Objective To investigate the effects of dilute concentration and acting time of pronase on quality of gastroscopy.Methods A total of 448 patients were randomly divided into two groups : sodium bicarbonate group and pronase with sodium bicarbonate group.Pronase was diluted into 50 ml (400 U/ml)and 100 ml (200 U/ml) using sodium bicarbonate.The patients were pretreated by pronase of different concentrations 10 min, 20 min, 30 min, 60 min and 120 min before gastroscopy.Diluent of same quantity were taken by the control group.Visibility of gastroscopy, procedure times and positive rates of lesions were compared.Results Pretreatment of pronase significantly improved visibility of gastroscopy, raised positive rates of lesions, and reduced procedure times of gastroscopy, compared with the control group (each P ＜ 0.05).The visibility of gastroscopy were over 80％ 20,30, and 60 minutes before the examination with no significant difference(P ＞ 0.05).The visibility of gastroscopy decreased sharply 30 minutes after taking pronase, especially after 60 minutes.There was no significant difference in the quality of gastroscopy between the 200 U/ml and 400 U/ml group 20-60 minutes before gastroscopy (P =0.640).Conclusion Pronase (200 U/ml-400 U/ml) significantly improves visibility of gastroscopy, raises positive detection rates of lesions, and reduces procedure time of gastroscopy 20-60 minutes before pretreatment.

Objective To investigate the experience and effect of emergency endoscopic treatment for massive upper gastrointestinal bleeding (UGB) of patients after liver transplantation. Methods Clinical data of 3 patients with massive UGB after liver transplantation receiving emergency endoscopic treatment in Digestive Endoscopy Center, the Third Affiliated Hospital of Sun Yat-sen University from May 2012 to December 2013 were analyzed retrospectively. All the patients were male with the age of 44, 54 and 61 years old, and all had symptoms of haematemesis, massive melena and shock to various degrees. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were prepared by fasting, supplementing blood volume, psychologically nursing before operation. And the endoscopic instruments, medicine and emergency rescue items were prepared. The patients were kept the airway clear, doctors and nurses well cooperated and the vital signs were closely observed. Clear endoscopic field was kept during the operation and appropriate hemostasis were performed according to different situations. The patients were sent back to bed-
ward after they were stable after the operation and were handed over to the attending physician meticulously. Results For case 1, hemostatic clips were used to stop the active bleeding from contralateral bare vessels on the horn of duodenal bulb and a local injection of sclerosing agent was given. For case 2, the COOK ligator was used to ligate the esophageal varices rupture to stop the active bleeding, and tissue glue was injected at the bleeding spots of severe gastric fundus varices. The bleedings in case 1 and 2 were stopped successfully. For case 3, the stomach was filled with masses of blood clots and dark red blood and still couldn't be visible after being repeatedly washed and drainage. Thus the patient was urgently transferred to undergo embolization of the bleeding artery. This patient died of pulmonary infection, hemorrhagic shock and cardiac insufficiency after the operation. Conclusions Preoperative preparation should be well made during the emergency endoscopic hemostasis in patients with massive UGB after liver transplantation, and well cooperation of doctors and nurses, close observation on patients' condition, clear endoscopic field, appropriate hemostasis are necessary for improving the outcome.

Objective To investigate the perioperative management of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of biliary complications following liver transplantation (LT). Methods A total of 102 patients with biliary complications following LT undergoing ERCP in Digestive Endoscopy Center, the Third Afifliated Hospital of Sun Yat-sen University from December 2008 to December 2012 were included in this prospective study. There were 90 males and 12 females with the age ranging from 23 to 65 years old and a median of 56 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Positive preoperative preparations were given to the patients:personalized psychological counseling, strict disinfection of surgical instruments, application of preoperative drugs, et al. The operators and nursing staff cooperated closely during the operation. Symptomatic treatments such as fasting, transfusion, anti-infection, antacids, somatostatin were given to the patients after operation. The nasobiliary ducts were properly ifxed and the conditions were closely observed. Health guidance was given to the patients after hospital discharge. Results In 102 patients, 94 patients were treated by ERCP successfully with the success rate of 92.2% (94/102). The curative rate was 77%(72/94), the improvement rate was 20%(19/94) and the total effective rate was 97%(91/94). Postoperative complications were observed in 15 cases including hyperamylasemia (n=8), mild pancreatitis (n=4), bleeding of the papillary muscles incision (n=3), and all were cured by conservative treatments. Conclusions Positive preoperative psychological counseling, close collaboration of medical staff during the operation, close observation on the postoperative complications and health guidance after hospital discharge are important factors for the success of ERCP in treating biliary complications following LT.

ObjectiveTo investigate the application value of endoscopic retrograde cholangiopancreatography (ERCP) in biliary stricture following liver transplantation (LT).MethodsClinical data of 47 patients with biliary stricture following LT treated with ERCP in the Third Affiliated Hospital of Sun Yat-sen University between January 2008 and January 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 47 patients, 41 were males and 6 were females with the age ranging from 24 to 62 years old and the median of 51 years old. Anastomotic stricture was observed in 31 cases and non-anastomotic stricture in 16 cases. ERCP was performed on patients to localize biliary stricture and then papillotomy was performed under the support of guide wire. The stricture was dilated progressively by dilating catheter or columnar balloon through the guide wire. Endoscopic nasobiliary drainage or plastic stent placement was chosen according to the ERCP results. The evaluation of curative effect was graded by cure, improvement, inefifcacy and restenosis.ResultsAll the 47 patients underwent ERCP successfully with totally 112 times. Nasobiliary drainage was performed 79 person-times, stent placement 33 person-times. Among the 31 patients with anastomtic stricture, 28 were cured and 3 were improved. Among the 16 patients with non-anastomtic stricture, 5 were cured, 3 were improved, and 8 were ineffective. The total cured rate of all the patients was 70% (33/47) and the effective rate was 83% (39/47). The incidence of complications was 9% (4/47), including 2 cases of mild pancreatitis, 1 case of hyperamylasemia and 1 case of biliary tract infection.ConclusionERCP is safe, effective and integrated in diagnosis and treatment for biliary stricture following LT, which is the ifrst choice for non-surgery treatment.