group B were com-pared.Results The sensitivity,specificity,positive predictive value,negative predictive value and accura-cy of white light endoscopy in the diagnosis of early gastric carcinoma lesions were 76.19% (16 /21 ), 45.57%(36 /79),27.12%(16 /59),87.80%(36 /41)and 52.00%(52 /100),respectively;while the these variables of NBI-ME for early gastric carcinoma lesions were 95.24%(20 /21),97.47%(77 /79), 90.91%(20 /22),98.72%(77 /78)and 97.00%(97 /100),respectively.The accuracy of NBI-ME for early gastric carcinoma lesions was significantly higher than that of white light endoscopy(χ2 =53.30,P <0.01).Conclusion NBI-ME is convenient and effective in the diagnosis of early gastric carcinoma lesions with high consistency of pathology and good clinical application value.

Objective:To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) in the treatment of rectal laterally spreading tumors (LSTs) .Methods:The clinical data of 20 patients with LSTs ,who were admitted in Jiangyin Tradi‐tional Chinese Medicine Hospital from September 2012 to September 2014 ,were retrospectively analyzed .According to the su‐perficial morphology of rectal mucosa ,the subtypes of LSTs were determined by endoscopy .Tumor size and morphological characteristics ,pathological features and operation time of ESD were counted .Furthermore ,postoperative complications and recurrence were followed up and statistically analyzed .Results:There were 8 (40% ) cases of LST granular type and 12 (60% ) cases of LST nongranular type .There were 18 cases of adenomas associated with low grade neoplasia and 2 (10% ) cases of high grade intraepithelial neoplasia .There were 7 cases of tubulovillous adenoma and 13 cases of tubular adenoma .The mean diameter of lesions was (33 .9 ± 11 .5) mm .The enbloc resection rate was 100% and the average time of ESD operations was (40 ± 15) min .The postoperative bleeding rate was 10% (2/20) and no perforation occurred .The mean follow‐up period was 12 .6 months ,during which no recurrence was found .Conclusions:With high enbloc resection rate and low complication rate ,ESD is a safe and efficacious treatment for rectal LSTs ,especially for the lesions larger than 2 cm which have higher potential of malignancy .