The optimal bariatric surgery is still not acquired although the obesity epidemic has become a worldwide problem. The recentness studies on obesity focused on mass balance regulated by central nervous system, in which an important circuit is vagus nerve. This review provides progress on obesity mediated by vagus nerve simulation and vagal blocking.

[Summary] Benign esophageal strictures can arise from various causes and mainly induce dysphagia .Commonly , the majority of benign esophageal strictures can achieve long-term relief through about three dilation sessions .However, some refractory benign esophageal strictures require other treatments , such as endoscopic stent placement and intralesional drug injection , but these treatments just attain short-time satisfactory results with a disappointingly low rate of long-term improvement.Recently, biodegradable stents and drug-eluting stents are developing and have obtained the positive effects .In this paper , we performed a review about the treatment of benign esophageal strictures .

Objective To evaluate the short-term effects and complications of transoral endoscopic suturing in the treatment of gastroesophageal reflux diseases (GERD). Methods Sixteen patients with GERD, confirmed by gastroscopy, upper gastrointestinal barium meal examination, and esophageal pH value examination, received gastroesophageal suturing by using an endoscopic suturing device (manufactured by Bard Co.). The site of suturing was 1cm below the dentation line, with a suture interval of 1.5cm and a knot interval of 2.0cm. Symptom severity scoring, esophageal 24-hour pH monitoring and the degree of esophagitis before and 1 month after the operation were compared respectively. Results A total of 42 sutures and 21 knots were made in the 16 cases. The mean operation time was 30 min. The sum of heartburn scores and regurgitation scores before the treatment were 39 (mean, 2.44) and 32 (mean, 2.0), and those after the treatment were 11 (mean, 0.68) and 10 (mean, 0.63), respectively, with statistical significances between preoperation and postoperation ( ? 2 =19.5 and 16.33; P

Objective To explore the efficacy of endoscopic therapy for common bile duct stones in the elderly. Methods From July 2003 to June 2006,421 elderly patients with common bile duct stones were treated in the Danyang People's Hospital(112 cases) and the Second Affiliated Hospital of Nanjing Medical University(309 cases).The clinical data of the patients were retrospectively analyzed Results ERCP was completed in all the 421 patients,of which 27 was converted to a pre-cut sphincterotomy because of difficulties in the deep cannulation of the bile duct.The diagnosis of common duct stones was confirmed during the operation in all the cases,and 46 of them were found complicated with cholecystolithiasis.Of the patients,266 patients had one stone,107 had two,and 48 had three or more.The calculi were removed using basket directly in 283 patients,balloon catheter in 122,lithotrity in 10,and plastic stent placement without calculus removal in 6.The stones were removed completed at the first operation in 392 cases,and the other 23 cases received a second operation after endoscopic nasobiliary drainage.Errhysis occurred in 20 patients during the pre-cut sphincterotomy,and was healed by locally sprinkling or injecting noradrenaline(1:10 000),or electric coagulation.Six patients had hemorrhage from the incision on the duodenal papilla 48 hours after the operation,and were cured by using submucous injection of noradrenaline(1:10 000,4 cases) or titanium clipper(2 cases).34 patients had a transient increase of serum amylase without abdominal pain;10 patients developed mild pancreatitis and then was cured by fasting,inhibiting pancreatic secretion and pancreatic enzyme activities,anti-inflammation therapy,and rehydration;4 patients developed cholangitis,and was cured by anti-inflammation therapy.All the patients were discharged without complications.342 of the patients were followed up for 6-12 months,4(1.2%) of them had recurrence of stones and was treated with endoscopy,3(0.9%) had cholangitis and received anti-inflammation therapy.In the 6 patients with plastic stent,the stones were dissolved in 2 of them in half a year.Conclusions Endoscopic therapy is safe and efficient for common bile duct stones in the elderly and is associated with a low rate of complications.

Objective To evaluate the therapeutic effects of titanium clips occlusion for the defects and complications caused by endoscopic mucosal resection(EMR).Methods Totally 62 patients with protuberant lesions in the esophagus or gastrointestinal tract(≤15 mm in diameter) were treated by EMR in our hospital.During the operation,69 lesions were cut and the surgical defects were clipped using titanium clips.The intra-and post-operative complications of the patients were reviewed.Six weeks after the treatment,the patients received re-examination by endoscopy to observe the healing of the mucosal defects.Results The 69 lesions in the 62 cases were resected completely.At each defect,1-3 titanium clips were used,no perforation or hemorrhage occurred in the patients.Endoscopy performed in 6 weeks showed that all the defects were healed without ulcer,stenosis or recurrence.The titanium clips dropped 65 of the defected mucosa.Conclusion Titanium clips is effective and safe for defects caused by endoscopic mucosal resection.

Objective To study the technique of placemen t of Nitinol stent for relieving malignant pylorus or duodenal obstruction, and to assess its clinical effectiveness.Methods In this group the strictures were caused by gastric car cinoma at the antrum (n=2), anastomosis site of previous gastrojejunostomy (n=2 ), gastric carcinoma at the cardia (n=4), colon cancer (n=1), pancreatic cancer (n=3) and duodenal cancer (n=4). Under fluoroscopic guidance the Nitinol stent w as inserted into pylorus or duodenal obstruction sites via oral cavity in all ca ses. Complications and clinical status were investigated during the study period .Results Successful stent placement was achieved in 15 cases. Tw o patients had undergone double stent placement (pylorus stent and bile duct ste nt). The rate of improvement in abdominal distention and vomiting 1 week after p rocedure was 73 3% and 86 7% respectively. Procedure-related complications ne ver occurred.Conclusion Nitinol alloy network stent is a safe and efficaciou s method for palliating malignant pylorus or duodenal obstruction, and improves patient's living quality.

The morbidity and mortality of tumors of digestive system is much higher in recent years .Realizing diagnosis of early phase tumors can improve the surgical resection rate and prolong survival time of patients .Compared with traditional diagnosis methods, multiphoton microscopy has got an obvious improvement in the penetration depth .Furthermore, phototoxicity and photo-bleaching has been largely reduced .Combining with the second harmonic microscopy , the change of collagen fibers can be observed in the organization.MPM can achieve early diagnosis of cancer at the cellular level .Therefore, multiphoton microscopy , with the imaging characteristics of unique high resolution , real-time, nondestructive , deeply spectral resolution , is of great potential in the diagnosis of early stage tumors of digestive system .Based on the latest research results , this review summarizes the latest progress of multiphoton microscopy diagnosing early phase of gastrointestinal tumor .

Objective To study the safety and feasibility of endobiliary intraductal radiofrequency ablation (RFA) to reopen occluded self-expandable metal stents in patients with malignant biliary obstruction.Methods 11 patients with malignant biliary obstruction and blocked metal stents were prospectively studied.During ERCP, after biliary cannulation, the blocked metal stents underwent RFA using a bipolar radiofrequency probe which was introduced into the stenotic bile duct via a guide wire.This was followed by a balloon to repeatedly remove debris and then endoscopic nasobiliary drainage.The patients were closely observed and followed up.Results RFA was successfully carried out in all the patients and patencies were achieved when compared with pre-RFA.The median post-RFA luminal diameter of the strictures showed significant improvement: 6 (4 ～ 10) mm versus 2 (0 ～ 5) mm, and the mean post-RFA total bilirubin level decreased sharply : (39.4 ± 8.7) μ mol/L versus (130.1 ± 38.2) μmol/L.Following this intervention, 3 patients developed fever, which were controlled with conservative therapy.There was no mortality, haemorrhage, bile duct perforation or bile leak.Of the 11 patients, 3 were dead and 6 were alive at a median follow-up of 187 (75 ～ 304) days.The median stent patency was 135 (75 ～ 203) days and the median survival was 278 (75 ～ 304) days.Four patients had their stents patent at the time of the last follow-up or death.Seven patients had their stents blocked on 113, 124, 154, 203, 96, 135 and 112 days post-procedure.Condusions Endobiliary intraductal RFA is technically feasible and safe to reopen occluded metal stents in malignant biliary obstruction.This efficacy needs to be confirmed by future randomized studies.

Objective To evaluate the safety and efficacy of an endoscopic dilation in association with the intramuscular injection of either mitomycin C for benign esophageal strictures. Methods A total of 89 patients with benign esophageal strictures were retrospectively divided into 3 groups, including 30 cases of dilation combined with mitomycin C injection (mitomycin C group) , 29 of dilation combined with dexamethasone injection (dexamethasone group) and 30 of dilation with saline injection (dilation group). The successful rate, complications and the clinical effect in the 3 groups were compared. Results The 89 patients all successfully received the procedure, with the endoscopic and clinical release. No massive hemorrhage occurred. In mitomycin C group, 1 case with major complication (perforation) and 7 minor complication occurred;9 and 7 cases with minor complication occurred in dexamethasone group and dilation group, respectively. There were no significant difference of the complications in the 3 groups (P<0. 05). The mean dysphagia-free period was 5. 25±1. 18 months in the mitomycin C group, 4. 46±1. 53 months in the dexamethasone group, and 3. 03±1. 62 months in the dilation group (P<0. 05). Conclusion Endo-scopic dilation with or without the intramuscular injection of either mitomycin C or dexamethasone are safe and effective. Dilation combined with drug injection may prolong the esophageal dysphagia-free period. Furthermore, mitomycin C injection may have the dominant effect.

ObjectiveTo assess the effectiveness and safety of target-controlled infusion (TCI) of remifentanil during remedial endoscopic retrograde cholangiopancreatography (ERCP) in the elderly patients.Methods390 patients (aged 65 years and over) undergoing ERCP were divided into two groups: remifentanil group (n =175) and lidocaine group (n =215). Remifentanil group were anaesthetized by TCI with remifentanil as method of sensible analgesia,while lidocaine group were anaesthetized by lidocaine as conventional local anesthesia.Arterial blood pressure,heart rate and oxygen saturation (SpO2) were monitored during ERCP.The memory and feeling of pain during operation and side effects after operation were followed up. ResultsThe statistical differences in changes of blood pressure,heart rate and SpO2 were not found between the two groups.There were 165 cases(94.3 ％) with satisfactory anaesthetization,10 cases (5.7 ％ ) with mild and endurable pain and 7 cases(6.7％) with side effects of circulation and respiration during operation,while these symptoms improved after symptomatic treatment in remifentanil group.In lidocaine group,there were 25 cases(8.6 ％ ) with side effects of circulation and respiration during operation,most of patients were obviously uncomfortable,2 cases (1.8％) were intolerant of operation. Conclusions Targetcontrolled infusion of remifentanil during ERCP in the elderly is safe,effective and worthy of clinical popularization.