Objective To evaluate the diagnostic and therapeutic effects of endoscopic retrograde cholangiopancreatography (ERCP) in biliary papillomatosis. Methods Data of 6 patients, who underwent ERCP and diagnosed as biliary papillomatosis from 2000 to 2008, were retrospectively analyzed. Results There were 3 males and 3 females, with the mean age of onset at 72.8 years (range 52-83 years). Recurrent cholangitis and jaundice were common presentations in all patients, with 5 patients having right upper abdominal pain and 3 others exhiting fever and algor. History of partial hepatectomy was observed in 2 patients. Endoscopic findings included dilated papillary orifice with mucin discharge in 5 patients and papillary-occupying lesion in 1 patient. Multiple filling defects in the lumen of the biliary system in dilated common bile duct were detected in all patients, accompanied with extra-hepatic ducts dilatation in 3, right intra-hepatic duct dilatation in 1, and major pancreatic duct dilation in 1. Of 6 patients, 5 underwent multiple ERCP, inclucling stents and endoscopic nasobiliary drainage (ENBD), and have survived for 10-30 months. Another 83-year-old patient underwent palliative endoscopic treatment with balloons, baskets and ENBD, but died of cholangitis 10 days after the procedure. Conclusion This case series reports the typical endoscopic findings of biliary papiliomatosis. For inoperable or postoperative recurrent patients, endoscopic palliative treatment is a safe, convenient and effective procedure.

To explore diagnostic significance of treadmill exercise test (TET) combined echocardiography (ECG) for coronary heart disease (CHD) and its severity .Methods :Clinical data of 400 patients who were initially diagnosed as CHD were retrospectively analyzed .With coronary angiography as gold standard ,sensitivities and spe‐cificities of single TET ,single ECG and TET + ECG ,and positive detection rate of different number of diseased vessels were analyzed .Results : Compared with single TET and single ECG ,there was significant reduction in sensi‐tivity (80.67%,68. 07% vs.54.20%) and significant rise in specificity (74.07%,64.82% vs.90.74%) in TET +ECG , P＜0. 01 all.Along with number of diseased coronary vessels rose ,positive detection rates of single TET ,sin‐gle ECG and TET + ECG increased .Compared with single TET and single ECG ,there were significant rise ? In positive detection rates of single vessel coronary disease (72. 32%,56. 25% vs.83.93%) ,double vessel coronary disease (85. 92%,71. 83% vs.97. 18%) and multi vessel coronary disease (90. 91%, 87.27% vs.98. 18%) in TET+ ECG , P＜0.05 or ＜0. 01. Conclusion :Diagnostic specificity of TET + ECG is significantly better than those of single TET and single ECG ;when number of diseased coronary vessels gets more ,positive detection rate of TET +ECG is more significant .

Objective To explore the experience on using duodenoscope to treat hepatolithiasis through normal physiological ways.Methods ERCP,EST were used firstly,then removed calculus of the extrahepatic bile duct.Endoscopic papillary balloon dilatation was used if there was stenosis of bile duct.Removed calculus when it had been crushed in the hepatic duct.Injected decoction to dissolve calculus through endoscopic nasobiliary drainage,or inserted the endoscopic retrograde biliary drainage when the calculus was hard to removded.Results 101 cases of calculus in the extrahepatic bile duct were all removed.215 cases of hepatolithiasis were cleaned out at first time.9 cases were cured 1 week after dissolving calculus through endoscopic nasobiliary drainage.59 cases carried out ERBD,and 21 of them were cured 3 months later,37 patients were still in regular follow-up.33 cases with stenosis of bile duct were treated by endoscopic papillary balloon dilatation,19 of them were cured,the others were inserted with the endoscopic retrograde biliary drainage.19 cases of cholangitic abscess were cured by endoscopic nasobiliary drainage.Conclusion Using duodenoscope to treat hepatolithiasis through normal physiological ways is safe and effectic.

Objective To explore the experience of the double guide wires technology in the difficult ERCP examinations.Methods There were 776 difficult ERCP patients.701 cases with difficult cannulation of the bile duct had been inserted another guide wire into the upper left corner of the duodenal papilla after retained pancreatic guide wire.75 cases with difficult cannulation of the pancreatic duct had been inserted another guide wire into the right vertical direction of the duodenal papilla after retained a guide wire into the commom bile.Results 697cases(99.4%)with difficult cannulation of the bile duct were examined successfully at first time;74 cases(98.7%)with difficult cannulation of the pancreatic duct were examined successfully at first time.Conclusion Double guide wires technology is easy to use.The method of retaining a guide wire into the duct which was cannulated easily may increases the achievement ratio of cannulation into another duct.The check time was shortened significantly.