Objective:To study the efficacy and safety of EndoClot polysaccharide hemostatic system (EndoClot PHS) for heparinized arterial hemorrhage of upper digestive tract (Forrest Ⅰa) in animal model.Methods:Twelve experimental pigs were randomly divided into the test group ( n=6) and the control group ( n=6) by simple random grouping method. Gastric arterial hemorrhage models were established. Endoclot PHS and Hemospray were used to spray on the wound to stop bleeding in the test group and the control group respectively. The time of effective hemostasis, the amount of hemostatic particles used, and the blockage of the powder feeding tube and its replacement were compared between the two groups. The survival and complications of experimental pigs were observed after the operation. In 10 days after the operation, the experimental pigs were euthanized for pathological dissection. Results:Spurting or pulsatile bleeding was achieved in all experimental pigs. There were significant differences in the time of effective hemostasis (8.75±0.84 min VS 9.83±0.62 min, t=-2.53, P=0.030) and the amount of hemostatic particles used to achieve effective hemostasis (6.71±0.39 g VS 14.10±1.62 g, t=-10.86, P<0.001) between the test group and the control group. There was no significant difference in the occurence of clogging or the replacement of powder feeding pipes between the two groups (0.64±0.02 times VS 0.67±0.04 times, t=-1.64, P=0.131). In addition, the gas source of the test group was stable, and the visual field under the endoscope was clear. Neither the test group nor the control group had gastric lesions, perforation, or embolism. The blood glucose, blood routine, and liver and kidney functions were normal, and no thrombosis or embolism of the main organs occurred in either group. Conclusion:EndoClot PHS is safe and effective for heparinized upper gastrointestinal arterial hemorrhage (Forrest Ⅰa) in animal models.

Objective:To evaluate the efficacy of hemostatic powder on preventing delayed bleeding after endoscopic submucosal dissection (ESD).Methods:Patients who received ESD in the First Affiliated Hospital of Soochow University and Yulin No.2 Hospital from June 2017 to August 2018 were enrolled with informed consents, and randomly divided into the study group and the control group. Hemostatic powder was applied on post-ESD ulcer after routine hemostasis method in the study group, and the control group was given routine hemostasis method only. The time and dosage of hemostatic powder spraying and its adverse events were observed in the study group. The operation time, rate of delayed bleeding (within 30 days after operation) and early delayed bleeding (within 48 hours after operation), and postoperative hospital stay were compared between the two groups.Results:A total of 196 patients were enrolled including 97 in the study group and 99 in the control group. The baseline data were comparable between the two groups (all P>0.05). In the study group, the time to spray powder was 68.78±19.75 s, dosage was 2.51±0.93 g. Powder delivery catheter was blocked in one case (1.03%, 1/97). No adverse event was reported during 30 days of follow-up. The operation time was not statistically different in the study group and the control group (61.92±11.71 min VS 59.76±11.01 min, t=1.330, P=0.185). The delayed bleeding rate of the study group was significantly lower than that of the control group [1.03% (1/97) VS 8.08% (8/99), P=0.035]. There was no case of early delayed bleeding occurred in the study group, while 6 cases (6.06%, 6/99) in the control group ( P=0.029). The postoperative hospital stay was not statistically different between the study group and the control group (4.57±0.85 d VS 4.86±1.37 d, t=1.778, P=0.077). Conclusion:Although capacity of hemostatic system remains to be improved, hemostatic powder is an effective, safe and simple method to reduce delayed bleeding rate after ESD, especially on early delayed bleeding.

Objective:To compare the efficiency and safety of T knife and Dual knife in endoscopic submucosal dissection (ESD) in the treatment of esophageal lesios.Methods:A total of 59 hospitalized patients with esophageal lesions who underwent ESD in the First Affiliated Hospital of Soochow University from June 2018 to January 2019 were enrolled in the study, and the patients were randomly divided into T knife group ( n=29) and Dual knife group ( n=30). The operation time, resection speed, complete resection rate, and complications of the two groups were compared. Results:There were no significant differences in gender, age and comorbidity between the T knife group and the Dual knife group (all P > 0.05). The operation time of T knife group and Dual knife group was 57.86±24.62 min and 66.28±29.48 min, respectively, and the difference was statistically significant ( t=1.189, P=0.024). The resection speed of the two groups was 22.80±7.31 mm 2/min and 16.20±7.24 mm 2/min, respectively, with significant difference ( t=3.484, P=0.001). The complete resection rate of the two group was 86.2% (25/29) and 86.7% (26/30), respectively, with no significant difference ( χ2 =0.108, P=0.742). There were 2 (6.9%) cases of complications in the T knife group, while 5 (16.7%) cases in the Dual knife group, the incidence of complications was no significant difference ( χ2=0.574, P=0.449). There was no perforation or bleeding in the both groups. Conclusion:In the treatment of esophageal lesions, T knife in ESD has the advantages of short operation time and high resection speed compared with Dual knife, and is worthy of clinical application.

Objective To evaluate the therapeutic value of endoscopic jejunal tube placement, endoscopic clipping, and over the scope clip ( OTSC) for digestive fistula. Methods Data of 38 patients with digestive fistulas at the First Affiliated Hospital of Soochow University admitted from July 2015 to July 2017 were retrospectively analyzed. Treatments were chosen according to the size and the site of the fistulas. Thirteen patients underwent jejunal tube placement ( the jejunal tube group ) , 20 underwent endoscopic clipping( the endoscopic clipping group) , and 5 underwent OTSC( the OTSC group) . The technical success rate, clinical cure rate and postoperative hospital stay were analyzed. Results All patients received the endoscopic operation successfully with no significant complications. In the jejunal tube group, 4 patients′fistulas fully healed, lesion was smaller after treatment in 3 patients, lesion didn′t change in 5 patients, and 1 patient died. The complete cure rate was 30. 8％ (4/13), and the postoperative hospital stay was 47. 4± 14. 1 days. For the endoscopic clipping group, 16 patients′ fistulas fully healed, lesion was no smaller compared with that before treatment in 3 cases, and 1 patient died. The complete cure rate was 80. 0％ ( 16/20) , and the postoperative hospital stay was 17. 9 ± 8. 9 days. Total patients in the OTSC group were completely cured, with 100. 0％( 5/5) of complete cure rate. One patient with refractory esophageal fistula underwent OTSC repeatedly with endoscopic clipping, and the healing time of fistula was 102 days. The postoperative hospital stay of 4 others was 5. 3±1. 7 days. The cure rate of fistula was higher (P=0. 03, P<0. 001) and the postoperative hospital stay was shorter ( P=0. 04, P<0. 001) in the OTSC group compared with the clipping group and the jejunal tube group. Conclusion Endoscopic management is safe and effective for digestive fistulas with less trauma, easy performance and short time of healing.

Objective To investigate the effect of blood transfusion physicians for participating in clinical consultation to provide a reference for blood transfusion physicians participating in clinical practice.Methods The clinical data in 5 224 inpatients receiving blood transfusion before the blood transfusion physicians participating in clinical consultation (from January 2010 to December 2015) and after participating in clinical consultation (from January 2013 to December 2015) were retrospectively analyzed.Results The occurrence rates of blood transfusion adverse reactions before and after the blood transfusion physicians participating in clinical consultation were 2.39 ％ and 1.48 ％ respectively (x2 =5.674,P=0.021),the blood transfusion ratios of inpatients were 4.85 ％ and 3.55 ％ respectively (x2 =135.5,P＜0.01),the average allogeneic blood transfusion volumes were 0.563 U and 0.420 U (t=3.986,P=0.016),and the constituent ratios of mild,moderate andsevere anemia were 5.40％ and 0.23 ％,29.60％ and 17.90％,and 65.00％ and 81.80％ respectively (x2 =237.6,P＜0.01).Conclusion Participating in clinical consultation by the blood transfusion physicians is conducive to clinical treatment.

Objective To evaluate effects and safety of mixed solution of sodium hyaluronate, normal saline and indicarmine during endoscopic submucosal dissection(ESD). Methods A total of 233 patients with gastric, esophageal and colonic lesions diagnosed by endoscopy in the digestive endoscopy center of the First Affiliated Hospital of Soochow University between September 2015 and November 2016 were randomly divided into the experimental group(173 patients)and the control group(50 patients). The experimental group was injected with sodium hyaluronate 100 mg+normal saline 60 mL+0.2% indicarmine 4 mL, and the control group with normal saline 70 mL+0.2% indicarmine 4 mL. The solutions were used for multi-point injection in submucosa outside markers of lesions, respectively, and ESD was performed until lesions were effectively lifted up. The location and size of lesions, operation time, dose of injection and the incidence of complications were compared between the two groups. Results The diameter of resected specimen was 1.9± 1.3 cm in the experimental group, slightly less than that in the control group(2.0 ± 1.8 cm,P>0.05). The operation time from lesion mark to the end of ESD in the experimental group was 59.5±26.7 min,significantly less than that in the control group(68.6±29.0 min, P<0.05). The dose of injection in the experimental group(55.5 ± 31.8 mL)was obviously lower than that in the control group (66.7±35.1 mL,P<0.05). The rate of delayed bleeding in the experimental group was 1.16%(2/173),which was significantly lower than that in the control group[12.00%(6/50), P<0.05]. No delayed perforation occurred in the experimental group,while 3 cases(6.00%)occurred in the control group(P<0.05). Conclusion ESD shows better effects and high safety after the submucosal injection of mixed solution of sodium hyaluronate,normal saline and indicarmine.

Objective To analyze the clinical characteristics and prognosis of patients with rectal gastrointestinal stromal tumor ( GIST) . Methods We collected the data of 31 rectal GIST patients definitely demonstrated by pathology and immunohistochemistry in the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University, and Suzhou Wuzhong People′s Hospital from January 2008 to December 2016. The clinical characteristics, therapeutic modalities, and prognoses were retrospectively analyzed. Results Among the 31 rectal GIST patients, 16 underwent local resection and 15 underwent radical surgery. There was no significant difference on the three-year survival rate between the two groups [ 93. 8％ ( 15/16 ) VS 73. 3％ ( 11/15 ) , P=0. 135 ] . There was no significant difference on the survival rate between the oral imatinib patients and non-oral imatinib patients in the local resection group [ 75. 0％ ( 3/4) VS 100. 0％ ( 12/12) , P=0. 083] and the radical surgery group[ 77. 8％ ( 7/9) VS 66. 7％(4/6), P=0. 579]. The postoperative recurrence and metastasis rate of the two groups was no significantly different[31. 3％ (5/16) VS 53. 3％ (8/15), P=0. 213]. Conclusion The choice of surgical procedure has no significant effects on the survival rate and postoperative recurrence for rectal GIST patients, and whether oral imatinib or not has no significant effects on the survival of patients.

Objective To evaluate the feasibility and safety of endoscopic treatment for gastric stromal tumors with maximum diameter of 3 to 5 cm. Methods From April 2010 to April 2016, a retrospective analysis was performed on the data of patients with gastric stromal tumors undergoing endoscopic (29 cases)or laparoscopic(26 cases)resection in the First Affiliated Hospital of Soochow University. Baseline data, perioperative data and follow-up data were collected and analyzed. Results There was significant difference on tumor location between the two groups(χ2=12.173, P=0.007). Tumors mainly located at gastric fundus in the endoscopic group(65.5%,19/29),while at gastric body in the laparoscopic group(61.5%, 16/26). Compared with the laparoscopic group, patients in the endoscopic group had shorter operation time[45(35, 60)min VS 70(60, 85)min, U = 686.000, P<0.05], lesser intraoperative blood loss[15(10,15)mL VS 20(10, 20)mL, U=513.000, P=0.017], and earlier recovery time of gastrointestinal function[12(6, 24)h VS 20(18, 24)h, U=585.500, P<0.001]. Compared with the laparoscopic group, the patients in the endoscopic group had a higher complication rate[55.2%(16/29)VS 11.5%(3/26), χ2=11.543, P<0.001]and a lower intact tumor removal rate [89.7%(26/29)VS 100.0%(26/26),χ2=23.989,P<0.001]. The other perioperative parameters such as the incidence of intraoperative major bleeding, postoperative peritonitis, postoperative fasting time, hospitalization time and total hospitalization expenses showed no statistical different(all P>0.05). The postoperative follow-up time was 30.0(17.5,50.0)and 38.5(26.0,49.8)months in the endoscopic and laparoscopic group,respectively. There was no significant difference in the recurrence rate between the two group[3.4%(1/29)VS 7.7%(2/26),χ2=0.009,P=0.922]. Conclusion Endoscopic resection may be an alternative therapeutic approach for large gastric stromal tumors with shorter operation time, less intraoperative blood loss,and earlier recovery time of gastrointestinal function.

Objective To evaluate a new type of endoloop for closure of full-thickness gastric defects left by EFR.Methods A total of 32 patients who underwent EFR at our hospital between October 2014 and February 2015 with gastric fundus submucosal tumors were retrospectively analyzed.After the resection,LeCampTM endoloops and Olympus endoloops were used respectively to close the gastric defect in the study group (n =14) and the control group(n =18).The closure success rates,closure time,complications and the healing rates were compared.Results All lesions were removed by using EFR technique.The closure success rates of the two groups were both 100％.The closure time were 13.86 ± 4.62 minutes and 18.28 ± 6.48 minutes in study group and control group respectively with significant difference (P ＜ 0.05).9.43 ±4.09 metallic clips and 1.00 ±0.00 endoloops were used in study group and 9.67 ± 3.61 metallic clips and 1.06 ± 0.24 endoloops were used in control group (P ＞ 0.05).One patient in study group and 2 patients in control group received abdominal puncture for relieving the pneumoperitoneum during the operation (P ＞ 0.05).No complications such as subcutaneous emphysema,pneumothorax,pneumomediastinum,delayed bleeding,or abdominal infection were found after the operations in either group.The wounds healed in all patients in 2 months after the procedure.Conclusion The use of novel endoloop and metallic clips is a relatively safe,easy,and feasible method for repairing large gastric post-EFR defects,which is of good clinical application value.

Objective To contrastively analyze the performance of two kinds of blood cell separators for apheresis platelets . Methods 80 blood donors were selected from 4 234 healthy apheresis platelet donors and their data before and after apheresis platelets were respectively collected by using two kinds of different blood cell separators Trima and Amicus .The product quality during the collection process ,residual WBC and RBC count ,acquisition time ,collection efficiency ,scrapping situation and safety were performed the comparative analysis between the two kinds of blood cell separator .Results In the case of the difference of the basic parameters before apheresis platelet having no statistical significance ,the two kinds of blood cell separator had no differences in the aspects of product quality ,processing blood amount and the use amount of anticoagulants(P>0 .05);but there were statisti‐cal differences in the aspects of acquisition time ,collection efficiency and pipeline residual blood amount (P<0 .05) .Conclusion Two kinds of blood cell separators have their own advantages and disadvantages during the use process ,so the blood cell separator should be selected according to the physical quality and their own characteristics of blood donors .