Objective To investigate the association between body mass index(BMI),waist circumference(WC),waist hip ratio(WHR) and the risk of colorectal adenoma,which was considered as a precancerous lesion.Methods Subjects aging from 25 to 88 years old who underwent colonoscopy at Tongji Hospital from December 2006 to December 2007 were selected and assigned into the adenoma group( n =250) and the control group(n=289) according to the findings of the colonoscopy.The body height,weight,waist and hip circumference of every subject were measured respectively.The logistic multi-factors regression analysis was applied to analyze the data.Results When obesity was determined by BMI or WC,the risk of adenorrm in pure obesity group and abdominal adiposity group was 2.48(95%CI = 1.19～5.20,P<0.05) and 1.75(95%CI=1.15～2.66,P<0.01 ),respectively.The corresponding value in male was 4.10(95%CI = 1.26～13.31,P<0.05) and 1.70(95%CI = 1.00 -2.88,P<0.05).The risk of advanced and non-advanced adenoma in pure obesity was 2.71(95%CI=1.01～7.29,P<0.05 ) and 2.39(95%CI=1.05～5.47,P<0.05) ; the risk of non-advanced adenonm in abdominal adiposity group was 2.03(95%CI=1.25～3.28,P<0.01),but no significant difference in risk of advanced adenoma was detected.When obesity was determined by WHR,no significant difference was found in any regarding.Conclusion Obesity and abdominal adiposity are associated with the risk of colorectal adenoma,beth advanced and non-advanced,which is more obvious in male.

Objective To evaluate the use of double balloon endoscopy(DBE) in diagnosis of ulcerative lesions in small intestine.Methods Data of patients diagnosed as small intestinal ulcer under DBE during September 2003 and December 2007 at Nanfang Hospital were analyzed retrospectively.Results Ulcer in small intestine was detected by DBE in a total of 62 patients,including 48 males and 14 females,aging from 10 to 71 years old( mean 43.9 yr).The main clinical manifestations consisted of small intestinal hemorrhage(38/62,61.3%),abdominal pain(16/62,25.8%),abdominal distention(5/62,8.1%),loss of weight(2/62,3.2%),and diarrhea(1/62,1.6%).The ulcers were diagnosed endoscopically as Crohn's disease(CD) in 53 cases(85.5%),drug induced lesions in 4(6.5%),nonspecific chronic inflammation in 2(3.2%),lymphoma in 2(3.2%) and tuberculosis in 1(1.6%).They were all microscopically diagnosed as chronic inflammation.Of the 62 patients,32(51.6%) underwent surgery.In 30 cases of CD diagnosed by DBE,22 were confirmed by post-surgery pathology(malignant cells were found in 3),while in the other 8 cases,4 were diagnosed as lymphoma,3 as Behcet's disease and 1 as tuberculosis.Meanwhile,the 1 case of tuberculosis and 1 lymphoma diagnosed by DBE were confirmed as CD after operation.The overall accurate diagnosis rate of small intestinal ulcerative lesions by DBE was 68.8%(22/32).Conclusion DBE is valuable in diagnosis of ulcerative lesions in small intestine,but surgery should be included into consideration to confirm the diagnosis when necessary.

Objective To evaluate the therapeutic effect of endoscopic cryotherapy for Barrett's esophagus (BE). Methods A total of 22 consecutive patients, who were diagnosed as BE from January 2008 to May 2009, underwent endoscopic cryotherapy by using pressurized gas of C02. The data including effective rate, therapy courses and procedure related complications were retrospectively analyzed.Results Except for 2 cases of withdrawal, the other 20 patients completed the treatment with a total therapy number of 42 times (mean 2. 1 times/patient) and were followed up for 6 months. Complete histologic reversal of BE mucus was achieved in all 20 patients after 1-3 times of cryotherapy, among whom complete endoscopic reversal was obtained in 9 and effective endoscopic reversal in 11. Histologic recurrence was observed in 3 cases during the follow-up, including 2 of occult intestinal metaplasia and 1 of mild intestinal metaplasia, which achieved a BE mucosal reversal rate of 85% (17/20). Procedure related complications included 1 case of esophageal ulcer and 3 cases of mild or severe esophagitis, which were all cured after acid suppression treatment. Conclusion Endoscopic cryotherapy in BE is effective and safe, with the advantages of easy manipulation, less complications and good compliances.

Objective To evaluate the endoscopic papillectomy (EP) for ampullary adenoma (AA). Methods The resection rate, complications, local residual rate and local recurrence of EP for AA at endoscopy center of Changhai Hospital were retrospectively reviewed. Results From July 2005 to July 2009, a total of 19 patients with endoscopically diagnosed and pathologically confirmed AA underwent EP, in which 18 cases were scattered AA (94. 7%) including 1 case of multiple adenomas in duodenum, and 1 (5.3%) was familial adenomatous polyposis (FAP). The lesion was resected en bloc in 11 cases (57.9%) , and piecemeal in 8 (42. 1%). All patients were followed up at a mean period of 24. 5 months (range 7-48 months). The residual rate after first EP was 21. 1% (4/19), and the total success rate was 89.5% (17/19). Short-term complications after EP included 3 cases of bleeding, 3 cases of mild acute pancreatitis and 2 cases of acute cholangitis. Long-term complications were 1 case of stenosis of the common bile duct (CBD) orifice accompanied with acute cholangitis, 1 case of CBD stone and 1 case of acute cholangitis after stent placement. No such severe complications as perforation or procedure-related death was observed.Conclusion EP is a safe and effective modality for ampullary adenoma.

Objective To evaluate and compare the effects of surgical and endoscopic therapy for common bile duct stenosis (CBDS) induced by chronic pancreatitis (CP). Methods A historical cohort study of CBDS subjects induced by CP, who underwent endoscopic or surgical treatments at Changhai Hospital from Januraryl997 to July 2007, was performed. Results Of 514 cases of CP, CBDS occurred in 51 (9.9%), in which complete follow-up data were available in 41 survived patients with a mean follow-up period of 42.9±28. 3 months. The mean ages of first onset and hospitalization were 46. 3±14.0 and 49. 8±11.9 years, respectively. Endoscopic therapy was applied in 13 patients, including bile duct stenting in 7, 6 of whom presented with cholangitis, cholestasis and/or jaundice. Surgery was performed in 26 patients, in which 7 also underwent endoscopic therapy, and occupying lesion in pancreatic head was found in 14. The other 2 patients were treated without endoscopy or surgery. At the end of the follow-up, all symptoms including cholangitis, cholestasis and jaundice were relieved and no recurrence or choler cirrhosis was recorded.Conclusion Surgical approach is the main treatment for CBDS induced by CP. Endoscopic therapy is an alternative for patients unfit for surgery, especially for those who had jaundice, cholestasis or cholangitis.

Objective To compare the short- and long- term effects and safety of endoscopic balloon dilatation vs. placement of specially designed reclaimable self-expanding anti-reflux esophageal stents for achalasia. Methods A total of 129 patients with achalasia were divided into 2 groups to receive either endoscopic scopic balloon dilatation(,l=63)or endoscopic placement of specially designed reclaimable self-expandinganti-reflux esophageal stents (n = 66). The dysphagia symptom scores were recorded before and 1-month,6-month and 12-month after the procedure, respectively. The change in width of esophagus, procedure related complications, length and costs of hospitalization were also analyzed. Results Dysphagia symptom score was significantly decreased after the treatment in both groups (P < 0.05). The effective rates evaluated at 1-month, 6-month and 12-month after the procedure in balloon dilatation group were 100. 0% , 96. 7% and 91.5% , respectively, which in stenting group were 100.0% , 98. 0% and 97.1% , respectively. There was no significant difference in changes of symptom score at 1-month and 6-month after treatment between the 2 groups (P > 0.05) , while at 12-month after treatment, the decrease of symptom score in stenting group was significantly higher than that in balloon dilatation group (P<0. 05). After the treatment, the significant widening of the stricture and narrowing of the dilated esophagus were achieve in both groups (P < 0.05),while no significant difference between these 2 groups was observed in changes of width (P > 0. 05). Procedure related complications in balloon dilatation group included esophageal perforation (n =1) and upper gastrointestinal bleeding (n=4) , which was not occurred in stenting group, but complications included hyperplasia of granulation tissue (n = 1), stent dislocation (n =2) and defulvium (n = 1) was observed inthe latter group. The length of hospitalization was similar in 2 groups (P > 0. 05) , and the cost of hospitalization in stenting group was significantly higher than that of balloon dilatation group (P < 0. 05). Conclusion Compared with endoscopic balloon dilatation, the specially designed reclaimable self-expanding antireflux stents is a more ideal method for achalasia, with similar short-term effect, but better long-term effect and safety.

Objective To evaluate percutaneous endoscopic gastrostomy (PEC) in long-term coma patients at different phases who received trans-nasal feeding in Department of Neurosurgery. Methods A total of 51 patients who received trans-nasal feeding because of long-term coma were randomly divided into 2 groups to undergo PEG at 25-39 days after coma (n =24) or at 40-60 days (n = 27) , respectively. The rates of upper gastrointestinal bleeding, average episodes of bleeding, average hemostatic time, the rates of aspiration and aspiration pneumonia were compared between the 2 groups. Results The rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in post-PEG patients were significantly lower than those in pre-PEG patients (P < 0.05). Before the procedure of PEG, the rates of upper gastrointestinal hemorrhage,average episodes of bleeding, rates of aspiration and aspiration pneumonia in 25-39-day group were significantly lower than those in 40-60-day group (P < 0.05). There was no significant difference between 2 groups, in regarding of either hemostatic time, or rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia after PEG (P > 0. 05). Conclusion PEG may decrease the rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in neurosurgical patients receiving trans-nasal feeding because of long-term coma. PEG is preferably performed on 25-39 days of onset to 40-60 days. If there is no contraindication, 25-39 days after coma is likely to be the optimal time for PEG.

Objective To investigate the value of colonoscopy with narrow band imaging (NBI) in predicting the histology of colorectal polypoid lesions. Methods A total of 173 colorectal polypoid lesions from 125 patients were included in the study. The lesions were diagnosed as neoplastic (adenoma or cancer)or non-neoplastic based on pit patterns and/or capillary patterns (CP), which was compared with the results of pathology, and the sensitivity, specificity and accuracy of each method were evaluated. Results In differentiation between neoplastic and non-neoplastic lesions, the sensitivity, specificity and accuracy of CP (94. 83% , 91. 23% and 93.64% , respectively), and those of CP combined with pit patterns (95. 69% ,96.49% and 95. 59% , respectively) were significantly higher than those of conventional colonoscopy (80. 17% , 84.21% and 81.50% , respectively, P<0.05). In differentiation between adenoma and cancer,the sensitivity, specificity and accuracy of CP were 86.90% , 100.00% and 87.93% , respectively.Conclusion NBI is superior to conventional colonoscopy in differentiation between neoplastic and non-neoplastic lesions, as well as in differentiation between adenoma and carcinoma.

Objective To establish diagnostic standards of confocal laser endomiroscopy (CLE) in pathological classifications of gastric cancer and evaluate the diagnostic value of CLE in vivo. Methods The confocal images of 36 patients, who were diagnosed as gastric cancer with confirmation of pathology, were collected and analyzed to establish diagnostic standards of CLE for pathological classifications of gastric cancer. The sensitivity, specificity and accuracy of CLE were determined with reference to histopathologic findiugs retrospectively. Results According to changes of glandular architecture and microvessels under CLE, gastric cancers were divided into differentiated and undifferentiated type. The sensitivity, specificity and accuracy of CLE in diagnosing differentiated carcinoma were 85.7%, 92. 3% and 90. 5%, respectively, which were 85.7%, 92. 3% and 90. 5%, respectively, in undifferentiated carcinoma. Conclusion CLE is a new tool to make pathological classifications of gastric cancer during routine endoscopic examination procedure, which correlates well with histopathologic fingdings.

Objective To evaluate the effectiveness and safety of minimal incision laparotomy assisted endoscopic resection for polyps in small intestine in patients with Peutz-Jeghers syndrome. Methods The clinical data of patients with Peutz-Jeghers syndrome, who underwent minimal incision laparotomy assisted endoscopic resection for polyps in small intestine, were retrospectively studied. The size and number of the endoscopically rosected polyps, and the procedure related complications were documented. Results A total of 812 polyps in small-bowel were resected in 8 patients, in which 384 were smaller than 10mm, 356 with diameter ranging from 11 mm to 30mm, and 72 were larger than 30mm in diameter. Procedure related complications included intestinal dysfunction in 1 patient and abdominal pain in another. No bleeding with a fall in Hb or other severe complications were observed. Conclusion Minimal incision laparotomy assisted endoscopic resectio is a safe and reliable procedure for the treatment of mid-small bowel polyps in patients with Peutz-Jeghers syndrome. It revolutionizes the therapeutic options for polyps in the region of the mid-small bowel and limits the indications for primary surgical management.