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.

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.

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 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

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 reproduce an experimental model of microsurgical reversible obstruction jaundice by micro-surgical technique. Methods Eight Banna miniature pigs were equally and randomly assigned into model group and control group. An improved Foley catheter was put into gall bladder of the pigs in the control group. A biliary calculus removal balloon tube was inserted into the common bile duct through the cystic duct in the experimental group to establish either partial or total biliary obstruction. The obstruction could be relieved by withdrawing the balloon tube from the common bile duct. Biliary tract visualization was conducted to evaluate the biliary obstruction, and venous blood samples were collected to determine the liver function (such as serum levels of TBIL and ALT etc.) in all pigs on the 2nd, 4th and 6th day after operation. Results Cholangiography showed a progressive dilation of both common hepatic duct and intrahepatic bile duct in the experimental group when the partial biliary obstruction was induced. During the periods when the total biliary obstruction was created the common bile duct, the common hepatic duct and intrahepatic bile duct of the animals in the experimental group were dilated progressively too. Both intra- and extra- hepatic bile ducts changed significantly compared to the control group. The dilatation subsided following the relief of obstruction. There was no dilatation of the bile duct in the control group. The serum levels of TBIL and ALT were significantly higher in the experimental group than that in the control group, and they were lowered after the relief of obstruction. Conclusion A microsurgical reversible obstruction jaundice model has been successfully reproduced with a biliary calculus removal balloon tube. It may provide a reliable experimental method for researches on the pothogenesis and treatment of obstruction jaundice.

Objective To determine the efficacy of endoscopic treatment for chronic pancreatitis(CP).Methods The clinical data of CP patients in our department from December of 2000 to March of 2009 were reviewed retrospectively.Results 77 patients had been successfully followed up.The short-term clinical symptom remission rate was 86.9% and the long-term 61.0%.9 patients underwent surgery after endoscopic treatment during the follow-up.The incidence of complications related to endoscopic treatment was 5.1% including post-ERCP(endoscopic retrograde cholangiopancreatography) pancreatitis,hemorrhage,cholangitis and perforation.No death related to endoscopic treatment occurred.Conclusion Endoscopic treatment for CP is safe and effective.