Consensus on endoscopic anterior fundoplication with MUSE for gastroesophageal reflux disease / 中华消化杂志

Endoscopic anterior fundoplication with the MUSE is an endoscopic therapy that combines ultrasound and endoscopic anti-reflux technology for moderate to severe gastroesophageal reflux disease. Training and learning procedures are required to obtain qualifications for this endoscopic therapy before clinical operations. At present, there is limited high-quality evidence-based medical evidence on MUSE treatment, and lack of expert consensus or guidance for training and the standard of MUSE therapy procedure. This consensus is based on the published literature, and formulated by experts with MUSE clinical experience in China, to provide guidance for the training and clinical standard operation of this technique.

Animal experimental study on the examination of upper digestive tract with medical disposable portable endoscopy / 中华消化杂志

Objective:To evaluate the safety, feasibility and operational performance of self-developed medical disposable portable endoscopy (YunSendo) for upper gastrointestinal endoscopy examination in Ba-Ma mini-pigs.Methods:A total of 10 Guangxi Ba-Ma mini-pigs were used in the experiment, and mucosal injury models were established in advance by biopsy forceps in esophagus, stomach, and duodenum. Each experimental animal underwent medical disposable portable endoscopy and Olympus endoscopy (GIF-Q260J) performed by two endoscopists separately. The time when the endoscope reached the duodenum, the number of detected mucosal injuries and endoscopic pictures of different parts with standard image acquisition were recorded. Endoscopic operational performance and endoscopic image quality were evaluated. Different endoscopists recorded experimental results with blind method. The procedures of the two endoscopic examinations were performed by coin-tossing method. The paired t test was used for statistical analysis. Results:There were no statistically significant differences in the insertion time and total operation time between medical disposable portable endoscopy and Olympus endoscopy ( (171.00±9.96) s vs. (164.00±17.84) s, (285.00±33.94) s vs. (273.40±23.46) s; t=1.289 and 1.281, P=0.230 and 0.232). There were no statistically significant differences in the percentage of time of clear visual field during endoscopy insertion and total operation between medical disposable portable endoscopy and Olympus endoscopy ((91.83±1.85)% vs. (91.52±1.51)%, (93.07±3.10)% vs. (92.06±2.57)%; t=0.401 and 0.689, P=0.698 and 0.508). Moreover, there were no statistically significant differences in the score of comprehensive operation performance, score of clear image number, score of image color recognition, score of image illumination, comprehensive score of image quality and number of detected mucosal injuries ((9.66±0.30) points vs. (9.86±0.15) points, (39.50±0.71) points vs. (39.30±1.06) points, (39.70±0.48) points vs. (39.40±0.70) points, (39.40±0.70) points vs. (39.50±0.71) points, (9.88±0.09) points vs. (9.85±0.20) points, 9.80±0.42 vs. 9.90±0.32; t=2.176, 1.000, 1.152, 0.317, 0.629 and 0.557, all P>0.05). There were no adverse events after operation in medical disposable portable endoscopy group and Olympus endoscopy group. Conclusions:The medical disposable portable endoscopy is safe and feasible for endoscopy examination in live animal models. Different parts of upper gastrointestinal tract and mucosal lesions can be clearly detected. The operational performance and the image quality are excellent, which is similar to Olympus endoscopy (GIF-Q260J).

Fecal microbiota transplantation as a novel therapy for severe psoriasis / 中华内科杂志

To explore the therapeutic effect of fecal microbiota transplantation (FMT) for severe psoriasis. A patient, male, 36 years old, diagnosed as severe plaque psoriasis for 10 years and irritable bowel syndrome (IBS) for 15 years, was administrated twice FMT via both upper endoscopy and colonoscopy with a 5-week interval. The following items were used to evaluate responses: body surface area (BSA), psoriasis area and severity index (PASI), dermatology life quality index (DLQI), histological examination, intestinal symptoms, adverse reactions and serum level of tumor necrosis factor (TNF)-α. After second FMT treatment for 5 weeks, aforementioned items were improved greatly compared with those before treatment. Moreover, IBS was completely relieved and no adverse reactions were observed during the treatment and follow-up. In conclusion, FMT could be a novel therapy for psoriasis. Further clinical trials are needed to provide solid evidences.

Fecal microbiota transplantation as a novel therapy for severe psoriasis / 中华内科杂志

[Summary] To explore the therapeutic effect of fecal microbiota transplantation (FMT) for severe psoriasis. A patient, male, 36 years old, diagnosed as severe plaque psoriasis for 10 years and irritable bowel syndrome (IBS) for 15 years, was administrated twice FMT via both upper endoscopy and colonoscopy with a 5‐week interval. The following items were used to evaluate responses: body surface area (BSA), psoriasis area and severity index (PASI), dermatology life quality index (DLQI), histological examination, intestinal symptoms, adverse reactions and serum level of tumor necrosis factor (TNF)‐α. After second FMT treatment for 5 weeks, aforementioned items were improved greatly compared with those before treatment. Moreover, IBS was completely relieved and no adverse reactions were observed during the treatment and follow‐up. In conclusion, FMT could be a novel therapy for psoriasis. Further clinical trials are needed to provide solid evidences.

Fecal microbiota transplantation for the treatment of ulcerative colitis: a Meta-analysis / 中华内科杂志

Objective We aimed to evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for the treatment of ulcerative colitis (UC) in this Meta-analysis.Methods Literature related to FMT for the treatment of UC from PubMed,Embase,Cochrane databases,CNKI,VIP and Wanfang Data were searched and screened with update study in May 2018.Two independent investigators extracted information according to inclusion and exclusion criteria.The Meta-analysis was conducted by Stata 12.0 software.Results A total of 4 randomized controlled trials (RCTs) and 19 non-randomized controlled trials (non-RCTs) including 536 participants met the inclusion criteria.Meta-analysis of RCTs showed that FMT significantly increased the clinical remission rate (OR=2.47,95％CI 1.40-4.33,P=0.02) and clinical response rate (OR=1.86,95％CI 1.15-3.02,P=-0.01) in UC patients without increasing the incidence of severe adverse effects (OR=1.40,95％CI 0.51-3.79,P=-0.51).The results from 19 non-RCTs showed that clinical remission rate in UC patients with FMT treatment was 20％(95％CI 13％-28％) and the clinical response rate was 50％(95％CI 36％-65％).All adverse events were graded as mild and self-resolving.No FMT-related severe adverse effects were reported.Conclusions Our analysis suggests that FMT is a safe and effective method for the treatment of UC.Considering several limitations of this Meta-analysis and previous clinical trials,further large-scale multicenter RCTs are still required to further verify the conclusion.

Animal study on master-slave system controlled robot-assisted flexible endoscopy in gastricendoscopy examination / 中华消化杂志

Objective@#To evaluate the safety, feasibility and operational effectiveness of master-slave system controlled Robot-assisted flexible endoscopy 'YunSRobot’ in upper gastrointestinal endoscopy examination in living pigs. @*Methods@#Seven Guangxi BA-MA Mini-pigs underwent upper gastrointestinal endoscopy examination with master-slave system controlled Robot-assisted flexible endoscopy 'YunSRobot’ and Olympus GIF-Q260J gastroendoscope (Japan). The experiment divided into manual operation group and robot operation group. Nine gastroenterologists skilled with endoscopy operation handled the robot once in vitro to familiar with the mechanism and method of robot operation. And then performed manual operation and robot operation four times each. Endoscopy pictures and operation time were recorded. T test and one-way analysis of variance were performed for statistical analysis. @*Results@#Both manual operation and robot operation could successfully finish standard esophagus and stomach endoscopic examination. There were no complications such as hemorrhage, perforation, mistaken insertion into of trachea, injures of pharynx and larynx and inhalation pneumonia. Esophagus, gastric cardia, gastric fundus, gastric body, gastric angle, gastric antrum and gastric pylorus could be clearly observed in both groups. The manual operating time of nine gastroenterologists was (3.67±1.95) minutes, which was shorter than that of robot operating time ((7.60±2.00) minutes), and the difference was statistically significant (t=8.445, P<0.01). The time of first in vitro operation performed by nine gastroenterologist was (13.10±6.32) minutes. The operation times of each case of nine gastrienterologist were (8.49±0.90) minutes, (7.50±1.19) minutes, (7.30±1.33) minutes and (7.12±1.61) minutes. The difference was statistically significant (F=7.901, P<0.01). Operation time gradually shortened and operation proficiency significantly improved. @*Conclusion@#Master-slave system controlled Robot-assisted flexible endoscopy 'YunSRobot’ which provides a clear observation of esophagus and stomach is safe in endoscopic examination of living animal.

Therapeutic effect of endoscopic anterior fundoplication by MUSETM in thirteen patients with gastroesophageal reflux disease / 中华消化杂志

Objective To evaluate the efficacy and safety of endoscopic anterior fundoplication by the MUSETM endoscopic stapling device in gastroesophageal reflux disease (GERD).Methods From March to November 2017,in the Department of Gastroenterology of Chinese PLA General Hospital in Beijing,The First People's Hospital Affiliated to Shanghai Jiao Tong University and Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,thirteen GERD patients who underwent the endoscopic anterior fundoplication by the MUSETM system were enrolled.The GERD health related quality of life questionnaire (GERD-HRQL) score,satisfaction of symptomatic control,questionnaire for gastroesophageal reflux disease (GERD-Q) score,the degree of esophagitis,condition of gastroesophageal flap valve,medicine administration and side effects were compared before and after the operation.Paired t test and Wilcoxon rank sum test were performed for statistical analysis.Results The total GERD-HRQL score decreased from 23 points (14 to 36 points) before operation when proton pump inhibitor (PPI) was stopped for seven days to 3 points (0 to 21 points) at three months after operation and 1 point (0 to 18 points) at six months after operation;and the differences were statistically significant (Z=-3.111 and -3.183,both P＜0.01).Among 13 patients,the GERD-HRQL score of 11 patients decreased over 50 ％ after operation.The heartburn score decreased from 21 points (13 to 29 points) before operation when PPI was stopped for seven days to 0 point (0 to 17 points) at three months after operation and 0 point (0 to 16 points) at six months after operation;and the differences were statistically significant (Z=-3.113 and -3.182,both P＜0.01).Among 13 patients,assessment of symptom control at three months after operation of seven patients were satisfactory,four patients were mostly satisfactory and two patients were unsatisfactory;assessment of symptom control at six months after operation of nine patients were satisfactory,four patients were mostly satisfactory;and the satisfaction rate were both higher than that before operation,and the differences were statistically significant (x2=16.235 and 25.159,both P＜0.01).The total GERD-Q score reduced from 13 points (8 to 17 points) before operation to 6 points (3 to 11 points) at three months after operation and 6 points (6 to 13 points) at six months after operation (Z=-3.192 and-3.066,both P＜0.01).DeMeester score decreased from 38.40 points (20.20 to 255.30 points) to 11.10 points (1.10 to 46.20 points) at six months after operation;and the percent of total time of esophageal pH＜4 reduced from 10％ (5％ to 75％) to 3％ (0 to 13％) at six months after operation;the difference was statistically significant (Z=-3.181 and-3.180,both P=0.001).There was no significant difference in esophageal motility changes before and after treatment (all P ＞ 0.05).The number of patients without esophagitis increased from three before treatment to eight after treatment.Additionally,the number of patients whose gastroesophageal flap valve was less than grade Ⅱ increased from three before operation to 11 at six months after operation.The patients were followed up for six months,among 13 patients,10 patients were completely deprived of PPI,one patient was reduced over 50％,and two patients were treated with less than 50％ reduction.All 13 patients had mild tolerable abdominal pain and sore throat within 48 hours after operation.No other adverse reactions were observed.Conclusion The endoscopic anterior fundoplication by the MUSETM is a safe and effective treatment for GERD.

Diagnostic value of intestinal-gas-injection capsule endoscopy for small intestinal diseases / 中华消化内镜杂志

Objective To investigate the effect of capsule endoscopy on the small intestinal mucosa in the state of air insufflation. Methods Patients undergoing capsule endoscopy from November 2011 to April 2012 were divided into the air insufflation intervention group ( n＝14) and routine examination group (n＝13) by random number table method. The detection rate of small bowel disease, the transit time of capsule endoscope in small intestine, the degree of intestinal cleaning and the degree of intestinal lumen expansion were compared between two groups. Results There was no significant difference in total intestinal examination rate [ 85. 71%( 12/14) VS 61. 54%( 8/13),P＝0. 209] or disease detection rate [ 71. 43%(10/14) VS 84. 62%( 11/13), P＞0. 05] between air insufflation intervention group and conventional examination group. The mean procedure time of the air insufflation intervention group was 270. 86 ± 144. 85 min, which was shorter than that of the conventional examination group (325. 15±161. 76 min, P＝0. 369). The overall cleanliness of the air insufflation intervention group was higher than that of the conventional examination group (2. 05±0. 40 VS 1. 75±0. 40,P＝0. 060). The overall degrees of expansion of small intestine lumen were 1. 79 ± 0. 40 and 1. 38 ± 0. 29 scores, respectively ( P ＝ 0. 004 ). Conclusion Capsule endoscopy can significantly improve the degree of intestinal lumen expansion with trend of improving the overall cleanliness of the small intestine, and shortening the working time of the small intestine.

The robot-assisted system YunSRobot for soft endoscopy: a trial of remote manipulation on simulation models / 中华内科杂志

Objective To evaluate the feasibility and safety of the robot - assisted system YunSRobot for remote manipulation endoscopy. Methods When the master of YunSRobot was installed in the gastroenterology office in Chinese PLA General Hospital, the robot slave and upper gastrointestinal simulation model (Takahashi Lm103,Japan) were installed at the same time in the State Key Laboratory of Robotics, Shenyang Institute of Automation. Three physicians were trained to operate the master robotics and performed gastroscopy on the simulation model based on network cloud. Each physician performed 3 procedures of oesophagogastroduodenoscopy (EGD) by YunSRobot using traditional manual endoscopy, on-site operating mode, and remote manipulation mode, respectively. The operating time, lumenal anatomic exposure,man-machine interaction and other parameters were recorded. Results The number of standard pictures obtained by traditional manual endoscopy group, on-site operating group and remote manipulation group were 39.9±0.3, 39.8±0.4, 39.9±0.3, respectively. The images of all five lesions could be obtained by each operation. The operating time in the duodenum of remote group was longer than that of on-site group, with average time (78.2±16.0)s vs. (68.9±15.8)s (P=0.021) respectively. As to the operating time on other parts or total time, all three groups were comparable. Although there was a mean delay of (572.1±48.5) ms in remote operation group, the operation was still smooth. However, compared with on-site group, the percentage of clear view time in the duodenum was significantly shortened in remote group: [(77.8±8.2)% vs. (83.9 ± 6.4)% , P=0.024]. Statistically significant difference was detected in percentage of clear view time neither in other sites, nor was in the total operating time between two groups. The operating time in each part of remote group was obviously longer than that of manual group as followings, pharyngeal (27.3±4.2) s vs. (9.2±1.3)s (P<0.001), esophageal (29.7±6.4)s vs. (19.3±1.6)s (P=0.004), stomach (56.7±17.0)s vs. (40.3±7.0)s (P=0.003), pylorus (20.2±5.5)s vs. (9.3±1.3)s (P<0.001), duodenum (78.2±16.0)s vs. (29.3±5.6)s (P<0.001). Thus the total operating time was also longer in remote group as (559.0±87.2)s vs. (253.1±16.6)s (P<0.001). The respective time in pharynx, esophagus, stomach, pylorus, duodenum, or the overall time was all longer in remote group than that in manual group. Conclusions The soft endoscopy robot YunSRobot has satisfactory safety and stability. Remote upper gastrointestinal endoscopy can be completed based on common network and an endoscope simulation model with smooth operation. The inspection time by YunSRobot robot per part and the overall time are longer than those of manual operation on site, still, remote operating time meets the standard of upper gastrointestinal endoscopy.

Value of endoscopic resection on duodenal space-occupying lesions / 中华消化内镜杂志

Objective To assess the clinical value and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for duodenal lesions.Methods The data of 12 patients with duodenal space-occupying lesions underwent EMR or ESD from January 2010 to December 2015 in Chinese PLA General Hospital were retrospectively analysed.Results All patients received operation, including 9 male and 3 female with mean age of 50.0 years(33.0-62.0 years).There were 8 lesions in duodenal bulb and 4 in descending part.The mean diameter of the lesions was 1.2 cm (0.5-3.0 cm).Three lesions were originated from mucosa, of which 2 were high-grade intraepithelial neoplasia and 1 was villous/tubular adenoma.Nine lesions were located in submucosa, including 3 cases of neuroendocrine neoplasm, 1 case of stromal tumor, 1 liomyoma case, 1 lipoma case, 1 case of Brunner glands adenoma, 1 case of ectopic pancreas, and 1 inflammatory lesion.One patient had perforation with rate of 8.3%(1/12) and was recovered after conserved treatment.The bleeding was very little during operation.No infection or stenosis happened.The mean hospitalized time was 6.0 days (1.0-12.0 days) after operation.No recurrence was found during 23.8 months(3.0-73.0 months) of follow-up.Conclusion EMR and ESD are effective and safe for treatment of duodenal space-occupying lesions.

Human Micro-Ecological Research Ethics: A New Field of Bioethics / 中国医学伦理学

The rapid development of human micro-ecology (human microbiome) in recent years has opened up new medical prospects for revealing the close relationship between microorganism and human health and disease.As the second genome of human,the special relationship between the microorganism and the host and its important function have brought new ethical and social problems,which requires to rethink and reform the existing ethical norms.This paper focused on the seven perspectives of “identity”,ownership,informed consent,risk benefit assessment,privacy,commercialization and public health,and demonstrated the importance to construct the ethics of micro-ecological research,which would enrich and expand the connotation of bioethics in theory and better guarantee the benign development of micro-ecology research in practice.

Advances in research of anti-aging mechanism / 解放军医学杂志

Aging is a biological process and state characterized by morphological change, hypofunction and metabolic disorder, often accompanied by severe degenerative diseases, including amyotrophy, atherosclerosis, neurodegeneration, and so on. Age-related diseases not only decrease the life quality of the elderly, but also impose great burden on family and society. As population aging, we are increasingly coming to realize that the longevity we want should be healthy aging but not simple increase of lifespan. By researching on the yeast, C. elegans, drosophila, mice and humans, we get to know the mechanisms of aging and methods for anti-aging, such as dietary restriction and use of anti-aging drugs like rapamycin. In this review, we summarized mainly the studies on mechanisms of aging and elaborate associated anti-aging strategies and underlying mechanisms.

Esophageal motility characteristics in gastroesophageal reflux disease patients with or without dysphagia / 中华消化杂志

Objective To investigate esophageal motility characteristics in gastroesophageal reflux disease (GERD) patients with or without dysphagia by high-resolution manometry and 24 h esophageal pH monitoring.Methods From August 2012 to November 2015,GERD patients with symptoms of acid reflux and heart burn who received 24 h esophageal pH monitoring were collected.The differences in esophageal motility were further analyzed between the GERD patients with dysphagia and without dysphagia.Student's t test,x2 test and Fisher's exact test were performed for comparison analysis.Results A total of 194 patients received 24 h esophageal pH monitoring and diagnosed as GERD,and at the same period completed esophageal high-resolution manometry.Among them,there were 17 GERD patients (8.8％) with dysphagia and 177 patients (91.2％) without dysphagia.The main classification of esophageal motility disorder of GERD patients with dysphagia was severe esophageal motility disorders (5/ 17),but the motility type of GERD patients without dysphagia patients mainly was mild esophageal motility disorders (10.2％,18/177).The integrated relaxation pressure,residual pressure of lower esophageal sphincter (LES),and contraction range at 3 cm and 11 cm above LES of GERD patients with dysphagia were all higher than those of patients without dysphagia ((9.70±0.98) mmHg (1 mmHg=0.133 kPa) vs (7.02±0.30) mmHg,(12.75±1.35) mmHg vs (9.18±0.42) mmHg,(106.80± 11.97) mmHg vs (70.82±3.48) mmHg,(82.66±10.70) mmHg vs (56.93±3.11) mmHg),and the differences were statistically significant (t=2.601,2.488,2.887,2.308,all P＜0.05).Distal esophageal contraction integral score of GERD patients with dysphagia was significantly higher than that of GERD patients without dysphagia ((2 128.94±310.47) mmHg · cm · s vs (1 029.88±90.16) mmHg · cm · s),and the difference was statistically significant (t =3.400,P =0.001).However,residual pressure of upper esophageal sphincter was significantly lower than that of patients without dysphagia ((2.84±1.21) mmHg vs (6.18±0.38) mmHg,t=-2.650,P=0.009).Conclusions Esophageal motility disorder of GERD patients with dysphagia is severer than that of patients without dysphagia.High resolution esophageal manometry can provide objective evidence of esophageal dynamics of GERD patients,which can guide the diagnosis and treatment of GERD.

Limited endoscopic sphincterotomy plus balloon dilation (ESBD)for large choledocholithiasis ac-companied with periampullary diverticula / 中华消化内镜杂志

Objective To explore the effectiveness and safety of limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD)for patients with large common duct stones and periampul-lary diverticula (PAD).Methods Data of 40 patients with large common duct stones (diameter ≥10 mm) and PAD who underwent ESBD were retrospectively reviewed.The clinical feature,operation method,suc-cess rates of stone removal and early complications rates during hospitalization were evaluated according to PAD subtypes.Results The stone removal rate in first session was 90.0%(36 /40,with a median time of 29 minutes per procedure.Three patients underwent a second procedure to remove residual stones.The over-all stone removal rate was 97.5% (39 /40).The early complications rate was 15%(6 /40),including mild pancreatitis in two cases(5%),hyperamylasemia in two (5%),postoperative late bleeding in two (5%), which were cured with conservative treatment.No perforation,massive hemorrhage or death occurred.No significant differences in success stone removal rate and early complication rate were found between PAD sub-types.Conclusion ESBD is an effective and safe procedure for removing choledocholithiasis in patients with PAD,regardless of PAD subtypes.

Effectiveness and safety of endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endoscopic submucosal dissection of the esophagogastric junction is the most difficult gastric and esophageal dissection procedure. No reports of endoscopic submucosal dissection for Siewert type II carcinoma of the esophagogastric junction have compared the outcomes of endoscopic submucosal dissection for all three Siewert types of adenocarcinoma. This study aimed to evaluate the efficacy and safety of endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction.</p><p><b>METHODS</b>From October 2008 to June 2013, 73 patients underwent endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction. The patients were prospectively evaluated regarding the executability of the technique, short-term results of the procedure, en bloc resection rate, curative resection rate, complications and additional treatment after endoscopic submucosal dissection, and follow-up outcomes.</p><p><b>RESULTS</b>Sixty-eight of the 73 patients (93.2%) underwent en bloc resection; the mean maximum specimen diameter was 33.7 mm. Fifty-seven of 61 patients (93.4%) who underwent curative resection were successfully followed-up for 1.0 to 56.0 months (average, 24.1 months). Local recurrence developed in one patient with high-grade intraepithelial neoplasm. Twelve patients underwent noncurative resection, including lateral resection margin residues in three, vertical resection margin residues in one, signet ring cell carcinoma or undifferentiated adenocarcinoma in four, lymphatic or vessel invasion in one, vertical residual margin residues combined with signet ring cell carcinoma in one, and undifferentiated adenocarcinoma with lymphatic or vessel invasion in two. In the noncurative resection group, one patient was lost to follow-up, seven underwent additional surgery, and the remaining four were periodically followed up; none had local recurrence or distant metastases. The only complication was delayed bleeding in three patients, which was successfully controlled by conservative treatment or endoscopic therapy.</p><p><b>CONCLUSIONS</b>Endoscopic submucosal dissection is safe and effective for intraepithelial neoplasia of the esophagogastric junction. R0 en bloc resection is possible and can avoid the risk of local recurrence.</p>

Influence factors of the timing of endoscopic examination in nonvariceal upper gastrointestinal bleeding / 中华消化杂志

Objective To explore the risk factors affected the timing of endoscopic examination in nonvariceal upper gastrointestinal bleeding (NVUGIB).Methods From January 2001 to December 2011 , 441 patients diagnosed as NVUGIB under endoscope were enrolled,and they were divided into the group receiving endoscopy within 24 hours (233 cases)and the group receiving endoscopy beyond 24 hours (208 cases).The demographic and clinical characteristics of the two groups were analyzed.Student′s t test was used for measurement data comparison and chi-square test for numerical data.Logistic regression analysis was used to analyze the multivariate factors which influenced the timing of endoscopy examination.Results The rates of complication in the group receiving endoscopy within 24 hours and the group receiving endoscopy beyond 24 hours were 9.0% (21/233)and 19.7% (41/208),and the difference was statistically significant (χ2 =10.411 ,P =0.001 ).The mean systolic blood pressure were (118 ±19 )and (122±19)mmHg (1 mmHg=0.133 kPa),respectively,and the difference was statistically significant (t=2.099,P = 0.036 ).On admission the mean hemoglobin were (98 ± 27 )and (93 ± 28 )g/L, respectively,and the difference was not statistically significant (t=1 .640,P =0.102).The mortality rate were 1 .3% (3/233 )and 5 .3% (11/208 ),respectively,and the difference was statistically significant (χ2 =5 .723,P =0.017).With multivariate Logistic regression,multivariate factors analysis indicated that complication was the main factor influenced the timing of endoscopy examination (OR =2.710,95 %CI :1 .502 to 4.899,P 0.05).Conclusion Complication is a risk factor in the timing delayed endoscopy.

A comparative study of cost-effectiveness between two curative means for treating early gastrointestinal carcinoma or precancerous lesions: endoscopic submucosal dissection (ESD) vs traditional surgery / 中华消化内镜杂志

Objective To compare the cost-effectiveness between endoscopic submucosal dissection (ESD) procedure and traditional surgery for the treatment of early gastrointestinal cancer or precancerous lesions.Methods A total of 866 early GI cancer/precancerous patients who had been admitted to Chinese PLA General hospital and Qilu hospital were included in this study.The medical records of all 866 patients were reviewed.Patients were divided into ESD group and traditional surgery group.Parameters of each patient,such as time of hospitalization,total treatment cost and incidence of complications,were documented and later compared in detail.Results A total of 607 patients were included in the ESD group and 259 in the traditional surgery group.There was no statistical difference in complete resection rate between the two groups (93.1％ vs 93.0％,P ＞ 0.05).The ESD group showed a shorter mean hospitalization time (d)(13.01 vs 18.88,P ＜ 0.05) and lower treatment cost (RMB) than the traditional surgery group (22932.17 vs 57993.88,P ＜ 0.05).The incidence of hemorrhage and perforation for each group were 3.63％ and 3.10％ respectively,which were not significantly different (1.98％ vs 3.01％,P ＞ 0.05; 2.80％ vs 1.16％,P ＞ 0.05).Conclusion ESD and surgery are both effective for early gastrointestinal cancer/precancerous lesions therapy,but ESD procedure is superior to surgery in terms of hospitalization time and expediture.

Objective assessment of competence of gastrointestinal endoscopy trainees by a virtual reality simulator / 中华消化内镜杂志

Objective To investigate the potential effectiveness of a computer-based gastrointestinal (GI) endoscopy simulator in assessing the competence of GI endoscopy trainees.Methods Fifty trainees working in the endoscopy center of General Hospital of Chinese PLA between February 2009 and October 2011 were enrolled.These participants were divided into four groups based on their prior endoscopic experience:novices (no endoscopy experience),intermediate experienced (≤200 colonoscopies or ≤ 500 gastroscopies),experienced (201-1000 colonoscopies or 501-2000 gastroscopies),and experts (＞ 1000 colonoscopies or ＞ 2000 gastroscopies).Assessment of endoscopic skills was performed during a hand-eye coordination task (Endo Bubble level 1) and was based on parameters measured by the computer system including time to finish,average time between two bubbles,number of times wall touched.Results When GI trainees were categorized by their prior gastroscopy number,the time to finish of each group were (302.43 ± 108.96)s,(188.00 ± 59.88) s,135.00 (40.00) s,150.00 (69.00) s,and the average time between two bubbles were (14.29 ± 5.47) s,(8.82 ± 3.28) s,6.00 (2.00) s,7.00 (4.00) s,respectively.Pairwise comparison showed that except experienced and experts groups (P ＞ 0.05),there were significantly differences between remaining groups (P ＜0.01).However,based on the colonoscopic experiences,the time to finish of each group were 220.00(91.00)s,127.00(28.25)s,155.50(81.00)s,150.00(58.50)s,respectively,which were significantly different between each two groups (P ＜ 0.01).Average time between two bubbles of each group were 10.00 (4.00) s,5.50 (1.50) s,7.00 (3.75) s,7.00 (3.50) s,respectively,which were found significantly different among whole groups (P ＜ 0.05 or P ＜ 0.01),but there were no differences between novice and experienced trainees and between intermediate experienced and experts groups.In contrast,the number of wall-touch was insufficient for assessment.Except the significant difference between novice and experienced group (P ＜ 0.05) as categorized by gastroscopy experience,there were no values to differentiate the trainees of different practical competence on gastroscopy or colonoscopy.Conclusion The parameter,time to finish,during a hand-eye coordination task using a virtual reality simulator might be able to differentiate the competence of operators,which was used prior to training in real-life endoscopy,but lack of accurate discriminatory function between experienced and experts.

The efficacy of endoscopic papillectomy for tumors of major duodenal papilla / 中华消化内镜杂志

Objective To evaluate and analyse the efficacy and safety of endoscopic papillectomy for tumors of major duodenal papilla.Methods The clinical data of thirty-four patients with tumors of major duodenal papilla who were treated by endoscopic papillectomy were retrospectively reviewed,and the clinical outcome was summarized.Results The success rate of endoscopic papillectomy was 94.12％ (32/34),and the complete resection was 66.67％ (20/30).Short-term complications occurred in 10 cases,including postoperative gastrointestinal bleeding in 7cases and postoperative pancreatitis in 3 cases.Five cases need further surgical intervention for the reason that tumor was too deep in 2 cases,bile duct was invaded in 2 cases and conservational medication was unsuccessful in 1 case.Thirty-three cases were pathologically diagnosed as low grade intraepithelial neoplasia (LGIN),17 cases high grade intraepithelial neoplasia (HGIN),1 case carcinoid and 3 cases adenocarcinoma.The recurrence rate was 23.33 (7/33).tumor recurrence rate of HGIN was higher than that of LGIN(42.86％ VS10％,P =0.078).Conclusion Endoscopic papillectomy is an effective method for treating tumors of major duodenal papilla,however,hemorrhage is the main postoperative complication,the recurrence rate is higher in HGIN group.

A survey of sedated gastrointestinal endoscopy / 中华消化内镜杂志

ObjectiveTo investigate the popularity of the sedated gastrointestinal endoscopy in mainland China.MethodsThe survey on the popularity of the sedated gastrointestinal endoscopy was conducted with questionnaires sent by e-mails or telephones to the GI endoscopy units of three levels of hospitals.ResultsFrom May,2010 to November,2010,169 units from 28 provinces (90.3％ ) were enrolled,including 46 hospitals of grade Ⅲ,91 of grade Ⅱ and 32 of grade Ⅰ.Sedated gastrointestinal endoscopy were performed in 110 (65.1％,110/169) hospitals,i.e.93.5％ (43/46) grade Ⅲ hospitals,68.1％(62/91) grade Ⅱ hospitals and 15.6％ (5/32) grade Ⅰ hospitals.Significant difference was observed between the grade Ⅲ and the grade Ⅱ hospitals (P ＜ 0.05 ),so was between the grade Ⅱ and the grade Ⅰ hospitals ( P ＜ 0.05 ).Propofol was frequently used in sedation in 98 hospitals ( 89.1％ ).The only 9.1％( 10/110)hospitals,which had full-time anesthetists or anesthetic nurses,were all grade Ⅲ hospitals.ConclusionThere has been great progress in the popularity of sedated gastrointestinal endoscopy in mainland China during the past decade.However,it is less frequently pefformed in grade Ⅰ and Ⅱ hospitals.Shortage of full-time anesthetists is still a problem.