Objective To evaluate the feasibility and clinical value of endoscopic decompression with metal stent and colorectal tube for acute malignant colorectal obstruction. Methods With the aid of fluoroscopy, 26 cases with acute malignant colorectal obstruction were treated. Their obstructive sites consisted of rectum(n=14), sigmoid colon(n=8), descending colon(n=2) and transverse colon(n=1). Results In 18 of 26 patients, metal stents were successfully inserted (18/20, 90%), in 6 cases colorectal tube were successfully inserted(6/6, 100%), the total technical success rate was 92. 3% (24/26). Thereafter, 1 patient has no effect, 23 patients showed relief of obstructive symptoms within 1-2 days, the clinical success rate was 88.5% (23/26). Permanent metal stent placements were performed in 13 cases for palliative treatment, 10 underwent subsequent elective surgical resection after 7 ~ 10 days, without complications, such as anastomotic leakage and intraperitoneal infection. One case was failed in recurrent rectal carcinoma after resection, one case with widespread metastatic sigmoid colon carcinoma occurred colon perforation and received immediate Hartmann operation. Recurrent obstruction was detected in one patient with distal stent migration within 6 weeks, and second stent were placed to solve the problems. Stent occlusion from stool impaction was found in one patient 1 month after stent insertion, and was solved by endoscpic interventions. Conclusion Endoscopic decompression with metal stent and colorectal tube can alleviate the acute malignant colorectal obstructive sympotoms with high success rate. It is a simple, safe, effective and well tolerated method, and can obviate colostomy, prominently reduce trauma and agony, and increase the living quality of patients.

Objective To evaluate the clinical value of endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) for treatment of esophageal mucosal lesion with diameter larger than 15 mm.Methods The data of 261 patients with esophageal mucosal lesions ≥15 mm and undergoing ESD (n=198) or EPMR (n=63) in Endoscopy Center of Zhongshan Hospital from September 2009 to August 2011 were retrospectively analyzed.Therapeutic effect, complications, and local recurrence were compared between the two groups.Results The lesion size was significantly larger in the ESD group than that in the EPMR group (3.02±1.13 mm VS 2.66±0.95 mm, P<0.05).The rates of en bloc resection, complete resection, and curative resection were 100% (198/198), 96% (190/198), and 94% (187/198), respectively in the ESD group.Only samples with horizontal margin obtained the pathological assessment in the EPMR group, and 2 cases were positive.The incidence of short-term complications including massive bleeding and perforation was no statistically different (P>0.05) between the two groups.The rate of postoperative esophageal stricture was higher in the EPMR group than that of the ESD group [22.6% (14/62) VS 6.2% (12/194),P<0.05] except for 5 cases with further surgery treatment (4 cases in the ESD group and 1 case in the EPMR group).The local recurrence rate was also higher in the EPMR group than that of the ESD group [11.5% (7/61) VS 3.7% (7/190), P<0.05], except for 10 cases with positive margin.Conclusion The therapeutic effect of ESD is superior to that of EPMR for esophageal mucosal lesions with diameter larger than 15 mm due to lower rate of local recurrence and acceptable complications.

Objective To explore effect comparison between high flux hemodialysis and conventional hemodialysis therapy on acute exacerbation chronic obstructive pulmonary diseases (AECOPD) patients with renal insufficiency.Methods Clinical data of 51 AECOPD combined renal insufficiency (BUN≥20 mmol/L,CREA≥400 μmol/L) cases admitted in ouRhospital and Guiyang First People′s Hospital from 2010 to 2015 were retrospectively analyzed.And were randomly divided into high flux hemodialysis (HFHD) group with 25 cases and conventional hemodialysis (CHD) group with 26 cases according to different dialysis method and dialysis,and the two groups before treatment all used the same internal medicine comprehensive treatment.Blood leukocyte count,neutrophil percentage,blood gas index[pH、SaO2、p(O2)],c-reactive protein (CRP) and interleukin-1 (IL-1),interleukin-6 (IL-6) and renal function (BUN and CREA) before and afteRtreatment were detected,and the difference of the above indexes before and afteRtreatment in both groups were compared.Results Leukocyte count,neutrophil percentage,CRP,IL-1,IL-6,BUN and CREA in two groups afteRtreatment were significantly decreased than treatment before (P<0.01),but HPHD group decreased more than CHD group (P<0.05).Blood and gas index in HPHD group and CHD group afteRtreatment fell,but there was no significant difference (P<0.05).Conclusion High flux hemodialysis (HPHD) has superioRcurative effect in the treatment of AECOPD and in removing inflammatory mediators,infection control,improving renal function,so it is worthy of clinical application.

Objective To explore effect comparison between high flux hemodialysis and conventional hemodialysis therapy on acute exacerbation chronic obstructive pulmonary diseases (AECOPD) patients with renal insufficiency.Methods Clinical data of 51 AECOPD combined renal insufficiency (BUN≥20 mmol/L,CREA≥400 μmol/L) cases admitted in ouRhospital and Guiyang First People′s Hospital from 2010 to 2015 were retrospectively analyzed.And were randomly divided into high flux hemodialysis (HFHD) group with 25 cases and conventional hemodialysis (CHD) group with 26 cases according to different dialysis method and dialysis,and the two groups before treatment all used the same internal medicine comprehensive treatment.Blood leukocyte count,neutrophil percentage,blood gas index[pH、SaO2、p(O2)],c-reactive protein (CRP) and interleukin-1 (IL-1),interleukin-6 (IL-6) and renal function (BUN and CREA) before and afteRtreatment were detected,and the difference of the above indexes before and afteRtreatment in both groups were compared.Results Leukocyte count,neutrophil percentage,CRP,IL-1,IL-6,BUN and CREA in two groups afteRtreatment were significantly decreased than treatment before (P<0.01),but HPHD group decreased more than CHD group (P<0.05).Blood and gas index in HPHD group and CHD group afteRtreatment fell,but there was no significant difference (P<0.05).Conclusion High flux hemodialysis (HPHD) has superioRcurative effect in the treatment of AECOPD and in removing inflammatory mediators,infection control,improving renal function,so it is worthy of clinical application.

Objective:To investigate the safety and efficacy of knife assisted polypectomy (KAP) in the treatment of colorectal pedicle polyps (Paris type 0-Ⅰp).Methods:A retrospective analysis was conducted on the data of 42 patients with colorectal pedicle polyps who were treated with KAP at Endoscopy Center of Zhongshan Hospital of Fudan University and Xuhui District Central Hospital from May to September 2019. Procedure time and complication rates were used to assess the effects of KAP.Results:A total of 48 polyps were found in 42 cases. The median diameter of polyps was 2.0 cm(0.8-3.5 cm). The mean operating time was 11.3±1.1 min. All patients had no severe bleeding or perforation during operation and no delayed bleeding, delayed perforation or electrocoagulation syndrome after operation. Postoperative pathology showed that the margins of all cases were negative.Conclusion:KAP operation is safe and efficient, but long-term efficacy still needs further clinical verification.

Objective:To investigate the efficacy and side effects of amnion stent implanted in lacrimal duct for the lacrimal duct obstruction diseases (LDOD).Methods:A randomized controlled clinical trial was adopted.Seventy-two eyes of 72 patients with LDOD treated in Jiangxi Provincial People's Hospital from June 2014 to January 2015 was randomized into the experiment group and the control group with amnion stent or silicone tube retrogradely implanted according to grouping in accordance with block randomization with 36 eyes in each group.All patients were performed irrigation of lacrimal passage at 3 and 6 months postoperatively to compare the patency rate of lacrimal duct and side effects between the two groups.This study followed the Declaration of Helsinki.Written informed consent was obtained from each subject prior to entering the study cohort.The study protocol was approved by the Ethics Committee of Jiangxi Provincial People's Hospital (No.2014-002).Results:The patency rate of lacrimal duct was 91.7%(33/36) and 80.6%(29/36) at 3 months postoperatively in the experimental and control group, respectively.Although the difference was obvious, there was no statistical significance ( P=0.307). The patency rate of lacrimal duct was 88.9%(32/36) and 75.0%(27/36) at 6 months postoperatively in the experimental and control groups, respectively.Similarly, the difference was obvious, however there was no statistical significance ( P=0.220). At 3 months and 6 months postoperatively, the incidence of epiphora in the experimental group was lower than that in the control group, it was significantly different ( Z=2.729, P=0.006), and there was no significant difference at 6 months postoperatively ( Z=1.921, P=0.055). At 6 months follow-up period, the attack rate of side effects, such as dacryon congestion and exudation, was 2.8%(1/36) and 13.9%(5/36) in the experiment and control groups, respectively, however, the difference was no statistical significance ( P=0.199). Conclusions:The implantation of amnion stent in lacrimal duct for LDOD is effective, and the patency rate of lacrimal duct is not lower than that of the implantation of silicone tube in the lacrimal duct.

Objective To compare the efficacy of endoscopic sphincterotomy ( EST) combined with large-balloon dilation ( LBD) and that of LBD alone for large bile duct stones. Methods Data of 61 patients who received EST combined with LBD ( the combination group ) and 48 patients who received LBD alone ( the LBD group) from February 2008 to November 2014 were collected. The efficacy and adverse events of two groups were compared. Results The procedure time from successful cannulating to complete stone removal was shorter in the LBD group than that in the combination group [ 17. 3 min ( 8-35 min ) VS 21. 5 min ( 10-42 min) , P=0. 041] . There were no significant differences in overall complete stone removal rate[90. 2％ (55/61) VS 91. 7％ (44/48), P=1. 000] and complete stone removal rate without mechanical lithotripsy[78. 7％ (48/61) VS 83. 3％ (40/48), P=0. 542] in the combination group and the LBD group. Massive bleeding occurred in one patient of the combination group, but was successfully coagulated under endoscopy. There was no significant difference in the incidence of postoperative pancreatitis between the two groups[4. 9％ (3/61) VS 6. 3％ (3/48), P=1. 000]. Conclusion EST combined with LBD offers no significant advantage over LBD alone for the removal of large bile duct stones. LBD can simplify the procedure compared with EST combined with LBD in terms of shortening the procedure time.

Objective:To investigate the short-term clinical efficacy of laparo-gastroscopic esophagectomy (LGE).Methods:The retrospective and descriptive study was conducted. The clini-copathological data of 11 patients with esophageal cancer who underwent LGE in the Zhongshan Hospital of Fudan University from June 2020 to October 2021 were collected. There were 8 males and 3 females, aged (68±4)years. Sorted by operation time, the sentinel lymph nodes navigation (SLN) was performed since the sixth patient in the cohort, and abdominal surgery and neck surgery were performed simultaneously to complete LGE. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination or telephone interview to detect death of patients during postoperative 30 days. Patients were followed up during postoperative 30 days. Measurement data with normal distribution were represented as Mean± SD, and count data were described as absolute numbers. Results:(1) Surgical situations. Of the 11 patients, 5 cases received SLN with satisfactory visualization, 6 cases did not receive SLN, 1 case terminated the operation as sentinel lymph nodes biopsy showing positive results and the rest of 10 cases completed LGE successfully without conversion to thoracotomy. The operation time and tumor diameter of the 10 patients completing LGE was (204±27)minutes and (2.5±1.0)cm, respec-tively. (2) Postoperative situations. Of the 10 patients completing LGE, 2 cases had pulmonary complications after surgery and recovered well with symptomatic treatment, and none of patient had anastomotic leakage or other serious complication. Results of postoperative histopathological examination showed squamous cell carcinoma in the 10 patients completing LGE. Nine patients were classified as T1b?3N0M0 stage and 1 patient was classified as T1bN1M0 stage. Ten patients completing LGE had R 0 resection and the number of lymph nodes dissected was 14±4. There were 3 cases with nerve bundle invasion, 2 cases with vascular invasion and 5 cases without nerve bundle and vascular invasion. The postoperative treatment time at intensive care unit and duration of hospital stay of the 10 patients completing LGE were (4.0±2.4)days and (7.2±1.5)days. (3) Follow-up. The 10 patients completing LGE were followed up and none of them died during the postoperative 30 days. Conclusions:LGE is safe and feasible. Combined with SLN can guarantee the oncology effect of surgery.

Objective To evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for superficial hypopharyngeal neoplasm. Methods Clinicopathological data of 9 patients, who received ESD for superficial hypopharyngeal neoplasm in Zhongshan Hospital affiliated to Fudan University from September 2015 to March 2018,were retrospectively analyzed. Results Nine patients including 7 males and 2 females with mean age of 61. 2 years (48-80 years) were included. The mean diameter of lesions was 16. 3 mm (5-27 mm),and the mean operation time was 52. 2 min(30-90 min). No bleeding, perforation, emphysema or dyspnea during or after ESD occurred. The mean length of hospitalization was 4. 6 days ( 3-7 days). Pathology indicated 1 high grade intraepithelial neoplasia and 8 squamous cell cancer, and all cases of squamous cell cancer were constrained within lamina propria. One patient had positive horizontal margin and received radiotherapy. No recurrence, metastasis or stenosis was found during 10. 2 months (3-29 months)of follow-up. Conclusion ESD is a safe and effective option for superficial hypopharyngeal neoplasm.

Objective:To review publications in the field of digestive endoscopic minimally-invasive resection in the past 10 years in and outside China.Methods:Literature of digestive endoscopic minimally-invasive resection in the Web of Science and CNKI databases from January 1, 2011 to July 17, 2021 was retrieved. VOSviewer 1.6.11 was used for clustering and time series analysis of countries, institutions, authors and keywords, and drawing evidence-based visualization maps, so as to analyze the cooperation among countries, academic institutions and researchers, to compare the differences in research topics between Chinese and English databases, and to predict the future research hot spots and directions.Results:A total of 22 834 English articles and 4 636 Chinese articles were included. Over the past 10 years, the number of Chinese and English publications has been growing steadily, and most of them were published in professional journals. The publications were mainly from China, Japan, South Korea and the United States, where all exceeded 2 000. The National Cancer Center of Japan had 497 publications, ranking the first among all institutions. The cooperation between academic institutions showed obvious regional characteristics, and the inter-institutional and interpersonal cooperation needed improvement. In terms of keyword clustering, there was no significant difference between Chinese and English publications, but there were two additional clusters in Chinese publications, endoscopic nursing and submucosal tumor. Overlays analysis of key words showed that endoscopic surgery, tunneling technique, and submucosal tumor could be hot spots and future directions.Conclusion:Digestive endoscopic minimally-invasive resection has experienced a vigorous development in the past 10 years with a growing number of Chinese and English publications. China is playing an increasingly important role on the international stage. The advanced nature of research focus in Chinese publications is comparable to that in English publications, yet also showing Chinese characteristics. In the future, more efforts should be taken to strengthen regional cooperation and focus on research hot spots.