Objective Finding characteristic of senile colon diverticula in 70 cases senile colon diverticula diagnosed by colonoscope through comparing and summarizing. Methods From Jan 1997 to Dec 2001, 70 cases older than 60 years old senile colon diverticula diagnosed by colonoscope in endoscopy department of PLA general hospital. Male 54 cases ,female 16 cases .Age from 60 to 84 years old, average age 68.70?5.39. Results ①With age increased, detectable rate of colon diverticula and multiple colon diverticula rised; ②Detectable rate in male higher than female; ③Whether the single or multiple diverticula ,all predilection site is in the right colon, rate of the right to the left is 2.8∶1(42∶15), and the single diverticula is more obvious. Conclusions ①Occurrence of diverticula have relation to age; ②Incidence in the right colon of senile is lower than of young people; ③The left colon diverticula and bilateral colon diverticula in senile is higher than in young people.

Objective To evaluate the feasibility and safety of trans-umbilical NOTES to perform abdominal adhesion lysis using a flexible endoscope.Methods A 42-year-old female was admitted to our hospital with a complain of abdominal pain due to abdominal adhesion after hysterectomy.A gastroscope (GIF-2TQ260M,Olympus)was inserted into the peritoneal cavity through an incision(1.5 cm)of the umbilical opening.Pneumoperitoneum was established by the endoscopic air supply system using CO2 instead of air.Abdominal exploration showed that omentum and bowel were stuck to the scar of the low central peritoneum incision.Separation of the abdominal wall adhesions was performed with an IT knife and a hook knife respectively.After most of the adhesions were separated,bleeding was found from the isolated adhesion wound of the omentum and bowel.Hemorrhaged blood vessel was difficult to be found with the flexible gastroscope.Then a 5 mm Trocar was placed at the left lower abdomen and laparoscopic assistance was adopted to search the bleeding point.However,no bleeding site was found and the hemorrhage was stopped automatically.Residual adhesion lysis was conducted with laparoscopic assist.After the procedure,the umbilical incision was closed with absorbable suture,but lower left abdominal incision was left without suturing.Results The operation time was 40 minutes.The patient suffered from minus pain from the umbilical incision without need of treatment.She had normal diet and got out of bed after reconsious.She was discharged 2 days after the procedure without any complaints.Conclusion Trans-umbilical NOTES using a flexible endoscope for peritoneal adhesion lysis is safe and feasible,but the effectiveness remains to be further confirmed.

Objective To explore the manipulation,feasibility and safety of laparoscopy assisted natural orifice translumenal endoscopic surgery(NOTES).Methods The technique was performed in 4 female porcine models.Diagnostic laparoscopy was performed first,and followed by transgastric access through the anterior gastric wall under the monitor of laparoscopy.The stoma was extended with the dilation ballon and the endoscope was sent to the abodominal cavity.Such procedures as endoscopic peritoneoseopy,fallopian tube ligation,oophorectomy,eholeeysteetomy and closure of gastrostomy were performed.The drainage tube and antibiotics of 3 days were used after operation according to the bleeding and potential risk of fistula and peritonitis.The animals were feeded on a semiliquid diet.Two weeks later,routine gastroseopy was pedbrmed to examine the healing of luminal incision.Subsequently,all models were sacrificed for the evaluation of the validity of NOTES.Results With the assistance of the laparoscope,endoscopic peritoneoseopy and,fallopian tube ligation,oophorectomy and cholecystectomy,twice for each,were successfully performed in all models.Abdominal drainage were used in two animals'after eholecystectomy.All porcines survived for 2 weeks postoperatively with no weight loss.Autopsic examination showed good healing of transgastric incisions,with little adhesion,no massive heinan'hage,abcesses,or injury to adjacent organs.Conclusion Combined laparoscopy and endoscopy for NOTES is feasible with relative safety.Laparoscopic assistance could facilitate the NOTES procedures at the present stage.

Objective To determine the incidence and clinical factors associated with bleeding after endoscopic submucosal dissection (ESD) of gastric mucosal lesions.Methods Clinical,endoscopic and pathological data of 223 lesions in 215 ESD patients between January 2009 and October 2011 were collected.The following factors associated with bleeding were analyzed:( 1 ) patient-related factors:sex,age,concomitant diseases including hypertension and diabetes mellitus,history of administration of anticoagulants or antiplatelet agents; (2) lesion-related factors:size,location,ulcer or scar findings,macroscopic types and pathological types; (3) procedure-related factors:en-bloc resection,spray of porcine fibrin sealant and operation time. Results Thirteen patients (13 lesions ) developed bleeding after ESD,among whom 7(53.8％) occurred within 24 hours after the procedure,5 (38.5％) within 1 week and 1 (7.7％) on the sixteenth day after ESD.Univariate and multivariate analysis revealed that lesion size ( ≥5 cm; odds ratio 8.663 ; 95％ CI:2.081 - 36.075) was an independent risk factor for bleeding.Conclusion Lesion size is the independent risk factor for bleeding after ESD,so careful preparation and close monitoring are required during and after ESD.In the meantime efforts should be made to identify and exactly demarcate lesions to minimize the size of resected specimens and reduce the risk of bleeding after ESD.

ObjectiveTo evaluate preoperative biopsy in the treatment of gastric mucosal lesions by endoscopic submucosal dissection (ESD).MethodsClinical data of 195 patients diagnosed as having gastric intraepithelial neoplasia (GIEN) or early cancer by preoperative biopsy were retrospectively analyzed.The discrepancy between endoscopic biopsies and pathological diagnosis after ESD were studied.ResultsThe overall consistency rate between preoperative biopsies and postoperative pathological diagnosis was 93.8％ (183/195) and complete consistency rate was 50.8％ (99/195).For low-grade and highgrade gastric intraepithelial neoplasia ( LGIEN),the complete consistency rates were 49.4％ (42/85)and 38.0％ (30/79),respectively,which were not different ( P ＞ 0.05 ).For early cancer it was 87.1％(27/31 ),which was significantly higher than those in the LGIEN group and HGIEN group ( P ＜ 0.05 ).Post-ESD diagnosis was more severe than biopsy in 66 patients (33.8％,66/195 ),including 36 LGIEN (42.4％,36/85) and 30 HGIEN (38.0％,30/79).Final pathological diagnosis was milder than biopsy in 18 patients (9.2％,18/195),i.e.14 HGIEN (17.7％,14/79) and 4 early cancer (12.9％,4/31).Gastritis was diagnosed in 12 patients (6.2％,12/195),i.e.7 LGIEN (8.2％,7/85) and 5 HGIEN (6.3％,5/79).ConclusionPreoperative biopsy is insufficient for accurate diagnosis of gastric mucosal lesions,but facilitates resection of gastric mucosal lesions by ESD.

Objective To investigate the diagnostic potential of magnifying narrow-band imaging endoscopy (NBI-ME) for different intrapapillary capillary loop (IPCL) for the diagnosis of esophageal lesion.Methods Patients with abnormal esophageal mucosa found by white light gastroscopy in digestive endoscopy center,Chinese PLA General Hospital during the period of November 2009 to November 2010 were enrolled in this study.IPCL was observed and divided into different types by NBI-ME.Histopathology of biopsy or endoscopic submucosal dissection (ESD) specimens was evaluated and used as the gold standard to evaluate the diagnostic value of NBI-ME for IPCL.Results A total of 146 lesions from 145 subjects with esophageal mucosa abnormal were collected. Among them, 88 were pathology-proven inflammation,5 were pathology-proven esophageal cancers,20 were pathology-proven low intraepithelial neoplasia (LIN) and 33 were pathology-proven high intraepithelial neoplasia (HIN) detected with NBI-ME.By a per-lesion analysis,the accuracy of inflammation and cancer were 100％ (88/88) and 7/7.For the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio of LIN and HIN were 7/10,69.8％ ( 30/43 ),69.8％ ( 37/53 ),35.0％ (7/20),90.9％ (30/33),12.5％ (70/559),2.3％ (30/1290) and 87.1％ (27/31),72.7％ ( 16/22),81.1％ ( 43/53 ),81.8％ ( 27/33 ),80.0％ ( 16/20 ),634.1％ ( 837/132 ) and 35.2％ ( 124/352 ),respectively.Conclusions NBI-ME can classify the different esophageal IPCL.Higher diagnostic accuracy of IPCL indicates the feasibility of NBI-ME for the efficacious diagnosis of esophageal inflammation and cancer.There is the higher diagnostic accuracy of HIN than LIN.

Objective To evaluate the technique of transpancreatic septum precut for cannulation of inaccessible common bile duct in endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of 109 patients with difficult biliary cannulation in ERCP, of whom 56 underwent transpancreatic septum precut and 53 had needle-knife sphincterotomy from January 2006 to July 2008, were analyzed retrospectively, and the success rate of cannulation and the occurrence of complications were compared between the two methods. Results Of 109 patients accepted precut papillotomy, common bile duct cannulation was successfully achieved in 97. The success rates of transpancreatic septum precut group and needle-knife sphincterotomy group were 96.4% (54/56) and 81.1% (43/53) respectively, which was significantly different (P<0.05). Complications occurred in 11 cases, including bleeding(n =4), acute pancreatitis(n=5), cholangitis(n=2). The tolal frequency of complications of the transpancreatic septum pre-cut papillotomy group was lower than that of needle-knife sphincterotomy group(3.6% vs. 17.0%, P<0.05). Conclusion In patients with inaccessible bile ducts, transpancreatic septum precut is a safe and effective procedure in cannulation, exhibiting a higher success rate and lower occurrence of complication when compared with needle-knife sphincterotomy.

Objective To investigate the incidence,location and morphological features of Laimer fibers between mucosal layer and inner circular muscularispropria in patients with achalasia.Methods Data of 107 patients with achalasia who underwent POEM between May 2010 and June 2013 were collected.Endoscopic video was reviewed to determine the incidence of Laimer fibers and the corresponding images were analyzed according to gender,age,Ling typing and location of Laimer fibers.Results Laimer fibers were found in lower esophageal sphincter of 44 patients (41.12％).There were no significant differences in the incidences of Laimer fiber among groups with different age or gender (P ＞ 0.05).The incidence in Ling type Ⅱb was 46.15％ (12/26),and 45.83％ (22/48) in Ling type Ⅰ,0 in Ling type Ⅲ.There was no significant difference among the groups of Ling type (x2 =2.042,P =0.564).All Laimer fibers were found in lower esophageal sphincter and the majority of which were in right wall (36.45 ％,39/107),followed by left wall (3.74％,4/107) and none was found in anterior wall (x2 =107.468,P =0.000).Conclusion Laimer fibers generally exists in lower esophageal sphincter and most of which are discovered on right wall of the esophagus.Further study is needed to explore its role in development and treatment of achalasia.

Objective To evaluate the curative effect of asymptotic full-thickness myotomy type of peroral endoscopic myotomy(POEM) for achalasia.Methods Data of 41 patients who underwent asymptotic POEM at our digestive endoscopy center from December 10th 2010 to January 10th 2014 were retrospectively studied.The postoperative and preoperative symptoms and reflux were compared.Results The postoperative Eckardt scores of symptoms of 41 patients improved significantly(P ＜ 0.001) compared with before.Esophageal dynamic pressure also showed the effectiveness of symptom relief.The incidence of postoperative reflux in symptoms and gastroscopy were 26.83％ and 27.27％,respectively.Conclusion Asymptotic fullthickness myotomy POEM can alleviate the symptoms of achalasia and the effect of inhibiting reflux is generally satisfactory.

ObjectiveTo investigate the procedure,effect and complication of endoscopic submucosal dissection (ESD) in the management of early gastrointestinal tumors and precancerous lesions.MethodsESD was performed in 28 patients with 29 lesions of early cancer and precancerous lesions in esophagus,stomach,colon and rectum.First we made marks around the lesion 3-5 mm away from the margin with a needle knife or APC,then injected solution into submucosa to elevate the lesion,and cut the mucosa and submucusa along the margin with a needle knife or IT knife.The submucosa was carefully dissected until the lesions were completely removed with IT knife.Bleeding was stopped with thermocoagulation forceps,argon plasma coagulation or clip.The samples were collected for pathological examination.All patients were followed up with endoscopy as scheduled.ResultsOf the 29 lesinas,22 were en bloc resected,6 were piecemeal resccted,and 1 was partial removed.The resection rate of antral lesion was 100% (12/12),and that of lesions between angulus and cardia was 5/7,that of esophageal lesions was 3/5 and that of colorectal ncoplasmns was 2/5.Delayed bleeding occured in 1 patient.The mean operation time for the antral lesions was 48 minutes.Twenty patients were followed up for 1 to 12 months.No residue or recurrence of the lesions was found.ConclusionThe major advantage of ESD is that the resection area can be determined by the size and shape of the lesion,and resection can be achieved en bloc even in a large neoplasm.