Objective To evaluate the therapeutic effect and safety of forward-viewing,doublechannel endoscope in the process of ERCP in patients with bile duct diseases after Billroth-Ⅱ gastroenterostomy.Methods ERCP was applied to 46 patients with bile duct diseases using forward-viewing,doublechannel endoscope.All patients had the history of Billroth-Ⅱ gastroenterostomy.The success rate of selective cannulation,complication rate and the outcome of all the patients were recorded.Results The procedure succeeded in 38 patients with a success rate of 82.6％,and failed in 8.Of all the failing cases,the afferent loop couldn't be accessed in 6,failure in biliary cannulation in 2.Of 38 successful cases,bile duct stones were successfully removed in 31,metal stents placed for malignant bile duct obstruction in 4,and endoscopic balloon dilation for benign common bile duct stricture in 3.All patients recovered without complications of perforation,delayed bleeding or pancreatitis.Conclusion For patients with history of Billroth-Ⅱgastroenterostomy,ERCP with forward-viewing,double-channel endoscope yields to a higher success rate and lower complication rate.

Objective To investigate the features of pit patterns by magnifying endoscopy on neo-plastic colorectal polyps. Methods The materials consisted of 129 polyps in 108 patients. Dye-assisted magnifying endoscopies were used to ascertain the pit patterns of polyps. Results Of 129 polyps, 106 were diagnosed pathologically as neoplastic lesions(adenomas and carcinomas) , in which 10 demonstratedⅡpit pattern with only mild to moderate atypia and no severe atypia; 73 ⅢL pit pattern; 1Ⅲs pit pattern; 7 Ⅳ pit pattern and 15 Ⅴ pit patterns which includes malignant change in 10 cases, and severe atypia in 5 cases. Ten lesions all demonstrated Ⅴ pit pattern were found to be carcinoma (7 mucosal and 2 submucosal and 1 advanced carcinomas). Of 7 mucosal carcinomas,6 showed ⅤA pit pattern,1 , Ⅴ N pit pattern; 2 submuco-sal carcinomas all showed VN pit pattern; 1 advanced carcinoma showed ⅤN pit pattern. Ten lateral sprea-ding tumors were also investigated, their pit patterns under magnifying endoscopy were Ⅲ LⅥor V pit pat-tern among them one case with malignant change. Conclusion The images of pit pattern obtained by magnif-ying endoscopy were essentially concordance to those provided by stereomicroscopy. The differentiation of tu-morous lesion or non-tumorous lesion can be fairly performed under the observation of pit patterns; it gives an important practical significance in diagnosing tumorous lesions.

Objective To compare the medical economics and safety of colonic metallic stent implantation as a bridge to elective resection with traditional emergency resection.Methods Data of colonic cancer obstruction cases in emergency room from 2008 to 2013 were retrospectively analyzed and divided into stent group(colonic stent as a bridge to surgery) and control group(emergency surgery).Main parameters between the two groups were compared,including surgery-associated mortality and morbidity,colostomy rate and re-anastomosis rate,ICU admitted rate,average days and costs in hospital,and colonic stent insertion associated clinical success rate and mortality.Results Ten and 11 patients were included in stent group and control group respectively.Surgery associated morbidity and colostomy rates were both 0 in stent group,and 18.2％ and 100.0％ in control group.Days of hospitalization and costs were 23 days and 67 742 Yuan in stent group,and 49 days and 92 553 Yuan in control group.The surgery associated mortality rates both were 0 in the two groups.ICU admitted rates were 20％ and 18％ respectively.Conclusion Colonic stenting as a bridge to surgery has a high clinical success rate and has a lower morbidity and colostomy rate,shorter hospitalization days,less cost compared with traditional emergency surgery.This strategy for colonic cancer obstruction is of safety and great health economic value.

Objective To evaluate the feasibility of diagnostic and therapeutic peroral direct cholan-gioscopy (PDCS)using an ultra-slim upper endoscopy assisted by a snare.Methods Between November 2014 and January 2015,8 patients underwent PDCS with assistance of an ultra-slim endoscopy.After endo-scopic papillary balloon dilation,the duodenoscopy was withdrew,an ultra-slim endoscopy was inserted di-rectly into the biliary tract assisted by a snare,and biopsy or laser lithotripsy was performed.The snare was closed tightly in the bent portion of the scope,and the snare was pulled while scope shaft had to become the form of U loop by counterclockwise rotation,in order to advance the scope into common bile duct.Results PDCS succeeded in all eight cases,one common hepatic duct adenoma was diagnosed by biopsy,and con-firmed by surgery;one benign biliary stricture was diagnosed by PDCS;laser lithotripsy was successfully per-formed in 4 patients with large CBD stones;bile duct clearance was verified by PDCS in two patients who was suspected of residual CBD stones.No perforation,bleeding or post-operative pancreatitis was found.Con-clusion PDCS using an ultra-slim gastroscopy assisted by a snare is a safe,simple and practical procedure in the diagnosis and treatment of biliary tract diseases.

Objective To explore the endoscopic managements for biliary and pancreatic diseases in patients with the history of complex gastrointestinal surgery.Methods Data of four patients who underwent balloon-assisted enteroscopy after complex digestive surgeries (2 patients underwent Roux-en-Y reconstruction,2 others Whipple reconstruction) were retrospectively collected.One patient with bilio-intestinal anastomosis was explored by double-balloon enteroscope (DBE),and balloon-assisted enteroscopy combined with ERCP was used for other 3 patients.Results Therapeutic ERCP was successfully performed on one patient,and the diagnosis of 3 others were confirmed.No operation-related complications such as bleeding or perforation was observed.Conclusion Balloon-assisted enteroscopy combined with ERCP is an important diagnostic and therapeutic method for biliary and pancreatic diseases in the patients after complex gastrointestinal surgery.

PurposeTo investigate the relationship between left atrial volume index (LAVI) and severity of coronary lesions in patients with stable angina pectoris, so as to provide information for the evaluation of the severity of coronary artery disease (CAD). Materials and MethodsAccording to the results of coronary angiography, 279 patients with stable angina pectoris and 92 healthy people were as control group, all subjects were divided into four groups: control group (n=92), single-vessel CAD group (n=116), double-vessel CAD group (n=93) and triple-vessel group (n=70). Each group was compared in the aspects of demographic characteristics, history of illness, liver and kidney functions and parameter's difference in echocardiogram; the correlation between LAVI and Gensini score was analyzed; and the receiver operating characteristic (ROC) curve was used to identify the predictive value of LAVI in severity of coronary lesions.ResultsCompared with the control group, the double-vessel and triple-vessel CAD groups had significantly larger left atrial diameter (P<0.05). In triple-vessel CAD group, the left atrial diameter was significantly larger than that in the single-vessel CAD group (P<0.05), and the left ventricular end-diastolic diameter was significantly larger than that in the control group and in the single-vessel CAD group (P<0.05), and the E/Em and LVMI were significantly higher than those in other groups (P<0.05). The LAVI was higher in patients with CAD compared with those in the control group and the LAVI in the triple-vessel CAD group was significantly higher than that in single-vessel CAD group and double-vessel CAD group (P<0.05); the LAVI was correlated positively with Gensini score (r=0.499,P<0.01). LAVI had certain value in predicting triple-vessel CAD (AUC=0.782,P<0.01). The results of multi-factor Logistic regression analysis showed that male patients with hypertension, mitral reflux, and multi-vessel CAD were more likely to had high LAVI.Conclusion The worsening LV diastolic function is associated with the increasing severity of coronary artery lesions, and LAVI may have predictive value for severity of CAD.

Objective To characterize the clinical features of patients with cardiac amyloidosis (CA).Methods Totally 42 patients with CA admitted to Guangdong General Hospital since 2008 were included and retrospectively analyzed in the present study.CA was confirmed by abdomen and endocardium biopsy examination.Clinical manifestations,electrocardiogram and echocardiography were collected for the evaluation.Results Several clinic features are common in CA.In the present study,37 cases (88.1％) presented with chest tightness,dyspnea,20 cases(47.6％) with chest pain,27 cases(64.3％) with right heart failure,27 cases (64.3％) with fatigue,and 30 cases (71.4％) with renal insufficiency and proteinuria.Electrocardiogram (ECG) showed that 32 of the patients (76.2％) were with low voltage in limb leads,29 cases (69％) of them were with poor R wave progression in precordial leads,17 cases (40.5％) with ST-T change,28 cases(66.7％) with pseudo-necrotic Q wave and 36 cases (85.7％) with various kinds of arrhythmia.Echocardiography indicated that all of the subjects (100％) were with different degrees of left ventricular posterior wall or ventricular septal thickness,and left atrial hypertrophy with different degree of myocardial grain appearance or ground-glass opacity.Thirty-six cases (85.7％) were with pericardial effusion,and 27 cases (64.3％) were with abnormal left ventricular eject function.Conclusion For those who were with unexplained clinical cardiac insufficiency,renal insufficiency,myocardial hypertrophy,but normal of ventricular size in echocardiography and low voltage on ECG limb leads,a tissue biopsy from abdomen,labial glands or endocardium should be considered in the diagnosis of CA.

OBJECTIVETo explore the clinical features and molecular mutation of early-onset familial adenomatous polyposis(FAP) in childhood.

METHODThe clinical features, endoscopic findings, pathology and therapeutic effect of sulindac during 11 years follow-up in a child with FAP were retrospectively reviewed . Adenomatous polyposis coli (APC) gene mutation analysis was performed by PCR and first generation sequencing.

RESULTThis 6-year-old girl was admitted for intermittent bloody stool during the last one and a half years. Colonoscopy showed hundreds of polyps in the rectum and colon. Pathological examination revealed tubular adenomas with high grade dysplasia. During the follow-up period of 11 years, the child presented intermittent mucous bloody stool. Endoscopy showed the number of polyps in colon and rectum increased to thousands, and found multiple polyps in gastric fundus and body.She was treated with sulindac at the age of 13. Then the number of polyps and the grade of pathology showed a slight improvement and no carcinoma was seen on biopsy. She has not accepted surgery until now. Gene sequencing of this child revealed 5 bp deletion at codon 1,309 of exon 15 (c.3927_3931delAAAGA) of tumor suppressor gene, whereas none of her parents had the same mutation. And no polyps were found on her parents colonoscopy.

CONCLUSIONThis child with FAP had an early onset of this disease, and clinical conditions were exacerbated with age. Sulindac was partially effective in controlling size and number of polyps. The site of mutation in this case was consistent with classic FAP, and without family history, the mutation may be a sporadic one.

Adenomatous Polyposis Coli ; Biopsy ; Child ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage ; Genes, APC ; Humans ; Mutation ; Polymerase Chain Reaction ; Rectum ; Retrospective Studies

Objective To study changes of the autoimmune antibody level in patients after autologous hematopoietic stem cell transplantation(CD_(34)~+).Methods Twelve patients with SLE received autologous hematopoietic stem cell transplantation.All they survived and their immune system were recoverd after a period of time.The serum autoimmune antibody levels were measured before and after the transplantation,Results The antibody levels became normal 6 months after transplantation.Conclusion Autologous hematopoietic stem cell transplantation can effectively reduces the level of autoimmune antibody in patients with SLE.

OBJECTIVESTo investigate the relationship between H. pylori infection, gastric cancer and other gastric diseases through the changes in gastric mucosa and the status of different gastric diseases within 5 years after H. pylori eradication in H. pylori-positive subjects in a high incidence region of gastric cancer.

METHODSOne thousand and six adults were selected from the general population in Yantai, Shandong province, a high incidence region for gastric cancer in China. Gastroscopy and Campylobacter-like organism (CLO) testing were performed on all subjects. Biopsy samples from the gastric antrum and body were obtained for histology and assessment of H. pylori infection. All H. pylori-positive subjects were then randomly divided into two groups: treatment group receiving Omeprazole Amoxicillin Clarythromycin (OAC) triple therapy and placebo as controls. These subjects were endoscopically followed up in the second and fifth year. We compared the endoscopic appearance and histology of the biopsy specimens from the same site obtained at the first and last visits.

RESULTSAll 552 H. pylori-positive subjects were randomly and evenly divided into treatment group or control group. During the five-year follow-up, the numbers of patients who continued to be negative or positive for H. pylori were 161 and 198, respectively. Statistical analysis revealed that: (1) At the initial visit, there were no significant differences in the severity and activity of inflammation, atrophy and intestinal metaplasia between the biopsy specimens from the antrum and body respectively in both groups. (2) The severity and activity of inflammation in both the antrum and body were markedly reduced after H. pylori eradication (P = 0.000). (3) Within five years after H. pylori eradication, intestinal metaplasia in the antrum either regressed or had no progression, while the proportion of intestinal metaplasia in the H. pylori-positive group increased significantly (P = 0.032). (4) After H. pylori eradication, the atrophy in both the antrum and body had no significant regression. The P value was 0.223 and 0.402, respectively.

CONCLUSIONSH. pylori eradication results in remarkable reduction in the severity and activity of chronic gastritis, marked resolution of intestinal metaplasia in the antrum. On the other hand, continuous H. pylori infection leads to progressive aggravation of atrophy and intestinal metaplasia.

Adult ; Aged ; Double-Blind Method ; Follow-Up Studies ; Gastric Mucosa ; pathology ; Gastritis ; etiology ; Helicobacter Infections ; complications ; drug therapy ; pathology ; Helicobacter pylori ; Humans ; Metaplasia ; Middle Aged ; Stomach Neoplasms ; etiology