The differential diagnosis of pancreatic head mass has been clinical difficulties.Endoscopic ultrasonography is now recognized as one of the sensitive and effective methods for the diagnosis of pancreatic diseases.This paper discusses the diagnostic performance of endo-scopic ultrasonography for various common types of pancreatic head mass,as well as the radiological features of this disease,reviews the di-agnostic value and safety of endoscopic ultrasonography-guided fine needle aspiration for pancreatic head mass,and briefly introduces the advances in the application of additional new techniques of endoscopic ultrasonography for this disease.Finally,it is pointed out that endo-scopic ultrasonography has a high diagnostic value for pancreatic head mass.

With the development of endoscopic techniques,the recent emergence of additional techniques of endoscopic ultrasound (EUS) have provided a novel means for the diagnosis and treatment of pancreatic tumors,which has received more and more attention and recogni-tion from around the world.This article reviews the progress in additional new techniques of EUS in the treatment of common pancreatic tumors.Finally,we can conclude that the additional techniques of EUS have high therapeutic values for pancreatic tumors.

With the method of endoscopic ultrasonography (EUS) and Color scale ultrasound, 156 patients with stomach and gallbladder diseases were examined, The features revealed by the EUS and color scale ultrasound for these diseases were compared with the pathological changes. The findings were that:the mean color quantity scale of benign gastric ulcer was higher than that of gastric cancer(p<0.01).The gallbladder stone was two color quantity scales higher than did polypoid lesions of gallbtadder(p<0.01).The color scale ultrasound can improve the clear degree of lesion pictures.The correct rates of diagnosis were no significant differences between color scale ultrasound and grev scale ultrasound.

In order to evaluate the use of transendoscopic miniature ultrasonic probe (TEMP) in the diagnosis of gastric submucosal tumor, 18 patients were investigated. The results obtained by TEMP were compared with those of gastroscopy, and endoscopical ultrasonography (EVS). The result showed that among those 18 patients, gastric submucosal leiomyomas, were common and accounted for 88.9％. Most of them were intramural. The diagnostic accuracy of TEMP for the size of tumor and gastric submucosal tumor was 88.9％ and 100％ respectively. Which were much higher than those of gastroscopy (33.3％ and 61.1％ respectively). The sonogrophic characteristics of gastric submucosal tumors in TEMP imaging were related to the nature of the tumors, hut the common manifestations were that all the tumors were hypoechoic under the hyperechoic mucosal layer with clear bell shaped origin, and usually appeared as round or nearly round intragastric eminence. It is concluded that the selective use of TEMP has great value in the diagnosis of gastric submucosal turmor, especially for those lesions which were small and difficult to be detected by EUS.

Objective To investigate the value of endoscopic ultrasonography ( EUS) in diagnosing pancreatic pseudocyst. Methods EUS was performed in 35 cases with pancreatic pseudocyst. Results Of the series, 41 cysts found in the head, body, tail and both body and tail of the pancreas were 13 , 3 , 19 and 6 respectively. The cystic wall was smooth in 29 cysts and rough in 6; good signal in cystic fluid 19, floccu-lar echo 16, cystic septum 1 and calcification of cyst wall 1, associated ductus pancreaticus expansion in 7, pancreas parenchyma uneven echo in 21, pancreas parenchyma calcification in 4, pancreas atrophy in 2, pancreas carcinoma in 2 , and normal pancreas in 6, protuberances impression on gastrointestinal tract 5 ( duodenal descending part obstruction, n = 1 ) stomach varicose vein in fundus 4 and digestive tract hemorrhage 2. Conclusion EUS may clearly show cyst's size, position, configuration and relation with the pancreas, also EUS guided FNA can be performed, so it has significance in diagnosing and distinguishing pancreatic pseudocyst.

70 patients with gastric carcinoma were studied by EUS prior to surgery. The results were correlated with the histology of resected specimens according to the new TNM classification. EUS was accurate in assessing the depth of tumor infiltration, the overall accuracy of EUS was 74.3%. The cancerous ulcer and obstruction are the main causes of over- and understaging, respectively. EUS was relatively accurate in the assessment of lymph node metastasis, the overall accuracy was 57.1%. However, negative-predictive rate is lower, about 42.9%. It is difficult to distinguish between inflammatory and metastatic lymph nodes. EUS was not reliable in diagnosing distant metastasis, due to its limited depth of penetration. In our experience, in staging the gastric carcinoma, greater accuracy would be achieved if we use EUS for T and N factors, and CT for M factor.

The purpose of this study was to investigate clinical feasibility of treatment of pancreatic pseudocyst by endoscopy. We reported here one case of large pancreatic psuedocyst that was treated by endoscopic ultrasonography guided cystogastrostomy.The patient's symptoms resolved on the same day of operation. And one week later, the pancreatic pseudocyst decreased by more than 50% in size. Pancreatic psuedocyst resolved and didn't relapse after 6 months. So endoscopic ultrasonography guided cystogastrostomy is a safe, reliable, effective therapy for pancreatic pseudocyst with few complications.

Objective Clinical features of primary biliary cirrhrosis(PBC) were reviewed in order to improve its diagnosis and treatment. Method The general conditions, clinical manifestations, biochemical and immunological changes, and pathological findings were assessed in 31 patients. Result Twenty five cases were females, the mean age at definite diagnosis was (49.2?10.7)years. Jaundice(74.2%) was the most frequent symptoms, pruritus (51.6%) and fatigues (32.3%)were the second and thrid, respectively. Three patients (9.7%)were complicated by ascites. Serum alkline phosphatase (ALP) , glutamyl transpeptidase (? GT) and bilirubin levels were markedly elevated ((388.9?277.5)U/L, (381.6?213.2)U/L and( 176.4 ?176.1)?mol/ L, respectively).ALT and AST levels were mildly or moderately elevated ((79.7?46.3) U/L and(119.8?61.2)U/L, respectively),mean level of IgM was also elevated to (3.0?1.9)g/L. 92% (23/25) of patients had positive anti mitochondrial antibody(AMA). Ursodeoxycholic acid (UDSA) was efficitive in 61.3% of patients. Conclusions PBC most frequently affects middle aged women. The elevated level of ALP, ? GT and IgM and AMA positive may be crucial to diagnosis of PBC. Liver biopsy can help to identify the diagnosis and carry on pathological staging.

Objective:To evaluate the diagnostic value of endobronchial ultrasonography(EUS)-guided fine-needle aspi-ration(FNA)in diagnosis of lung cancer.Methods:EUS-guided FNA was used in16patients suspected of lung cancer of sub-mucosal and parabronchial structures.Bronchoscopic methods failed to detect any abnormality in them.Results:Final diag-noses were made in15patients,including8cases of bronchopulmonary adenocarcinoma,4cases of bronchopulmonary squa-mous carcinoma and3cases of lymphatic metastasis of bronchral adenocarcinoma.The sensitivity of EUS-guided FNA was 93.8%. There was no severe complications associated with the use of EUS.No patients developed bleeding or pneumatotho rax.Conclusion:EUS is useful in detecting pathologic changes in the submucosal and parabronchial structures.EUS guided FNA is accurate and safe for diagnosis of lung cancer,especially in small nodes.

Objective To evaluate the endoscopic papillectomy (EP) for ampullary adenoma (AA). Methods The resection rate, complications, local residual rate and local recurrence of EP for AA at endoscopy center of Changhai Hospital were retrospectively reviewed. Results From July 2005 to July 2009, a total of 19 patients with endoscopically diagnosed and pathologically confirmed AA underwent EP, in which 18 cases were scattered AA (94. 7%) including 1 case of multiple adenomas in duodenum, and 1 (5.3%) was familial adenomatous polyposis (FAP). The lesion was resected en bloc in 11 cases (57.9%) , and piecemeal in 8 (42. 1%). All patients were followed up at a mean period of 24. 5 months (range 7-48 months). The residual rate after first EP was 21. 1% (4/19), and the total success rate was 89.5% (17/19). Short-term complications after EP included 3 cases of bleeding, 3 cases of mild acute pancreatitis and 2 cases of acute cholangitis. Long-term complications were 1 case of stenosis of the common bile duct (CBD) orifice accompanied with acute cholangitis, 1 case of CBD stone and 1 case of acute cholangitis after stent placement. No such severe complications as perforation or procedure-related death was observed.Conclusion EP is a safe and effective modality for ampullary adenoma.