第1届世界（19届中国）肉镜医师大会在香港召开暨世界内镜医师协会成立大会

2009年12月19日，第1届世界（19届中国）内镜医师大会在香港召开。全球15个医学专科内镜专家汇聚香港。联盟成立世界内镜医师协会和世界内镜博览会。成立揭牌仪式上，中国卫生部副部长、中央保健局局长黄洁夫教授参会致贺词，世界内镜医师大会组委会、第19届中国内镜医师大会、世界内镜医师协会、世界内镜博览会主席、内镜专业技术全国考评委员会主任和卫生部肝胆肠外科研究中心主任、中南大学生物医学工程研究院院长张阳德教授代表大会致欢迎词。

普通和真空包装镜鲤鱼肉在-2℃贮藏过程中挥发性成分分析

采用顶空固相微萃取-气相色谱-质谱(headspace solid phase microextraction-gas chromatography-mass spectrometry,HS-SPME-GC-MS)联合电子鼻技术研究普通和真空包装镜鲤鱼肉在-2℃贮藏过程中挥发性成分的变化。结果表明,电子鼻主成分分析显示样品间响应值存在显著差异,风味明显改变。采用HS-SPME-GC-MS共检测出98种化合物,主要为醛类、醇类和烃类化合物。经普通包装方式处理后,醛类物质相对含量呈现上升趋势;醇类物质相对含量先上升后下降;烷烃类物质相对含量逐渐下降;酯类、其他物质相对含量上下波动。真空包装组检出的醛类、醇类物质相对含量均明显低于普通包装组,己醛、1-己醇等使鱼体呈腥味的物质大幅降低,酸类物质在贮藏后期所占比重相对增加。感官评定和微生物检测结果表明真空包装可延缓菌落总数的增加和感官品质的下降。综上说明真空包装处理在一定程度上可以有效降低鱼体腥味及不良挥发性物质的产生。

鼻内窥镜手术治疗术后复发性鼻窦炎及鼻息肉62例小结

目的 总结功能性鼻内窥镜手术 (FESS)治疗术后复发性鼻窦炎及鼻息肉经验。方法 对术后复发性鼻窦炎、鼻息肉 12 4侧 (6 2例 )再次FESS结果进行分析。结果 无严重手术并发症 ,经鼻内窥镜术后随访 3～ 6月 ,治愈 72侧 (58.1% ) ,好转 52侧 (4 1.9% )。结论 术后复发性鼻窦炎、鼻息肉病例施行FESS时需熟悉中鼻甲前上附着处、上颌窦口上骨嵴等解剖标志 。

经皮肝胆道支架置入与内镜下塑料支架置入治疗恶性梗阻性黄疸疗效对比分析

目的探析经皮肝胆道支架置入与内镜下塑料支架置入治疗对恶性梗阻性黄疸患者肝功能指标、减黄程度及术后并发症的影响。方法将我院自2013年12月~2017年6月间收治的恶性梗阻性黄疸患者纳入研究范围,将其就诊编号按随机分层法分为A组(n=44)与B组(n=40),A组经皮肝胆道支架置入治疗,B组内镜下塑料支架置入治疗,对比一般治疗情况、肝功能指标、减黄程度及术后并发症发生率。结果 A组支架成功率为90.91%,略高于B组的82.50%,胆汁引流量、住院费用均略低于B组,且A组并发症总发生率为22.73%,略低于B组的27.50%,但上述对比差异无统计学意义(P>0.05);同时,治疗后两组ALP、γ-GGT、ALT、TBIL、DBIL、TBA等指标水平均显著下降,但A组低于B组,且对比差异有统计学意义(P<0.05)。结论较内镜下塑料支架置入治疗,经皮肝胆道支架置入治疗恶性梗阻性黄疸对患者肝功能指标、黄染程度的改善更显著,或具更高的支架置入成功率、更低的并发症发生率。

Gastric polypoid lesions:Analysis of 150 endoscopic polypectomy specimens from 91 patients

AIM:To analyze gastric polypoid lesions in our patient- population with respect to histopathologic features and demographic,clinical,and endoscopic characteristics of patients. METHODS:Clinical records and histopathologic reports of patients with gastric polypoid lesions were analyzed retrospectively.All lesions had been totally removed by either endoscopic polypectomy or hot biopsy forceps.The histopathologic slides were re-evaluated by the same histopathologist. RESULTS:One-hundred and fifty gastric polypoid lesions were identified in 91 patients.There were 53(58 %)women and 38(42 %)men with a median age of 53(range,31 to 82)years.The most frequent presenting symptom was dyspepsia that was observed in 35(38.5 %)patients. Symptoms were mostly related to various associated gastric abnormalities such as chronic gastritis or H pylori infection rather than polypoid lesion itself.Polypoid lesions were commonly located in the antrum followed by cardia.Out of 150 lesions,80(53 %)had the largest dimensions less than or equal to 5 mm and only 7 were pedunculated.The frequencies of hyperplastic polyps,foveolar hyperplasia,and fundic gland polyps were 46 %,18 %,and 14 % respectively. We also detected gastritis varioliformis in 12 specimens, lymphoid follicles in 9,4 adenomatous polyps in 4,polypoid lesions with edematous mucosa in 4,inflammatory polyps in 3,and carcinoid tumor in 1.Adenomatous changes were observed within two hyperplastic polyps and low grade dysplasia in one adenoma.Histopathologic evaluation of the surrounding gastric mucosa demonstrated chronic gastritis in 72(79 %)patients and H pylori infection in 45(49 %). CONCLUSION:Hyperplastic polyps are the mbst frequently encountered subtype of gastric polypoid lesions.They are usually associated with chronic gastritis or H pylori gastritis.Contrary to the previous belief,they may harbour adenomatous changes or dysplastic foci. Therefore,endoscopic polypectomy seems as a safe and fast procedure for both diagnosis and treatment of gastric polypoid lesions at the same session.In addition, edematous mucosa may appear misleadingly as a polypoid lesion in some instances and it can be ruled out only by histopathologic examination.

Narrow-band imaging optical chromocolonoscopy: Advantages and limitations

Narrow-band imaging （NBI） is an innovative optical technology that modifies the center wavelength and bandwidth of an endoscope＇s light into narrow-band illumination of 415 ：1： 30 nm. NBI markedly improves capillary pattern contrast and is an in vivo method for visualizing microvessel morphological changes in superficial neoplastic lesions. The scientific basis for NBI is that short wavelength light falls within the hemoglobin absorption band, thereby facilitating clearer visualization of vascular structures. Several studies have reported advantages and limitations of NBI colonoscopy in the colorectum. One difficulty in evaluating results, however, has been nonstandardization of NBI systems （Sequential and nonsequential）. Utilization of NBI technology has been increasing worldwide, but accurate pit pattern analysis and sufficient skill in magnifying colonoscopy are basic fundamentals required for proficiency in NBI diagnosis of colorectal lesions. Modern optical technology without proper image interpretation wastes resources, confuses untrained endoscopists and delays interinstitutional validation studies. Training in the principles of ＂optical image-enhanced endoscopy＂ is needed to close the gap between technological advancements and their clinical usefulness. Currently available evidence indicates that NBI constitutes an effective and reliable alternative to chromocolonoscopy for in vivo visualization of vascular structures, but further study assessing reproducibility and effectiveness in the colorectum is ongoing at various medical centers.

Endoscopic polypectomy: A promising therapeutic choice for esophageal carcinosarcoma

Esophageal carcinosarcoma is a rare malignant tumor composing of both carcinomatous and sarcomatous elements. Endoscopic therapy is less invasive and may represent an alternative to esophagectomy for superf icial esophageal carcinosarcoma. Here, we report a 61-year-old male who was diagnosed as esophageal carcinosarcoma and underwent endoscopic polypectomy with well tolerance and favorable prognosis. We also present a brief review of the literature.

Histologic characteristics of gastric polyps in Korea: Emphasis on discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimen

AIM： To investigate histological characteristics of gastric polyps in the Korean population. METHODS： We reviewed endoscopic photographs and medical records of patients with gastric polyps who underwent endoscopic mucosal resection from April 1996 through February 2003. RESULTS： A total of 85 gastric polyps from 74 patients were reviewed, Male-to-female ratio was 1：1,96, Mean age was 59.9 =1：10,8 years. Multiple polyps were observed in 10,8%, Gastric polyps occurred most frequently in the antrum （58.8%）, Pathological results on resected specimens were as follows： tubular adenoma 45.9%, hyperplastic polyp 31.8%, inflammatory polyp 9.4%, hamartoma 3.5%, fundic gland polyp 2.4%, tubulovillous adenoma 2.4%, adenocarcinoma 2.4%, dysplasia 1.1%, and mucosal pseudolipomatosis 1.1%. Discrepancy rate between endoscopic biopsy and pathology of resected specimens was 27.1%. There was no relationship between the size of the polyp and concordance rate. CONCLUSION： There is considerable discrepancy in histologic findings between endoscopic forceps biopsy and resected specimens. Approaches to review of the histology of an entire polyp should be performed, especially when an adenoma is suspected.

Colon capsule endoscopy

Wireless capsule endoscopy has become the first imaging tool for small bowel examination. Recently, new capsule endoscopy applications have been developed, such as esophageal capsule endoscopy and colon capsule endoscopy. Clinical trials results have shown that colon capsule endoscopy is feasible, accurate and safe in patients suffering from colonic diseases. It could be a good alternative in patients refusing conventional colonoscopy or when it is contraindicated. Upcoming studies are needed to demonstrate its utility for colon cancer screening and other indications such us ulcerative colitis. Comparative studies including both conventional and virtual colonoscopy are also required.

Pedunculated Brunner's gland hamartoma of the duodenum causing upper gastrointestinal hemorrhage

A case of pedunculated Brunner＇s gland hamartoma （BGH） of the duodenum causing upper gastrointestinal （GI） hemorrhage is reported. The patient was a 47-year-old man who visited our hospital for further evaluation of tarry stools and shortness of breath. Endoscopic examination of the upper digestive tract revealed a large peduncular polyp with bleeding, about 30 mm in diameter, arising from the wall of the second portion of the duodenum. GI bleeding occurred from the base of the stalk of the polyp. Endoscopic polypectomy was performed. Histological examination of the specimen revealed that the main body of the polyp contained several Iobules of mature Brunner＇s gland with areas of cystic dilatation. The surface epithelium consisted of normal duodenal mucosa with areas of focal ulceration. This polyp was diagnosed as a BGH. The symptom of tarry stools resolved after endoscopic resection. Our case shows that treatment is necessary for duodenal BGH if GI bleeding occurs.

Efficacy, risk factors and complications of endoscopic polypectomy: Ten year experience at a single center

AIM: To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions. METHODS: We retrospectively reviewed 1354 polypectomies performed on 1038 patients over a ten- year period. One hundred and sixty of these were performed for large polyps, those measuring ≥ 20 mm. Size, shape, location, histology, the technique of polypectomy used, complications, drugs assumption and associated intestinal or extra intestinal diseases were analyzed. For statistical analysis, the Pearson χ2 test, NPC test and a Binary Logistic Regression were used. RESULTS: The mean patient age was 65.9 ± 12.4 years, with 671 men and 367 women. The mean size of polyps removed was 9.45 ± 9.56 mm while the size of large polyps was 31.5 ± 10.8 mm. There were 388 pedunculated and 966 sessile polyps and the most common location was the sigmoid colon (41.3%). The most frequent histology was tubular adenoma (55.9%) while for the large polyps was villous (92/160 -57.5%). Coexistent malignancy was observed in 28 polyps (2.1%) and of these, 20 were large polyps. There were 17 procedural bleeding (1.3%) and one perforation. The statistical analysis showed that cancer is correlated to polyp size (P < 0.0001); sessile shape (P < 0.0001) and bleeding are correlated to cardiac disease (P = 0.034), tubular adenoma (P = 0.016) and polyp size.CONCLUSION: The endoscopic resection is a simple and safe procedure for removing colon rectal neoplastic lesions and should be considered the treatment of choice for large colorectal polyps. The polyp size is an important risk factor for malignancy and for bleeding.

Increasing prevalence of advanced colonic polyps in young patients undergoing colonoscopy in a referral academic hospital in Hong Kong

AIM： To investigate the distribution and frequency of advanced polyps over eight years.METHODS：6424 colonoscopies were reviewea aunng the study period 1998 to 2005. The study period was subdivided into period I ： 1998 to 2001 and period 11： 2002-2005. RESULTS： 1856 polyps （33% advanced polyps） and 328 CRCs were detected. The mean ages of the patients with advanced polyps and cancer were 69.2 ± 12.0 and 71.6± 13.8 years, respectively. Advanced polyps were mainly lerc sided （59.5%）. Advanced polyps were found in patients ≤60 years from 17.7% in period Ⅰto 26.3% in period Ⅱ（P 〈 0.05）, especially in male subjects ≤60 years （21.6% vs 31.6%, P 〈 0.05）. Advanced tubuloviUous polyps rose from 21.5% in period I to 29.5% in period Ⅱ （P 〈 0.05）. Whereas cancers in male patients ≤ 60 years were similar in both periods： 23.2% vs 16.5% （P 〉 0.05）.CONCLUSION： Advanced polyps increased significantly in the younger male group in the most recent period and there seems to be a shiE towards a proximal location.

Inflammatory fibroid polyp occurring in the transverse colon diagnosed by endoscopic biopsy

A case of an inflammatory fibroid polyp occurring in the transverse colon and diagnosed by endoscopic biopsy is reported. The patient was an 82-year-old man who visited our hospital for further evaluation of occult blood in stool. The Colonoscopy revealed a small, red, and peduncular polyp, about 6 mm in diameter, in the transverse colon. Histological examination of the biopsy specimen obtained from the polyp revealed proliferation of fibroblasts and infiltration of inflammatory cells such as plasma cells and eosinophils. This polyp was diagnosed as an inflammatory fibroid polyp, which can appear in many different locations throughout gastrointestinal tract, though still rare in the transverse colon.

Conventional colonoscopy and magnified chromoendoscopy for the endoscopic histological prediction of diminutive colorectal polyps: A single operator study

AIM： To accurately differentiate the adenomatous from the non-adenomatous polyps by colonoscopy. METHODS： All lesions detected by colonoscopy were first diagnosed using the conventional view followed by chromoendoscopy with magnification. The diagnosis at each step was recorded consecutively. All polyps were completely removed endoscopically for histological evaluation. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as gold standard. RESULTS： A total of 240 lesions were identified, of which 158 （65.8%） were non-neoplastic and 82 （34.2%） were adenomatous. The overall diagnostic accuracy of conventional view, and chromoendoscopy with magnification was 76.3% （183/240） and 95.4% （229/240）, respectively （P〈 0.001） CONCLUSION： The combination of colonoscopy and magnified chromoendoscopy is the most reliable nonbiopsy method for distinguishing the non-neoplastic from the neoplastic lesions.

Giant sporadic fundic gland polyp:Endoscopic and endosonographic features and management

Fundic gland polyps are the most common gastric polyps. They are usually small in size, sporadic and asymptomatic. We present a case of giant fundic gland polyp. Our case is particular because of the clinical presentation, the endoscopic and endosonographic documented findings, and the treatment otpions followed.

Detection and treatment of synchronous lesions in colorectal cancer: The clinical implication of perioperative colonoscopy

AIM： To evaluate the clinical significance of preand intra-operative colonoscopy for the detection of synchronous lesions in colon cancer.METHODS： Two hundred and sixty-five pre-operative and 51 intra-operative colonoscopic evaluations were performed in 316 colorectal cancer patients who underwent curative resection from January 2001 to June 2006. The incidence and characteristics of synchronous lesions and their influence on surgery were evaluated.RESULTS： Two hundred and eighty-two synchronous lesions were detected in 124 （39.2%） of 316 patients including all lesions regardless of their histologic type. True adenomatous polyps were found in 91 （28.8%） of 326 patients, and 27 （5.4% of all patients） patients had synchronous colon cancers. The preoperative identification of synchronous lesions altered the planned surgery in 37 （14.0%） of 265 patients. In 18 patients among the surgically removed cases, the lesions were removed by extending the resection range. Further segmental resection or polypectomy through enterotomy was necessary in 29 patients. Nineteen （37.2%） of 52 intraoperative colonoscopy cases had synchronous lesions. Additional surgical procedures including segmental bowel resection and polypectomy with enterotomy were necessary in 7 （23.7%） of 52 intraoperative colonoscopy cases to remove the lesions.CONCLUSION： Synchronous colorectal polyps or cancer are frequent and their preoperative detection is important for optimal surgical planning and treatment. Intraoperative colonoscopy is a useful option in cases where a preoperative colonoscopy is not feasible.

Wireless capsule endoscopy in detecting small-intestinal polyps in familial adenomatous polyposis

AIM:To detect the prevalence of small bowel polyps by wireless capsule endoscopy(WCE)in patients with familial adenomatous polyposis(FAP).METHODS:We examined prospectively 14 patients with FAP to assess the location,size and number of small-intestinal polyps.Patients'age,sex,years of observation after surgery,type of surgery,duodenal polyps and colorectal cancer at surgery were analyzed.RESULTS:During WCE,polyps were detected in 9/14(64.3%)patients.Duodenal adenomatous polyps were found in nine(64.3%)patients,and jejunal and ileal polyps in seven(50%)and eight(57.1%),respectively.The Spigelman stage of duodenal polyposis was associated with the presence of jejunal and ileal polyps.Identification of the ampulla of Vater was not achieved with WCE.Importantly,the findings of WCE had no immediate impact on the further clinical management of FAP patients.No procedure-related complications were observed in the patients.CONCLUSION:WCE is a promising noninvasive new method for the detection of small-intestinal polyps.Further investigation is required to determine which phenotype of FAP is needed for surveillance with WCE.

Successful endoscopic removal of a giant upper esophageal inflammatory fi brous polyp

Giant esophageal inflammatory fibrous polyp （espedally 〉 17 cm in size） is seen rarely. Endoscopic removal has been reported rarely because the procedure is technically demanding and the hemostasis is difficult to ascertain. Here, we describe a case of a giant upper esophageal inflammatory fibrous polyp that was resected successfully by endoscopy.