ObjectiveTo investigate the efficacy and safety of the self-expandable metal stent for treatment of gastric outlet and duodenal obstruction.MethodsData of 24 patients with symptomatic gastric outlet and duodenal obstruction diagnosed from January 2005 to February 2011 were retrospectively studied.All patients were measured by gastric outlet obstruction scoring system ( GOOSS ) before and one week after the placement of self-expandable metal stent.ResultsStent placement was succeeded in all patients with a mean operation time of 25.90 ± 11.03 min.Twenty patients (83.3％) were able to intake liquid food after the procedure.The GOOSS (P50 =0) before and after stent placement were 0.14 (P50 =0) and 1.42( P50 =2),respectively,with significant difference (P ＜0.01 ).Minor digestive bleeding occurred in 3 patients,but no severe complications including perforation or aspiration were observed.ConclusionPlacement of a self-expandable metal stent in patients with gastric outlet or duodenal obstruction is safe and effective for resolving obstructive symptoms.

Objective To explore the safety and efficacy of endoscopic retrograde cholangiopancreatography(ERCP)by using carbon dioxide for malignant biliary obstruction.Methods A total of 60 patients with malignant biliary obstruction, hospitalized from September 2008 to February 2010, were randomly divided into 3 groups to receive ERCP by using carbon dioxide, contrast agent or magnetic resonance cholangiopancreatography(MRCP)without any agent.The safety and efficacy of 3 contrast methods were compared.Results Successful stent or drainage tube insertion was achieved in all patients.Carbon dioxide was superior to contrast agent in terms of lowering postoperative infection rate(P ＜ 0.05), and it was also superior to MRCP for more effective drainage(P ＜ 0.05).There was no significant difference in occurrence of postoperative pancreatitis and hyperamylasemia between 3 groups.Conclusion Using carbon dioxide during ERCP, safe and effective, is superior to use of contrast agent in less leukocyte increase, and to MRCP in more adequate drainage in patients with malignant biliary obstruction.Furthermore, there is no more risk of pancreatitis and hyperamylasemia.

Objective To study the independent risk factors of early rebleeding after endoscopic variceal ligation (EVL) and/or endoscopic injection of fibrin tissue adhesive.Methods Data of 370 patients who had cirrhosis and accepted 396 procedures of EVL and/or endoscopic injection of fibrin tissue adhesive were retrospectively studied.Independent risk factors for early rebleeding were determined by Logistic regression analysis.Results Results of all the factors that were significantly different between the re-bleeding and non-rebleeding patients,the portal vein diameter,ascites volume,Child-Pugh score and serum albumin were independent ones of early rebleeding after EVL and/or endoscopic injection of fibrin tissue adhesive ( P ＜ 0.05).Larger volume of ascites,wider portal vein diameter,reduced albumin,Child-Pugh score greater than 10 were indicative factors of rebleeding.Conclusion The early rebleeding rate after EVL and/or endoscopic injection of fibrin tissue adhesive is determined by portal vein diameter,ascites volume,ChildPugh score,and serum albumin.

Objective To evaluate the clinical utility of SpyGlass single-operator ERCP-guided cholangiopancreatoscopy system for the diagnosis and treatment of bile duct disorders.Methods A total of 9 patients with biliary diseases were treated with SpyGlass single-operator ERCP-guided cholangiopancreatoscopy system.Four patients with large bile duct stones accepted laser lithotripsy,and stones were removed by ERCP.Five patients with indeterminate bile duct stricture accepted cholangioscopy-guided sampling.All patients underwent ENBD,routine blood test,blood amylase test,oral food and water restriction,acid suppression and prophylactic antibiotics.Results SpyGlass was successful in all patients with a manipulating time of 21.2min and total procedure time of 46.2min.Complete stone clearance was achieved in all 4 patients with large biliary stones.Sample quality was adequate in all patients with bile duct stricture with 2 patients diagnosed as having malignant biliary tumor and 3 as inflammatory bile duct stenosis.Post-ERCP complications including mild pancreatitis in 2 patients,and the patients recovered gradually after corresponding treatment.Conclusion ERCP-guided cholangiopancreatoscopy with the SpyGlass system is technically feasible and can be successfully and safely performed in patients with biliary disorders.

Objective To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for pancreaticobiliary diseases in children. Methods Data of 9 patients younger than 14 years who underwent ERCP at between November 2004 and May 2010 were indentified through a computer database search. Therapeutic methods, success rate and procedure-related complications were evaluated.Results A total of 9 patients underwent 17 ERCP procedures under anesthesia, including 16 therapeutic and 1 diagnostic procedure. The success rate was 94. 1% (16/17) and the complication rate was 11.8%(2/17), including 1 mild pancreatitis and 1 peri-pancreatic infection. Conclusion ERCP is an important tool with high safety and efficacy for diagnosis and treatment of pancreaticobiliary diseases in children.

Objective To evaluate the safety and efficacy of the endoscopic resection of large nonampullary duodenal adenomas.Methods Twenty cases with large nonampullary duodenal adenomas(≥ 1.0 cm) were referred for EMR.After submucosal injection of the mixture of glycerin fructose solution and methylene blue,either en bloc or piecemeal snare polypectomy was performed.All resected specimens were retrieved for pathologic study.Follow-up gastroscopy was performed in patients after EMR.Results Among 20 lesions,six were found located in the 1st part(30％),13 were in the 2nd part(65％),and one in the 3rd part(5％)of the duodenum.The mean diameter of the lesions was 1.9 ± 1.1 cm.Endoscopic ultrasonography (EUS) was performed in 12 patients,and all lesions were originated from the mucosa.EMR was performed successfully in 20 patients.The en bloc resection rate was 75％ (15/20),and the mean time for EMR was 33.8 ± 16.7 min.The perioperative complication rate was 20％ (4/20).Bleeding occurred within 24 hours after EMR in 4 cases.There were no perforations.The complete resection rate was 100％.Of these 20 adenomas,14 adenomas were tubulous and 6 was tubulovillous.During the follow-up period (2-39 months),1 patient showed recurrence within 6 months after EMR.Conclusion Endoscopic resection of large nonampullary duodenal adenomas is safe and effective treatment.

Objectiye To evaluate the therapeutic efficacy and safety of (endoscopic sphincterotomy, EST) plus balloon dilation for difficult bile duct stones. Methods Patients with difficult common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP) from March 2008 to December 2009 were randomly divided into 2 groups to receive EST or EST plus balloon dilation ( EST + EPBD), respectively. The success rate of complete stone removal, number of endoscopic sessions, the rate of using mechanical lithotripsy and the complication rate related to the procedure were compared between the 2 groups. Results Compared with EST alone, EST plus balloon dilation resulted in similar outcomes in terms of overall successful stone removal rate (2/62 vs. 2/61 ) and early complication rate (4/62 vs. 6/61, P ＞0. 05). However,EST group needed more sessions ( EST 15/46 vs. EST + EPBD 5/57, P ＜0. 05) and use of mechanical lithotripsy to achieve complete removal of stones ( EST 12/61 vs. EST + EPBD 4/61, P ＜0. 05 ). Conclusion EST plus balloon dilation is as safe and effective as, but more convenient than EST, for endoscopic removal of common bile duct stones.

Objective To compare therapeutic efficacy and safety of covered and uncovered self-expandable metal stents for malignant biliary obstruction.Methods From October 2010 to August 2012,patients with unresectable malignant biliary obstruction were recruited and divided into 2 groups to receive covered metal stents (group A) or uncovered metal stents (group B).Efficacy and complication of the procedure were compared.Results A total of 81 patients were recruited,with 41 in group A and 40 in group B.Stents were placed successfully in all patients.The median patency time of stent in group A was 182.5 d,which was not significantly different from that of group B (195.0 d,P =0.616).Complications occurred in 3 patients of group A (7.3％) and 4 of group B (10％).Conclusion Covered and uncovered metal stents are both safe and effective for treatment of malignant biliary obstruction with same patency time.

Objective To investigate the effect of small interfering RNA (siRNA) mediated silencing of △Np73 on 5-FU chemotherapy sensitivity in SW620 colocancer cells and provide new treatment approach for the colon cancer.Methods siRNAs were transfected into SW620 colon cancer cells.The expression of △Np73 was observed.Cell viability of colon cancer cells were measured by MTr assay and cell apoptosis was assessed with flow cytometry after treatment of control siRNA or △Np73 siRNA or combined with 5-FU,respectively.The tumorigenesis was assessed by injecting △Np73 siRNA or control siRNA transfeeted SW620 colon cancer cells into nude mice,followed by treatment with 5-FU in the tumors.Results △Np73 siRNA was able to strongly inhibit △Np73 expression,however,it did not inhibit the growth of cells.Combination treatment with △Np73 siRNA and 5-FU produced significant higher apoptotic cell(42.9%) as compared with those with 5-FU treatment(18.9%) alone or those with △Np73 siRNA(8.8%) alone.The treatment with 5-FU in the xenngrafts derived from △Np73 siRNA transfected SW620 cells in nude mice can inhibitor tumor growth significantly (t=15.32,P<0.05).Conclusion △Np73siRNAs can specifically repress the expression of △Np73.Thus it sensitizess the cells to 5-FU chemotherapy in colon cancer.

Objective To evaluate a method named “one-step procedure”,i.e.,combined duode-noscopy,laparoscopy and choledochoscopy for choledocholithiasis accompanied with cholecystolithiasis.Meth-ods Fifty-three cases with gallbladder stones combined with common bile duct stones diagnosed from February 2012 to February 2014 were assigned to two groups,29 cases in “one-step procedure”group,who underwent duodenoscopy,laparoscopy and choledochoscopy in one operation,and 24 cases in the control group,who first-ly underwent endoscopic sphincterotomy to remove common bile duct stones,and then LC was performed after several days.The rate of complications related to the procedure,success rate of complete stone removal,length of hospital stay and hospitalization expenses were compared between the two groups.Results All 53 patients underwent the surgery and ERCP procedure successfully.There were no significant differences between the“one-step procedure”group and the control group in complication rates[3.4%(1 /29)VS 12.5%(3 /24),P =0.21],complete stone removal rates[96.6%(28 /29)VS 100.0%(24/24),P =0.37].Differences were sig-nificant in length of hospital stay (6.7 ±1.3d VS 10.9 ±1.6d,P <0.01 )and hospitalization expenses (15 724 ±1 613 yuan VS 19 829 ±2 433 yuan,P <0.05)between the “one-step procedure”group and the control group.Conclusion The “one-step procedure”,the combined duodenoscopy,laparoscopy and chole-dochoscopy,is safe,effective,and has smaller length of hospital stay and lower hospitalization expenses.