Objective To investigate the clinical benefit response (CBR) in treating the unresectable pancreatic carcinoma by applying the EUS guided iodine-125 seed implantation combined with chemotherapy of gemeitabine and comparing chemotherapy of gemcitabine alone. Methods Forty-one patients with unresectable pancreatic carcinoma were randomly divided into two groups, one group (Group A) included 21 cases which underwent EUS-guided iodine-125 seed implantation combined with gemcitabine chemotherapy, the rest 20 cases (Group B) were treated with gemcitabine chemotherapy alone. EUS-guided iodine-125 seed implantation were carried according to the treatment plan system (TPS), following chemotherapy after 1 week. Gemcitabine was administered at the dose of 1 000 mg/m2, through intravenous administration once a week for 3 consecutive weeks every 4 weeks. CBR was assessed. Results CBR of Group A was 57.1% and median time to CBR was 1 week and median duration of CBR was 21 weeks, while CBR of Group B was 25%, and median time to CBR was 4 weeks and median duration of CBR was 15 weeks (P<0.01). Conclusions EUS-guided iodine-125 seed implantation combined with chemotherapy of gemcitabine was superior to gemcitabine chemotherapy alone in the term of CBR in patients with unresectable pancreatic carcinoma.

Objective To evaluate the safety and efficacy of direct celiac ganglion irradiation with 125I seeds for pain relief secondary to advanced pancreatic carcinoma (PC).Methods This study enrolled 23 consecutive patients who had moderate to severe pain resulting from advanced PC.All patients underwent EUS-guided direct celiac ganglion irradiation with 125I seeds.Follow-up was conducted at least once weekly until death.Blood parameters,Visual Analog Scale (VAS) score,mean analgesic consumption,and complications were evaluated during follow-up.Results All patients successfully underwent implantation at one attempt.The mean number of seeds implanted in the celiac ganglion per patient was 4 (range 2-6).Immediately after the procedure,pain relief and analgesic consumption showed no significant changes compared with preoperative values.Six patients (26％) reported pain exacerbation.Two weeks later,the VAS score and mean analgesic consumption were significantly less than preoperative values.No procedure-related deaths or major complications occurred.Conclusion EUS-guided direct celiac ganglion irradiation with 125I seeds can reduce the VAS score and analgesic drug consumption in patients with unresectable PC.

Objective To explore the feasibility of establishing porcine model for training of endoscopic ultrasound (EUS) guided celiac plexus paracentesis.Methods A total of 6 healthy pigs were sedated with an intramuscular injection of Ketamin at 10 mg/kg,followed by intravenous injection of 3% pentobarbital at 0.8 ml/kg.EUS was then performed and empty seeds were implanted into celiac plexus.Enhanced CT scan was performed to confirm the location of the implanted seeds.Results No animal died after the procedure.All seeds were accurately distributed on both sides of the celiac trunk except in one pig the seed was found in stomach by CT scan and was re-implanted another day.Conclusion Pigs are similar to human in anatomic structure and they can be excellent models for beginner endoscopy physicians to acquire the skill of EUS guided celiac plexus paracentesis.

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD)in treatment of patients with early gastric cancer(EGC).Methods A total of 4 3 consecutive patients with EGC were treated with ESD at Changhai Hospital from July 2007 to July 2008.The data referred to one-piece resection,histologically complete resection,operation time,complications,the post-ESD ulcer-healing and local recurrance were retrospectively analyzed.ResultsEn bloc resection was achieved in 97.7 0A(4 2/43)lesions in one-piece resection.The histologically complete resection rate was 95.3%(41/43).Only one patient had acute minor bleeding during the ESD procedure(2.3%,1/43)and one patient had delayed bleeding(2.3%,1/43).Post-ESD epigastric pain was found in 2 2 patients(51.2%).There was no complications such as acute major bleeding,perforation,requiring surgical treatment and death.The median operation time was 60.4 miutes.The post-ESD ulcer-healing was achieved in 100%(42/42)8 weeks after esomeprazole treatment.During follow-uP of 10.3 months(ranged from 8 to 1 8 months),no residual or local recurrence of EGC was seen.Conclusion ESD has the advantages of increasing one-piece resection and histologically curative resection rates.It is a safe and effective procedure in treatment of EGC.

Objective To compare the yield of endoscopic ultrasonography guided fine needle aspira-tion (EUS-FNA) with 3 different sample processing methods. Methods The clinical data of 118 patients, who underwent EUS-FNA performed by one physician from February 2005 to September 2008, were retrospectively analyzed. The FNA sample processing methods included liquid-based cytology, on-site cytology and smear method. The pathological diagnosis was classified as definite, suspicious malignancy, dissatisfying sampling and indefinite. Results The success rate of obtaining samples through on-site cytological procedure was 95.2% (40/42), which was significantly higher than that of conventional smear (32/47, 68%, P <0. 05), and was higher than that of liquid-based cytological method (26/29, 89. 7% ), but without significant differ-ence (P>0.05). The yield of definite diagnosis with liquid-based cytology and on-site cytology were 82.8% (24/29) and 78. 6% (33/42), respectively, which were both significantly higher than that of smear method (57. 4%, 27/47, P <0. 05). The sensitivity and accuracy of on-site cytology were higher than those of smear method and liquid-based cytology, but without significant differences (P >0. 05). Conclusion Compared with conventional smear method, an-site cytology and liquid-based cytology yield more results from EUS-FNA.

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 assess the safety of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)of pancreatic lesions.Methods Patients who underwent EUS-FNA of a pancreatic lesion between January 2005 and June 2007were studied retrospectively.Possible risk factors were assessed by using logistic analysis.Results In 119 patients who underwent pancreatic EUS-FNA,mild acute pancreatitis were observed in 1(0.84%)patient after the operation.No complication occurred in 12 patients with regional portal vein hypertension.Nine patients(7.6%)showed hyperamylasemia 3 h after the procedure,rangeing from 197 to 835 U/L,with an average of(327±200)U/L.Blood amylase level kept increasing 24 h postoperatively in 6 cases of the 9.Logistic regression analysis showed past history of acute pancreatitis,gender,needle size,number of puncture,cystic foci,preoperative blood amylase level and location of foci would not possibly be the risk factors of hyperamylasemia.Conclusion Incidence of complications after EUS-FNA is 0.84%,and the occurrence rate of hyperamylasemia is 7.6%,indicating,EUS-FNA is a safe procedure.

Objective To evaluate the diagnostic accuracy of contrast-enhanced harmonic EUS (CH-EUS)for pancreatic cancer.Methods Patients with pancreatic occupying lesion underwent CH-EUS with ultrasonic contrast medium Sonovue.Pathological diagnoses by EUS-FNA or surgery and the follow-up results were made as the final diagnosis to evaluate the accuracy of CH-EUS for pancreatic cancer.Character-istics of CH-EUS in different pancreatic tumors were analysed.Results A total of 76 patients were en-rolled,with an average age of 53. 1 ±14. 2.Thirty-five were finally diagnosed as having pancreatic cancer, 21 local mass-type pancreatitis,10 pancreatic neuroendocrine tumor,6 cystadenoma,4 intraductal papillary mucinous neoplasm.Tumor diameter was 3. 4 ±1. 4 cm and there were 18 less than 2 cm.The sensitivity and specificity,positive and negative predictive value of CH-EUS for pancreatic cancer was 97. 1%, 92. 9%,91. 7% and 97. 5% respectively.The sensitivity was 100% combined with FNA.Conclusion CH-EUS is safe,convenient for pancreatic cancer with high accuracy and can be used as an additional diag-nostic method to EUS-FNA.

Objective To evaluate technical efficacy,feasibility and safety of a fully covered self-expanding metal stent for EUS-guided transgastric pancreatic pseudocyst drainage. Methods Data of a total of 11 patients who received EUS-guided transgastric pancreatic pseudocyst drainage with a covered self-ex-panding metal stent at Changhai Hospital from September 2013 to May 2014 were retrospectively studied. The manipulative success rates,curative success rates and complication rates were evaluated. Results All 11 patients were treated by EUS-guided transgastric pancreatic pseudocyst drainage with fully covered self-ex-panding metal stents successfully,with success rate of 100%. Two patients developed infection and displace-ment occurred in 1 patient. There was no hemorrhage,perforation or death. Stents were removed in 7 pa-tients and the pseudocysts vanished. Conclusion Endosonography-guided transgastric pancreatic pseudocyst drainage using a fully covered self-expanding metal stent can be accomplished with high technical and clinical success rate and low rate of complications.

Objective To evaluate the influence of brachytherapy with 125Ⅰ seeds on celiac ganglia in porcine models. Methods Twelve pigs were randomly assigned into 3 groups to accept celiac plexus block by bilateral injection with 2 non-radioactive seeds in group A (n = 4), 0.4 mCi seeds in Group B (n = 4) and 0.8 mCi seeds in Group C (n = 4), respectively. Prophylactic antibiotics were administered postoperatively. Enhanced CT and three-dimensional reconstruction of blood vessels were performed to confirm the proper placement of the seeds. The animals were sacrificed 14 days and 60 days after the procedure, and TUNEL assay was employed to study neuron apoptosis in ediac ganglia. Results The procedure was succossfully performed in,10 pigs(83.3%)and failed in two others. The rescue procedure was performed on the day after and succeeded in both pigs. Apoptosis of neurons significantly increased in brachytherapy groups than in the control group and it was positively correlated with dose and time of radiation. Conclusion Brachytherapy can cause apoptosis of neurons of celiac ganglion, which could be the basis of its clinical application.