Application of transpancreatic precut sphincterotomy combined with pancreatic duct stent placement to difficult biliary cannulation / 中华消化内镜杂志

Objective:To explore the application value of transpancreatic precut sphincterotomy combined with pancreatic duct stent placement for difficult intubation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:A total of 169 patients with difficult papilla intubation who underwent ERCP treatment in the Third Affiliated Hospital of Naval Medical University from January 2017 to December 2019 were included. Double guide wire intubation was used in 137 cases and transpancreatic precut sphincterotomy combined with pancreatic duct stent placement was used in 32 cases. The success rate of intubation, intubation time and postoperative complications of the two groups were compared.Results:The success rates of intubation in the double guide wire group and the transpancreatic precut sphincterotomy combined with pancreatic duct stent placement group were 98.54% (135/137) and 100.00% (32/32) ( P>0.05); the mean intubation time of the two groups were 15.69±9.07 min and 17.06±5.79 min ( P>0.05); the incidence of postoperative complications were 25.55% (35/137) and 9.38% (3/32) ( P<0.05), among which incidences of pancreatitis were 5.8% (8/137) and 0 respectively. Conclusion:During difficult ERCP papilla intubation, the transpancreatic precut sphincterotomy combined with pancreatic duct stent placement can yield higher safety and a similar success rate compared with the double-guide wire technique, which is worthy of clinical application.

Analysis of Clinical Features of 985 High-risk People with Intestinal Polyps in Colorectal Cancer Screening / 胃肠病学

Background:Colorectal polyps are common gastrointestinal diseases,which are closely related to the development of colorectal cancer. Aims:To investigate the clinical features of high-risk people with intestinal polyps in colorectal cancer screening. Methods:People in Hongkou District,Shanghai,who were positive in fecal occult blood test or of the high risk category in colorectal cancer questionnaire from April 2013 to December 2014 were enrolled,and colonoscopy was performed at Branch of Shanghai First People’s Hospital. The overall detection rate,gender,age,location of lesion, morphology,and pathology were analyzed. Results:A total of 985 patients with colorectal polyps were recruited in this study. The overall detection rate of polyps was 48. 7% . The prevalence of colorectal polyps was significantly higher in males than in females(58. 7% vs. 38. 9% ;χ2 = 79. 788,P < 0. 01). The detection rates of colorectal polyps in different age groups were statistically significant(χ2 = 23. 820,P < 0. 01). Detection rate of polyps was significantly higher in left colon than in right colon(62. 4% vs. 37. 6% ;χ2 =190. 643,P <0. 01). The overall detection rate of protruding lesion 0-Ⅰwas 94. 5% ,and slightly elevated lesion 0-Ⅱa was 48. 3% . Detection rate of adenomatous pylops was significantly higher than non-adenomatous pylops(59. 3% vs. 47. 1% ;χ2 = 27. 326,P < 0. 01). The histological results were differed between two examination in 119 patients. Only 17. 8% of the patients operated were followed up by colonoscopy,and polyps recurred in 62. 3% of them. Conclusions:A higher incidence of colorectal polyps is found in people with high risk of colorectal cancer screening. High quality colonoscopy examination and effective operation in time can reduce the incidence of colorectal cancer.

Analysis on colonoscopic results of screening 1990 community people with high-risk of colorectal cancer / 中华消化杂志

Objective To investigate the prevalence of colorectal cancer in community people in Shanghai,and clarify the necessity of colorectal cancer screening in community residents.Methods From April 2013 to September 2014,colonoscopy examination was carried out in people who participated in colorectal cancer screening in Shanghai with positive result of fecal occult blood test or with high-risk in colorectal cancer evaluated with the risk factors questionnaire.A total of 1 990 individuals were recruited.The colonoscopic results of them were retrospectively analyzed.Chi-square test was performed for statistical analysis.Results The 1 990 individuals received colonoscopy examination aged from 50 to 92.Among the 1 990 individuals with colonoscopy examination,colorectal polyps,colorectal cancer and carcinoid were found in 1 027 cases,and the total detection rate was 51.6％.The detection rate of colorectal polyps was 48.7％ (969/1 990),and the maximum diameter of polyps was 3.5 cm.The detection rate of colorectal polyps of the male was 59.3％ (532/897),which was higher than that of the female (40.0％,437/1 093),and the difference was statistically significant (x2 =73.7,P＜0.01).The detection rate of colorectal polyps in group 50 to 60 (not include 60) years old,60 to 70 (not include 70) years old,70 to 80 (not include 80) years old and ≥80 years old was 37.5％ (139/371),48.7％ (524/1 075),55.9％ (248/444) and 58.0％ (58/100),respectively.The difference was statistically significant (x2 =31.3,P＜0.01).The detection rate of colorectal cancer was 2.7 ％ (54/1 990).The detection rate of male rectal cancer was 3.8％ (34/897),which was significantly higher than that of female (1.8％,20/1 093),and the difference was statistically significant (x2 =7.2,P＜0.05).The detection rate of colorectal cancer in group 50 to 60 (not include 60) years old,60 to 70 (not include 70) years old,70 to 80 (not include 80) years old and ≥80 years old was 1.6％ (6/371),1.9％ (20/1 075),4.3％ (19/444) and 9.0％ (9/100),respectively.The difference was statistically significant (x2 =23.7,P＜0.01).The detection rate of rectal carcinoid was 0.2 ％ (4/1 990).Conclusions The prevalence of colorectal polyps and cancer is high in screening community people with high-risk of colorectal cancer.Colorectal cancer screening in community people ≥ 50 years old with sequential screening method is important.

Effect of Capsaicin on Chronic Atrophic Gastritis / 胃肠病学

Background:Chronic atrophic gastritis( CAG)is a common type of gastritis and is closely related to the pathogenesis of gastric carcinoma,however,the efficacy of its drug treatment is not clear. Aims:To study the therapeutic effect of capsaicin on CAG in rats. Methods:CAG rat model was established by intragastric administration of sodium deoxycholate, ethanol and ammonium hydroxide. Forty-four survival model rats were randomly divided into CAG model group and low, moderate,high dose capsaicin groups,rats in the latter 3 groups were intragastrically administrated with 1 mg·kg-1 ·d-1 , 10 mg·kg-1 · d-1 ,30 mg · kg-1 · d-1 capsaicin,respectively,for 28 days. The inflammation and degree of atrophy of gastric mucosa were observed by HE staining. Gastric mucosal levels of pepsinogen( PG)Ⅰ,PGⅡ were determined by ELISA. The protein expressions of IKKβ,NF-κB,XIAP were determined by Western blotting. Results:The differences in inflammation and degree of atrophy of gastric mucosa,levels of PGⅠ,PGⅡ,protein expressions of IKKβ,NF-κB,XIAP were statistically significant among model group,low,moderate,high dose capsaicin groups( P <0. 05 ). With the increasing of capsaicin dose,inflammation and degree of atrophy of gastric mucosa were improved in a dose-dependent manner(P<0. 05),protein expressions of IKKβ,NF-κB,XIAP were decreased. Conclusions:Capsaicin is effective for the treatment of CAG.