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Objectives Microbiota dysbiosis in inflammatory bowel disease (IBD) has been widely reported. The gut microbiota connect diet to the metabolism by producing small molecules via diverse metabolic pathways. In this study we aimed to investigate the dietary preferences of IBD patients, and to explore the interactions among gut microbiota composition, dietary components, and metabolites in relation to IBD. Methods Dietary preferences of IBD patients (including those with ulcerative colitis [UC] and Crohn's disease [CD]) and health controls were investigated, and their gut microbiota were analyzed using 16S rRNA gene sequencing and metagenomic analyses of fecal and biopsy samples. The metabolite profiles of the samples were then analyzed using gas and liquid chromatography-mass spectrometry analyses. Results The daily intake of folic acid, niacin, vitamins C and D, calcium, and selenium differed significantly between patients with IBD and healthy controls. A decrease in long-chain (such as arachidic, and oleic acid) and medium-chain fatty acids (sebacic acid and isocaproic acid) as well as bile acid was observed in patients with IBD. Compared with healthy controls, 22 microbial species (including Sulfolobus acidocaldarius, and Clostridium clostridioforme CAG132) in the UC group and 37 microbial species (such as Bacteroides fragilis and Fusobacterium nucleatum) in the CD group were found to be correlated to diet and metabolites. Bacteroides fragilis was enriched in patients with IBD and associated with multi-nutrients, and 21 metabolites including 25-hydroxyvitamin D3 and taurolithocholic acid. Conclusions This study provides an interaction network to identify key micronutrients, microbiota components and metabolites that contribute to IBD.

OBJECTIVE Esophagogastroduodenoscopy (EGD) is a standard instrument for detecting upper gastrointestinal lesions. However, the distal duodenum is often missed. This study aimed to clarify the diagnostic role of EGD in the distal duodenum. METHODS This retrospective study enrolled patients with distal duodenal lesions who underwent EGD between January 2004 and July 2016 at our center. The rate of missed diagnosis using EGD examination was calculated. Logistic regression analysis was performed to identify the factors associated with the missed diagnoses. RESULTS Sixty-three patients were included in the study. The overall diagnostic rate of distal duodenal lesions on EGD was 58.7%. After excluding the patients in whom the EGD did not reach the distal duodenum, this rate rose to 82.2%. In univariate analysis, intravenous sedation (26.8% vs 68.2%, odds ratio [OR] 0.171, P = 0.002), signs of lesions adjacent to the stomach (19.4% vs 62.5%, OR 0.099, P = 0.001), prior enteroscopy experience (15.0% vs 87.0%, OR 0.026, P < 0.001), and endoscopists with experiences of over 10 years (13.8% vs 64.7%, OR 0.087, P = 0.000) were associated with a decreased risk of missed diagnosis. In multivariate analysis, signs of lesions adjacent to the stomach (OR 0.167, P = 0.039) and prior enteroscopy experience (OR 0.035, P < 0.001) were significant independent protective factors. CONCLUSION EGD may be important in diagnosing distal duodenal lesions. Patients with gastric retention, blood in the stomach or erosion in the proximal duodenum may benefit from the deep insertion of EGD.

Background Data from single-center experience or small sample-sized studies have shown that chromoendoscopy (CE) might be superior to white-light endoscopy (WLE) for dysplasia surveillance in ulcerative colitis (UC) patients. We performed a prospective randomized trial with a long-term follow-up to compare the detection rate of dysplasia among WLE with targeted biopsies (WLT), WLE with random biopsies (WLR), and dye-based CE with targeted biopsies (CET) in UC patients. Methods Patients with long-standing UC were enrolled from 11 medical centers from March 2012 to December 2013 and randomized into three arms (WLT, WLR, and CET). Only high-definition endoscopy was used in all three groups. The patients were followed up by annual endoscopy with biopsies through December 2017. Results With a median follow-up time of 55 months, a total of 122 patients with 447 colonoscopies were finally analysed in the per-protocol set: WLT (n = 43), WLR (n = 40), and CET (n = 39). A total of 34 dysplastic lesions were found in 29 colonoscopies of 21 patients. WLR and CET could identify more colonoscopies that diagnosed dysplasia than WLT (8.1% and 9.7% vs 1.9%; P = 0.014 and 0.004, respectively). WLR obtained more biopsied samples than WLT and CET (16.4 ± 5.1 vs 4.3 ± 1.4 and 4.3 ± 1.4; both P Conclusions For a better outcome of cancer/dysplasia surveillance in patients with long-standing UC, CET appeared to be more effective than WLT and less tedious than WLR. CET was found to be particularly useful when a long-term (>3 years) follow-up was conducted for dysplasia surveillance. The trial was registered on www.chictr.org.cn (ChiCTR1900023689).

The ingestion of foreign bodies is a common emergency in clinical practice, representing about 4% of all emergency endoscopies. If not treated promptly, ingested foreign bodies may cause serious complications, even result in death. Currently, the international guidelines and consensuses on the management of foreign bodies in the upper gastrointestinal tract mainly include Management of ingested foreign bodies and food impactions by the American Society for Gastrointestinal Endoscopy (ASGE), Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), Pediatric button battery injuries: 2013 task force update by the American Broncho-Esophagological Association (ABEA); Management of ingested magnets in children by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and NASPGHAN; and Clinical guidelines for imaging and reporting ingested foreign bodies by the American Roentgen Ray Society (ARRS). But no guideline or consensus on the endoscopic management of foreign bodies in the upper gastrointestinal tract is available in China. Thus, the Chinese Society of Digestive Endoscopy has led and organized experts from various disciplines, including gastroenterology, digestive endoscopy, thoracic surgery, gastrointestinal surgery, otorhinolaryngology, emergency medicine, pediatrics, and radiology, to co-develop this consensus based on the current status of management for upper gastrointestinal foreign bodies in China, with reference to the latest international guidelines and consensuses. This article is protected by copyright. All rights reserved.

Objective Small fundal submucosal tumors (SMTs) originated from the muscularis propria pose great difficulties to conventional therapies. We aimed to evaluate the feasibility and safety of endoscopic cap-aspiration lumpectomy (CASL) as a new and simple full-thickness resection for the treatment of small fundal SMTs. Methods From July 2013 to February 2014, patients with small fundal SMTs of ≤10 mm in diameter that were originated from muscularis propria were included in the study. CASL was performed by suctioning SMTs into a transparent cap, ligating with a metal snare and resecting the tumors. The wall deficit was closed by using endoclips. Results Altogether 28 patients were included in the study. CASL achieved an en bloc resection rate of 100%, with a mean total procedure time of 23.9 min. Active perforation was found in 20 (71.4%) patients, and endoclips closed the wall defect in all 20 cases. One patient developed pneumoperitoneum and self-limited peritonitis was found in two patients, all of whom were managed successfully. Pathological examination showed that 71.4% (20/28) of the tumors were gastrointestinal stromal tumors. No tumor recurrence was observed during the follow-up. ConclusionS CASL may be a feasible and safe full-thickness resection modality for the treatment of small fundal SMTs arising from the muscularis propria. Further randomized studies are needed to confirm the results.

Objective This study aimed to evaluate the efficacy including the patients' response rates to infliximab (IFX) therapy, relapse rates after IFX-induced clinical remission, and the safety of IFX in Chinese patients with ulcerative colitis (UC) from a single center in southern China and to identify the risk factors associated with disease relapse. Methods Medical records of Chinese UC patients who were diagnosed and received at least two infusions of IFX at Nanfang Hospital, Southern Medical University from July 2010 to February 2013 were retrospectively reviewed. Primary outcomes were regarded as the clinical response and relapse rates during 30 weeks after the initiation of the therapy. Overall adverse events and relapse-related risk factors were also evaluated. Results A total of 24 UC patients was finally included. The clinical response and remission rates were 83.3% and 50.0% at week 2, 91.3% and 73.9% at week 6 and 84.6% and 61.5% by week 30. Relapse after IFX-induced clinical remission was initiated at the fourth infusion. The relapse rate was 29.4% at week 14, 25.0% at week 22 and 20.0% at week 30, respectively. After 30 weeks only 33.3% remained on maintenance therapy. IFX-associated adverse events occurred in 29.2% of patients, with most being mild and transient. Patients with distal or extensive colitis were at a higher risk of relapse than those with ulcerative proctitis. Conclusions IFX is effective and safe in treating Chinese UC patients, although long-term remission is hard to achieve. Distal or extensive colitis may be an independent predictor of disease relapse.

Objective This study aimed to evaluate the performance, diagnostic yield, and safety of single-balloon enteroscopy (SBE) at a Chinese tertiary-care center. Methods A total of 67 patients with suspected small bowel diseases who underwent SBE via the oral and/or anal routes from January 2009 to August 2011 were retrospectively analyzed. Data were extracted from electronic clinical and endoscopy records. The indications, SBE procedure time, diagnostic yield and complications were summarized and evaluated. Results A total of 42 SBE procedures through the oral route and 38 via the anal route were performed in these 67 patients. Patients were referred mainly for obscure gastrointestinal bleeding (OGIB) (40.3%) and abdominal pain (29.8%). The mean procedure duration was 68.1 min from the oral cavity and 77.5 min from the anus. The estimated depth of insertion was 247.6 ± 80.3 cm from the oral cavity and 131.1 ± 68.7 cm from the anus. The overall significant diagnostic yield was 68.7%. In patients with OGIB and unexplained chronic abdominal pain, the diagnostic yield was 74.1% and 50.0%, respectively. There were no significant complications. Conclusion SBE appears to be a safe and effective method for the diagnosis and treatment of deep small bowel disease.

Microscopic colitis includes lymphocytic colitis and collagenous colitis. The entity is considered as an important cause for unknown chronic diarrhea, but rarely reported in China before. This study aimed to determine the prevalence of microscopic colitis in patients with chronic diarrhea and normal colonoscopy findings in Southern China, and to reveal the clinical feature of microscopic colitis in these patients.Patients with chronic diarrhea and normal colonoscopic findings were enrolled from three hospitals in Southern China from January, 2009 to June, 2010. Multiple colorectal biopsies were obtained in these patients and histological examination was underwent with hematoxyin and eosin stain, Masson's trichrome stain and immunohistochemistry for tenascin to screen lymphocytic colitis and collagenous colitis. The clinical symptom and risk factor of microscopic colitis were assessed by comparing with controls. The diagnostic overlap between microscopic colitis and irritable bowel syndrome or functional diarrhea was also analyzed.Randomly mucosal biopsies were performed in 613 patients with chronic diarrhea and normal or near normal colonoscopic finding. Fifty-nine cases of lymphocytic colitis and 28 cases of collagenous colitis were found by histological examination. The rates of rheumatoid arthritis in lymphocytic colitis group (15.4 %) and collagenous colitis group (14.3 %) were significant higher than in control group (2.2 %). Rheumatoid arthritis was confirmed as the risk factor of microscopic colitis by logistic regression analysis. There was no difference on the symptoms among the controls, patients with lymphocytic colitis, and patients with collagenous colitis. There were 13.8 % (12/87) of patients with microscopic colitis fulfilled Rome III criteria of irritable bowel syndrome and 42.5 % (37/87) fulfilled the criteria of functional diarrhea.Microscopic colitis is not an uncommon disorder in Chinese population. Rheumatoid arthritis is the risk factor of microscopic colitis. Microscopic colitis has a symptomatic overlap with irritable bowel syndrome and functional diarrhea. It is reasonable to obtain multiple biopsies in patients with chronic diarrhea when the mucosa grossly normal at colonoscopy.

Background and study aim: Although the majority of submucosal tumors (SMTs) are benign, some do have a malignant potential. Resection of SMTs would aid in establishing the diagnosis and may be curative. Our aim was to examine the feasibility and safety of a novel method for endoscopic resection of upper gastrointestinal SMTs. Patients and methods: In 12 patients who presented with an upper gastrointestinal SMT of ≤ 40 mm located in the esophagus or cardia, a submucosal tunnel was endoscopically created starting approximately 5 cm proximal to the lesion. After careful submucosal dissection with carbon dioxide or air insufflation, the SMTs were completely removed, and the entrance of the tunnel closed using endoclips. Results: SMTs had a mean size of 19.5 mm (range 10 – 40 mm); eight were located in the esophagus and four in the cardia. SMT resection was successful in all patients with en bloc resection in 10 patients (83.3 %) and resection in two pieces in the remaining two patients. The mean time required for the procedure was 48.3 minutes (range 30 – 60 minutes). Two patients had both pneumothorax and subcutaneous emphysema. All the complications resolved with conservative management. Conclusions: In this pilot study, endoscopic submucosal tunnel dissection (ESTD) of esophageal and cardia SMTs was effective and appeared to be safe. Larger studies that also examine its application for gastric SMTs are warranted.

The diagnosis of irritable bowel syndrome is symptom based, and colonoscopy is the most direct way to rule out organic colonic diseases. It is controversial on the necessity of colonoscopy for patients with suspected irritable bowel syndrome and lacking alarm features. This study was designed to verify the organic lesions and discuss the value of colonoscopy in this type of patients.Colonoscopy of 3,332 patients with suspected irritable bowel syndrome and lacking warning signs from 2000 to 2009 were reviewed. One thousand five hundred eighty-eight patients under 50 years of age who underwent colonoscopy screening for health care in the same period were used as controls. The prevalence of different colonic organic lesions was compared between two groups.Organic colonic lesions were found in 30.3% of the patients with suspected irritable bowel syndrome (1,010/3,332) and 39.0% of the controls (619/1,588). Compared with controls, patients with suspected irritable bowel syndrome had higher prevalence of noninflammatory bowel disease and noninfectious colitis and terminal ileitis, however, had lower prevalence of diverticular disease, adenomatous polyps, and non-adenomatous polyps (all P0.001).The diagnostic sensitivity of symptom criteria on irritable bowel syndrome without colonoscopy is not more than 69.7% in patients with suspected irritable bowel syndrome lacking warning signs. Though the method of colonoscopy is hard to screen tumor in this type of patients, it is beneficial to uncover some other relevant organic lesions such as terminal ileitis. Colonoscopy should not be refused to suspected irritable bowel syndrome patients without warning signs.

Since the introduction of endoscopic retrograde cholangiopancreatology (ERCP) in clinical use, pancreatitis has become a common complication of ERCP. Octreotide is an inhibitor of pancreatic enzyme secretions. Several studies have evaluated the effect of octreotide on the incidence of clinical pancreatitis after ERCP, but with different results. The aim was to determine the efficacy of prophylactic administration of octreotide for the prevention of post-ERCP pancreatitis (PEP) and hyperamylasemia.In this study, patients with scheduled ERCP were randomized to receive either octreotide (0.3 mg) via intramuscular injection or a placebo. The study was conducted in 12 digestive endoscopic units in China. Patients were randomized into two groups: an octreotide group (N = 414) and a control group (N = 418). In the octreotide group, octreotide (0.3 mg) was dissolved in 500 mL of 0.9% saline solution and administered by continuous intravenous infusion, beginning 1 h before endoscopic examination and continued for 6 h thereafter; 0.1 mg of octreotide was injected subcutaneously at 6 and 12 h after the intravenous injection was stopped. The control group was given a placebo intravenously. The end point was the development of acute pancreatitis.The overall incidence of acute pancreatitis was 3.85%; this included 2.42% (10/414) in the octreotide group and 5.26% (22/418) in the control group (P = 0.046). The overall incidence of hyperamylasemia was 14.9%; 12.32% (51/414) in the octreotide group and 17.46% (73/418) in the control group (P = 0.041). No side effects were found.The results indicate that octreotide can prevent PEP and hyperamylasemia.

Supplemental Digital Content is available in the text, The evidence for optimal endoscopic management of bleeding gastric varices is lacking. The clinical outcome is controversial in trials comparing cyanoacrylate injection and band ligation. To help guide endoscopic decisions regarding acute gastric variceal bleeding, a meta-analysis was conducted. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ScienceDirect were searched for all randomized controlled trials (RCTs) containing the 2 interventions. The main outcomes evaluated in the meta-analysis were active bleeding control, blood transfusion, rebleeding, recurrence of varices, complications, and survival. Three RCTs were identified, which included 194 patients with active gastric variceal bleeding from Taiwan and Romania. Active bleeding control was achieved in 46 of 49 (93.9%) patients in the cyanoacrylate injection group, compared with 35 of 44 (79.5%) in the band ligation group (P = 0.032), for a pooled odds ratio of 4.44 (95% confidence interval, 1.14–17.30). Rebleeding rate was comparable in type 2 gastroesophageal varices (GOV2) between the 2 interventions (35.7% vs 34.8%, P = 0.895), but cyanoacrylate injection seemed superior for reducing rebleeding rate in type 1 gastroesophageal varices (GOV1, 26.1% vs 47.7%, P = 0.035) and type 1 isolated gastric varices (IGV1, 17.6% vs 85.7%, P = 0.015). Cyanoacrylate injection was also superior in controlling recurrence of gastric varices to band ligation (36.0% vs 66.0%, P = 0.002). There was no difference in complications or mortality between the 2 interventions. The major limitation of this meta-analysis is the small number of studies/patients included. Compared with band ligation, injection cyanocrylate have an advantage in the control of acute gastric variceal bleeding, also with lower recurrence rate and rebleeding (except GOV2). The limited amount of studies included attenuates the strength of this meta-analysis; therefore, more high-quality RCTs are needed.

OBJECTIVE: At present, there are few materials available for esophagus reconstruction anywhere in the world. The reported survival rate in animals during the perioperative period is comparatively low. The present study assessed the feasibility of using a biotype artificial esophagus in the reconstruction of a dog's esophagus. METHODS: In 30 mongrel dogs, a portion of the thoracic esophagus was resected and an 8 cm section of artificial esophagus was transplanted to reconstruct the organ. The survival rate, food intake and process of healing were observed. RESULTS: Of the 30 dogs, 28 survived the peri­operative period (93.3% survival). Two dogs (6.7%) developed an anastomotic fistula; 19 dogs survived for 1 year, a survival rate of 79.2% (19/24) with the remaining six dogs were killed according to the experimental protocol. Detachment of the artificial esophagus occurred on average 28.8 days after operation and the dogs suffered from varying degrees of dysphagia 23−45 days after operation. Gradual remission occurred after 4 months. The histological study revealed that the regenerated esophagus was composed of fibrous and connective tissues and the luminal surface was covered with squamous epithelium in 3−6 months. CONCLUSION: The transplanted artificial esophagus detached after the surrounding ‘regenerated esophagus’ had formed, and the squamous epithelium gradually covered the luminal surface. Continuous remodeling of the ‘regenerated esophagus’ gradually relieved the stenosis. Whether detachment of the implant and the postoperative stenosis can be solved is the key problem restricting the use of the biotype artificial esophagus in clinical practice.

Magnifying endoscopy with narrow band imaging (ME-NBI) is widely used in gastroscopy, especially in the diagnosis of early gastric cancer. The purpose of this meta-analysis is to compare the diagnostic efficacy of white light imaging (WLI) and that of ME-NBI for early gastric cancer. PubMed/MEDLINE, EMBASE, and the Cochrane Library were searched to identify studies which met the inclusion criteria. A random-effects model was used to calculate overall sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) to assess the diagnostic efficacy of WLI and ME-NBI in early gastric cancer. Sensitivity analysis was performed to assess the stability of the results. Ten studies met the inclusion criteria, and included 1724 patients and 2153 lesions. The pooled sensitivity, specificity, and AUC for the diagnosis of early gastric cancer using WLI were 0.48 [95 % confidence interval (CI) 0.39–0.57; I 2 = 78.6 %], 0.67 (95 % CI 0.62–0.71; I 2 = 81.9 %), and 0.62, respectively. The pooled sensitivity, specificity, and AUC using ME-NBI were 0.83 (95 % CI 0.79–0.87; I 2 = 79.8 %), 0.96 (95 % CI 0.95–0.97; I 2 = 89.3 %), and 0.96, respectively. The studies showed a high degree of heterogeneity. Further sensitivity analysis was mainly performed for the studies of small lesions (mean size 10 mm or less) and the studies with a the score of 12 points or greater in the literature quality assessment, and the AUCs for ME-NBI for diagnosis of early gastric cancer were between 0.93 and 0.98, which suggested that the diagnostic value was still high and stable. Compared with WLI, ME-NBI can effectively diagnose early gastric cancer.

To explore the feasibility of transferring the skills from the AccuTouch flexible endoscopy simulator colonoscopy training to clinical practices.The novice colonoscopies were divided into 2 groups.Group A (control group) including 4 trainees for traditional training, Group B (experimental group) including 4 trainees for simulator training. After training, we compared the number of cases for achieving independent competence, assisted competence and incompetence in the first ten patients.No significant differences existed between two groups in terms of age and gender (both P0.05). Significant differences existed in educational background and the controlled group was better than the experimental group (Z = -2.005, P = 0.04). The cases of independent completion, assisted competence and incompetence of the control and experimental groups were 2, 4, 9 and 21, 29, 15 respectively. Rank tests show that the simulator training was better than the traditional counterpart (average rank: 56.14 vs 24.86, Z = -6.393, P = 0.00).The skills acquired from AccuTouch Endoscopy Simulator may be well transferred into the clinical colonoscopy environment. It clearly supports the scheme of integrating simulator training into colonoscopic education curricula.

OBJECTIVE: To compare the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) versus endoscopic retrograde cholangiopancreato­graphy (ERCP) in the detection of cholangiopan­creatic diseases via a prospective study. METHODS: Magnetic resonance cholangiopancreatography was performed in 63 patients with suspected cholangiopancreatic diseases and followed by ERCP within 24 h. The MRCP and ERCP images were analyzed and compared. RESULTS: Of the 63 patients studied, 56 (88.9%) were correctly diagnosed by using ERCP and seven (11.1%) by using percutaneous transhepatic cholangio­graphy (PTC); however, all these patients were successfully diagnosed by using MRCP. Cholangio­pancreatic diseases were diagnosed by MRCP with a sensitivity of 98.2%, a specificity of 83.3%, a misdiagnostic rate of 16.7% and a missed diagnostic rate of 1.8%. The total concordance rate of MRCP, ERCP and PTC was 85.7%. For specific conditions, the concordance rates were as follows: biliary calculi 100%; tumors of the bile duct 92.9%; papillary lesions 70.6%; hepatic distomiasis 66.7%; chronic pancreatitis 100%. The complications associated with ERCP were five cases of acute pancreatitis and one case of perinephric abscess. The patient with perinephric abscess had previously had a B-II operation. The complication rate associated with ERCP was 9.5% (6/63), but no complications were associated with MRCP. CONCLUSION: We conclude that MRCP is as effective as ERCP for the diagnosis of bile duct lesions, such as biliary calculi and tumors, but not for papillary lesions and liver fluke infections. Although MRCP can be used in patients who can’t tolerate ERCP or when there are contraindications to using ERCP, it should not be used for therapeutic purposes.

Repeat colonoscopy is often performed within a short time after polypectomy due to the fear that colorectal adenomas were missed during the initial colonoscopy or that new adenomas have developed. The aim of this study was to estimate the actual recurrence rate of adenoma and its association with the length of the surveillance interval after polypectomy in a southern Chinese population.A total of 1,356 patients undergoing endoscopic polypectomy and completing three or more surveillence colonoscopies between 1976 and 2007 were retrospectively analyzed. The recurrence rates of adenoma and advanced adenoma and surveillance intervals after polypectomy were identified based on the features of adenomas detected on initial colonoscopy.The recurrence rates of advanced adenoma in patients with non-advanced adenoma on the initial colonoscopy were 0.9, 3.9, 5.8, and 29.2% during surveillance intervals of 1-3, 3-5, 5-10, and 10-20 years post-initial colonoscopy; for patients with advanced adenoma on the initial colonoscopy, the recurrence rates were 3.8, 13.1, 34.7, and 52.0% during the same surveillance intervals, respectively. Older age (p0.05 for trend) and male sex [hazard ratio (HR) 2.11, 95% confidence interval (CI) 1.27-3.53] were significantly associated with recurrence for advanced adenoma, as were the size and number of baseline adenoma (p0.05 for trend), tubulovillous, villous adenoma (HR 2.57, 95% CI 1.24-5.32), and high-grade dysplasia (HR 1.61, 95% CI 1.07-2.42). When 5% of patients had recurring advanced adenoma, the surveillance interval was estimated to be 6.9 (95% CI 6.3-12.2) years in the low-risk group and 3.0 (95% CI 2.7-3.2) years in the high-risk group.Among our patient group, the recurrence of advanced adenoma after polypectomy increased with the length of the surveillance interval. Based on our results, a 3-year follow-up of patients after polypectomy could be effective in preventing the recurrence of advanced adenoma in high-risk patients.

Laterally spreading tumors (LSTs) are being increasingly reported nowadays in Japan and the western countries with the application of magnification chromoendoscopy. The aim of this study was to analyze the clinicopathologic features of LSTs and to assess the outcome and safety of endoscopic mucosal resection (EMR) in China. One hundred nine patients with LSTs who underwent magnification chromoendoscopy were studied retrospectively. Clinicopathological features of 111 LSTs were analyzed. The efficacy and safety of EMR was assessed in 79 LSTs based on the outcome of follow-up colonoscopy and resection-related complications. A total of 111 LSTs were diagnosed in 109 patients, including 89 (80%) laterally spreading tumor-granular (LST-G) type and 22 (20%) laterally spreading tumor-non-granular (LST-NG) type. There was significant difference in the dominant pit pattern between LST-G type and LST-NG type (p

To investigate the potential risk factors for endoscopic retrograde cholangiopancreatography (ERCP) complications and to identify whether the risk factors are different for pancreatitis and asymptomatic hyperamylasemia.Consecutive ERCP procedures were studied at 14 centers in China from May 2006 to April 2007. The complications after the patients' first-only procedures were evaluated. Multivariate analysis based on the first-only procedures was used to identify the risk factors.A total of 3,178 procedures were performed on 2,691 patients. Overall, complications developed in 213 (7.92%) patients, pancreatitis in 116 (4.31%), and asymptomatic hyperamylasemia in 396 (14.72%). In the multivariate analysis, female gender (adjusted odds ratios (ORs): 1.52, 95% confidence interval (CI): 1.14-2.02, P=0.004), periampullary diverticulum (OR: 2.02, 95% CI: 1.49-2.73, P0.001), cannulation time10 min (OR: 1.51, 95% CI: 1.08-2.10, P=0.016),or =1 pancreatic deep wire pass (OR: 1.80, 95% CI: 1.33-2.42, P0.001), and needle-knife precut (OR: 2.70, 95% CI: 1.42-5.14, P=0.002) were risk factors for overall complications. Female gender (OR: 1.84, 95% CI: 1.25-2.70, P=0.002), ageor =60 year (OR: 1.59, 95% CI: 1.06-2.39, P=0.025), cannulation time10 min (OR: 1.76, 95% CI: 1.13-2.74, P=0.012),or =1 pancreatic deep wire pass (OR: 2.77, 95% CI: 1.79-4.30, P0.001), and needle-knife precut (OR: 4.34, 95% CI: 1.92-9.79, P0.001) were risk factors for pancreatitis. Cannulation time10 min (OR: 1.96, 95% CI: 1.52-2.54, P0.001),or =1 pancreatic deep wire pass (OR: 2.24, 95% CI: 1.74-2.89, P0.001), needle-knife precut (OR: 2.34, 95% CI: 1.32-4.14, P=0.004), and major papilla pancreatic sphincterotomy (OR: 1.71, 95% CI: 1.23-2.37, P=0.001) were risk factors for asymptomatic hyperamylasemia.Patient-related factors are as important as procedure-related factors in determining high-risk predictors for post-ERCP overall complications and pancreatitis. However, the risk factors for asymptomatic hyperamylasemia may be mostly procedure related.

OBJECTIVES: Live demonstrations of endoscopic retrograde cholangiopancreatography (ERCP) have a high educational value and contribute significantly to endoscopy development and training. However, the success and safety of live demonstration have been questioned. The aim of this study was to evaluate the success rate and complications of therapeutic ERCP among patients who participated in live demonstrations. METHODS: Patients who underwent therapeutic ERCP during live demonstrations at gastrointestinal endoscopy conferences in China between January 2002 and December 2007 were included. The matched control for each patient was a patient admitted to the same ERCP unit with similar indication, who received ERCP by an endoscopist with similar experience as those who performed the live demonstration. Patient's age, gender, indication, success rate, and complications of ERCP were collected and compared. ERCP outcomes between local and visiting faculty were also compared. RESULTS: In total, 36 conferences with live ERCP demonstrations involving 406 patients were held in 14 endoscopy centers. There were no significant differences in patients' gender, age, and indications between live demonstrations and controls. The overall complication rate of ERCP in live demonstrations was not significantly different compared with controls (10.3% vs. 8.6%, P=0.473). However, the success rate was significantly lower in live demonstrations than in controls (94.1% vs. 97.5%, P=0.021). The success and complication rates of ERCP performed by local faculty, domestic visiting, and foreign visiting faculties were similar. CONCLUSIONS: Although the success rate of therapeutic ERCP performed during live demonstrations was lower than that of routine procedures, the overall complication rate did not significantly increase. ERCP performed by visiting endoscopists was as safe as that done by local faculty in live demonstrations.

Background Diseases of the small intestine include, among others, ulceration, chronic inflammation, Meckel's diverticula, vascular deformities, and cancer. Objective To study the diagnostic value of double balloon enteroscopy (DBE) for small-intestinal disease in a Chinese patient cohort. Design DBE was performed via the mouth, anus, or both approaches to diagnose small-intestinal disease. Patients We studied 155 patients with clinically suspected small-intestinal disease: 110 men and 45 women. Their age ranged from 6 to 75 (mean 41). There were 92 cases with small-intestinal hemorrhage, 39 with abdominal pain, 7 with diarrhea, 13 with abdominal distention, 3 cases with malnutrition, and 1 with diarrhea and refractory hypoalbuminemia. Results Among the 155 patients, lesions were found in 126 (81.3%). These lesions found were small-intestinal ulcers (including Crohn's disease), chronic inflammation, Meckel's diverticulae, vascular deformities, and carcinoma. Eighty-five of the 92 patients with suspected intestinal hemorrhage were confirmed, with a positive rate of 92.4%. Also confirmed were 24 of the 39 patients with abdominal pain (positive rate of 61.5%); 16 of the 23 patients with diarrhea, abdominal distention, or malnutrition (positive rate of 69.6%); and 1 patient with refractory hypoalbuminemia. Among the 126 patients with positive findings, the lesions were located in the small intestine in 116 patients, in the stomach and duodenum in 9 patients, and in the colon in 1 patient. In the 45 patients with small-intestinal ulcer, 29 patients had recurrent hemorrhage, 9 had abdominal pain, 4 had abdominal distention, 2 had malnutrition, and 1 had diarrhea. Ulcers were located in the jejunum in 20 patients, in the ileum in 20 patients, and in both the jejunum and ileum in 5 patients. For 7 patients with small-intestinal ulceration diagnosed as Crohn's disease, the concordance rate of diagnosis between preoperative and postoperative diagnosis was 57.1%, lower than other diseases (P Conclusion DBE is effective and safe for the diagnosis of small-intestine disease in a Chinese patient cohort.

To investigate the relationship between gastric dysmotility, gastrointestinal hormone abnormalities, and neuroendocrine cells in gastrointestinal mucosa in patients with functional dyspepsia (FD).Gastric emptying was assessed with solid radiopaque markers in 54 FD patients, and the patients were divided into two groups according to the results, one with delayed gastric emptying and the other with normal gastric emptying. Seventeen healthy volunteers acted as normal controls. Fasting and postprandial plasma levels and gastroduodenal mucosal levels of gastrointestinal hormones gastrin, somatostatin (SS) and neurotensin (NT) were measured by radioimmunoassay in all the subjects. G cells (gastrin-producing cells) and D cells (SS-producing cells) in gastric antral mucosa were immunostained with rabbit anti-gastrin polyclonal antibody and rabbit anti-SS polyclonal antibody, respectively, and analyzed quantitatively by computerized image analysis.The postprandial plasma gastrin levels, the fasting and postprandial plasma levels and the gastric and duodenal mucosal levels of NT were significantly higher in the FD patients with delayed gastric emptying than in those with normal gastric emptying and normal controls. The number and gray value of G and D cells and the G cell/D cell number ratio did not differ significantly between normal controls and the FD patients with or without delayed gastric emptying.Our findings suggest that the abnormalities of gastrin and NT may play a role in the pathophysiology of gastric dysmotility in FD patients, and the abnormality of postprandial plasma gastrin levels in FD patients with delayed gastric emptying is not related to the changes both in the number and gray value of G cells and in the G cell/D cell number ratio in gastric antral mucosa.

AIM: To assess the therapeutic value of endoscopic nasobiliary drainage (ENBD) and oral praziquantel for severe Clonorchiasis sinensis infection. METHODS: Of the 84 Clonorchiasis sinensis-infected patients enrolled, 58 were treated with ENBD (as observing group, ENBD group), 26 received operations (control group, operation group). Both of the two groups were comparable in terms of patient’s age, body mass index. Before and one week after treatment, the average diameters of common bile ducts were measured by ultrasound, and serum bilirubin, ALP, γ-GT and ALT were detected by biochemical methods. After ENBD or operation, the patients took praziquantel for two days. RESULTS: Compared with the patients in operation group, ENBD patients in ENBD group had higher recovery rates of abdominal pain and fever as well as jaundice, quicker remission, smaller trauma, fewer complications and lower cost. CONCLUSION: ENBD combined with oral praziquantel is an effective and safe method for the treatment of severe Clonorchiasis sinensis.

Few studies have analyzed the training of endoscopists in the diagnosis of early gastric cancer (EGC). This study assessed whether specific training of endoscopists improves the detection rate of EGC. The rates of detection of EGC by endoscopists at the Digestive Endoscopy Center of the Affiliated Nanfang Hospital of China Southern Medical University between January 2013 and May 2014 were retrospectively analyzed. Because some endoscopists received training in the diagnosis of EGC, beginning in September 2013, the study was divided into 3 time periods: January to September 2013 (period 1), September 2013 to January 2014 (period 2), and January to May 2014 (period 3). The rates of EGC detection during these 3 periods were analyzed. From January 2013 to May 2014, a total of 25,314 gastroscopy examinations were performed at our center, with 48 of these examinations (0.2%) detecting EGCs, accounting for 12.1% (48/396) of the total number of gastric cancers detected. The EGC detection rates by trained endoscopists during periods 1, 2, and 3 were 0.3%, 0.6%, and 1.5%, respectively, accounting for 22.0%, 39.0%, and 60.0%, respectively, of the gastric cancers detected during these time periods. In comparison, the EGC detection rates by untrained endoscopists during periods 1, 2, and 3 were 0.05%, 0.08%, and 0.10%, respectively, accounting for 3.1%, 6.0%, and 5.7%, respectively, of the gastric cancers detected during these times. After training, the detection rate by some trained endoscopists markedly increased from 0.2% during period 1 to 2.3% during period 3. Further, the use of magnifying endoscopy with narrow-band imaging (M-NBI) (odds ratio = 3.1, 95% confidence interval 2.4-4.1, P < 0.001) contributed to the diagnosis of EGC. In conclusion, specific training could improve the endoscopic detection rate of EGC. M-NBI contributed to the diagnosis of EGC.