Objective To explore the efficacy and safety of choledochoscopy combined with laser lithotripsy for refractory residual biliary calculi after operation. Methods Clinical data of 22 patients, who underwent choledochoseopy together with laser lithotripsy for refractory intra- and extra-hepatic calculi after operation from February 2007 to February 2009, were retrospectively studied. Results The success rate of stone removal was 95.5% (21/22) , with one session success rate of 86. 4% (19/22), and two sessions of 9. 1% (2/22). Stone removal could not be performed in one patient due to multiple intra-hepatic calculi, difficult calculi location at bile ducts of grade Ⅱ, and wide biliary angle with no access. No biliary duct hem-orrhage, perforation, or infection occurred. Conclusion Choledochoscopy combined with laser lithotripsy is an effective and safe procedure for refractory residual biliary calculi after operation.

key of success.

Objective To evaluate the safety and feasibility of natural orifice transluminal endoscopic surgery(NOTES)with current available techniques and endoscopic accessories.Methods Transgastric and transvaginal endoscopic abdominal cavity exploration were performed in 6 female pigs.A needle-knife and a ERCP scalpel were used to make an anterior gastric wall incision,and a dilating balloon to expand the passage,through which a therapeutic gastroscope was sent into the abdominal cavity to seek the target organ.Partial liver resection was performed in 2 cases.For incision closure,a clip was applied to the incision orifice or it was just given putting-aside therapy.One week later,the abdominal cavity was examined via vagina.Another week later,it was observed via other incision of the stomach.Four weeks after the operation,the pigs were sacrificed.Adhesion,injury to the organs and closure of the incision were evaluated.Results Transgastric procedures were performed 12 times and transvaginal procedures 6 times.Mean operation time via stomach was 33.4±10.9 min.and that via vagina WaS 10.1±2.5 min.All animals recovered and gained weight after the operation.The incision healed up with no obvious complications.Re-exploration showed adhesion of various degrees,no effusion,or injury to the organs were observed.Ketamine plus propofol achieved satisfactory anesthetic effect with no complications.One of the two animals which underwent liver partial resection died of disphragmatic muscle perforation.Hemarrhage occurred twice,both in the procedures via satisfied.One case developed abdominal abscess.Conclusion It Was feasible and safe to perform NOTES via transgastric and transvaginal approach to the abdominal cavity and liver resection.But development of NOTES specific instruments is essential to the procedure.

ObjectiveTo evaluate the disinfective effect of a new peracetic acid solution for digestive endoscope.MethodsForty endoscopes were divided into experimental group and control group,10 gastroscopes and 10 enteroscopes in each group,the experimental group was disinfected with the new peracetic acid solution for 10 min,the control group was disinfected with 2％ glutaral for 10 min,the disinfection effect was compared.Subsequently,80 other endoscopes were divided into 4 groups,10 gastroscopes and 10 enteroscopes in each group,each group was disinfected for 2 min,3 min,4 min and 5 min,the disinfection efficiency was evaluated.ResultsThe disinfection rates of gastroscopes and enteroscopes in the control were 100％ (10/10)and 90％ (9/10)respectively.Bacteria were found in both endoscopes.In the experimental group,disinfection rates of both gastroscopes and enteroscopes were 100％ (10/10),and no bacterium was found,which was superior to the control.disinfection rates of gastroscopes of 3 min,4 min and 5 min were all 100％ (10/10),which were higher than that of 2 min group (30％) (P ＜0.05).Bacteria were found in 3 min group.Disinfection rates of 4 min and 5 min group were 100％ ( 10/10),which were higher than that of 3 min group (80％)(P ＜0.05).Bacteria were found in 4 min group,and 2 min group was not disinfected.ConclusionThe new peracetic acid solution is effective for clinic digestive endoscope disinfection,and is superior to 2％ glutaral.

Objective To explore a new approach of sequential cannulation in bile duct and pancreatic duct in the pig model for ERCP training.Methods A group of 5 trainees received 5 to 10 sessions of training of bile duct cannulation first, the results were evaluated by ERCP experts.When the trainees passed the assessment, they received next phase of training of pancreatic duct cannulation.A 3 scores system was used to evaluate the level of operation before and after the training conducted by experts.Results All participants successfully completed the sequential cannulation training.Compared with the operation level before training, the insertion time of ERCP after training was shortened (5.2±1.5 min vs.2.5±0.7 min, P<0.05), and the operating skills were also improved significantly (1.3±0.5 vs.2.7±0.5, P<0.05).The training project was accepted very well by all participants.Conclusion The sequential cannulation in bile duct and pancreatic duct in pig model is of good cost-effectiveness and can get better training results under the premise of increasing the operating frequency and operating difficulties.

Objective To evaluate the efficacy and tolerability of EUS-guided intra-tumoral injection of E1B gene-deleted adenovirus (H101) combined with intravenous gemcitabine for unresectable pancreatic carcinomas. Methods Nineteen patients with advanced adenocarcinoma of the pancreas who were not resectable and never to anti-cancer treatment were enrolled in this study. Each patient underwent two sessions of EUS-guided H101 intra-tumoral injection in combination with gemcitabine (i. v. , 1000 mg/m2, d3, 10, 17). The tumor size before and after H101 intra-tumoral injection were recorded for efficacy assessment. The changes of pain score and KPS, adverse effects and complication rates, survival were estimated. Results The tumor size decreased in twelve patients by5.3% ~ 69.7% , but the difference was not statistically significant (P =0.275). All of nineteen patients completed two cycles of combination treatment. Among them, 3 (15. 8% ) achieved partial response, 10 (52.6% ) had stable disease, and none had complete response. The mean pain score after injection was significantly lower than that before injection (3.1 ±1.7 vs. 3.9±1.6, P = 0.004). KPS after injection was significantly increased more than that before injection [ (68.4 ± 12.1)% vs. (61.1 ±9.9)%, P =0.003)]. There was no complication associated with the procedure. Major adverse effects associated with H101 injection were fever and diarrhea. The survival time was 2.5 to 10 months. Nine patients were still alive. Conclusions EUS-guided E1B gene-deleted adenovirus intra-tumral injection in unresectable pancreatic carcinomas is feasible and well tolerated in combination with intravenous gemcitabine, which can improve the quality of life and decrease the pain score.

Objective To evaluate the feasibility and efficacy of betadine solution irrigation of gastrointestinal tract for infection prevention during the procedure of natural orifice transluminal endoscopic surgery(NOTES).Methods Twelve female porcine were divided into control group(n =4)to receive lavage with 500 ml normal saline and experimental group(n =8)to undergo lavage with 500 ml normal saline followed by 200 ml betadine solution.Fluid from gastrointestinal tract(5 ml)were collected before and after lavage,and after NOTES for culture.Endoscopy was performed 24 hours after NOTES to observe possible existence of inflammation,ulcer or bleeding.The animals were sacrificed 3 weeks after NOTES to explore intra-peritoneal adhesions,abscesses and other infections.Results One swine died of diaphragmatic injury and the other 11 animals successfully survived for 3 weeks.In trans-gastric approach,the average bacterial load of the fluid was 17.5 x 103 CFU/ml before lavage.In control group,the average bacterial load of the fluid was 2.5 × 103 CFU/ml after lavage and 5.5 × 103 CFU/ml after NOTES,while those in experimental group were 0 CFU/ml and 7.5 CFU/ml,respectively.In trans-colonic approach,the average bacterial load of the fluid before lavage was 76.2 × 103 CFU/ml.In control group,the average bacterial load of the fluid was 19.5 × 103 CFU/ml after lavage and 21 × 103 CFU/ml after NOTES,while those in experimental group were 2.25 × 103 CFU/ml and 1 × 103 CFU/ml,respectively.No inflammation,ulcer or bleeding were observed by endoscopy at 24 hours after NOTES.More adhesion and abscess were found in the control group than in the experimental group.In experimental group with trans-colonic approach,only one case of adhesion was observed.Conclusion It is effective and feasible of using betadine solution irrigation of gastrointestinal tract in infection prevention during the procedure of NOTES.However,further clinical studies assessing the effectiveness and safety are still necessary.

Objective To evaluate the efficacy and salty of endoscopic ultrasonography-guided celiac plexus neurolysis (EUS-CPN) in the treatment of pain due to pancreatic cancer and celiac metastatic carcinoma.Methods Thirty-three patients with celiac carcinoma were selected for EUS-CPN. Among whom 15 pateints were received chemotherapy before procedure . Using endoscopic ultrasounography,transgastric injection of the celiac plexus with bupivacaine and 98% dehydrated absolute alcohol was accomplished.The abdominal pain was evaluated by the numeric pain intensity scale before and at 24,48,72 hours and one week after the precedure.The successful rate of precedure,the complication and the relief of the pain were observed. Results All procedures were performed successfully . No serious complications such as pancreatitis by trauma,pancreatic fistula,bleeding and celiac infection was found.Compared with baseline,pain was significantly relieved at 12,24,72 hours and 1 week after EUS-CPN (100%,98%,90% and 88%,respectively).The pain remission at 24,48,72 hours and one week in patients who received chemotherapy before procedure were 100%,100%,980% and 98%,respectively,while in those who had not treated chemically were 100%,98%,95% and 90%,respectively.The complete%relief of pain in chemotherapy group was significantly higher than that in nonchemotherapy group (75 % vs 56 %,P%0.05).Conclusions EUS CPN is a safe and effective method for relieving pain with low complications.It can raise the quality life of the patients and chemical therapy may be helpful in pain control.

Objective To evaluate the feasibility of slightly acidic electrolyzed oxidizing water for the disinfection of gastrointestinal endoscopes.Methods Electrolyzed oxidizion water generator was utilized to produce the water,which was applied for the disinfection of gastrointestinal endoscopes.The disinfectant efficiency and effect were evaluated.Results A total of 215 samples were taken for bacterial culture after the disinfection.The mean sterilization efficiency of slightly acidic electrolyzed oxidized water and 2％ glutaraldehyde by machine were 99.92％ and 99.85％,respectively,while the mean sterilization efficiency were 99.85％ and 99.84％ by manual disinfection.There were no statistical significance between the two groups.The effective rates of both groups were 100％.No deformation or aging was observed in the endoscopes.The disinfectant caused no damage to the cleansing and disinfection.Conclusion It is feasible to apply slightly acidic electrolyzed oxidizing water to the disinfection of endoscopes.

Objective To evaluate the feasibility of getting retroperitoneal lymph node biopsy via technique of natural orifice transluminal endoscopic surgery(NOTES)in human being with current available devices.Methods We performed trans-gastric endoscopic biopsy of retroperitoneal lymph node with the aid of laparoscopy in a 50-year-old man,who presented with abdominal pain and enlarged retroperitoneal lymph nodes and signed a written informed consent before the procedure.After routine anesthesia and abdominal skin sterilization,a pneumoperitoneum was induced with a Veress needle placed in the umbilical area,followed by the introduction of a 5-mm trocar.Gastral cavity Was sterilized with antibiotics and povidone iodine.Under laparoscopie optical control,we made a styliform incision in the anterior wall of gastric corpus with a needle knife,and enlarged the incision by a dilatation balloon and then entered the peritoneal cavity with a sterile endoscope.We got two biopsies from the enlarged lymph node with a heat forceps assisted by laparoscopy.The specimen was taken out by retrieval basket through the stomach.The gastric incision Was closed with metal clips.Results The biopsy by means of NOTES was successfully performed without intra-or postoperative complications.The diagnosis was confirmed as lymphoma pathologically.The patient received chemotherapy and was discharged on the sixth postoperative day.There was no short or long-term complication.Conclusion Transgastric access for laparoscopy-assisted biopsy of retroperitoneal lymph node is feasible and safe in human being.