Risk factors of pain during colonoscopic examination / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the risk factorsthat predict pain during colonoscopy for decision of sedation or analgesia before the examination.</p><p><b>METHODS</b>A total of 283 consecutive patients undergoing colonoscopicexamination at Nanfang Hospital between July, 2016 and September, 2016were retrospectively analyzed. The clinical data and visual analogue scale after the examination were analyzed to identify the risk factors for pain during colonoscopy using univariate analysis and multivariate logistic regression. A risk stratification model for predicting pain in colonoscopy was established.</p><p><b>RESULTS</b>The completion rate of the procedure was significantly lower in patients with a visual analogue scale ≥5 (P<0.000). Univariate analysis showed that female patients, previous abdominal surgery, no previous experience with colonoscopy, complaint of abdominal pain before colonoscopy, insufficient experience of the endoscopists, patient's anticipation of high painlevelbefore examination, and a low body mass index (BMI) were all associated with the experience of pain in colonoscopy (P<0.05). Multivariate logistic regressionanalysis identified BMI index (X), level of experience of the endoscopist (A, A, A) and the patient's anticipation of painlevel (X) as the risk factors of pain in colonoscopy(P<0.05), and the establishedmodel with the 3 variables was: P=e/(1+e),Y=0.049-0.124×X-0.97×X+1.713×A+0.781×A+0.147×A, which showed a sensitivity of 70.3% and a specificity of 67.5%for predicting pain in colonoscopy.</p><p><b>CONCLUSION</b>The patient's anticipation of a high pain level in colonoscopy, insufficient experience of the endoscopist, and a low BMI are the independent risk factors for pain in colonoscopy, and evaluation of these factors can help in the decision-making concerning the use of sedation or analgesia before colonoscopy.</p>

Value of urgent colonoscopy in diagnosis of severe acute lower gastrointestinal bleeding in patients with different bowel cleanliness / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the value of urgent colonoscopy in the diagnosis of severe acute lower gastrointestinal bleeding and the optimal bowel preparation before examination.</p><p><b>METHODS</b>The clinical data were collected from 188 patients undergoing wither urgent or elective colonoscopy for severe acute lower gastrointestinal bleeding in Nanfang Hospital. Univariate analysis was used to assess the effect of the timing of colonoscopy on the diagnostic rate of hemorrhage, and a multivariate model which stratified bowel cleanliness was used to analyze the impact of bowel cleanliness on the diagnostic rate of urgent colonoscopy.</p><p><b>RESULTS</b>Of the 188 patients, 118 underwent urgent colonoscopy and 70 underwent elective colonoscopy examinations. The diagnostic rates were comparable between the two groups (44.1% vs 41.4%, P=0.724), but urgent colonoscopy resulted in a significantly higher diagnostic rate for identifying the bleeding source (32.2% vs 18.6%, P=0.041). The proportion of the patients taking oral laxatives was significantly lower in urgent colonoscopy group (P<0.001). Oral laxatives versus enema resulted in good, moderate, and poor bowel cleanliness in 63.6% vs 13.5%, 28.6% vs 24.3%, and 7.8% vs 62.2% of the patients (P<0.001). Univariate analysis indicated that good bowel cleanliness was associated with a significantly higher diagnostic rate of colonoscopy than poor bowel cleanliness (P=0.012). Multivariate analysis showed that with good bowel cleanliness, urgent colonoscopy yielded a significantly higher diagnostic rate than elective colonoscopy (P=0.030); subgroup analyses suggested that good bowel cleanliness improved the diagnostic rate of urgent colonoscopy as compared with poor bowel cleanliness (P=0.015).</p><p><b>CONCLUSION</b>In patients with good bowel cleanliness, urgent colonoscopy yields a higher diagnostic rate than elective colonoscopy for severe acute lower gastrointestinal bleeding. Poor bowel cleanliness resulting from bowel preparation by enema significantly lowers the diagnostic performance of urgent colonoscopy. Oral laxatives are recommended over enemas for bowel preparation before urgent colonoscopy when the patients have stable hemodynamics.</p>

The study on retention of gastroscopy skills after simulator training / 中华医学教育探索杂志

ObjectiveTo investigate whether the eight- year program students retain the skills from the endoscopy simulator gastroscopy training.Methods4 trainees accepted virtual reality simulator gastroscopy training and performed a standardized VR gastroscopy scenario at the end of training,and after a median 12 months without practice ( retention ).The intensified training was done by trainees based on the differences between the training end and the retention for a median 12 months and the number of intensified training times was found.ResultsThe significant differences existed in the overinsufflation and opeirational force and time.The score at the training end was better than after retention.Through the average 5.5 times intensified trainings the original levels could be reached.ConclusionThrough Endoscopy Simulator the key skills could be retained well and through a litde training the original levels could also be reached.

Value of deep small-bowel endoscopy in the diagnosis of Crohn's disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the value of deep small-bowel endoscopy (DSBE) in the diagnosis of Crohns disease (CD).</p><p><b>METHODS</b>The endoscopic and clinical data of 54 patients with CD receiving capsule endoscopy (CE) and double-balloon enteroscopy (DBE) between January, 2004 and December, 2008 were summarized and analyzed retrospectively.</p><p><b>RESULTS</b>The main indications for DSBE in our series were suspected CD (42.6%) and obscure gastrointestinal bleeding (25.9%). DSBE was obviously superior to barium imaging. The detection rate of CD was significantly higher with DSBE (92.6%) than with ileocolonoscopy (75.9%, P=0.017), and DSBE provides much more detailed descriptions of specific endoscopic features such as segmental distribution and lumen changes. DSBE significantly improve the diagnostic efficiency, giving priority to offer a guide and raise suspected diagnosis for CD.</p><p><b>CONCLUSION</b>DSBE is a valuable modality for detecting CD lesions in the jejunum and ileum and for evaluating lesion involvement and severity. The combination with a comprehensive analysis of routine imaging findings, gastro endoscopy, and clinical data can further enhance the diagnostic efficiency of DSBE.</p>

Correlation of the autophagosome gene ATG16L1 polymorphism and inflammatory bowel disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To understand the relationship between the susceptibility to inflammatory bowel disease (IBD) and ATG16L1 gene single nucleotide polymorphism (SNP) site, rs2241880.</p><p><b>METHODS</b>Peripheral blood samples were collected from 80 IBD patients (including 40 with Crohn's disease and 40 with ulcerative colitis) and 50 healthy controls, and the genomic DNA was extracted from the white blood cells. Specific primers were designed according to the target gene sequence for PCR amplification of the target gene fragment, and the PCR products were purified followed by sequence analysis of the target region of ATG16L1 gene. The results of the sequence analysis were compared with the BenBank data to analyze the relationship between the allele gene polymorphisms and the susceptibility to Crohn's disease.</p><p><b>RESULTS</b>No significant differences were noted in the ATG16L1 gene SNP site rs2241880 polymorphisms among the patients with Crohn's disease, ulcerative colitis and the control subjects (Chi(2)=4.94, P=0.293).</p><p><b>CONCLUSION</b>ATG16L1 gene polymorphisms in the SNP site rs2241880 are not found to correlate to the susceptibility to Crohn's disease as reported in literature. The SNP site associated with Crohn's disease susceptibility identified in foreign populations does not seem to be identical with that in Chinese population.</p>

Experimental study of preventing postoperative stenosis by modifying artificial esophagus in dogs / 中国医学科学院学报

<p><b>OBJECTIVE</b>To observe the effect of the modified artificial esophagus on postoperative stenosis in dogs.</p><p><b>METHODS</b>The models of defected esophagus were established in dogs. The double-layered membrane tube (modifying type) was implanted in the test group (n = 10) and the esophageal stent was further inserted when the stenosis occurred. The single pattern tube (original type) was transplanted to the control group (n = 30). The dilation treatment was performed to relieve the postoperative stenosis; alternatively, the esophageal stent was implanted in the unsuccessful dogs.</p><p><b>RESULTS</b>The average artificial esophagus removal time was 19.10 days in the test group, which was significantly lower than 39.07 days in the control group (t = 15.6, P = 0.000). No obstruction after removal was observed in the experimental group. The incidence of postoperative stenosis had no significant difference between these two groups.</p><p><b>CONCLUSION</b>The double-layered membrane tube can make the tube removal safer by shortening the removal time.</p>

Clinical classification of Peutz-Jeghers syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>To propose the clinical classification of Peutz-Jeghers syndrome (PJS).</p><p><b>METHODS AND RESULTS</b>Retrospective analysis of 52 patients with PJS admitted in Nanfang Hospital from 1980 to 2003 was conducted. Twenty-four patients were found to have family history of PJS, who had a mean age of 19 years. In the PJS patients, the incidence of gastric polyps was 64.4%, colorectal polyps 76%, and small bowel polyps 95%. The number of polyps was above 50 in 19 of the 31 patients with gastric polyps, in 18 of the 38 patients with colorectal polyps, and in 8 of the 19 patients with small bowel polyps. The pathology of the majority of the polyps (63/108) was characterized by hamartomas, and the incidence of malignancy was 13.5% in the PJS patients.</p><p><b>CONCLUSIONS</b>PJS can be classified according to family history and location, pathology, and number of the polyps. As most patients with over 50 polyps require surgical intervention, 50 polyps is recommended as the criteria for PJS classification. Endoscopic surgery may suffice for management of patients with fewer polyps (<50), while in patients with more polyps or small bowel polyps, open surgery combined with intraoperative endoscopic surgery is recommended.</p>

Comparison study on diagnostic value of ERCP,US and CT on clonorchiasis and clonorchiasis-related cholangiopancreatic diseases / 中华消化杂志

Objective To explore the diagnostic value of endoscopic retrograde cholangio-pancreatiography (ERCP),ultrasonography (US) and CT scanning on cholagio-pancreatic diseases caused by clonorchis sinensis infection.Methods The results of US,CF and ERCP examination in 65 cases of obstructive jaundice caused by clonorchiasis and confirmed by presence of imagoes or eggs in feces or bile juice were analyzed and compared retrospectively.Results US examination was the simplest and most convenient which was characterized by diffuse even dilatation,thickening of walls,strengthened echo with the shape of“equal sign”intrahepatic bile ducts.The characteristic findings of CT included saccular dilatation of bile ducts of the periphery of the liver,thickening of the walls of bile ducts.Under duodenoscopy,32.3% (21/65) of cases presented as abnormal papilla such as small opening,mucosa outward turned,trapping or stiffness.Alterations in ERCP were characterized by shm or oval filling defect,diffuse saccular dilatation of terminal intrahepatic bile ducts.The most common complications included cholangiolithiasis (40%,26/65),carcinoma of bile duct on papilla (9.8%,6/65),and pancreatitis (1.5%,1/ 65).Conclusions Three methods were all useful for diagnosis of cholangio-pancreatic diseases caused by clonorchis sinensis infection,which were identically characterized by diffuse saccular dilatation of terminal intrahepatic bile ducts.The gold standard of diagnosis was the presence of imagoes or eggs in bile juice aspirated by the route of ERCP.Endoscopic sphincterectomy with postoperative vermifugal was the first choice of the treatment.