Gastrointestinal endoscopy (GIE) continues to be a key area in minimally invasive medicine.GIE has made rapid progress in 2009.New methods and technology has enriched the discipline system of digestive endoscopy.GIE has developed the most comprehensive and mature,and it has already become the most important diagnosis and treatment method of digestive disease.At this point,we review the important progress in GIE hoping to enlighten endoscopists on the researches and improve their operating level in future.

Chronic pancreatitis (CP) is pathologically characterized by fibrosis of pancreatic parenchyma.Treatment of CP is to alleviate pain and preserve pancreatic endo-/exo-crine function.Endotherapy,as a micro-invasive method,has been testified to be efficient and safe for pancreatic duct stones and stenosis,pancreatic pseudocyst and common bile duct stenosis secondary to CP.It has partially replaced the role of surgery in CP therapy.Whether endoscopic or surgical treatment has its limitations,CP treatment needs medicine,surgery,endoscopy,anesthesia,nutrition and other disciplines together to develop the best solution to improve the quality of life.

Objective To evaluate the efficacy and safety of N-acetyl-D-glucosamine in treatment of diarrhea-predominant irritable bowel syndrome (D-IBS). Methods A multi-center, randomized, double-blind, placebo-controlled clinical study was performed in 430 patientswith D-IBS. After 2-week baseline period, eligible subjects were randomly either received 100 mg of N-acetyl-D-glucosamine (treated group,n=323) or placebo (control group,n= 107) 3 times a day for consecutive 4 weeks, followed by 2-week withdrawal follow-up. The major parameters were assessed by visual analogue scale (VAS) score and Common Symptom Sensation score. The minor parameters included abdominal pain or discomfort, severity of diarrhea, bloating, urgency, defecation frequencies with consistency per bowel movement which was judged by bristol stool scale and utilization of Smect. The evidence of adverse events was reeoded. Results The major parameters were singnifieantly improved in the treated group with effective rate of 65.16 % at the fourth week of treatment in comparison with control group (effective rate of 34. 29% ,P<0.01). Except the utilization of Smect (P= 1.00), the other minor parameters were significantly improved in treated group compared with control group (P< 0.01) after 1 week treatment. The occurrence of adverse events was 0.96% in the treated group and 0. 95% in the control group (P = 1. 00). Conclusions The results indicate that N-acetyl-D-glucosamine is effective and safe in the treatment of D-IBS by improving ecological environment and preventing activation of mast cells.

Changes of gastric-duodenal mucosal blood flow (GDMBF) in the healing process of 81 patients with gastric ulcer and 130 with duodenal ulcer and 9 with active ulcer induced by gastric polypectomy were studied by endoscopic laser Dopple flowmetey, 108 cases of no gastric-duodenal lesions were used as controls.In normal sut mucosal blood flow at the angle and antrum of the lessor curvature and at the anterior wall of the duodenal bulb was the smallest (P

The relationship between gastric mucosal blood flow (GMBF) and acid secretion was studied in rats by using secretory stimulant (pantagastrin) and inhibitor (cimetidine) GMBF was measured by laser Doppler flowmetry (LDF) and gastric mucosal pH determined by microglass pH electrode. GMBF was increased and gastric mucosal pH decreased significantly after intravenous injection of 6?g/kg of pcntagaslrin, while GMBF was decreased and gaslric mucosal pH increased markedly after intravenous administration of 109 mg/kg caretidine. This indicates that pentagastrin can increase GMBF and acid secretion, and cimctidine can decrease GMBF ang acid secretion.GBMF is closely relatel to acid secretion in rats

Some advances in epidemiology of pancreatic cancer were comprehensively reviewed.The contents included the relationship between the occurrence of pancreatic cancer and individual, premorbidity, life history, and environmental factors, and also the first appearing, common and rare clinical symptoms.

To review the recent development of the theory of endoscopic treatment in chronic pancreatitis, introduce the new technique about endoscopic treatment, and prospect the trend of endoscopic treatment in the future.

Irritable bowel syndrome(IBS) is a functional bowel disorder characterized by abdominal discomfort and altered bowel habits.Techniques applicable to evaluate the visceral hypersensitivity associated with brain gut dysfunction in IBS can be grouped under 3 headings: visceral perception,reflex responses and central responses.And visceral hypersensitivity has been proved to be a pathophysiological characteristic of patients with IBS.The exact mechanisms of visceral hypersensitivity in patients with IBS are unknown,perhaps involving supersensitive mechanoreceptor and primary afferents in the intestinal wall,transient or long term changes in peripheral and central pathways.Abnormal central excitability and nerve mast cell communication may be the trigger of visceral hypersensitivity in IBS.In summary,a variety of different mechanisms in brain gut axis,alone or in combination,may be responsible for visceral hypersensitivity.Some of these mechanisms have been characterized in animal models of hyperalgesia.Recent breakthroughs in the neurophysiology of visceral sensation provided clue on the development of visceral hypersensitivity about the candidate neurotransmitter, which involving brain gut interaction.Advanced investigation would give us more precise results in brain gut axis to explain the visceral hypersensitivity of IBS in future.

Pancreatic carcinoma is one of the malignant tumors which is seriously harmful to the human health.Early diagnosis and operation of pancreatic carcinoma can significantly improve the survival rate and remarkably improve prognosis.Tumor markers have come into the research domain recent years such as CA19-9,CA50,CA242 and CA494.But none of tumor markers with sufficient sensitivity and specificity have been found to screen early panceatic carcinoma.Some cytokines including TGF,MIC-2,sICAM-1,sVCAM-1 and P-selectin play an important role in the diagnosis,therapy monitoring,and prognosis assessment of panceatic carcinoma.Being simple,convenient,economic,noninvasive and painless,B-ultrasound is the first choice of image diagnosis method for pancreatic carcinoma.Using CT,spiral CT,MR cholangio-pancreaticograph(MRCP) and endoscope ultrasound(EUS) alone has both advantages and disadvantages on diagnosing early pancreatic carcinoma.Detection of pancreatic juice,exfoliated cells,K-ras oncogene and telomerase activity by endoscopic retrograde cholangio-pancreaticography(ERCP) will be the major tendency to early diagnose the pancreatic carcinoma.The image method or serum marker alone may be unfit for the early clinical diagnosis of pancreatic carcinoma since their low sensitivity and specificity.Therefore,it should be done to seek the new tumor markers,and establish the united diagnosis model including image,exfoliated cells,oncogene,tumor suppressor gene and telomerase activity to improve the levels of pancreatic carcinoma diagnosis and treatment.

Since 21st century,minimally invasive medicine has been in a fast development period and facing an unprecedented historical challenge.In the core technology of minimally invasive medicine,gastrointestinal endoscopy has most comprehensivey developed and mature,and it has already become the most important method for the diagnosis and treatment of digestive diseases.The fibro-endoscope technique was introduced to China in the early 1970s.After 40 years of development,di-gestive endoscopy has developed from a simple diagnostic tool into an important treatment measure and widely used in clinic.Minimally invasive diagnosis and treatment of digestive diseases have entered a new era.