0.05). Conclusion Though the noninvasive MRCP offers a diagnostic means equivalent to that of ERCP it is still too early to say it will take the place of ERCP.

Objective To compare the detection rates of capsule endoseopies with push endoseo-pies. Methods From May 2002 through January 2003 , thirty - nine patients with suspected small bowel diseases, particularly the gastrointestinal bleeding of unknown origin were examined by capsule endoscopies. Of the 39 patients. 32 complained of obscure recurrent gastrointestinal bleeding. From January 1993 to October 1996, 36 patients suffered from unexplained GI bleeding underwent push endoscopies. All patients had prior normal results on gastroseopy, colonoscopy, small bowel barium radiography, seintigraphy and/ or angiogra-phy. Results M2A capsule endoscopies disclosed abnormal small bowel findings in 26 out of 32 patients (81% ). Twenty one of 26 patients had significant pathological findings in explaining their clinical disorders with diagnostic yield of 66% (21 of 32 patients). Definite bleeding sites diagnosed by capsule endoscopies in 21 patients including angiodysplasia 8, inflammatory small bowel diseases 5, small bowel polyps 4, GI stro-mal tumor 2,earcinoid tumor and lipoma 1 , and bemorrhagie gastritis 1. Push endoscopies detected the definite sources of bleeding in 9 of 36 patients (25%). Definite bleeding sources included angiodysplasia 2, leiomyosareoma 2, leiomyoma 1 , lymphoma 1 , Grohns disease 1 , small bowel polyps 1 ,and adenocareinoma of ampulla 1. Suspected bleeding sources were seen with push endoscopies in two additional patients, and other five patients with capsule endoscopies. Conclusion Gapsule endoseopy is superior to push endoscopy in detecting obscure GI bleeding ( P

Objective To evaluate the effectiveness of wireless capsule endoscopies in patients with suspected CD of the small bowel.Methods From May 2002 through April 2003, we prospectively examined 20 suspected CD patients by capsule endoscopies with normal results in other conventional examinations. It includes the presence of the following symptoms and signs: abdominal pain, weight loss, positive fecal occult blood test, iron deficiency anemia, diarrhea and fever. Mean duration of symptoms before diagnosis was 6 5 years.Results Of the 20 participants, 13 (65%) were diagnosed as having CD of the small bowel according to the findings of the M2A Given Capsule. Among the findings detected by the capsule were mucosal erosions (2 patients), aphthae (5 patients), granulomatous nodularity (1 patient), large ulcers (2 patients), and ulceration with incomplete obstruction (3 patients). All of the 13 patients who received medications showed good clinical improvement.Conclusion Wireless capsule endoscopies were the effective device for diagnosing patients with suspected CD, undetected by conventional diagnostic measures.It may be more likely to detect early lesions in the small bowel of patients with CD.

lem and direct necessary intervention to improve the completion rate of whole small intestine examination.

Objective To evaluate the safety and effectiveness of capsule endoscopy(CE) in a large cohort of the elderly patients with obscure gastrointestinal bleeding(OGIB). Methods The demographic, clinical and diagnostic data of all geriatric patients with obscure gastrointestinal bleeding who underwent CE between May 2002 and February 2007 were retrospectively analyzed. For comparison, non-geriatric patients with obscure gastrointestinal bleeding who underwent CE during the same period were selected as the control group. Results Ninety-seven geriatric patients [40men/57 women, mean age (70.84-6.8) yrs]and ninety-nine non-geriatric patients [61 men/38women, mean age (44. 4±10. 3) yrs)were retrospectively reviewed. Eighty-nine patients presented with overt OGIB while eight patients had occult OGIB in the geriatric group. The section in the nongeriatric group was ninety-one and eight respectively. No significance was seen in the gastric transit time, completion rate and delay rate between two groups. The small bowel transit time was significantly longer in the geriatric group than that in the non-geriatric group (P<0. 05). Sixty-two patients in the geriatric group obtained positive diagnosis and angiodysplasia was the most frequent lesion;while sixty-seven patients in the non-geriatric group obtained positive diagnosis and Crohn's disease was the most frequent lesion. No significance was seen in the positive diagnostic rate between two groups (P>0. 05). However, the constituent ratio of the positive diagnosis was significantly different between two groups (P<0. 01). Conclusions CE is a safe and effective procedure for geriatric patients with obscure gastrointestinal bleeding. Angioectasia accounts for the majority of positive findings in geriatric group.

objective To analyse the incidence of technical breakdown and clinical problem leading to the failure of capsule endoscopy examination and their influence on the diagnosis and to evaluate its feasibility and safety in special patient population.Methods A retrospective study of 300 consecutive patients referred to Renji Hospital for evaluation of suspected small bowel diseases between May 2002 and May 2006 was done.This included 300 consecutive patients.The median age of the patients was 51y (range,3～91Y).The young children group was defined as less than 10 years and the elderly group as more than 80 years.Technical problems were those related to the functioning of the equipment and clinical problems were those related to the patient.The incidence and the type of above-mentioned events and their influence on the diagnosis were analyzed.The safety and feasibility of the capsule endoscopy procedure were evaluated in the young children group,elderly group and patients with pacemakers,gastrectomy and Billroth Ⅱ gastrojejunostomy,intestinal diverticula,Crohn's disease and polyp of small intestine.Results A total of 300 patients were involved.The incidence of technical problems was 1.3%.including one case of failing in activating the capsule,one case of failing in loading the data and two cases of short life of battery.Failure of diagnosis was encountered in two cases.The incidence of clinical problems was 33.0%(99 cases)and they caused 35.4%(35 cases)failure of diagnosis in the 99 cases.Three patients in the young children group were unable to swallow the capsule and endoscope-guided overtube technique was used with success in all.In the elderly group.the incidence of capsule retaining in the oesophagus and stomach was as high as 23.0%.In two patients with pacemaker no interference between pacemaker and capsule was detected.In two patients with Billroth Ⅱ gastrojejunostomy uo capsule retention occurred.In 16 patients with diverticulum,capsule retention occurred in 1 case(6.0%).In 42 patients with Crohn's disease,capsule retention occurred in 5 cases.No acute gastrointestinal obstruction was found in the 42 patients with Crohn's disease and in 5 patients with polyp of small intestine.Conclusions With capsule endoscopy technical mistakes causing failure were very rare.The majority of the clinical problems were related to the inability capsule to reach the colon during the recording time.Capsule endoscopy provides a well-tolerated,safe and effective tool to investigate the gastrointestinal diseases.especially some small bowel diseases.

Objective To report on the clinical presentations of patients with colonic angiodysplasia and the results of electrocoagulation under the guide of colonoscopy. Methods Study on the clinical and endoscopic manifestation of patient with colonic angiodysplasia and follow-up study for the risk of bleeding in asymptomatic AD and in those after electrocoagulation. Results Totally 10 200 cases were involved in colonoscopy, among them 126(1. 24%) cases of CAD were found. Prevalence rate in asymptomatic group was 0. 89%, in bleeding group 2. 62%, and in nonbleeding group 0. 82%. In 9 asymptomatic AD cases no bleeding occurred in a period of 3-year follow-up. However, most of the bleeding AD patients have bleeding relapsed within 3 years. The curative effect of electrocoagulation during 1 year is significant the relapse rate of bleeding, 18% as compared to 54% in patients with bleeding without electrocoagilation P

Objective To investigate the mechanism and effect of thalidomide on gastrointestinal bleeding of angiodysplasia. Methods The endothelial cells of human umbilical vein were cultured in vitro to exponential phase of growth, then were divided into blank control, solvent control and different concentrations (10- 100 μg/ml) of thalidomide incubated with or without basic fibroblast growth factor (bFGF). The cell proliferation was measured by MTT assay 72 h after stimulation. The expressions of vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) were detected by ELISA and real-time PCR, respectively. Results The proliferation of endothelial cells of human umbilical vein was inhibited by thalidomide (≥40 μg/ml) both in presence or absence of bFGF. The expression of VEGF could be inhibited by 20 μg/ml of thalidomide in the absence of bFGF and 10 μg/ml in the presence of hFGF. No expression of TNF-α was detected. Conclusions The in vitro study reveals that thalidomide can inhibit the proliferation and the expression of VEGF, which may treat gastrointestinal bleeding of angiodysplasia by suppressing the angiogenesis.

Objective To observe and investigate the therapeutic effect of thalidomide on gastrointestinal bleeding of angiodysplasia.Methods Eighteen patients with recurrent gastrointestinal bleeding of angiodysplasia were treated with thalidomide 100 mg daily for 4 months.Median follow-up time was 16.7 months.The changes of clinical setting and serum.vascular endothelial growth factor(VEGF)and tumor necrosis faetor-α(TNF-α)level between pre-therapy and post-therapy were compared.Results The clinical setting of patients in post therapy was significantly better than that in pre-therapy.The overall symptom score,the median bleeding frequency and median transfusion volume of patients after therapy was significantly lower than those before the therapy[(15.000±3.630)vs(5.330±3.325),(11.220±6.404)vs(1.000±1.237),(1422.22±1556.601)ml vs(100.00±240.098)ml,respectively,all P＜0.01],while median hemoglobin was obviously higher than that before the therapy[(5.950±1.656)g/ml vs(9.533±2.278)g/ml,P＜0.01].Serum VEGF and TNF-α levels decreased obviously after the therapy(118 pg/ml vs 58 pg/ml,116 pg/ml vs 34 pg/ml,P＜0.01).Conclusions Thalidomide can suppress the serum VEGF and TNF-α levels of the patients with recurrent gastrointestinal bleeding of angiodysplasia,then play a significantly role in preventing the rebleeding in patients with recurrent gastrointestinal bleeding of angiodysplasia.

Objective To analyze the cost of capsule endoscopy in diagnosing small bowel bleeding and to compare it with traditional diagnostic methods.Methods The patients suspected with small bowel bleeding were divided into group A(n=58,collected during 1998 to 2005)diagnosed with traditional processes and group B (n=93,collected during 2002 to January 2005)diagnosed with capsule endoscopy.The diagnostic yield,specific treatments,examination costs and other accumulated costs of two groups was compared.The examination cost ratio and the integration cost ratio were evaluated.The sensitivity analysis was performed.Results The diagnostic yield of small bowel bleeding in group A and group B were 22.4%(13/58) and 86%(80/93),respectively.The total of examination costs were 133 750 RMB and 790 500 RMB,respectively.The examination costs in group B(RMB 9881.3/each) was slightly lower than group A(RMB 10 288.5/each).Furthermore,as the diagnostic yield of group B was significantly higher than group A(P=0.001).The specific treatments based on the results of the diagnosis was 37.4% higher in group B(49.5%) than group A(12.1%).That means the cost of repeat- ed consultations,emergencies room visit,examinations,supporting treatments and hospitalizations in group B were significantly decreased.After the adjustment,the cost in group B(RMB 9881/patient) was lower than group A(16 361.5 RMB in one month—97 424.0 over 5 years/patient).The total cost of each patient in group A was 6480.2—87 542.7 RMB more than group B,which represented 1.7—9.9 folds increase.Conclusions The patients who suspected with small bowel bleeding and had a negative results of gastroscopy and colonoscopy were recommended to have capsule endoscopy which yields early diagnosis and less cost.