Objective To evaluat the endoscopic diagnosis and treatment of duodenal varices.Methods Twenty-six cases of duodenal varices detected by endoscopy from a total of 93 283 patients from November 2000 to August 2008.were classified according to the location,diameter and risk factor(LDRf)of the varices.The patients were treated according to the classification and followed. Results The duodenal variees were classified as Ldl(5,19.2%),Ld1,2(2,7.7%)and Ld2(19,73.1%);D0(0),D0.3(2),D1(10),D2(13)and D3(1);Rf0(23),Rf1(0)and Rf2(3).Of 26 patients,18 were accompanied with esophageal and (or)gastric fundic varicosis.Hepatitis B-related cirrhosis occurred in 9 of 17 hospitalized cases,of which 3 cases of Rf,were treated with endoscopic procedures.Histoacry injection was performed in 1 patient ofcase of Ld2D1Rf2.The patients were followed up for 14.6 months on average.Duodenal varieesis in 3 patients vanished in 1.0-3.5 months after the treatment,and there was no recurrence.Ofthose patients who did not receive endoscopic treatment,11 were followed up,and no varices bleeding was found.Two patients died of other reasons.Conclusion LDPd classification can reflect endoscopic features of duodenal varieosis,and it is safe and feasible to choose therapy according to LDRf classification.

Objective To evaluate the feasibility of developing a novel classification system for gastroesophageal variees according to its location(L), diameter(D) and risk of bleeding(R). Methods The data of 381 patients with gastroesophageal varices, who underwent emergency endoscopy because of variceal bleeding, were retrospectively analyzed. The varices were classified into different types according to their location, diameter and risk of bleeding (LDRf). Results Bleeding was most common in varices located at middle and lower part of the esophagus, and red sign on varices was a risk factor of bleeding. All varices could be classified into one certain type according to LDRf. Of 293 cases of esophageal varices, 133 (45.4%) were Rf1 and 160 (54. 6% ) were Rf2 ; of 88 cases of gastric varices, 47 (53.4%) were Rf1 and 41 (46. 6% ) were Rf2. Condusion The LDRf classification system is feasible in gastroesophageal varices.

Objective To study the feasibility of LDRf classification for gastrointestinal tract ectopic varices (EcV) outside the esophagus.Methods Data of 914 patients with gastrointestinal EcV were classified by LDRf and analyzed for EcV location (L),vascular diameter (D),and risk factor (Rf).The etiology of the portal hypertension (PH) was determined,and the patients were treated and followed up.Results The EcVs were located in duodenum of 198 cases,in jejunum and ileum of 93,in bile duct of 105,in colon of 65,and in rectum of 453.Diameters of blood vessels of EcV varied from 0.3 to 3.5 cm.PH causes were cirrhosis with portal hypertention in 630 patients (68.9％),in which 3 were autoimmune cirrhosis and 3 were portal spongiform liver disease (0.6％).Combined esophageal and gastric varices were found in 252 cases (27.6 ％),including 4 cases (0.5％) of splenectomy.Various treatments were applied in 315 patients,including endoscopic tissue adhesive injection in 43,endoscopic sclerotherapy in 76,endoscopic ligation in 74,interventional treatment in 52,and surgical laparotomy in 70.A total of 19 patients died of variceal bleeding.The patients were followed up for 13 to 36 months,no varices relapsed,and 1-year survival rate was 100％.Conclusion LDRf classification,simple,applicable,standardized,is suitable for the whole gastrointestinal varicose veins.

0.05). The blood CD + 8 in IBS group was higher than that in control group ( P 0.05). Conclusions The peripheral blood lymphocytes count in IBS was not significantly different from the controls, the number of CD + 3 T lymphocytes was normal in IBS, but CD + 8T lymphocytes was higher, CD + 4 was lower, and CD4/CD8 ratio was decreased in IBS patients as compared with the controls. The results of this study indicated that the patients with diarrhea type IBS might be associated with hypo immunity.

ObjectiveTo determine the efficacy and safety of peroral endoscopic myotomy with transverse entry incision (T-POEM).MethodsThe data of 31 patients with achalasia (AC) who underwent T-POEM were collected and analyzed.ResultsThe success rate of T-POEM was 100％ with an average operation time of 78.6 minutes.Patients were followed up for (6.3 ± 5.4) months averagely.The symptom remission rate was 100％ with complication rate of 19.4％ (6/31).The mena Eckardt score after T-POEM was 0.7 ± 0.5,which was significantly lower than that before the procedure ( 7.8 ± 0.9) ( P ＜ 0.05 ).ConclusionThe short term results of T-POEM is satisfying with low complication rate.

Objective To explore the influence of porcine esophageal variceal pressure on complete ligation for polycyclic ligator in vitro.Methods The experimental porcine venous vessels were selected to make the models of different venous pressure,which were divided into 3 groups according to the preset pressure range,P1 group 25-30 cmH2O(1 cmH2O =0.098 KPa),P2 group 35-40 cmH2O,P3 group 45-50 cmH2O.Ligation effects of each group were analysed.Results There were 75 complete ligations (47.77％,75/157) in group P1,41 in group P2 (32.28％,41/127),and 29 in group P3 (23.58％,29/123).There were significant differences among the three groups (x2 =19.558 5,P =0.000 6).Conclusion The higher the variceal pressure is,the worse the effect of ligation is.Variceal pressure could predict the effect of endoscopic ligation,and is helpful for the choice of endoscopic treatment.

Objective To explore the influence of different pressures and diameters in vitro on complete ligation degree of esophageal varices based on the principle of LDRf typing.Methods According to the different preset venous pressure,the experimental porcine veins were used to establish vascular pressure models and divided into three groups (group A 25-30 cmH2O,group B 35-40 cmH2O,group C 45-50 cmH2 O).The porcine esophagus was selected to establish models of esophageal varices,and divided into three groups according to the diameter of esophageal varices (group D1 0.4-1.0 cm,group D2 1.0-1.5 cm,group D3 1.6-2.0 cm).Influence of pressure and diameter on complete ligation degrees was evaluated by univariate and multivariate analysis.Results Group A completed 18 ligations (56.25％,18/32),group B 12 ligations (37.50％,12/32),and group C 11 ligations (33.33％,11/33),which were not significantly different by pressure (x2 =3.6126,P =0.0573).Group D1 completed 35 ligations (94.59％,35/37),group D2 6 ligations(16.67％,6/36),and D3 completed no ligation (0％,0/24),which were significantly different by diameter (x2 =38.0014,P =0.0000),indicating that the diameter of the varices exerted greater influence on the ligation degree.The logistic regression analysis showed that variceal pressure and diameter were the independent factors for complete ligation degree (P =0.000).Conclusion Complete ligation is effective and safe when the variceal diameter is 0.4-1.0 cm,or variceal pressure is 25-30 cm H2O.Endoscopic treatment for varices with the guide of LDRf typing is scientific and feasible.

Objective To reproduce a new canine model of benign esophageal stenosis and to observe its pathological changes at different periods. Methods The esophargus wall 32~35cm from the incisor was cauterized circumferentially with a electric current of 40J/s through an endoscope. 8 adult dogs were used. The morphological changes were examined endoscopically and microscopically at the end of 1st, 2nd, 4th and 8th week. Results At the end of one week, the Narrowing of the lumen was detected at the end of the 1st week. The mucosa became highly congested and swollen, with neerosis of tissue and infiltration of inflammatory cells. At the end of two weeks, the narrowing was getting worse, and granulation and fibrous tissue appeared in the submucosa with marked cellular infiltration. At the end of four and eight weeks, the narrowing was stable with a diameter of 0.4-0.6cm, and excessive granulation tissue and proliferation of fibrous tissues with reduction of inflammatory reaction were detected in the whole-hickness of the esophageal wall. Conclusion An animal model of benign esophageal stenosis as a result of cauterization is reliable, and it is characterized by inflammatory response, which is replaced gradually by granulation tissue and fibrosis.

Objective To review the results of minimally invasive intervention on acute suppurative cholangitis(ASC);the effects of intervention was analyzed.Methods ASC patients had been admitted to our hospital from 2001,6 to 2005,6,and their data was analyzed;35 cases were selected according to the ASC diagnosis criteria,among whom 28 cases were treated by intervention;the data change of WBC and ratio of N before and after treatment were analyzed by T test.Results Twenty-two cases were treated by therapeutic ERCP only;all of them were cured after intervention,among whom 9 cases were drained by therapeutic ERCP for biliary duct obstruction.The effects of 5 cases who suffered from extrohepatic duct obstruction were better than those of 4 cases who suffered from hepatic duct obstruction,but the symptoms of all cases were released after drainage;4 cases were cured by combination of therapeutic ERCP and PTCD;2 cases were treated by PTCD only,among whom one was cured and one was released after treatment.No obvious complication occurred.Conclusion The minimally invasive methods of therapeutic ERCP,PTC and combined therapeutic ERCP and PTCD are good methods for ASC.

Objective The study intends to evaluate the extent to which the rapid exchange biliary system(RX system)provides improved efficiency in comparison with conventional guide wire combinations during therapeutic endoscopic retrograde cholangiopancreatography(ERCP).Methods A prospective study was carried out in which 213 patients were randomized to undergo traditional devices(106 patients)or RX system(107 patients).The parameters were recorded in every case,including the wire loss rates,catheter/guide wire exchange times and fluoroscopy times.Results Wires accessing to the desired ductal/strictures were achieved in 97.1% of conventional devices group and 98.1% of RX system group.But in the conventional devices group,the wire loss rates(%)were significantly higher than the rates in RX system group(10.2?2.3 vs 2.4?1.2,P