Objective To evaluate the efficacy and safety of endoscopic submucosal dissection for the treatment of colorectal large laterally spreading tumor. Methods ESD was applied to treat 150 cases of colorectal LST with diameter larger than 4 cm. The morphological features of LST, distribution, the clinicopathological data and the en-bloc resection rate, complete resection rate, complications were retrospectively evaluated. Results There were 87 patients with LST-granular lesions and 63 patients with LST-nongranular lesions. Colorectal LST mainly distributed in the rectum for 109 cases (72.7%), sigmoid colon for 13 cases (8.7%), descending colon for 5 cases (3.3%), transverse colon for 8 cases (5.3%), ascending colon for 13 cases (8.7%), cecum for 2 cases (1.3%). There were 23 patients with low-grade neoplasia, 104 patients with high-grade intraepithelial neoplasia, 7 with intramucosal carcinoma and 16 with submucosal carcinoma. The en-bloc resection rate and complete resection rate were 92.7% (139/150) and 89.3%(134/150). Adverse events were intra-operative bleeding in 12 patients (8.0%), postoperative bleeding in 2 patients (1.3%), perforation in 3 patients (2.0%), postoperative stenosis in 3 patients (2.0%). Conclusion Colorectal large LST-NG has higher potential for malignancy. ESD is a safe and effective method to provide en-bloc and complete resection of colorectal large LST.

Objective: To use the meta-analysis in evaluating the hemorrhage-prevention value of second-look endoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer. Methods: A literature search was conducted to identify all relevant studies comparing second-look endoscopy and non-second-look endoscopy after gastric ESD. The Medline/PubMed, Ovid, Elsevier ScienceDirect, EBSCO, CNKI and VIP databases were searched systematically. Literature inclusion criteria: (1) all the patients were diagnosed as early gastric cancer receiving ESD; (2) end point of the study included postoperative bleeding rate of ESD. Exclusion criteria: (1) papers of repeated research, review, comment, guideline, etc; (2) non-control study. Meta-analysis method was used to calculate a pooled odds ratio (OR) for developing post-ESD bleeding. Results: The meta-analysis showed that post-ESD bleeding was observed in 40 of 1287 patients (3.1%) without second-look endoscopy and in 40 of 968 patients (4.1%) with second- look endoscopy (OR=1.25, 95% CI: 0.79-1.98), with no significant difference between these two groups. Subgroup analysis on research method still indicated no significant difference of post-ESD bleeding between RCT group (OR=1.45,95%CI: 0.79-2.65) and non-RCT group (OR=1.02, 95%CI: 0.50-2.08) (all P>0.05). Conclusion Based on meta analysis, second-look endoscopy can not reduce the rate of postoperative bleeding of ESD. Therefore, routine second-look endoscopy after gastric ESD may not be necessary to prevent delayed postoperative bleeding of ESD.

OBJECTIVETo investigate the efficacy of tissue adhesive on intractable bleeding during endoscopic submucosal dissection(ESD) and delayed bleeding.

METHODSA total of 9874 patients with gastrointestinal mucosal or submucosal tumors underwent ESD in our center from September 2006 to August 2013 and intractable bleeding occurred during ESD in 5 cases. Under the condition of no effective hemostasis methods, the tissue adhesive injection or spray were used to stop the bleeding. The efficacy and safety were evaluated.

RESULTSAll the 5 cases were successfully managed by the hemostasis method with tissue adhesive without any adverse event. In follow-up of two months after operation, wound healing and scar formation were observed under endoscopy.

CONCLUSIONTissue adhesive is safe, effective and fast for intractable bleeding during ESD and delayed bleeding.

Dissection ; Endoscopy, Gastrointestinal ; Gastric Mucosa ; surgery ; Hemorrhage ; etiology ; therapy ; Humans ; Intestinal Mucosa ; surgery ; Tissue Adhesives ; therapeutic use ; Treatment Outcome

Objective To use the meta?analysis in evaluating the hemorrhage?prevention value of second?look endoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer. Methods A literature search was conducted to identify all relevant studies comparing second?look endoscopy and non?second?look endoscopy after gastric ESD. The Medline/PubMed, Ovid, Elsevier ScienceDirect, EBSCO, CNKI and VIP databases were searched systematically. Literature inclusion criteria: (1) all the patients were diagnosed as early gastric cancer receiving ESD; (2) end point of the study included postoperative bleeding rate of ESD. Exclusion criteria: (1) papers of repeated research, review, comment, guideline, etc; (2) non?control study. Meta?analysis method was used to calculate a pooled odds ratio (OR) for developing post?ESD bleeding. Results The meta?analysis showed that post?ESD bleeding was observed in 40 of 1287 patients (3.1%) without second?look endoscopy and in 40 of 968 patients (4.1%) with second?look endoscopy (OR=1.25, 95% CI: 0.79?1.98), with no significant difference between these two groups. Subgroup analysis on research method still indicated no significant difference of post?ESD bleeding between RCT group (OR=1.45,95%CI: 0.79?2.65) and non?RCT group (OR=1.02, 95%CI:0.50?2.08) (all P>0.05). Conclusion Based on meta analysis, second?look endoscopy can not reduce the rate of postoperative bleeding of ESD. Therefore, routine second?look endoscopy after gastric ESD may not be necessary to prevent delayed postoperative bleeding of ESD.

Objective To use the meta?analysis in evaluating the hemorrhage?prevention value of second?look endoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer. Methods A literature search was conducted to identify all relevant studies comparing second?look endoscopy and non?second?look endoscopy after gastric ESD. The Medline/PubMed, Ovid, Elsevier ScienceDirect, EBSCO, CNKI and VIP databases were searched systematically. Literature inclusion criteria: (1) all the patients were diagnosed as early gastric cancer receiving ESD; (2) end point of the study included postoperative bleeding rate of ESD. Exclusion criteria: (1) papers of repeated research, review, comment, guideline, etc; (2) non?control study. Meta?analysis method was used to calculate a pooled odds ratio (OR) for developing post?ESD bleeding. Results The meta?analysis showed that post?ESD bleeding was observed in 40 of 1287 patients (3.1%) without second?look endoscopy and in 40 of 968 patients (4.1%) with second?look endoscopy (OR=1.25, 95% CI: 0.79?1.98), with no significant difference between these two groups. Subgroup analysis on research method still indicated no significant difference of post?ESD bleeding between RCT group (OR=1.45,95%CI: 0.79?2.65) and non?RCT group (OR=1.02, 95%CI:0.50?2.08) (all P>0.05). Conclusion Based on meta analysis, second?look endoscopy can not reduce the rate of postoperative bleeding of ESD. Therefore, routine second?look endoscopy after gastric ESD may not be necessary to prevent delayed postoperative bleeding of ESD.

Objective To investigate the value of endoscopic ultrasonography(EUS)in the diagnosis and treatment of undetermined etiology of common bile duct (CBD) dilatation. Methods Patients, who were referred for dilated CBD but unable to identify the cause by imaging, underwent EUS for the diagnosis of etiology in Endoscopy Center of Zhongshan Hospital Affiliated to Fudan University from December 2015 to December 2016. The therapy was on the basis of diagnosis of EUS. Final diagnoses were determined by surgical pathology or follow-up for at least 3 months. Results A total of 76 patients were included in the study. The sensitivity, specificity and accuracy of EUS for patients with choledocholithiasis,patients with ampullary tumor, and patients with inflammatory stenosis were 100.0%(7/7), 100.0%(69/69), 100.0%(76/76), and 88.0%(22/25), 92.2%(47/51), 90.8%(69/76),and 90.9%(40/44), 93.8%(29/32), 90.8%(69/76), respectively. Accuracy of EUS for etiological diagnosis of CBD dilatation was 90.8%(69/76). The sensitivity,specificity and accuracy of EUS combined with tumor markers for patients with malignant CBD dilatation were 96.0%(24/25), 96.1%(49/51),and 96.1%(73/76), respectively. Conclusion EUS is an effective method for the etiological diagnosis of CBD dilatation and has guiding significance for the treatment. EUS combined with tumor markers may benefit differential diagnosis of benign and malignant CBD dilatation.

Objective To understand the mutual relation of general self-efficiency and high quality care among clinical nurses .Methods Using the General Self-Efficiency Scale ( GSES) and the quality nursing care brief questionnaire , we surveyed 120 nurses selected from a hospital in Xiamen .Results The mean score of GSES was (2.41 ±0.82), which was lower than the norm score of (2.95 ±0.53).The difference was significant (t=-4.385,P<0.05).The mean score of quality nursing care brief questionnaire was (94.84 ± 12.49).Nurses, with different age, titles and working years, had significant differences in the score of GSES (t=4.464, 2.55, 2.89, respectively;P<0.05).There was a positive relationship between nurses ’ general self-efficacy and high quality care (r =0.245,P<0.05).Multiple linear regression analysis revealed that attitude towards work , technical ability and timely operation were the influencing factors of nurses ’ general self-efficacy scores .Conclusions The general self-efficacy of nurses should be improved .Nursing administrators should pay attention to nurses ’ general self-efficacy and encourage them to adopt active communication skills , and strengthen their conviction and take some measures , such as increasing propaganda , clearing the meaning of high quality care , so as to promote the development of nursing staff .