Objective:To investigate the value of the water pressure method (WPM) for endoscopic submucosal dissection (ESD) of difficult early gastrointestinal cancer.Methods:Clinical data of 7 patients with difficult early gastrointestinal cancer who underwent WPM-ESD at Digestive Endoscopy Center of Jiangsu Province Hospital of Chinese Medicine from April 2023 to April 2024 were retrospectively collected. Operation time, complete resection rate and complications were recorded.Results:WPM-ESD was successfully completed in all 7 cases. According to the lesion location and factors for difficulty, there were 2 cases of early esophageal cancer (1 case with remarkable external compression, and the other with remarkable hyperkeratosis), 1 case of early gastric cancer (a large lesion located at the greater curvature), 1 case of early descending duodenal cancer (severe submucosal fibrosis due to a history of two sessions of biopsies), 2 cases of early colon cancer (1 case with severe submucosal adipose deposition, and the other with deep submucosal invasion ), and 1 case of early rectal cancer (close to the dentate line). Operation time ranged from 15-85 min. Only 1 case required supplemental rubber-band traction. Complete resection was achieved in all 7 cases. Two patients developed fever postoperatively; no perforation, bleeding or other complications were observed.Conclusion:WPM demonstrates feasibility and efficacy for ESD in difficult early gastrointestinal cancer.

Objective:To analyze the clinical characteristics and identify predictive factors for spontaneous passage of common bile duct (CBD) stones.Methods:A retrospective analysis was conducted on patients diagnosed as having choledocholithiasis via abdominal imaging at outpatient and emergency departments of Jiangsu Province Hospital of Chinese Medicine and other medical institutions from January 2021 to November 2023. Participants were stratified into spontaneous passage versus non-passage groups. Multivariate logistic regression analysis was used to identify predictors for the spontaneous passage of common bile duct stones.Results:Spontaneous stone passage were confirmed in 70 cases (15.5%). Multivariate logistic regression analysis identified that an admission diagnosis of acute biliary pancreatitis ( OR=3.317, 95% CI: 1.427-7.713, P=0.005), larger common bile duct diameter ( OR=1.117, 95% CI: 1.000-1.248, P=0.049), and solitary stones ( OR=11.135, 95% CI: 3.602-34.418, P<0.001) significantly increased the probability of spontaneous stones. In contrast, larger stone long diameter ( OR=0.539, 95% CI: 0.441-0.659, P<0.001) markedly decreased passage likelihood. Receiver operator characteristic (ROC) curve analysis demonstrated that the common bile duct diameter predicted spontaneous stone passage with an area under the curve (AUC) of 0.662, yielding sensitivity of 52.9% (37/70) and specificity of 73.6% (51/70) at a cutoff value of 9.5 mm. The common bile duct stone diameter achieved an AUC of 0.852 for predicting spontaneous stone passage, with sensitivity of 75.7% (53/70) and specificity of 89.0% (62/70) at a cutoff value of 4.5 mm. Conclusion:Solitary small stones, ductal dilation, and an admission diagnosis of acute biliary pancreatitis are key predictive factors for spontaneous common bile duct stone passage. A common bile duct diameter ≥9.5 mm and stone long diameter ≤4.5 mm are more likely to result in spontaneous stone passage.

Objective:To investigate the value of the water pressure method (WPM) for endoscopic submucosal dissection (ESD) of difficult early gastrointestinal cancer.Methods:Clinical data of 7 patients with difficult early gastrointestinal cancer who underwent WPM-ESD at Digestive Endoscopy Center of Jiangsu Province Hospital of Chinese Medicine from April 2023 to April 2024 were retrospectively collected. Operation time, complete resection rate and complications were recorded.Results:WPM-ESD was successfully completed in all 7 cases. According to the lesion location and factors for difficulty, there were 2 cases of early esophageal cancer (1 case with remarkable external compression, and the other with remarkable hyperkeratosis), 1 case of early gastric cancer (a large lesion located at the greater curvature), 1 case of early descending duodenal cancer (severe submucosal fibrosis due to a history of two sessions of biopsies), 2 cases of early colon cancer (1 case with severe submucosal adipose deposition, and the other with deep submucosal invasion ), and 1 case of early rectal cancer (close to the dentate line). Operation time ranged from 15-85 min. Only 1 case required supplemental rubber-band traction. Complete resection was achieved in all 7 cases. Two patients developed fever postoperatively; no perforation, bleeding or other complications were observed.Conclusion:WPM demonstrates feasibility and efficacy for ESD in difficult early gastrointestinal cancer.

Objective:To analyze the clinical characteristics and identify predictive factors for spontaneous passage of common bile duct (CBD) stones.Methods:A retrospective analysis was conducted on patients diagnosed as having choledocholithiasis via abdominal imaging at outpatient and emergency departments of Jiangsu Province Hospital of Chinese Medicine and other medical institutions from January 2021 to November 2023. Participants were stratified into spontaneous passage versus non-passage groups. Multivariate logistic regression analysis was used to identify predictors for the spontaneous passage of common bile duct stones.Results:Spontaneous stone passage were confirmed in 70 cases (15.5%). Multivariate logistic regression analysis identified that an admission diagnosis of acute biliary pancreatitis ( OR=3.317, 95% CI: 1.427-7.713, P=0.005), larger common bile duct diameter ( OR=1.117, 95% CI: 1.000-1.248, P=0.049), and solitary stones ( OR=11.135, 95% CI: 3.602-34.418, P<0.001) significantly increased the probability of spontaneous stones. In contrast, larger stone long diameter ( OR=0.539, 95% CI: 0.441-0.659, P<0.001) markedly decreased passage likelihood. Receiver operator characteristic (ROC) curve analysis demonstrated that the common bile duct diameter predicted spontaneous stone passage with an area under the curve (AUC) of 0.662, yielding sensitivity of 52.9% (37/70) and specificity of 73.6% (51/70) at a cutoff value of 9.5 mm. The common bile duct stone diameter achieved an AUC of 0.852 for predicting spontaneous stone passage, with sensitivity of 75.7% (53/70) and specificity of 89.0% (62/70) at a cutoff value of 4.5 mm. Conclusion:Solitary small stones, ductal dilation, and an admission diagnosis of acute biliary pancreatitis are key predictive factors for spontaneous common bile duct stone passage. A common bile duct diameter ≥9.5 mm and stone long diameter ≤4.5 mm are more likely to result in spontaneous stone passage.

Objective To investigate the clinical utility of magnifying endoscopy combined with nar-row-band imaging( ME-NBI)and endoscopic ultrasonography( EUS)in predicting the depth of early eso-phageal cancer. Methods Sixty-eight patients with early esophageal cancer after gastroscopic and pathological diagnosis were enrolled in Jiangsu Provincal Hospital of Traditional Chinese Medicine from January 2017 to May 2018,ME-NBI and EUS were performed preoperatively to determine the depth of lesion infiltration respectively, the accuracies of the two methods were calculated by referring to the postoperative pathology,and the McNemar test and Kappa test were used for comparison. Results The lesion confined to shallow mucosa and submucosa superficial layer was confirmed in 57 patients by postoperative pathology,submucosa superficial below in 11 pa-tients. Compared with that of histology,the ability of assessment of the invasion depth was moderately consistent with ME-NBI(McNemar test P = 0. 508;Kappa = 0. 560,P < 0. 001),not with EUS(McNemar test P =0. 019;Kappa = 0. 266,P = 0. 015). The accuracy for assessing invasion depth of early esophageal cancer was 86. 8％(59 / 68)by ME-NBI,72. 1％(49 / 68)by EUS,respectively,with statistically significant difference (McNemar test P = 0. 015;Kappa = 0. 258,P = 0. 026). Conclusion ME-NBI and EUS can help to deter-mine the infiltration level of early esophageal cancer. The accuracy of ME-NBI is higher,which is of high value for the formulation of surgical plans for patients.