Objective To evaluate the therapeutic value of endoscopic band ligation in gastric stromal tumors.Methods Twenty-nine patients with small gastric stromal tumors(diameter<12mm)underwent endoscopic band ligation,and were followed up with routine endoscopy and EUS.Results Twentyeight patients recovered completely,with the surface healing up 4-6 weeks(average 4.8 weeks)thereafter.The neoplasm did not slough off in one patient,so he underwent a second ligation.Hemorrhage occurred in one patient three days after ligation,but was successfully managed with hemoclips.Other patients showed no complications.All the patients were followed up for 36 to 51 months,and there was one case of recurrence.Conclusion Endoscopic band ligation is an effective and safe treatment for small GISTs of less than 12 mm.

Objective To study the of effets of hFRNK gene transfected by adenoviral vector on human colon cancer cell invasion induced by gastfin.Methods The subjects were divided into three groups:control,G17 and hFRNK group.The G17 group was treated with 100 umol/L gastrin 17 for 12 h to induce Col0320WT cells.As to hFRNK group,Colo320WT cells were infected by pAdhFRNK(MOI:100)for 48 h after transient transfection of pCR3.1-CAR for 48 h and subsequently treated with gastrinl7 for 12 h,and the control group was untreated Colo320WT cells.Expression of phosphorylated FAK(PY397)were assayed by western blot.FAK(PY397)at lamellipoda was observed with a confocal microscope.The influence of hFRNK on formation of signal complex of FAK-Src-p130Cas-Dockl80 was assayed with coimnlunoprecipitation and immunity blotting.Activity of Rac-GTPase was determined by pull down.Results Phosphorylated FAKTyr397 drastically increased with the induction of gastrin.Compared with that of G17 group,FAK (PY397)expression decreased and little FAK(PY397)was found at lamellipoda,at the same time,the signal complex of FAK-Src-p130Cas-Dockl80 did not form,and the activity of Rac decreased.Conclusion hFRNK gene may block gastrin-induced FAK phosphorylation,prevent formation of the signal complex,prevention and treatment of tumor invasion and metastasis.

Objective To study microcirculation of acute pancreatitis(AP)in vivo with confocal la-ser endoscopy(CLE).Methods Thirty-two SD rats were randomly divided into 2 groups，I.e.control(n=8)and experiment group(n=24).In the control group，pancreas were identified，the blood was collectedfrom the inferior vena cava,0.5％uranin was administered at 4 ml/kg intravenously,and the pancreas were observed through CLE.In the experiment group,AP model was established by ligation of the end of common bile duct.The abdomen was opened to observe the pancreas at 12 h(n=8)，24 h(n=8)and 48 h(n=8)， uranin was administered intravenously，and the pancreatic tissue was observed through CLE.Pancreatic tis- sue in each group was sent for pathological study.Results Both healthy and affected pancreatic microcircu- lation can be viewed through CLE.The number of red blood cells can be counted within certain period of time cross-sectionally.In 12 h group，the construction of pancreatic acini was normal，and the flow of red blood cells could be seen in the capillary，but quite slow.In 24 h group，the structure was vague，but there were still normal pancreatic acini less visible capillaries and less and slower red blood cells flow were ob- served.In 48 h group，some pancreatic acini were not visible，normal pancreatic acinar structure and micro- circulation could not be observed，neither could red blood cells.Insulin tissue，white blood cells and micro- thrombosis could not be observed through CLE.ConclusionCLE is distinctly valuable for pancreatic mi- crocirculation study，especially for AP microcirculation in vivo.However，color developing agents and image processing techniques should be improved to ensure better images and better application.

Objective To observe the effect and safety of endoscopic retrograde cholangiopancre-atography(ERCP)in pregnant patients with acute biliary pancreatitis(ABP). Methods Twenty-four ABP patients,14 mild and 10 severe cases combined with pregnancy,were hospitalized from Januaray 2002 to Januaray 2007. Besides conventional managements,emergency endoscopic nasobiliary drainage(ENBD) without monitor of X-ray was performed in all patients to decrease the pressure in bile duct. Once the condi- tion of the patients Was stabilized and the common bile duct stone was confirmed,secondary endoscopic retro- grade biliary drainage(ERBD)with stent was performed in patients at early and midtrimester pregnancy,while secondary ERCP was employed in late pregnant patients after pregnancy termination. Results All pa-tients safely went through emergency ENBD without complication,and 4 patients with ampulla incarceration accepted sphinectomy with needle knife and stones were removed successfully. Common bile duct stone was confirmed in 15 patients and 5 of them underwent ERBD,the other 10 accepted ERCP. No patient died or needed surgical intervention,and they were all discharged with complete remission. Fetus of two patient with severe ABP did not survive. Conclusion Emergency ENBD and secondary ERCP or ERBD are safe and ef-fective in management of pregnancy patient with ABP.

Objective To study gastroscopic features and clinical diagnosis of prepyloric mem-brane. Methods Clinical characteristics,gastroscopic manifestation and operational findings of 18 pa-tients,whose prepyloric membrane have been confirmed by operations,were retrospectively reviewed. Results Gastroscopie findings showed that all the 1 8 patients suffered gastric retention and pyloric obstruc-tion to some degree,with 4 cases of esophageal erosion and/or esophageal ulcer,five cases of erosive hemor-rhagic gastritis,one case of ulcer at gastric antrum,gastric comer and pylorus respectively. There were 2 ca-ses of aperture like narrowing in prepyloric region. And there were 9 cases that showed obvious congestion and edema in the prepyloric mucus,with uniform circular mucusal protrusion around the stenosing stoma,and volcano-like depression in the middle,three cases of which showed mucosal membrane standing out to the gastric cavity. The membrane found in the above 11 cases located in pyloric exit or tube,and they under-went membrane excision and py|oroplasty. The other 7 cases showed thick mucosal folds at the distal antrum with radial arrangement. Round or irregular stenosing stoma were observed. These cases proved to be antral membrane,1-3 cm away from the duodenum and pylorus,and underwent simple membrane resection. Conclusion Congenital prepyloric membrane is rare and it likely mis-diagnosed. The onset and the degree of symptoms depend on the diameter of aperture of the membrane. Early endoscopy,in addition to barium contrast,should be performed on those children who have intermittent bilious vomiting,where false-positive radiological findings can be avoided,therefore,to facilitate right diagnosis and appropriate operation.

Objective To determine the detection rate of duodenal papilla and the diagnostic rate of small bowel diseases by capsule endoscopy(CE)and its possible influencing factors.Methods A total of 369 cases with suspected small bowel disease who had undergone CE were retrospectively reviewed. The de- tection rate of duodenal papilla and that of small bowel disease were calculated respectively. The detection rate of duodenal papilla in another 369 patients having received gastroscopy was also counted in order to findout the miss detection rate of forward-viewing endoscopy. The CE findings were reviewed at the rate of 1 im-age and 15 images per second by hand-motion respectively. The detection rate of duodenal papilla was calcu-lated,and the number of frames showing duodenal papilla was counted. Differences of detection rate of duo-denal papilla were also analyzed by different age and gender groups. In addition,the potential difference in detection rate of duodenal papilla between different bowel preparations before CE of two different reviewing approaches was also investigated respectively. Results The miss detection rate of duodenal papilla with for-ward-viewing gastroscopy was 22. 0%. The detection rate of duodenal papilla reviewed at the rate of 1 image by hand-motion,where less frames were needed to visualize duodenal papilla(3. 7vs7. 0),was significantly higher than that at the rate of 15 images per second(32. 2%vs13. 6%,P=0. 001). The diagnostic rate of small bowel diseases was also significantly higher than that of duodenal papilla by CE(67. 2%vs32. 2%,P=0. 000). Age and gender were not significantly correlated with the detection rate of duodenal papilla. No significant correlation was found between various kinds of bowel preparation before CE at different viewing rate and the detection rate of duodenal papilla. Conclusion It iS relatively difficult to identify duodenal pa- pilla by CE,as they are peculiarly positioned in anatomy,so the detection of duodenal papilla does not nec- essarily represent the detection rate of small bowel diseases. The major factors that influencing the detection of duodenal papilla by CE include local anatomy,viewing rate and technical limitations of CE.

Objective To determine the effectiveness and safety of endoscopic botulinum toxin injection versus pneumatic dilation in treatment of achalasia.Methods A systematic review of all the relevant randomized controlled trials was performed according to international Cochrane Collaboration.Results Twelve trials involving 559 patients were included in the systematic review.Meta analysis showed:(1)Pneumatic dilation was superior to botulinum toxin injection in short term symptom relief(83.21% VS 71.27%.P=0.0007);(2)It was also superior to botulinum toxin injection in long term symptom relief(54.59% vs 27.60%,P=0.005);(3)The recurrent rate is lower in botulinum toxin injection than in pneumatic dilation(55.66% vs 18.84%,P<0.0001);(4)There were more side-effects and complications in pneumatic dilation than in botulinum toxin injection(13.01% VS 1.35%,P=0.0008).Conclusion The limited current evidence showed that endoscopic botulinum toxin injection and pneumatic dilation are safe and effective in the short term treatment for achalasia.Pneumatic dilation is more effective than endoscopic botulinum toxin injection in the long term treatment for achalasia.

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 explore the value of EUS in the diagnosis,differential diagnosis and follow-up of primary gastric lymphoma(PGL).Methods A total of 26 patients whose endoscopic findings were highly suspected for PGL were enrolled in this study.Initial endoscopic examination anti routine biopsy were performed in all patients.EUS were undergone in all cases and its guided large piecemeal biopsy was administered in selected patients.The results of EUS,routine biopsy and routine biopsy combined with a large piecemeal biopsy were compared.Results Compared with biopsy and histopathological results,EUS made the fight diagnosis in 23 cases with overall accuracy of 88.46%,which was significantly superior to routine endoscopy and biopsy(50.0%,P=0.006),but was slightly lower than that of routine biopsy combined with large piecemeal biopsy(88.5%vs.92.3%,P=1.000).EUS can accurately differentiate gastric malignancy from benign disease with accuracy of 100.0%(23/23).Meanwhile EUS accuracy of tumor invasion(T stage)was 100.0%(12/12)as well.Conclusion EUS is valuable in the diagnosis,differential diagnosis and follow-up of PGL.

Objective To assess the agreement of different endoscopy grading or scoring systems for inflammatory bowel diseases(IBD)including ulcerative colitis(UC)and Crohn's disease(CD).Methods A standardized table was prepared based on the searches for endoscopic grading or scoring systems on Medline and Chinese Biomedical Database,the data of 80 patients with UC and 31 with CD.who underwent colonoscopy in Shanghai Renji hospital from June 2006 to February 2007,were evaluated with each system by two physicians independently.Data were analyzed with SPSS 13.0.Results Six endoscopic grading and scoring systems of UC and three of CD were included for evaluation.For the systems of UC and CD,Kendall's coefficients of concordance were 0.71(P<0.01)and 0.34(P<0.01),respectively.There was no significant differenee between every two systems for UC.Nonetheless.Spearman's correlation coefficient between Chinese Grading System of Crohn's Disease(CGSCD)and Crohn's Disease Endoscopic Index of Severity(CDEIS)was 0.32(P=0.08).Significant differences in frequencies were detected in endoscopic systems for UC by Kruskal Wallis test(P<0.01).Conclusion There is satisfactory concordance among the endoscopic grading and scoring systems of UC,while CGSCD needs further improvement.Furthermore,Jeroen elassifieation inclines to severe category,while modified Baron scale tends to be a mild one.