Flat colon lesions, which include superficial colon tumor and depressed colon tumor, have close relationship with colon cancers. The main type of flat colon tumor is laterally spreading tumor (LST) while the main type of depressed tumor is depressed early colon cancer (IIc type). Little has been reported about the flat colon tumor because it is difficult to be detected and has not yet been broadly recognized by clinicians. Recently, clinicians with the Nanfang Hospital have innovated some novel colonoscopic approaches to improve the diagnosis and treatment of flat colon tumor and accumalate experiences in this regard. Their conclusions are: 1. Improvement in recognizing the physical characteristics of the lesion and the application of chromoscopic colonoscopy are the key points to reveal and identify the flat colon tumors. 2. The best theraputic methods for flat colon lesions are endoscopic mucosal resection and piecemeal endoscopic mucosal resection.

Objective To investigate the effect of blood pressure control for early enlargement of hypertensive intracerebral hemorrhage.Methods A total of 96 patients were divided randomly into intensive blood pressure lowering group (n = 48 )and standard antihypertensive group(n=48).Patients were checked head CT and was evaluated defect of nerve function score immedi-ately when they arrive at hospital and after 24 hours.Then the clinical curative effect was evaluated.Results The defect of nerve function score in intensive blood pressure lowering group was lower than that of the standard antihypertensive group(P <0.05 ). The hematomas volume within 24 hours of admission and the rate of hematoma enlargement of intensive blood pressure lowering group were sharply smaller than those of standard antihypertensive group(P <0.05).Conclusion Controlling blood pressure ac-tively could decrease ratio early enlargement of hematoma and defect of nerve function score in patients with hypertensive cerebral hemorrhage.

ObjectiveTo investigate the diagnostic value of transgastic peritoneoscopy for ascites of unknown aetiology.MethodsTransgastric peritoneoscopy was performed on 7 patients with ascites of unknown aetiology.Diagnosis and complications were both recorded.ResultsDiagnosis of all the 7 patients were confirmed after transgastric peritoneoscopy,among whom 6 ( 85.7％ ) were found to have tuberculosis peritonitis,and 1 ( 14.3％ ) with liver disease.All patients recovered after the operation.No intraoperative or postoperative complications occurred.ConclusionTransgastric peritoneoscopy is a valuable diagnostic method for ascites of unknown aetiology.

ObjectiveTo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of laterally spreading tumors (LST).MethodsESD was applied to remove 32 colorectal LSTs larger than 2 cm.The characteristics of the tumors and clinical results including en bloc resection rate,procedure time,complication and recttrrence rates were retrospectively evaluated.Results The lesions ranged from 2.5 cm to 8.0 cm,with a mean diameter of 4.1 ± 2.1 cm.En bloc resection wasachieved in 29 patients (90.6％ ) with a mean operation time of 75.7 ±66.0 min.Immediate arerial bleeding occurred in 5 ( 15.6％ ) cases but was stopped successfully by clips or coagulations.Late bleeding occurred in 2 ( 6.2％ ) and perforations in 3 (9.4％ ),which were closed successfully by clips without surgery.Pathological diagnosis revealed low-grade intraepithelial dysplasia in 19 (59.4％ ),high-grade intraepithelial dysplasia in 6 ( 18.8％ ),and carcinomas in 7 (21.9％).The lesions were restricted in mucosal layer in 25 (78.1％ ),infiltrating into sm1 layer in 5 ( 15.6％ ) and sm2 layer in 2 (6.2％ ),and the later 2 were referred to surgery.Twenty patients were followed up for 3-12 months,and no local recurrence was found..ConclusionESD was an effective and safe therapy for colorectal LST larger than 2 cm.

Objective To compare the diagnostic value of magnifying chromoendoscopy with probebased confocal laser endomicroscopy (pCLE) for differentiation of neoplastic from non-neoplastic colorectal polyps. Methods A total of 16 consecutive patients, who were diagnosed as having polyps with endoscopy between December 2009 and January 2010 at Nanfang Hospital, were included in this study. The pit pattern of the polyp was first determined with magnifying chromoendoscopy in all patients. Then, confocal images of the polyps were recorded and subsequently analyzed offline. Using pathological diagnosis as golden standard,the sensitivity and specificity of the two methods were compared. Results A total of 26 polyps from 16 patients were found. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of magnifying chromoendoscopy was 94. 1%, 77.8%, 88. 8%, 87. 5% and 88.4%, respectively,while those of pCLE were 100. 0%, 88. 8%, 94. 4% ,100. 0% and 96. 1%, respectively. There was no significant difference between pCLE and magnifying chromoendoscopy. Conclusion In differentiation between neoplastic and non-neoplastic colorectal lesions, pCLE shows higher sensitivity and specificity than does magnifying chromoendoscopy, although without significant difference. pCLE can be used as a new real time method to determine the property of colorectal polyps.

Objective To investigate the miss rate of adenoma with colonoscopy and assess the features and risk factors for missed diagnosis.Methods Patients with colorectal adenoma received a second colonoscopy within 120 days after adenoma was detected and removed on the initial colonoscopy.The findings of two colonoscopies were reviewed and analyzed.The features of adenoma (including size, location, shape, number and pathology) , clinical characteristics of patients (including age, sex, reasons of colonoscopy, history of diverticular disease, history of abdominal or pelvic surgery and colonoscopy with sedation) and endoscopists were recorded.Miss rate and features of different types of missed adenoma were analyzed.We also assessed the effects of adenoma features, patients' characteristics and endoscopists on missed diagnosis of adenoma.Results Adenoma missed diagnosis was found in 271 patients out of 809 recruited subjects (33% ).A total of 425 adenomas were missed out of 2134 (20% ) adenomas detected by repeated colonoscopy.A large diameter was associated with a decrease in the miss rate for adenoma (P < 0.01).Conversely , sessile or flat shape (P < 0.01) , locations at sigmoid, hepatic flexure, cecum and ascending colonic ( P < 0.05) were significantly associated with a higher miss rate of adenoma, as was the number of adenomas (P <0.01).A higher adenoma missed diagnosis rate was observed in beginner colonoscopists, as compared with experienced ones (P < 0.01).Conclusion A marked miss rate of adenoma exists on colonoscopy, which is significantly associated with the size, shape, location and number of adenomas and endoscopists.

Objective To evaluate diagnostic value of pit pattern analysis on detection of early colorectal carcinoma. Methods 4176 patients were examined with colonoscopy and had the mucosal lesions stained with 0.4% indigo carmine, and part of them observed with magnifying endoscope and stereomicroscope, then compared the mucosal crypt patterns (the pit patterns Kudo classification) with pathologic diagnosis. Results There were 955 protruded and flat lesions on the large intestine mucosa in 752 patients, and among them there are 14 early cancers, 209 advanced cancers, 76Ⅱa、Ⅱb、Ⅱc、Ⅱa+Ⅱc lesions. We also found 43 laterally spreading tumors (LST) ranging from 16 to 110 mm in diameter, 2 for pit Ⅱ,18 for pit Ⅲ L, 19 for pit Ⅳ, 1 for pit Ⅴ A, 1 for Ⅴ N. The pit pattern of the most non neoplastic lesions was type Ⅰ or Ⅱ, which is about 85.4% (303/355), and the type of the adenomas was type Ⅲ or Ⅳ, about 86.0% (504/586). All the invasive carcinomas'pit patterns were type Ⅴ and there were 8 for type Ⅴ (2 Ⅴ A, 6Ⅴ N) among 14 early carcinomas. Conclusion Pit pattern analysis is a very important tool to determine the nature of lesions, which helps to decide the kinds of later therapeutic intervention.

Objective To evaluate the effectiveness of single balloon enteroscopy (SBE) in diagno-sing of suspected lesions in small intestine. Methods Data of 23 patients with suspected small intestinal disease, who underwent SBE (Olympus) between February 2009 and August 2009, were retrospectively studied. A total of 34 procedures were performed in 23 patients. The indications for the examination were suspected obscure gastrointestinal bleeding (n = 9), abdominal pain (n = 7), suspected intestinal tumor re-vealed by capsule endoscopy (n = 4), and Crohn disease (n = 3). Results The average preparation time of SBE was less than 5 minutes. The mean procedure time was 61±25 minutes and 67±28 minutes for the oral and anal routes, respectively. Examination of whole length of small intestine was achieved in 6 patients. The diagnostic rate of small-intestinal lesions was 60. 9%, and no severe complications including perforation occurred. Conclusion SBE is safe and easy to prepare and perform, which can be a useful diagnostic and therapeutic tool for suspected small bowel disease.

Objective To evaluate the relationship between endoscopic rectal aberrant crypt foci (ACF) and colon neoplasm, including lesions with high risk of aggressive progression (adenoma with diameter ≥ 1cm, villus adenoma, tubular-villus adenoma, adenoma of high grade dysplasia, or cancer). Methods The rectum of 212 patients who underwent colonoscopy was stained by 0. 4% indigo armine, and the patient was classified into different grade according to the number of rectal ACF, namely Grade 0 as no ACF, Grade Ⅰ as 1-4, Grade Ⅱ as 5-9 and Grade Ⅲ as more than 10. The correlation between rectal ACF grade and colon lesions was analyzed. Results Of 212 patients, 72 were classified as Grade 0, 48 as Grade Ⅰ , 41 as Grade Ⅱ, and 51 as Grade Ⅲ. The detection rate of colon neoplasm and lesions with high risk of aggressive progression in patients with rectal ACF were significantly higher than that in patients without rectal ACF (OR at 95% CI was 22. 352 (6. 716 -74. 395) and 7. 982 ( 1. 838-34. 672), respcetively). Conclusion Rectal ACF may predict the detection of colon lesions, including those with high risk of aggressive progression.

Objective To evaluate the diagnostic value of pit pattern analysis in detection of early colorectal carcinoma.Methods From November 2004 to August 2007,a total of 1496 colorectal lesions were observed by mannifying colonoscopy with 0.4%indigo carmine staining.The mucosal crypt patterns (classified according to Kudo classification criteria)of these lesions were compared with pathological diagnosis.Results In 1496 lesions,458(30.6%)were non-neoplastic,657(43.9%)were adenoma,and 381 (25.5%)were adenocarcinoma.In 657 adenoma lesions,415 were tubular adenoma,with low grade dysplasia in 363(87.5%),150 were tubulovillous adenomas with hish grade dysplasia in 61(40.7%)and 49 were villous adenoma with hiish grade dysplasia in 42(85.7%).Among the adenocarcinoma lesions,61 were early colorectal cancers and 36 were laterally spreading tumors(LST).The LST lesions ranged from 10 to 62 mm in diameter.The pit pattern of 3 cases was Type Ⅱ,14 were Type Ⅲ,17 were Type Ⅳ and 2 were Type Ⅴ.Conclusion Pit pattern analysis is important in distinguishing tumorous lesions from non-tumorous ones and in improving the diagnosis rate of early colorectal cancer,which helps in choosing appropriate managements.