Elderly patients with biliary and pancreatic diseases are often complicated by other underlying diseases and have poor cardiopulmonary function,and most of them cannot tolerate general anesthesia.The patients aged above 80 years who have undergone bile duct exploration have high mortality rate and incidence rate of complications.Endoscopic retrograde cholangiopancreatography (ERCP) is applicable to elderly patients with biliary and pancreatic diseases.This article elaborates on the features of perioperative treatment and technical operation of ERCP in elderly patients.

Endoscopic drainage was practised in 23 patients with acute or chronic pancreatitis. Among them 13 cases with acute pancreatits (AP) including 5 serious ones were treated with endoscopic sphincterotomy (EST) and naso biliary drainage (ENBD).Following successful drainage ( n =11) all the patients were cured with an average of 10 4 days (5-18 days). Among 11 patients with chronic pancreatitis, there were 7 cases treated by endoscopic pancreatic sphinterotomy (EPS), 2 cases by extraction of pancreatic duct stones with balloon, 5 cases by dilatation of pancreatic duct with bougienage, 6 cases by endoscopic naso pancreatic drainage(ENPD), and 7 cases by pancreatic duct drainage(PDE). After the operation, abdominal pain was eliminated in 5/7 cases. Pancreatic duct stones were extracted out in 2 patients and pancreatic cyst disappeared in 4 patients. It is concluded that endoscopic drainage is safe and useful in management of acute or chronic pancreatitis.

Background:The incidence of ischemic colitis(IC)is increasing in recent years with the aging of population,and the rate of delayed diagnosis or misdiagnosis is high because of the lacking of specific clinical characteristics. Aims:To study the clinical characteristics of IC so as to improve its early diagnosis and treatment. Methods:The clinical and endoscopic characteristics of 75 IC patients from Jan. 2009 to Dec. 2014 at Urumqi General Hospital were retrospectively analyzed. Results:IC usually occurred in elderly patients with age ≥60 years,females were more common. Most patients had underlying diseases,including hypertension,coronary heart disease,diabetes,hyperlipidemia and arrhythmia,etc. Colonoscopy and medications could also induce IC. The main clinical presentations were abdominal pain,hematochezia and diarrhea. The lesions were mostly located in left colon and of the transient type. Conclusions:IC should be suspected when elderly patients with underlying diseases,complaining abdominal pain,hematochezia and diarrhea,colonoscopy and pathologic study should be undertaken as early as possible. Prognosis is good when treated timely.

Background:The diagnostic accuracy of APRI and FIB-4 for liver fibrosis in patients with chronic hepatitis B is nothigh,especially for significant liver fibrosis (F≥2). Noninvasive diagnosis for liver fibrosis has become a research hotspot;and the diagnostic value of APRI combined with FIB-4 is not clear. Aims:To investigate the diagnostic value ofAPRI combined with FIB-4 for significant liver fibrosis in patients with chronic hepatitis B. Methods:A total of 171patients with chronic hepatitis B from January 2011 to October 2016 at General Hospital of Xinjiang Military Region wereenrolled. Liver biochemical indices,routine blood test and liver biopsy pathology were performed. APRI and FIB-4 werecalculated,ROC curve was drawn,and cutoff value of APRI and FIB-4 for diagnosing significant liver fibrosis wasdetermined,and mode of APRI combined with FIB-4 for diagnosing significant liver fibrosis was established. Results:Withthe increase in degree of liver fibrosis,APRI and FIB-4 were gradually increased (P < 0. 05). Area under ROC curve(AUC)for APRI and FIB-4 were 0. 812 and 0. 770,respectively. The sensitivity of FIB-4 for diagnosing significant liverfibrosis was higher than that of APRI. Sensitivity,specificity,negative predictive value,positive predictive value,andaccuracy of APRI combined with FIB-4 for diagnosing significant liver fibrosis were superior to APRI or FIB-4 used alone;and the specificity,accuracy of mode 2 were superior to mode 1. Conclusions:APRI combined with FIB-4 can increasethe accuracy for diagnosing significant liver fibrosis.

Background:With the progress and widely application of endoscopic techniques,the prevalence rate of periampullary diverticulum (PAD)is increasing in recent years. However,the results of studies investigating the correlation of PAD and its types with common bile duct (CBD)stone are different. Aims:To investigate the influence of PAD and its types on CBD stone. Methods:A total of 1524 consecutive inpatients who underwent diagnostic and therapeutic ERCP for pancreatobiliary diseases from Jan. 2014 to Dec. 2016 at the General Hospital of Xinjiang Military Region of Chinese PLA were enrolled and divided into two groups according to the presence or absence of PAD. Patients in PAD group were further classified into 3 subgroups by the papilla's location with respect to the diverticulum. Their clinical data were collected and retrospectively analyzed. Results:The proportion of elderly patients (≥60 years old)in PAD group was 82. 2% (310 /377),which was significantly higher than that in non-PAD group [60. 8% (697 / 1147),P < 0. 05]. The prevalences of CBD stone,gallstone associated with CBD stone,post-cholecystectomy and recurrent CBD stone were higher and the size of CBD stone was larger in PAD group than in non-PAD group (P all < 0. 05). Furthermore,stratified analysis revealed that the CBD stone was more prevalent and the size of stone was larger in type Ⅱ PAD than in type Ⅰ and type Ⅲ PAD (P <0. 05), while recurrent CBD stone was more frequent in type Ⅰ and type Ⅱ PAD than in type Ⅲ PAD (P < 0. 05). Multivariate analysis indicated that the elderly and PAD were the risk factors for recurrence of CBD stone,and cholecystectomy was a protective factor. Conclusions:The elderly is predisposed to PAD. PAD and its types are associated with the development and recurrence of CBD stone. CBD stone is more prevalent in patients with PAD especially type Ⅱ PAD. The size of stone is larger and the post ERCP recurrence rate is high in type Ⅱ PAD.

Adenoma ; pathology ; Colonic Neoplasms ; pathology ; Humans ; Intestinal Mucosa ; pathology

ObjectiveTo investigate the safety of endoscopic retrograde cholangiopancreatography (ERCP) after Billroth-Ⅱ gastrectomy. MethodsA total of 43 patients who were admitted to our hospital and underwent Billroth-Ⅱ gastrectomy from June 2012 to June 2015 were enrolled and underwent ERCP. ResultsOf all 43 patients undergoing ERCP, 39 (90.7%) received successful intubation, 2 (4.7%) received failed intubation, and 2 (47%) experienced the complication of digestive tract perforation. Among the 39 patients who underwent ERCP, 31 (79.5%) were diagnosed with common bile duct stones (3 underwent sphincterotomy and 28 underwent endoscopic papillary balloon dilation to remove stones), 6 (15.4%) were diagnosed with benign stenosis at the end of bile duct (4 underwent papillary balloon dilation alone and 2 underwent biliary plastic stent implantation), and 1 patient each (2.6%) was diagnosed with ampullary tumor and hepatic portal metastasis of gastric cancer and received implantation of metal and plastic stents, respectively. One patient (26%) experienced acute pancreatitis after surgery. ConclusionERCP is safe and effective in patients after Billroth-Ⅱ gastrectomy and holds promise for clinical application.

Esophageal leiomyoma is the most common benign tumor of the esophagus,usually asymptomatic.With the development and widespread application of endoscopic ultrasonography technology,its detection rate has been increasing year by year.Its diagnostic methods have evolved from initial esophagography and chest electronic computed tomography,to endoscopic ultrasonography,endoscopic ultrasonography-guided fine-needle aspiration,and endoscopic ultrasonography-guided fine-needle biopsy.The technology is constantly updated,and the diagnostic accuracy is constantly improving.The treatment methods have also shifted from previous open chest surgery to thoracoscopic surgery,and in recent years,there has been a shift towards ultra minimally invasive techniques such as endoscopic mucosal resection,endoscopic submucosal dissection,endoscopic submucosal excavation,endoscopic full-thickness resection,and submucosal tunnel endoscopic resection.This article provides a review of the diagnosis and endoscopic treatment progress of esophageal leiomyoma.

Background:At present,the detection rate of esophageal leiomyoma is increasing year by year,among which giant esophageal leiomyoma(GEL)can be caused by secondary compression,malignant and even death.The safety and effectiveness of submucosal tunnel endoscopic resection(STER)in the treatment of GEL need to be further verified.Aims:To assess the safety and efficacy of STER in the treatment of GEL.Methods:Fifteen patients who underwent endoscopic ultrasound and STER surgery from June 2020 to June 2023 at General Hospital of Xinjiang Military Region,and postoperative pathological biopsy confirmed GEL to assess the efficacy,complications,tumor recurrence and follow-up.Results:In 15 patients with GEL,8 were male and 7 female;GEL was completely resected and the margin was clean;the maximum tumor diameter was 8.5 cm;mean operation time of 52 minutes;fewer adverse events and no delayed bleeding;all underwent conservative treatment;mean hospital stay of 6 days;and no discomfort and recurrence in the postoperative follow-up.Conclusions:STER is safe and effective in the treatment of GEL.

Background: The traditional bowel preparation compound polyethylene glycol electrolyte powder (PEG) has poor tolerance in some patients due to the need for a large amount of water, which has a limited cleaning effect and affects the visual field of observation. Therefore, it is of clinical significance to find a bowel cleaning method with strong cleaning power, high safety and is acceptable to most of the patients. Aims: To explore the efficacy and safety of PEG combined with linaclotide in bowel preparation. Methods: A total of 414 patients were randomly divided into 3 groups: control group (3 L PEG group), observation group A (3 L PEG+290 μg linaclotide), observation group B (2 L PEG+290 μg linaclotide). The primary outcome was the efficacy of bowel preparation based on the Boston bowel preparation scale (BBPS), the secondary outcomes were withdrawal time, time interval from preparation to colonoscopy, incidence of complications, cecal insertion rate, detection rates of polyps, adenoma, hemorrhoid and other diseases. BBPS score in constipation subgroup was analyzed. Results: The appropriate bowel preparation rate, BBPS score, and detection rates of polyps and hemorrhoid in observation group A were significantly higher than those in control group and observation group B (P<0.05), and no significant differences in above⁃mentioned indices were found between observation group B and control group (P>0.05). There were no significant differences in cecal insertion rate, incomplete colonoscopy rate, detection rates of adenoma and other diseases, withdrawal time, time interval from preparation to colonoscopy, and incidence of adverse reactions among the three groups (P>0.05). BBPS score in constipation patients in observation group A was significantly higher than that in observation group B and control group (P<0.05). Conclusions: Linaclotide is safe and effective as an adjuvant for bowel preparation. 3 L PEG combined with linaclotide can improve the quality of bowel cleaning.