Objective To evaluate the efficacy of transcatheter arterial chemoembolization (TACE) combined with hypofractionated 3 dimensional conformal radiotherapy for hepatocellular carcinoma (HCC). Methods During May 1998 and Dec. 1999, 81 unresectable HCC patients were divided into two groups. Forty one patients in group A were treated with TACE and hypofractionated 3 dimensional conformal radiotherapy and 40 patients in group B were treated with TACE alone. Acute effects were analyzed and survival rates were assessed from the date of the beginning of treatment using the Kaplan Meier method. The survival rates of two groups were compared using Log rank. The Cox proportional hazards model was used to analyze the prognostic factors in group A. Results The objective response rate in group A was higher than that in group B (85.4% vs. 65.0% , P

Objective To assess the therapeutic value of endoscopic nasobiliary drainage (ENBD) and oral praziquantel on severe clonorchiasis sinensis. Methods Fifty-eight patients with severe clonorchiasis sinensis were treated by ENBD (observing group, ENBD group) , and other 26 patients treated by surgical operation (control group, operation group). Both groups are matched in age, gender etc. After the procedure all patients receive orally praziquantel 1. 2g, three times a day for 2 days. Results In ENBD group the symptoms, such as abdominal pain, fever, jaundice improved earlier than those in operation group. In compare with the surgical operation, ENBD shares the advantages of earlier remission and recovery, less trauma, scarce complications and low expense. Conclusion ENBD and oral praziquantel is an effective and safe procedure in treating severe clonorchiasis sinensis.

Objective Laterally spreading tumor (LST) has a close relationship with colorectal cancer, its diagnosis and treatment are differed from those of ordinary protuded tumors. The aim of this study is to attract much attention to this particular tumor. Methods Four thousand two hundred and ten patients were examined with magnifying endoscope and mucosa staining from December, first 2000 to May 31 , 2002. Results In 34 patients with LST, there were 35 lesions, including granular type 15, nodular - mixed type 18, and pseudocaved 2; and there were 4 patients with intramucosa carcinoma and other 2 with serrated adenoma. The biggest lesion is 68 mm ? 85 mm, and the smallest 11 mm? 12 mm. Of the 35 lesions the diameters are 8 within 11 -20 mm, 13, 21 -30 mm and 14 above 31mm. The pit patterns of the 35 lesions are mainly IV pit patterns, about 62. 9% (22/35). The pathological diagnoses of 3 patients with VA pit patterns LST are intramucosa carcinoma, and 8 patients with Ⅲ L pit patterns are tubulovillous adenoma. All of the 35 lesions are resected by EMR or EPMR. Complication occurred in two patients during treatment of EMR such as hemorrhage and local peritonitis. Conclusion Mucosa staining and magnifying endoscopy is very useful in detecting LST. We must pay more attention to those signs, such as reddish and eneven mucosa or unclear or interrupted vascular network. Furthermore it is necessary to stain the mucosa with indigo carmine spray to get the evidences of flat tumor. Pit patterns of LST mostly are IV or ⅢL, and LST with Ⅳ pit patterns are mainly villous adenoma, ⅢL tubular adenoma, while LST with the Ⅴ pit pattern signifies the cancerated metaplasia.

Objective To evaluate the diagnostic value of colonoscopy for patients with chronic diarrhea.Methods Data of 2449 patients with chronic diarrhea who underwent colonoscopy from January,1999 to December,2008 were reviewed.A total of 2110 patients who underwent colonoscopy screening for health checkup during the same period were used as controls.The rates of clinic-relevant abnormal endoscopic findings and negative finding were compared between two groups.Results Lesions with clinic significance were found in 44.1％ of patients with chronic diarrhea (1080/2449) and in 41.7％ of controls (870/2110,x2 =2.756,P =0.097).Compared with controls,incidence of non-IBD and noninfectious colitis (x2 =58.578,P ＜ 0.001),IBD (x2 =59.609,P ＜ 0.001),malignant tumor (x2 =21.649,P ＜0.001),terminal ileitis (x2 =6.275,P =0.012),infectious colitis (x2 =17.019,P ＜0.001),intestinal tuberculosis (x2 =7.021,P =0.008),melanosis coli (x2 =6.040,P =0.014) and parasitic infection (x2 =4.245,P =0.039) were all significantly higher in patients with chronic diarrhea.However,incidences of adenomatous polyps (x2 =14.124,P ＜ 0.001),non-adenomatous polyps (x2 =33.427,P ＜0.001) and diverticular disease (x2 =9.921,P =0.002) were significantly higher in the control group.There was no significant difference in incidences of the benign tumor (x2 =1.627,P =0.202) and angiodysplasia (x2 =0.231,P =0.631) between the two groups.The overall screening rate of colonic polyps,diverticulosis,and vascular lesions was 37.3％ in chronic diarrhea group.Conclusion Colonic polyps,diverticulitis,benign tumors and angiodysplasia may not be the causes of chronic diarrhea.Etiology of more than 1/3 patients with chronic diarrhea remains unknown after colonoscopy.

Objective To investigate the role of β-arrestin2 in intestinal inflammation and illustrate the mechanisms from the perspective of epithelial barrier function. Methods Dextran sodium sulfate(DSS)is used to induce acute intestinal colitis in mice. The experiment groups are designed as the wild type control(WT),the wild type colitis (WT+DSS) and the β-arrestin2- knockout colitis (KO+DSS). The expression of β-arrestin2 gene by mRNA and protein level is compared between the WT and WT + DSS groups. The difference of weight loss , disease activity index(DAI),spleen weight,colon length,histological score,intestinal permeability and important tight junction proteins (occludin ,claudin1 and ZO-1) were detected in the WT+DSS and KO+DSS groups. Results Compared with the WT group,the expression of β-arrestin2 was significantly higher in the colon of the WT+DSS group. Compared with the WT+DSS group,the KO+DSS group had less weight loss(P < 0.05),lower DAI(P<0.05),smaller spleen,longer colon and lower histological score(P=0.002). The KO+DSS group had a lower intestinal permeability(P = 0.009)and higher protein level of occludin and claudin1.There was no signifi-cant difference of ZO-1 in the two groups. Conclusion β-arrestin2 may promote mouse colitis through impairment of epithelial barrier function.

Objective The aim of this study was to evaluate magnetic resonance cholangiopancreatography(MRCP)using half-Fourier acquisition single-shot fast spin-echo(HASTE)sequence in the diagnosis of biliary obstructions.Methods Forty-five patients with pancreaticobiliary duct diseases underwent MRCP on 1.5 T scanner,a heavily T 2-weighted HASTE was used during a breath-hold.The source images were three-dimensional reconstructed postprocessed on workstation.The findings of MRCP images were analyzed and compared with US,CT,ERCP or PTC.Results The diagnostic accuracy of MRCP was 94%,the same as ERCP(92%),but it was superior to US and CT(?

ObjectiveTo detect the changes of gastroesophageal reflux disease (GERD) with high resolution endoscopy,and to explore its diagnostic value for nonerosive reflux disease (NERD). Methods From April 2007 to January 2008, consecutive out-patients visiting the Department of Gastroenterology due to continuous or recurrent symptoms of acid reflux, heartburn, cardiac-like chest pain for at least three months and volunteer healthy controls were recruited to the study. The subjects were classified into the normal group ( n =48 ), the NERD group ( n =70), the erosive esophagitis (EE) group ( n =70), and the Barrett esophagus (BE) group ( n =48). All subjects underwent endoscopy, and the shape of Z-lines, the shape of mucosal pits, mucosa roughness above Z-line and the shape of mucosal blood vessels were observed. The NERD changes were analyzed with optimal scale. ResultsZ-line shape of NERD group showed a significant difference from that of EE and BE groups ( P ＜ 0. 01 ), which was not different from that of normal controls ( P ＞0. 01 ). The shape of mucosal pits of NERD group was different from that of EE and BE (P ＜0. 01 ), which also was not different from that of control (P＞0. 01 ). Roughness of the mucosa above Z-line of NERD group was different from other 3 groups (P ＜0. 05). And the shape of mucosal blood vessels of NERD was different from the control (P＜0. 05), but was not from two others. Features of NERD relative images were thin,straight and spiral blood vessels, bar-like pits, plat mucosa, round, smooth and wide tooth-like Z-line and mucosa of white particle hypertrophy. ConclusionHigh resolution endoscopic features of most NERD patients are cloudy, white and rough mucosal surface, with white particular hypertrophy, spiral vascular dilation, extending to Z-line. These features can be indicators of NERD.

ObjectiveTo investigate the safety and efficacy of carbon dioxide ( CO2 ) insufflation during ERCP.MethodsBetween January and August 2011,a total of 102 consecutive patients who underwent ERCP were randomized to accept CO2 insufflation ( n =52 ) of air insufflation ( n =50 ) during the procedure.ERCP was carried out with the same instrument by an expert endoscopist who was blinded to the insufflation gas used and the procedure was controlled at 30 minutes to 1 hour.The heart rate,oxygen saturation of the patient was continuously monitored during the procedure.Before the procedure and 1 hour after the end of operation,abdominal X-ray was taken to evaluate the width of intestine,and the degree of intestinal expansion was defined as normal,mild,moderate and severe according to the width increased.A questionnaire with 100 mm visual analogue scale (VAS) was used to quantify the abdominal pain and distention experienced at 1 hour,2 hours,and 6 hours after the procedure.The patients' vital signs,bowel dilatation,the average operating time,abdominal pain score and distention score on VAS,and complications in 2 groups were analyzed.ResultsThe baseline characteristics of 2 groups were comparable.ERCP was successfully performed in all the patients and no complication was observed.In CO2 group,the average operating time,mean heart rate and oxygen saturation were (45.2 ± 10.6) min,( 102.2 ± 10.3 ) bpm and ( 99.5 ± 0.5)％,which were (48.5 ± 11.2) min,( 100.3 ± 11.4) bpm and (98.9 ±0.6)％,respectively,in air group.There were no significant differences on these items between the 2 groups ( P ＞ 0.05 ).Moderate to severe intestinal expansion 1 hour after ERCP was found in 14 patients (26.9％ ) in CO2 group and in 28 patients (56.0％ ) in air group,and the latter was significantly higher than the former (x2 =11.61,P =0.009).Both of the mean abdominal pain and abdominal distention scores at 1 hour post-ERCP in CO2 group were lower than those in air group,but without significant difference (P ＞0.05).However,the mean abdominal pain scores at 2 hours and 6 hours post-ERCP in CO2 group were significantly lower than those of patients in air group (7.4 ±2.2 vs.18.7 ±4.6 at 2 hours post-ERCP,9.6 ±3.7 vs.20.1 ±4.5 at 6 hours post-ERCP,all P ＜ 0.05 ).Similarly,the mean abdominal distention scores at 2 hours and 6 hours post-ERCP in CO2 group were significant lower than those of patients in air group (7.6 ±3.6 vs.18.3 ±4.1 at 2 hours post-ERCP,8.9 ±3.7 vs.19.4 ±4.2 at 6 hours post-ERCP,all P ＜0.05).ConclusionThe use of CO2 insufflation instead of air during ERCP appears to be safe.Insufflation of CO2 during ERCP palliates the intestinal expansion,post-ERCP abdominal pain and distention comparison to insufflation of air.However,because of the single-center clinical observation with limited number of cases,the safety and efficacy of CO2insufflation during ERCP requires to be further evaluated.

Objective To investigate the effect of EST and EPBD on the gallbladder function.Methods Fifty-eight patients who underwent common bile duct lithotomy were divided into three groups,the EST major incision group (21),the EST minor incision group (20) and the endoscopic papillary balloon dilation group (17).Twenty healthy people were involved as the control group.The hepatobiliary dynamic imaging was used to evaluate the gallbladder function,indices including (1) Half time of liver excretion (TEX),(2)Peak time of common bile duct excretion (CBD Tup),(3)Gallbladder imaging time(GBVT),(4) Half time of gallbladder excretion (GBT1/2),(5)Gallbladder excretion fraction at the 30th minute (GBEF30min),(6) Gallbladder excretion rate at the 30th minute (GBER 30 min),(7)Duodenum imaging time (DUT),(8) Peak time of bile flowing in duodenal (DU Tup),(9) Bile ratio in gallbladder at the 30th minute(Fgb),(10)Bile ratio in intestinal at the 30th minute (Fsi).Effects of the three operative methods on the gallbladder function were evaluated.Results Compared with the other two treatment groups and control group respectively,the TEX of the EST major incision group was significantly shorter (P ＜0.05),CBD Tup,DUT and DU Tup appeared earlier (P ＜0.05),GBVT was delayed (P ＜0.001),GBT1/2 was shorter (P ＜0.001),GBEF 30 min was higher (P ＜0.001) and GBER 30 min was faster (P ＜0.001) in this group.Gallbladder and intestines ratio (Fgb,Fsi) at the 30th minute were significantly different (P ＜0.001) with Fgb reducing while Fsi increasing in this group,compared with others.Compared with the control group respectively,neither the minor incision group nor the EPBD group (P ＞ 0.05) showed significant differences in these indices.Conclusion The storage function of gallbladder has been injured and excretion has been enhanced after EST major incision.Neither minor incision nor the EPBD leads to significant change in the gallbladder function.

ObjectiveTo investigate the diagnostic value of transgastic peritoneoscopy for ascites of unknown aetiology.MethodsTransgastric peritoneoscopy was performed on 7 patients with ascites of unknown aetiology.Diagnosis and complications were both recorded.ResultsDiagnosis of all the 7 patients were confirmed after transgastric peritoneoscopy,among whom 6 ( 85.7％ ) were found to have tuberculosis peritonitis,and 1 ( 14.3％ ) with liver disease.All patients recovered after the operation.No intraoperative or postoperative complications occurred.ConclusionTransgastric peritoneoscopy is a valuable diagnostic method for ascites of unknown aetiology.