Correlation of endoscopy findings with symptoms in patients undergoing gastroscopy: a prospective study / 中华消化内镜杂志

Objective:To investigate the correlation of endoscopy findings with symptoms in patients undergoing gastroscopy.Methods:Patients who underwent gastroscopy for the first time in Renji Hospital of Shanghai Jiao Tong University School of Medicine from January to December 2017 were included in the questionnaire survey. The participants were asked to report their main symptoms of the digestive tract in details, and gastroscopy was completed within 2 weeks. Final gastroscopic diagnosis was made based on both gastroscopy and pathology, then patients were divided into the major-lesion (peptic ulcer and malignancy) group and the non-major-lesion (chronic gastritis, reflux esophagitis and others) group. The correlation of gastrointestinal symptoms with gastroscopic findings was analyzed. The risk for major gastroscopic lesions (peptic ulcer and malignant tumors) was assessed by multivariate Logistic regression analysis.Results:A total of 5 885 patients completed the questionnaire, 5 496 (93.4%) of whom completed gastroscopy. The detection rates of peptic ulcer were 12.3% (373/3 028), 12.6% (52/412), 17.9% (49/273), 9.5% (64/675) and 9.2% (102/1 108) in patients with dyspepsia, reflux, alarm, other symptoms and no symptoms, respectively, the detection rates of malignant tumors were 1.2% (36/3 028), 0.7% (3/412), 7.7% (21/273), 0.7% (5/675) and 0.4% (4/1 108), respectively in these patients. The most common symptoms was dyspepsia, accounted for 58.3% (373/640) and 52.2% (36/69) patients with peptic ulcer and malignant tumors, respectively. Alarm symptoms were found in 30.4% (21/69) patients with malignant tumors, and 15.9% (102/640) peptic ulcer patients and 5.8% (4/69) malignant tumor patients had no gastrointestinal symptoms. Compared to asymptomatic individuals, patients with dyspepsia ( P<0.001, OR=1.52, 95% CI: 1.21-1.92) and those with warning symptoms ( P<0.001, OR=2.87, 95% CI: 2.02-4.08) had significantly increased risk for major lesions (peptic ulcer and malignant tumors) detected by gastroscopy. Conclusion:Although dyspepsia and alarm symptoms are positively associated with upper gastrointestinal malignancy and peptic ulcer, they are of limited predictive value for upper gastrointestinal diseases.

Role of Early Capsule Endoscopy and Device⁃assisted Enteroscopy in Diagnosis of Overt Small Bowel Bleeding / 胃肠病学

Small bowel bleeding is defined as bleeding from the gastrointestinal tract where the cause cannot be clearly identified after routine gastroscopy and colonoscopy, of which bleeding visible to the naked eye is classified as overt bleeding. Endoscopy, such as capsule endoscopy and device⁃assisted enteroscopy, occupies a dominant position in the diagnosis of overt small bowel bleeding, and how to choose the right time for endoscopy is closely related to the diagnostic yield. This article provided an overview of the timing and diagnostic role of early capsule endoscopy and device⁃assisted enteroscopy in overt small bowel bleeding.

Characteristics of Helicobacter pylori-positive Peptic Ulcer From 2013 to 2019 / 胃肠病学

Background: Despite the decline in prevalence of Helicobacter pylori infection, peptic ulcer remains a major health burden in China. Aims: To investigate the trends of peptic ulcer in recent years, especially the changes of Helicobacter pylori-positive peptic ulcer, and to provide a theoretical basis for the prevention and treatment of peptic ulcer. Methods: Gender, age, and Helicobacter pylori status of patients diagnosed as peptic ulcer by gastroscopy from January 2013 to December 2019 at Shanghai Renji Hospital were retrospectively reviewed, and clinical and epidemiological characteristics were analyzed. Results: During the study period, peptic ulcer was found in 40 385 of the 383 413 patients undergoing gastroscopy, including gastric ulcer 15 114 patients and duodenal ulcer 25 271 patients. The ratio of male to female of peptic ulcer patients was 2.02:1. Helicobacter pylori was present in 60.0% of peptic ulcer patients (48.5% in gastric ulcer, 66.9% in duodenal ulcer). The detection rate of Helicobacter pylori-positive peptic ulcer was decreased with the increasing year of patients. The detection rate of Helicobacter pylori-positive gastric ulcer declined from 52.2% to 49.3% during 2013 to 2019, and Helicobacter pylori-positive duodenal ulcer from 70.0% to 63.9%. Conclusions: With the decrease of Helicobacter pylori infection rate, the incidence of Helicobacter pylori-positive peptic ulcer, especially duodenal ulcer, decreased significantly, and the incidence of non-Helicobacter pylori ulcer increased, which should be paid more attention.

Diagnosis and treatment of 40 cases of gastritis cystica profunda / 中华消化内镜杂志

Objective To investigate the clinical,endoscopic and pathological features of gastritis cystica profunda (GCP).Methods A total of 40 patients with GCP confirmed by pathology who received endoscopic or surgical treatment at Renji Hospital,School of Medicine,Shanghai Jiaotong University from May 2013 to May 2018,were included in the retrospective analysis.The clinical data such as population composition,clinical manifestations,endoscopic findings and pathological results were summarized and analyzed.Results Among the 40 patients were predominantly males (75.0％,30/40),and the mean age of onset was 61.2 years.The most common sites were cardia (32.5％,13/40) and gastric antrum (30.0％,12/40).The clinical symptoms of the patients were atypical and it was difficult to diagnose GCP with routine endoscopy examination.The endoscopic findings were mostly type 0-Ⅱ (50.0％,20/40).GCP with neoplastic lesions accounted for 55％ (22/40).Unconditional logistic regression analysis showed that male (P =0.013,OR =31.093,95％ CI:2.079-464.976) and Helicobacter pylori infection (P =0.041,OR =10.225,95％ CI:1.096-95.411) were risk factors for GCP with neoplastic lesions.Conclusion GCP commonly occurs in middle-aged and elderly men,and varies in different manifestations under white light endoscopy.GCP is not a benign lesion,but can also coexist with neoplastic lesions,which are mostly differentiated intramucosal cancer.

Clinical Application and Research Progress in Magnetic Endoscopic Imaging System / 胃肠病学

Magnetic endoscopic imaging (MEI)is a non-radiographic imaging technique that has been developed in recent years. MEI is capable of displaying real-time three dimensional images of the colonoscope shaft within the abdominal cavity. MEI system has been shown to be beneficial in increasing the cecal intubation rate,helping remove colonoscope insertion tube loops,reducing the duration of looping,assisting training of colonoscopy when compared with traditional colonoscopy. This article reviewed the progress in research on MEI.

Advances in Studies on Surveillance after Resection of Colorectal Adenoma and Interval Cancer / 胃肠病学

Colorectal polyps are eminence lesions that protruded from mucosa into lumen,including adenomatous polyps and non-adenomatous polyps. Early detection and resection of adenoma has significance in prevention of colorectal cancer,and the surveillance afterwards is also crucial. Interval cancer is the colorectal cancer that develops between initial negative colonoscopy or all the polyps having cleared and the next colonoscopy. It is an important duty for endoscopists to reduce the incidence of interval cancer. This article reviewed the advances in studies on surveillance after resection of colorectal adenoma and the development of interval cancer.

Efficacy of NICE classification under narrow-band imaging in real-time diagnosis of colorectal polyps / 中华消化内镜杂志

Objective To evaluate the diagnostic efficacy of non-magnified NBI in distinguishing neoplastic from non-neoplastic colorectal polyps,using a simple classification system(NBI international colo-rectal endoscopic[NICE]classification).Methods A total of 181 lesions detected by white light colonosco-py were enrolled in this prospective study.Each lesion was assessed by NBI,and the histology was predicted according to characteristics of lesion color,microvascular architecture,and surface pattern.The results were compared with actual histologic findings.Results The diagnostic sensitivity,specificity,PPV,NPV,and accuracy of NBI were 95. 8%(114/119),91. 9%(57/62),95. 8%(114/119),91. 9%(57/62),and 94. 5%(171/181),respectively.Diagnostic accuracy was 90. 0%(72/80)in the 1 to 5 mm group,95. 9%(47/49)in the 6 to 9 mm group,98. 1%(51/52)in the more than 10 mm group,with no statistically sig-nificant differences(P=0. 175).The sensitivity,specificity,PPV,NPV,and accuracy of NBI for diminu-tive rectosigmoid neoplasms were 87. 5%(14/16),95. 2%(20/21),93. 3%(14/15),90. 9%(20/22), and 91. 9%(34/37).Conclusion NICE classification with non-magnified NBI is effective in distinguishing neoplastic from non-neoplastic colorectal lesions.

Early Postoperative Cognitive Dysfunction after Sedation for Esophagogastroduodenoscopy / 胃肠病学

Background:It is commonly recommended that patients should refrain from driving for 24 hours after sedation for endoscopy,however,this recommendation has been queried recently. Aims:To investigate the effect of sedation on early postoperative cognitive function in patients undergoing endoscopy. Methods:One hundred adult patients undergoing sedative esophagogastroduodenoscopy ( EGD ) were randomly recruited, and another 100 adult patients undergoing conventional EGD were served as controls. All patients had an education level more than 9 years. Cognitive function was assessed by number connection test-A( NCT-A),number cancellation test and digit symbol test( DST)before propofol sedation or the beginning of endoscopic procedure and was reassessed when the discharge criteria were met. If the results obtained were inferior to those before EGD,a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels. Results:All patients completed the first and second assessment,and 124 patients had taken the third assessment. When the discharge criteria were met,result of number cancellation test was inferior to that before EGD in sedation group( P =0. 000 ). Furthermore,the results were analyzed by grouping with age,number cancellation test in young patients and NCT-A in elderly patients were inferior to that before EGD,respectively(P=0. 000 and P =0. 025 ). In control group,none of the results were inferior to those before EGD. The results of the third assessment recovered or being superior to the baseline levels. Conclusions:Early postoperative cognitive dysfunction at discharge is common in patients undergoing endoscopy using propofol sedation,but the impairment will recover by a prolonged staying calm before discharge. The optimal time for discharge and resuming driving remains to be further studied.

The value of target biopsy using magnifying endoscopy combined with narrow band imaging for early gastric malignancy / 中华消化内镜杂志

Objective To evaluate target biopsy using magnifying endoscopy combined with narrow band imaging(ME-NBI) in suspicious gastric lesions.Methods A total of 113 patients with suspicious early gastric lesions under white light endoscopy(WLE) were prospectively enrolled and biopsied between May 2011 and May 2013.Further endoscopy was conducted using ME-NBI and target biopsy.All patients received endoscopic resection(ER).Outcomes of WLE biopsy and target biopsy were compared,with histology of ER specimen as golden standard.Results The overall diagnostic accuracy of WLE biopsy and target biopsy were 22.1％ (25/113) and 54.0％ (61/113),(P ＜ 0.0001).In diagnosing early gastric cancer (EGC) and high-grade intraepithelial neoplasia (HGIN),the sensitivity of target and WLE biopsy were 70.9％ and 37.9％ (P ＜ O.0001),respectively.The specificity were 90.0％ in both groups.The accuracy rates were 72.6％ and 42.5％,respectively(P ＜0.0001).The positive predictive values were 98.6％ and 97.5％ (P ＞ 0.05).The negative predictive values were 23.1％ and 12.3％ (P ＞ 0.05),respectively.The overall progression rate of target biopsy was 46.9％ (53/113).Conclusion ME-NBI target biopsy is superior to traditional WLE biopsy in diagnosis of early gastric cancer.

Clinical observation of fluorescence endoscopy in medical diagnosis / 中国医疗器械杂志

It's difficult to diagnose precancerous lesion and early cancer for a long time, because both of them haven't typical morphological characteristics. As a novel diagnostic modality, fluorescence endoscopy can accurately reflect minimal changes in human's tissue, thus making a meaningful progress for cancer diagnosing. 200 patients were examined by fluorescence endoscopy to evaluate the diagnostic value. The overall accuracy, sensitivity and specificity for detecting malignant gastrointestinal tumor was 94.0%, 94.6% and 93.5%, respectively. Thus, fluorescence endoscopy can be used to diagnose malignant gastrointestinal tumors with high validity and reliability, and is advantageous over conventional white light endoscopy especially in detecting the atypical and suspicious lesions. Furthermore, fluorescence endoscopy can also guide target biopsy, is significant to improve the early cancer detection rate, has a broad development prospect.

The analysis of influencing factors in chronic atrophic gastritis diagnosed by endoscopists / 中华消化杂志

ObjectiveTo investigate the related factors which influencing endoscopists in the accuracy of diagnosis of chronic atrophic gastritis (CAG). Methods With retrospective analysis method,from January to December in 2009,10 765 chronic gastritis cases underwent endoscopy examination in Renji Hospital,school of medicine,Shanghai Jiaotong University were collected.The influence of congestion and exudation,gastric ulcer,bile reflux,gastric polyps and H.pylori infection under endoscopy on CAG endoscopic and pathological diagnosis was analyzed.ResultsThe percentage of histopathological diagnosed CAG was 69.41％,endoscopic diagnosed CAG was 54.27％. The coincidence rate was 62.30％.2575 cases were H.pylori positive (23.92％),the coincidence rate between endoscopic and histopathological diagnosis in H.pylori positivc cascs was 90％.of that of H.pylori negative cases (β=-0.1067,P＜0.05).The coincidence was positively related to age.For each 1 year increase in age,the coincidence rate increased by 0.01 time [OR=exp(0.00855)=1.01]; For each 10-year increase in age,the coincidence rate increased by 0.09 time [OR=exp(0.0855) =1.09].The coincidence rate was negatively related to congestion and exudation.The coincidence rate of CAG between endoscopic and histopathological diagnosis in cases with congestion and exudation was 40％ of that without congestion and exudation (β=-0.1067,P＜0.01).ConclusionCAG diagnosed under endoscopy was somewhat subjective and should be combined with histopathological analysis.The patients' age,H.pylori infection,congestion and exudation may have influence on the coincidence rate between endoscopic and histopathological diagnosis of CAG.

Correlation analyses among Capsule Endoscopy Scroring Index, simplified Crohn Disease Activity Index and C-reactive protein in small bowel Crohn disease / 中华消化内镜杂志

ObjectiveTo investigate the correlation between any two of Capsule Endoscopy ScroringIndex (Lewis score),simplified Crohn Disease Activity Index (CDAI) and C-reactive protein (CRP) in small bowel Crohn disease (CD).MethodsA total of 58 consecutive patients with known small bowel CD were enrolled. We evaluated disease activity with Lewis score and simplified CDAI. Correlations among CRP,simplified CDAI and Lewis score were calculated with Spearman's rank order correlation coefficient.The optimal CRP cut-off value was calculated using the ROC curve.ResultsThe Lewis score showed inactive,mild and moderate-severe patients were 13,21 and 24,respectively.CRP of moderate-severe group was significantly higher than that in mild and inactive groups ( P ＜ 0.05 ).The optimal CRP cut-off value that differentiated patients with moderate to severe disease from the others was 13.50 mg/L with sensitivity of 87.5％ and specificity of 82.4％.The area under the ROC curve to analyze the cut-off was 0.849.Lewis score was moderately correlated with CRP (r =0.58,P ＜ 0.01 ),and weakly correlated with the simplified CDAI (r =0.40,P ＜ 0.01 ).ConclusionSerum CRP and the simplified CDAI cannot replace Lewis score for capsule endoscopy in the assessment of disease activity in small bowel CD.However,CRP may be considered as an inflammatory marker for evaluating the moderate to severe capsule endoscopic activity.

Efficacy of implantation of a modified temporary metallic stent for cardia achalasia / 中华消化内镜杂志

Objective To study the efficacy and safety of implantation of a modified temporary self-expanding metallic stent for cardia achalasia.Methods A total of 30 patients diagnosed as having cardia achalasia were randomly divided into 2 groups,group A (traditional stents) and group B (modified stents)(n =15 in each group).Two days after stent implantation at the cardia by endoscopy,stents were withdrawn with endoscope guided by X-ray.LES Pressure,X-ray images ( including the diameter of the most dilated part of esophageal and the most narrow part of cardia) and the symptoms of dysphagia were compared before and half year after the treatment.The width changes of the most narrow stenting part on the point of stenting and 2 days after removal were compared.The side effects and complications during the treatment were recorded.Results All thirty stents were successfully implanted and removed.Stent dislocation occured in 2 cases in group A,but none in group B.Dysphagia had significant improvement after the treatment in both groups ( P ＜ 0.05 ),but the recurrence rate of group A ( 26.7％ ) was significantly higher than group B (6.67％ ) in 6 months ( P ＜ 0.05 ).LES pressure and X-ray images of both groups significantly improved after treatment ( P ＜ 0.001 ),and those of group B were superior to group A ( P ＜ 0.05 ).There was no difference in adverse reaction between the two groups.No perforation occured in any group.Conclusion Self-expanding metallic stents is safe for patients with cardia achalasia,with implantation convenience,symptomatic improvement,low recurrence,and few complications or dislocation.

The potential pathogenesis of gastrointestinal vascular malformation and the potential mechanism of thalidomide in the treatment of gastrointestinal vascular malformation / 中华内科杂志

ObjectiveTo study the pathogcncsis of gastrointestinal vascular malformation (GIVM) and the potential mechanism of thalidomide in the treatment of gastrointestinal bleeding due to GIVM.Methods We collected the surgical intestinal specimens from 10 patients who suffered from massive hemorrhage of gastrointestinal tract owning to GIVM and the normal intestinal mucosa around the lesions,as well as normal intestinal mucosa from healthy subjects.Immunohistochemical(IHC) staining was carried out to investigate the differences of angiopoietin 2 ( Ang2 ),Notch1 and delta like ligand 4 (Dll4) in the above three intestinal mucosa to find the relationship with the pathogenesis of GIVM. Human umbilical vein endothelial cells(HUVECs) were cultured with 0,25,50,100 and 200 mg/L thalidomide for 24 or 48 hours to observe their mRNA and protein expressions of Ang2,Notch1,Dll4 by real-time PCR and Western blot.ResultsBy IHC staining,more expressions of Ang2,Notch1 and Dll4 in the lesions were detected than those in the normal intestinal mucosa around the lesions and the normal intestinal mucosa in healthy people.The expressions of Ang2,Notch1 and Dll4 were significantly correlated (P =0.016,r =0.732),and the expressions of Notch1 and Dll4 were absolutely correlated ( P =0.000,r =1.000).Real-time PCR and Western blot showed that thalidomide could down-regulate the expressions of them,which were in a concentration-dependent manner.ConclusionAng2,Notch1 and Dll4 may correlate with the pathogenesis of GIVM,while thalidomide can concentration-dependently down-regulate the expression of Ang2,Notch1 and Dll4,which may be one of the mechanism that thalidomide play a therapeutic role in GIVM.

Risk factors of rebleeding in patients with obscure gastrointestinal bleeding / 中华消化内镜杂志

ObjectiveTo investigate the long-term (＞1 year) rebleeding rate after capsule endoscopy (CE)-guided intervention in patients with obscure gastrointestinal bleeding (OGIB) and to identify the risk factors of rebleeding.MethodsA total of 307 consecutive patients who underwent CE for OGIB in our hospital from June 2002 to October 2010 were enrolled.Follow-up data were obtained by reviewing medical records,CE database and contacting the patients or their relatives by telephone.We evaluated the rebleeding rates and analyzed risk factors predictive of rebleeding by means of COX ratio hazard model.ResultsThe medium follow-up was 52 months (range13-112 months).Significant lesions were found in 202 patients (65.8％).The overall rebleeding rate after interventional therapy induced by CE findings was 28.0％ (86/307).CE positive patients had higher rebleeding rate than CE negative patients (37.6％ vs 9.5％,log-rank test,P=0.000),while specific therapy could prevent rebleeding,compared with nonspecific therapy (32.9％ vs 23.0％,P=0.042).95.3％ (82/86) rebleeding occurred within 24 months after CE.Multivariate analysis performed by using COX proportional hazards model showed that age over 50 years,CE positive findings,lowest hemoglobin (Hb) level 3 months before CE ≤7 g/dl,receiving nonspecific therapy after CE,hypertension,administration of anticoagulants,antiplatelet medicine or NSAIDs after CE were six risk factors associated with rebleeding.Conclusion Clinicians should be aware of these risk factors for OGIB rebleeding,which can reduce the occurrence of rebleeding and improve OGIB patients' prognosis.Those high risk OGIB patients should be followed up for at least 24 months after CE.

Endoscopic submucosal dissection for tumors originating from gastric muscularis propria / 中华消化内镜杂志

Objective To explore the feasibility,efficacy and safety of endoscopic submucosal dissection (ESD) for tumors originating from gastric muscularis propria.Methods A total of 20 patients with tumors originating from gastric muscularis propria confirmed by EUS and CT scan underwent ESD.Laparoscopic intervention was applied in 3 cases when difficulties in en bloc removal or perforation occurred.Results The mean ESD procedure time was 74.8 min (40-120 min),and the mean resected tumor size was 2.6 cm (1.5-3.5 cm).No severe complication occurred.Pathological findings were 17 cases of gastrointestinal stromal tumors and 3 cases of leiomyoma.Conclusion ESD is an effective method for treating the tumors originating from gastric muscularis propria,and laparoscopic intervention is necessary for en bloc resection in some cases.

Diagnostic value of confocal laser endomicroscopy for non-protruding gastric lesions / 中华消化内镜杂志

Objective To discuss the differential diagnostic value of confocal laser endomicroscopy (CLE)for benign and malignant non-protruding gastric lesions.Methods A total of 37 patients with nonprotruding gastric lesions diagnosed by conventional gastroscopy underwent CLE.Fluorescein sodium was intravenously injected,and target biopsy was obtained.Malignant lesionss diagnosed with CLE or biopsy were treated by endoscopy or surgery.Patients with benign lesions were give routine medication and followed up every 3 months until the lesions were cured.Results CLE diagnosed 11 malignant and 26 benign lesions.However,1 of 11 cancers was confirmed as benign by histopathology,while 1 of 26 benign lesions was confirmed cancer.Lesions in 12 patients were resected,with 3 by endoscopy,and 9 by surgery,and findings of post-operative pathology were consistent with those of target biopsy.No malignancy was found during the follow-up of benign lesions,and all lesions were healed after 3.16(3.58 ± 1.20)months.The sensitivity,specificity,and accuracy of CLE in diagnosis of malignant non-protruding gastric lesion were 90.9％,96.2％,and 90.9％,respectively.The positive and negative predictive values were 90.9％ and 96.2％,respectively.The Kappa value of CLE and histopathology was 0.871.Conclusion CLE is of significant value for the diagnosis of non-protruding gastric lesions,and may replace biopsy in real-time histological diagnosis.

A predictive method of small intestinal lesion location with wireless capsule endoscopy / 中华消化内镜杂志

Objective To investigate the method of locating intestinal lesions by scatter diagram which simulating the movement of capsule endoscopy in small intestine and its significance. Methods A total of 30 consecutive patients with lesions in small intestine which was diagnosed by wireless capsule endoscopy (WCE) and confirmed by following surgery were enrolled in the study as group A. The time index was defined as the ratio of the transition time from the duodenojejunal flexure to the lesion to that to the ileocaecal valve. For each case in group A, the time index was marked on a horizontal axis with the distance between duodenojejunal flexure and the lesion on a vertical axis. The best curve was obtained to simulate the intestinal movement, and 30 other patients selected by the same criteria were used as group B to testify the accuracy of the curve. Results Parabola and quadratic equation were obtained from group A to simulate the intestinal peristalsis. Calculation of errors in group B showed a minimal error of 0. 79 cm, a maximal error of 41.49 cm and a mean error of ( 19. 64± 13. 98 ) cm. Patients with errors less than 20 cm accounted for 50%(15/30), those with errors less than 30 cm were 67% (20/30), and those with errors less than 50 cm amounted to 100% (30/30). Conclusion Locating the lesion in small intestine by transition time of WCE is of high accuracy and is able to facilitating the diagnosis yield of WCE.

Diagnostic value of colon capsule endoscopy for active ulcerative colitis / 中华消化内镜杂志

Objective To investigate diagnostic value of colon capsule endoscopy (CCE) for mucosal lesions of patients with active ulcerative colitis. Methods A total of 19 consecutive patients, including 12 males and 7 females, were enrolled from July 2009 to June 2010, with a mean age at 44. 16 + 14.64.Dominant symptoms were hematochezia, diarrhea and abdominal pain, consistent with the criteria of ulcerative colitis. All cases were scored into 3 grades according to severity of mucosal lesions. Using conventionalcolonoscopic findings as golden standard, the consistence of mucosal classification of CCE was calculated with kappa- and P-value. Meanwhile, related data such as the rate of completion, colonic cleanliness and adverse reactions were also collected and analyzed. Results CCE revealed that mild, moderate and severe cases were 2, 8 and 9, respectively, while the 3 types shown by conventional colonoscopy were 3, 8 and 8,respectively. Kappa-value was 0. 826 and P-value was less than 0. 001, which indicated good consistence. In addition, the completion rate of CCE and excellent/fine rate of the colonic cleanliness were 100% (19/19)and 79% ( 15/19), respectively. There were no adverse reactions recorded. Conclusion With high diag-nostic consistency to conventional colonoscopy in classification of mucosa severity, CCE precisely reveals the mucosal lesions of ulcerative colitis and becomes a potential alternative to partially replace conventional colonoscopy, especially in surveillance.

Long-term effect of argon plasma coagulation combined with proton pump inhibitor on Barrett esophagus / 中华消化内镜杂志

Objective To study the long-term effect of argon plasma coagulation (APC) combined with proton pump inhibitor (PPI) on Barrett esophagus (BE). Methods A total of 36 patients, histologically proven as having BE from 2004 to 2007, were enrolled to underwent a therapy of APC plus PPI. The patients were re-examined on endoscopy at 1, 6 and 12 months after first APC and once a year thereafter.Results A total of 48 APC sessions were given to 36 patients with a mean number at 1. 33 per patient. The effective rate of reversal of BE was 100%. The follow-up was accomplished for all patients in 14-51 months with a median of 36months. The total recurrence rate (RR) of BE reached 16. 7% (6/36). The 1-year and 2-year RRs were 2. 8% (1/36) and 11.1% (4/36), respectively. The logistic regression analysis suggested that 2-year and total RRs were related to APC sessions ( P ＜ 0. 01 ). Conclusion The therapy of APC combined with PPI for BE is safe and of long-term effects.