Objective To explore the application value of simple manual rubber traction device in endoscopic submucosal dissection(ESD)of colorectal laterally spreading tumor(LST).Methods A retrospective cohort study was used to collect patients who underwent ESD for colorectal LST from June 1,2022 to June 9,2023.According to the use of the manual rubber traction device,patients were divided into colorectal traction ESD group(tESD group,n=22)and colorectal conventional ESD group(cESD group,n=44),the differences were compared between the two groups in the number of intraoperative hemostasis,the number of titanium clips used,the success rate of ESD,incidence of postoperative complications,hospital stay time,and treatment costs.Results The tESD group had relatively longer operation time and shorter hospitalization days than those of cESD group,but the difference was not statistically significant(P>0.05);There were no statistically significant differences in the number of titanium clips used,postoperative complication rates,and hospitalization costs between the two groups(P>0.05).Conclusion Colorectal traction ESD can be used as a remedial plan when traditional ESD is difficult to perform,and the use of traction does not increase the hospitalization cost of patients,and the postoperative complications of the two methods are similar.It is worthy of clinical application.

Objective:To compare the safety and efficacy of two-person and three-person operation of endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y anastomosis.Methods:A total of 31 cases of bile duct stones where endoscopic access was successful and papilla was detected after Roux-en-Y anastomosis in Hangzhou First People's Hospital from January 2021 to September 2022 were recruited. Based on the retrospective study, 17 patients with the two-person operation (an operator and an assistant completed selective intubation) were included in group A from January to December 2021, and 14 patients with the three-person operation (an operator and two assistants completed the selective intubation) from January to September 2022 were included in group B. The success rate, the time of intubation, and complication incidence of the two groups were compared.Results:The intubation success rate of all enrolled patients was 90.32% (28/31). There was no significant difference in the intubation success rate between group A and group B [82.35% (14/17) VS 100.00% (14/14), P=0.232]. The intubation time in group B was significantly less than that of group A (42.89±6.57 min VS 61.02±9.23 min) with significant difference ( t=5.77, P<0.001). The incidence of postoperative complication of ERCP in all enrolled patients was 16.13% (5/31). There was no significant difference in the postoperative complication incidence between group A and group B [17.65% (3/17) VS 14.29% (2/14), P=1.000]. Conclusion:For patients undergoing ERCP after Roux-en-Y anastomosis, the two methods were not statistically different in terms of the intubation success rate and the incidence of procedure-related complications. But three-person operation shows clear advantage in terms of operation time.

Objective:To investigate the clinical value of high-frequency ultrasound combined with virtual touch tissue imaging and quantification in the assessment of limb muscle tension after stroke in patients.Methods:A total of 31 patients with stroke who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to May 2022 and 41 healthy controls who concurrently underwent physical examination in the same hospital were included in this study. Before rehabilitation treatment, the shear wave velocity of the main muscle groups of the limbs was measured using virtual touch tissue imaging and quantification in all participants. The shear wave velocity of the main muscle groups was compared between the affected and healthy sides of patients between two sides of patients. The patient's muscle tension was evaluated using the modified Ashworth Scale. The shear wave velocity of the affected muscle groups in patients was correlated with the modified Ashworth Scale score.Results:There were no significant differences in the shear wave velocities of the main muscle groups of upper (biceps, flexor digitorum sublimis, flexor digitorum profundus) and lower [medial head of the gastrocnemius muscle, lateral head of the gastrocnemius muscle] limbs between the left [(2.46 ± 0.26) m/s, (2.81 ± 0.50) m/s, (2.96 ± 0.31) m/s, (2.49 ± 0.44) m/s, (2.21 ± 0.20) m/s] and right [(2.42 ± 0.29) m/s, (2.80 ± 0.47) m/s, (3.02 ± 0.36) m/s, (2.54 ± 0.37) m/s, (2.18 ± 0.17) m/s] sides in healthy controls ( t = 0.78, 0.04, 0.83, 0.58, 1.15, P = 0.435, 0.967, 0.405, 0.558, 0.216). The shear wave velocities of the main muscle groups of upper [flexor digitorum sublimis (3.74 ± 0.67) m/s, flexor digitorum profundus (3.64 ± 0.60) m/s), biceps (3.63 ± 0.64) m/s] and lower [medial head of the gastrocnemius muscle (3.28 ± 0.61) m/s, lateral head of the gastrocnemius muscle (2.90 ± 0.37) m/s] limbs on the affected side in patients with stroke were significantly higher than (2.56 ± 0.40) m/s, (2.67 ± 0.38) m/s, (2.78 ± 0.41) m/s, (2.30 ± 0.21) m/s, (2.25 ± 0.23) m/s on the healthy side ( t = 11.81, 8.21, 8.75, 8.91, 10.43, all P < 0.001). The shear wave velocities of the main muscle groups of the upper (flexor digitorum sublimis, flexor digitorum profundus, and biceps) and lower (medial head of the gastrocnemius muscle and lateral head of the gastrocnemius muscle) limbs were positively correlated with the modified Ashworth Scale score ( r = 0.77, 0.70, 0.72, 0.74, 0.78, P = 0.007, 0.029, 0.021, 0.016, 0.001). Conclusion:Monitoring the shear wave velocities of the main muscle groups of the upper and lower limbs using high-frequency ultrasound combined with virtual touch tissue imaging and quantification can effectively reflect the change in limb muscle tension of patients with stroke, which is highly valuable for evaluating rehabilitation efficacy and prognosis in patients with stroke.

Objective:To explore the preventive effects of pancreatic duct stent combined with rectal administration of indomethacin suppository for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after difficult bile duct intubation during endoscopic retrograde cholangiopancreatography (ERCP).Methods:From January 2019 to December 2021, patients with biliary and pancreatic diseases undergoing ERCP in Hangzhou Hospital Affiliated to Nanjing Medical University were given 100 mg indomethacin suppository to anal canal 30 minutes before the operation. And those with difficult bile duct intubation during the operation ( n=204) were included in this study. According to the random number table, they were divided into the combination group (implanted with pancreatic duct stent during the operation, n=104) and the indomethacin group (not implanted with stent, n=100). The incidences of hyperamylasemia and PEP were compared between the two groups. Results:The incidences of postoperative hyperamylasemia [21.2% (22/104) VS 34.0% (34/100), χ2=4.22, P=0.040] and PEP [14.4% (15/104) VS 32.0% (32/100), χ2=8.88, P=0.003] in the combination group were significantly lower than those in the indomethacin group. There was no significant difference in the incidence of severe PEP between the two groups [1.0% (1/104) VS 1.0% (1/100), χ2=0.001, P=0.978]. Conclusion:Compared with rectal administration of indomethacin suppository alone, the incidences of hyperamylasemia and PEP after difficult bile duct intubation during ERCP can be further reduced when it is combined with pancreatic duct stent placement.

Objective:To study the influencing factors of postoperative complications in patients with malignant biliary obstruction treated by endoscopic radiofrequency ablation(RFA).Methods:Data of patients with malignant biliary obstruction who underwent endoscopic RFA at the Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine from January 2010 to June 2021 were retrospectively analyzed. There were 62 males and 48 females, with age (74.1±11.1) years. Based on occurrence of postoperative complications, these patients were divided into the complication group ( n=18) and the control group ( n=92). Univariate and multivariate logistic regression analysis were used to analysis the influencing factors of complications. Results:RFA was successfully performed in 110 patients with malignant biliary obstruction, and the technical success rate was 100.0% (110/110). Postoperative complications occurred in 18 patients (16.4%), including 12 patients with of biliary tract infection (8 patients with acute cholangitis, 4 patients with acute cholecystitis) and 6 patients with acute pancreatitis. All these patients responded well to treatment. The proportion of patients who developed complications having associated diabetes, bile duct stenosis length >2.5 cm, fractional RFA for bile duct stenosis, and single stent drainage were significantly higher than those in the control group (all P<0.05). Multivariate logistic regression analysis showed that the risk of complications after endoscopic RFA was significantly increased in patients with diabetes ( OR=6.967, 95% CI: 1.256-38.658) and fractional RFA of bile duct stenosis ( OR=8.297, 95% CI: 1.526-45.122), while the risk of complications after multiple stents drainage ( OR=0.037, 95% CI: 0.008-0.169) was significantly decreased (all P<0.05). Conclusion:Diabetes and fractional RFA of bile duct stenosis were risk factors for complications after endoscopic RFA of malignant biliary obstruction. Multiple stents drainage was a protective factor. Better clinical attention should be paid to the patients with high risk factors.

Objective:To evaluate the efficacy and safety of endoscopic papillectomy (EP) combined with endobiliary radio frequency ablation (RFA) for duodenal papilla tumor with intraductal biliary infiltration.Methods:Data of 12 patients with histologically confirmed duodenal papilla tumor combined with intraductal biliary infiltration treated by EP with RFA from February 2013 to February 2019 were retrospectively analyzed. Clinical characteristics,endoscopic features, treatment efficacy and postoperative complications of patients were reviewed and recurrence was followed up.Results:The median diameter of lesions measured by endoscopic ultrasound was 18.5 mm×15.5 mm, and the length of intrabiliary invasion was 14.1±5.8 mm. EP combined with RFA was successfully performed in all patients with a technical success rate of 100%. Postoperative pathology showed adenocarcinoma in 5 patients, adenoma with high-grade intraepithelial neoplasia in 6 patients, and adenoma with low-grade intraepithelial neoplasia in 1 patient. Patients received mean 4.1±1.6 times of ERCP with intraductal biopsy during a mean follow-up period of 28.5±10.4 months. Recurrence occurred in 2 patients at 14 and 20 months respectively, both were adenocarcinoma.Conclusion:EP combined with RFA is effective and safe for duodenal papilla tumor with intraductal biliary infiltration. However, given the risk of recurrence, close surveillance is recommended.

Objective:To evaluate the efficacy and safety of lumen-apposing metal stent (LAMS) for the treatment of pancreatic walled-off necrosis (WON).Methods:A retrospective cohort study was performed on data of 43 consecutive patients with pancreatic WON who underwent endoscopic ultrasound-guided drainage by LAMS or plastic stents (PS) in Hangzhou First People's Hospital from December 2010 to June 2020. According to the type of stent used, the patients were divided into the LAMS group ( n=16) and the PS group ( n=27). The technical success rate, the clinical success rate, the operation time, the session of endoscopic necrosectomy, the stent insertion time and adverse events were compared between the two groups. Results:All 43 patients were successfully stented, indicating a technical success rate of 100% in both groups. For the LAMS group, the clinical success rate, the operation time, the session of endoscopic necrosectomy, the stent insertion time and overall incidence of adverse events were 75.0% (12/16), 26.0 (19.1, 39.8) min, 0.5 (0, 2.0) times, (41.3±28.4) days, and 43.7% (7/16), respectively, whereas these indices of the PS group were 37.0% (10/27) ( χ2=5.795, P=0.016), 31.0 (26.0, 48.0) min ( Z=1.221, P=0.222), 0 (0, 0) times ( Z=2.245, P=0.025), (176.1±99.1) days ( t=5.187, P<0.001) and 14.8% (4/27) ( χ2=8.893, P=0.064), respectively. Conclusion:LAMS placement is safe and effective for the treatment of pancreatic WON with a higher clinical success rate compared with PS. However, it requires more endoscopic intervention.

Objective:To evaluate the safety, efficacy and performance of disposable cholangiopancreatoscope in the diagnosis and treatment of bile duct diseases.Methods:A total of 20 subjects were selected and 16 subjects were enrolled in the prospective and exploratory clinical study which were performed in the Digestive Endoscope Center of Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine from July 2021 to August 2021. The disposable cholangiopancreatoscope was used to diagnose bile duct diseases in routine endoscopic retrograde cholangiopancreatography. Biopsies were performed in cases where malignancy was considered. The use related indexes and performance indexes of the instruments were analyzed.Results:Among the 16 patients, there were 6 cases of biliary space-occupying lesions, 6 cases of biliary calculi, and 4 cases of benign biliary stricture before operation. The success rate of the disposable insertion was 100.00% (16/16), and the success rate of observation was 100.00% (16/16). Three biliary space-occupying lesions diagnosed as malignant tumor under cholangiopancreatoscope were confirmed by pathology after operation. Diagnosis of other patients was consistent with preoperative diagnose, so no biopsy was conducted. The rate of positive feedback from operators in directional control was 81.25% (13/16), the image failure rate was 18.75% (3/16), and the rate of positive feedback for image clarity was 93.75% (15/16). In terms of clinical performance, the imaging quality of excellence was 93.75% (15/16), the flexible degree of excellence was 81.25% (13/16), and other indexes were all 100.00% excellence. During the period, there were no instrument defects, pancreatitis, perforation, bleeding or other instrument-related adverse events.Conclusion:The effectiveness, safety and performance indexes of domestic disposable cholangiopancreatoscope have reached the standards of clinical application with high pixel, integration, and portability. It's worthy of clinical recommendation.

To evaluate the clinical efficacy and safety of Hot AXIOS, a novel luminal metal stent with a cautery system guided by endoscopic ultrasound, for the treatment of infected pancreatic necrosis (IPN), 5 cases of IPN treated with endoscopic ultrasound-guided Hot AXIOS placement in Hangzhou First People's Hospital from December 2021 to January 2022 were retrospectively analyzed. The results showed that all 5 cases successfully completed the treatment, with 8-21 minutes of the operation time. The symptoms of abdominal pain and bloating on the first day after operation were significantly relieved, and the abdominal CT showed that the walled-off necrosis was significantly reduced. After 2-9 times of direct endoscopic necrosectomy, supplemented by antibiotics, patient's temperature and blood inflammatory indexes returned to normal, the cavity was reduced and necrosis was removed. The Hot AXIOS stent was indwelled for 12-40 days and then removed. After 25-113 days of the follow-up, all patients survived without recurrence. Preliminary results suggest that endoscopic ultrasound-guided Hot AXIOS placement is safe and effective for the treatment of IPN.

Objective:To evaluate the diagnostic performance of probe-based confocal laser endomicroscopy (pCLE) for indeterminate biliary strictures.Methods:Twelve patients with indeterminate biliary strictures who underwent pCLE and brush cytology from April 1, 2013 to December 30, 2016 were enrolled. Clinical data, the results of endoscopic retrograde cholangiopancreatography, pCLE examination and brush cytology were collected. Compared with post-operative pathology and follow-up over 12 months, sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), and accuracy of pCLE and brush cytology of the diagnosis of malignant biliary strictures were analyzed.Results:The final diagnosis were 9 malignant and 3 benign. The sensitivity, specificity, PPV, NPV and accuracy of brush cytology were 3/9, 3/3, 3/3, 3/9 and 50.0%(6/12), respectively. The corresponding indicators of pCLE were 9/9, 2/3, 9/10, 2/2, and 91.7%(11/12), respectively.Conclusion:pCLE can be used for differential diagnosis of indeterminate biliary stricture.