Objective To compare effects of warm water infusion and air insufflation on patient tolerance and satisfaction during the insertion phase of unsedated colonoscopy.Methods In a single-center,prospective,single blind randomized trial,patients were randomly assigned to three groups (water infusion group,air insufflation group,or hybrid method group) during the insertion phase of colonoscopy.Main outcome measurements included insertion time,cecal intubation rate,adenoma detection rate,the rate of position change,the rate of abdominal compression,intraoperative pain and distension VAS scores,postoperative pain and distension VAS scores.Results A total of 180 cases were enrolled,60 in each group.Patients in water infusion group and hybrid method group required less abdominal compression or position change,longer insertion time,reported lower intraoperative pain and distension VAS scores than air insufflation group during the insertion phase of colonoscopy.There were no significant differences in cecal intubation rates,adenoma detection rates,postoperative pain and distension or VAS scores among three groups.Conclusion Water infusion significantly decreases patient abdominal pain and distension during the insertion phase of colonoscopy without affecting cecal intubation rate and adenoma detection rate.

objective To retrospectively evaluate the accuracy of endoscopic ultrasonography (EUS)and CT in preoperative tumor,and nodal metastasis(TN)staging of esophageal carcinoma.Methods TN stages of 87 cases diagnosed with preoperative EUS and CT were compared with postoperative pathological results.No patient underwent radiotherapy or chemotheraphy.The radial echoendoscope was used,and balloon dilation was required in 5 cases with stricture.Results The total accuracy of T staging with EUS was 85.1%.CT could not differentiate Tl from T2.The sensitivity of EUS for N staging was 85.0%,higher than that of CT(60.8%).However,some lymph nodes which were not detected by EUS could be revealed by CT.Accuracy of EUS plus CT in T staging is 85.1%.and that in N staging is 90.8%.Conclusion EUS is the most accurate measure in assessing the depth of tumor invasion,whereas the combination of EUS and CT is capable of an overall evaluation for TNM staging.

Objective To evaluate the feasibility and efficacy of twin grasper combined with endoloops on closing acute stomach perforation.Methods Two experimental porcines of stomach perforation underwent endoscopic closure by twin grasper combined with endoloops.Survival conditions and closure of perforating were observed.Results Mild infection and abdominal adhesions were observed in one week after operation.The nylon rope fell off and an ulcer-like lesion was presented in the closed position.The methylene blue leak test was negative.Histologic examination revealed chronic inflammatory cells infiltration,granulation,fibroplasias,and regenerative mucous membrane crawling toward the center of perforation.Conclusion The technique of twin grasper combined with nylon ropes in closing the acute stomach perforation is feasible and effective.