Objective To investigate the diagnostic value of intraductal ultrasonography (IDUS) for bile duct stones by comparing between magnetic resonance cholangiopancreatography ( MRCP), endoscopic retrograde cholangiography (ERC) and IDUS. Methods ERC was performed in 30 patients with suspected extrahepatic cholelithiotic after MRCP. IDUS was applied through guide wire after ERC, and stones were removed if necessary. Results MRCP detected bile duct stones in 22 cases, misdiagnosed bile duct floc as stones in 2 and missed stones in 2 others. The accuracy, sensitivity and specificity of MRCP in diagnosis of bile duct stone were 86. 7% (26/30), 91. 7% (22/24), and 66. 7% (4/6), respectively. ERC detected bile duct stones in 23 cases, misdiagnosed bile duct air bubble as stones in 2 and missed stones in 1. The accuracy , sensitivity and specificity of MRCP in diagnosis of bile duct stone were 90% (27/30), 92% (23/25) and 66.7% (4/6) , respectively. IDUS detected 24 cases of bile duct stones, 4 bile duct floc and 2 air bubble without any misdiagnosis. The accuracy, sensitivity and specificity of IDUS in diagnosis of bile duct stone were 100%. Conclusion IDUS, safe and reliable, is superior to ERC and MRCP in diagnosis of bile duct stone.

Objective To investigate the difference between nodular gastritis and atrophy gastritis.Methods During 2004.4～2005.3, the clinical, endoscopic and pathological findings of nodular gastritis and atrophy gastritis were analysed.Results Nodular gastritis is usually classified as nodular type A(nodular gastritis) and type B(atrophic gastritis with nodular changes). The endoscopic appearance of nodular gastritis was characterized as uniform miliary pattern and predominantly affected young women. The incidence of dyspeptic symptom was higher in patients with nodular gastritis than in atrophy gastritis. Nodular gastritis in adults is caused by Helicobacter pylori infection. Antral biopsy specimens showed lymphoid follicle formation and/or marked lymphoid aggregates. The prevalence of lymphoid follicle formation in the antrum was higher in patients with nodular gastritis than atrophy gastritis. Moderate to severe atrophy gastritis also usually has the same nodular endoscopic appearance,but that is not uniform and intensive.Conclusion Nodular gastritis is a very special gastritis with Helicobacter pylori infection and is different from atrophy gastritis.It is worth to be noticed.

Objective To study the application of intra-luminal ultrasonography (intra-small intestinal ultrasonography,ISIU) in demonstration of normal small intestine and diagnosis of small bowel lesions.Methods From December 2011 to December 2012,ISIU was performed in 50 patients who were screened by capsule endoscopy,gastroscopy,colonoscopy,and double-balloon enteroscopy to observe the normal tissue structures and lesions of the small intestine.Additional abdominal ultrasound (US) and spiral CT (SCT) were applied in patients with identified lesions in small intestine.Results ISIU was completed in 47patients out of 50 enrolled ones.A total of 10 lesions in small intestine were detected,all of them were identified by ISIU,while in which only 1 was found by US and 3 by SCT.Normal small intestinal wall demonstrated 6 layers under ISIU,with slight difference between jejunum and ileum.Conclusion ISIU provides high-resolution image of the structure at all levels of the normal small intestine,and can clearly observe lesion source and internal echo,and thus help to improve the rate of diagnosis of diseases of the small intestine.

Objective To investigate the morphologic features of gastric intestinal metaplasia (IM)using narrow band imaging(NBI)endoscopy,and its feasibility and accuracy for diagnosis of IM combined with histopathology.Methods The endoscopic examination was performed on 80 patients and suspected lesions associated with IM was further observed by NBI combined with magnifying endoscopy.The biopsy specimens were obtained from regions containing light blue crest(LBC)or non-LBC mucosa for pathological examination,and the results were analyzed.Results In 80 patients examined with NBI,IM was pathologically confirmed in 65 patients.Of which LBC was seen in 61 patients with a sensitivity of 94%and a specificity of 95%.In a total of 94 specimens obtained from LBC region,86 had histological evidence of IM with a positive predictive value of 9 1.49%.There was no evidence of IM in 79 out of 94 specimens obtained from non-LBC region of patients with or without LBC with a negative predictive value of 84.04%.The results indicated that the detective rate of IM could be increased if biopsy specimen was obtained from LBC region with help of NBI endoscopy(P＜0.05).Conclusions It has been demonstrated that NBI combined with magnifying endoscopy may improve the diagnosis of IM by clearly observing microvasculature and targeted-biopsy in LBC region,which is helpful in early diagnosis of gastric cancer.

Objective To explore the safe and effective intravenous anesthetic regimen for intemperants' painless endoscopy.Methods 120 cases of intemperants,aged 25-65 years old,ASA grade Ⅰ or Ⅱ,were randomly divided into 3 groups (n =40):sulfentanyl group (group S),midazolam and sulfentanyl group(group MS),ketamine and sulfentanyl group (group KS).Group S were intravenous injected with sufentanil 0.1 μg/kg,propofol 1-2 mg/kg,etomidate 0.1 mg/kg.Group MS and group KS were additional intravenous injected with midazolam 0.01 mg/kg and ketamine 0.1 mg/kg on the basis of Group S respectively.The occurrence of hypoxia,cough,body movement and blood pressure were recorded,the use of vasoactive drugs and the recovery time were also recorded.Results There are no statistical significant difference of age,gender,and testing time among the three groups (P ＞0.05).Compared with the group S,the total dose of propofol,the incidence of hypoxemia and hypotension,the incidence of body movement and cough reaction in group MS and group KS were all lower (P ＜ 0.01).And compared with the group MS,the patients have lower incidence of hypoxemia and hypotension in group KS (P ＜ 0.05).All the patients were awake well (P ＞ 0.05).Conclusions Small doses of midazolam or ketamine combined with sulfentanyl,propofol and etomidate are safe and effective in the process of anesthesia during endoscopic diagnosis and treatment of intemperants.