Cholangiopancreatography troubleshooting:the usefulness of endoscopic retrieval of migrated biliary and pancreatic stents

BACKGROUND:Stent migration in the hepatopancreatic duct might arise as one of the rare complications associated with biliary or pancreatic stenting.Although there are some procedures to retrieve the migrated stent,including surgical,percutaneous,and endoscopic approaches,endoscopy should be attempted first because it is least invasive.This study set out to evaluate the usefulness of endoscopic retrieval of migrated biliary and pancreatic stents.METHODS:Plastic stents that migrated in the bile duct(35 patients)or pancreatic duct(2)were retrieved with endoscopic retrograde cholangiopancreatography.Devices used were snare forceps,a basket catheter,grasping forceps,biopsy forceps,a balloon catheter,and the Soehendra stent retriever.RESULTS:Endoscopic retrieval of migrated stents was performed successfully in 36(97.0%)of the 37 patients.The devices utilized for successful treatment were basket catheter(13 patients),grasping forceps(10),snare forceps(8),balloon catheter(3),biopsy forceps(1),and the Soehendra stent retriever(1).The unsuccessfully treated patient with chronic pancreatitis underwent surgery since the guide wire did not move forward due to bile duct stenosis,and there was also duodenal stenosis.One patient developed mild pancreatitis after withdrawal of the stent;the pancreatitis was relieved with conservative treatment.CONCLUSIONS:Endoscopic retrieval of migrated biliary and pancreatic stents appears to be useful because of its safety and low invasiveness.However,various forceps should be prepared for the retrieval of a migrated stent.

Doppler study of hepatic vein in cirrhotic patients:Correlation with liver dysfunction and hepatic hemodynamics

AIM: To elucidate the significance of Doppler measurements of hepatic vein in cirrhotic patients and to correlate with liver dysfunction and hepatic hemodynamics. METHODS: One hundred patients with liver cirrhosis and 60 non-cirrhotic controls were studied. Doppler waveforms were obtained from right hepatic vein and flow velocity measured during quiet respiration. Doppler measurements were also obtained from portal trunk, right portal vein and proper hepatic artery. RESULTS: Hepatic vein waveforms were classified into three classical patterns. Flat waveform was uncommon. Mean hepatic vein velocity was significantly higher in cirrhotic patients (12.7 ± 6.4 vs 5.1 ± 2.1 and 6.2 ± 3.2 cm/s; P < 0.0001). The poorer the grade of cirrhosis, the higher was the mean velocity. Maximum forward velocity was never greater than 40 cm/s in controls. Degree of ascites was found to be highly correlated with mean velocity. “Very high” group (≥ 20 cm/s) presented clinically with moderate to massive ascites. Correlations between right portal flow and mean velocity was significant (P < 0.0001, r = 0.687). CONCLUSION: Doppler waveforms of hepatic vein, which is independent of liver dysfunction, should be obtained during normal respiration. Mean hepatic vein velocity reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of liver cirrhosis.

Relationship between therapeutic efficacy of arterial infusion chemotherapy and expression of P-glycoprotein and p53 protein in advanced hepatocellular carcinoma

瞄准：在先进肝细胞癌(HCC ) 调查在化学疗法的药功效和 P-glycoprotein (PGP ) 和 p53 蛋白质的表示之间的关系。方法：学习在 41 上被进行被对待由的有先进 HCC 的病人重复了动脉的注入化疗。从肿瘤的活体检视标本在所有病人在治疗的开始前被收集，并且标本被存储结冰直到免疫，到组织化学的染色，它在治疗的开始以后被执行检测 PGP 和 p53 蛋白质表情。41 个病人中的二十个与 anthracycline 药被对待(epirubicin 水疗院氯化物；anthracycline 组) ，并且留下 21 与 non-anthracycline 药被对待(在 11 个病人的 mitoxantrone 水疗院氯化物和在 10 个病人的 carboplatin；non-anthracycline 组) 。在化学疗法的功效和染色的免疫的结果之间的关系在二个组之间被比较。结果：在治疗的开始前， PGP 积极的率是 90.2%( 强烈积极， 36.6%) 并且蛋白质积极的率是的 p53 34.1%( 强烈积极， 19.5%) 。在 anthracycline 组，反应率是 40.0% 。显示出差的反应到治疗的病人的数字在有强烈积极的 PGP 表示(P=0.005 ) 的病人是显著地更大的，并且他们的预测是穷人(P=0.001 ) 。在 non-anthracycline 组，反应率是 42.9% ，并且在化学疗法的药功效和 PGP 或 p53 蛋白质表示之间没有重要关系。当仅仅从 11 个病人的数据与蒽醌对待药时， mitoxantrone，然而，被分析显示出差的反应到治疗的病人的数字在 p53 积极的病人(P=0.012 ) 之中是显著地更高的，不管幸存结果。结论：有为先进 HCC 的 anthracycline 药的化学疗法的功效能被免疫预言 PGP 的组织化学的分析表示。同样，染色评估 p53 蛋白质的免疫可能是有用的在与蒽醌药对待的病人预言反应。

Effect of lamivudinein in BeAg-positive chronic hepatitis B: Discordant effect on HBeAg and HBV DNA according to pretreatment ALT level

AIM: To clarify differences in antiviral effect of the drug in patients with different ALT levels, we examined the changes in HBV markers in patients with high or low ALT levels with or without lamivudine treatment. METHODS: Thirty-seven HBeAg-positive patients were studied. Ten patients with ALT levels higher than 200 IU/L (group 1) and 8 patients with ALT below 200 IU/L (group 2) were treated orally with 100 mg/d of lamivudine. As untreated control, 9 patients with ALT above 200 IU/L (group 3) and 10 patients with ALT below 200 IU/L (group 4) were examined. ALT level, HBeAg/HBeAb status, and HBV DNA level were examined monthly for 11.9±0.4 mo.RESULTS: The ALT level normalized in all 10 patients of group 1, 7/8 of group 2, 4/9 of group 3, and 1/10 of group 4 within 6 mo (groups 1 vs 2, P = NS; groups 1 vs 3, P = 0.002; groups 1vs 4, P＜0.0001). HBV DNA fell below the detection limit in all 10 patients of group 1, 7/8 of group 2, 0/9 of group 3, and 0/10 of group 4 within 6 mo (groups 1 vs 2, P = NS). HBeAg became seronegative in 7/10 patients of group 1, 1/8 of group 2, 3/9 of group 3, and 0/10 of group 4 within 12 mo (groups 1 vs2, P= 0.02;groups 1 vs 3, P = NS).CONCLUSION: Our data suggest that HBeAg-positive patients with higher ALT levels can be considered good candidates for lamivudine therapy, probably because lamivudine accelerates the natural seroconversion of HBeAg, accompanied by HBV DNA loss, in these patients.

Current role of ultrasound for the management of hepatocellular carcinoma

Hepatocellular carcinoma(HCC)has a decisive influence on the prognosis of cirrhotic patients.Although α-fetoprotein(AFP)is a known and specific tumor maker for HCC,it is not suitable for the screening and surveillance of HCC because of its poor predictive value and low sensitivity.The use of imaging modalities is essential for the screening,diagnosis and treatment of HCC.Ultrasound(US)plays a major role among them,because it provides realtime and non-invasive observation by a simple and easy technique.In addition, US-guided needle puncture methods are frequently required for the diagnosis and/or treatment process of HCC.The development of digital technology has led to the detection of blood flow by color Doppler US, and the sensitivity for detecting tumor vascularity has shown remarkable improvement with the introduction of microbubble contrast agents.Moreover,near real- time 3-dimensional US images are now available.As for the treatment of HCC,high intensity focused ultrasound (HIFU)was developed as a novel technology that provides a transcutaneous ablation effect without needle puncture.These advancements in the US field have led to rapid progress in HCC management,and continuing advances are expected.This article reviews the current application of US for HCC in clinical practice.

Importance of adequate immunosuppressive therapy for the recovery of patients with "life-threatening" severe exacerbation of chronic hepatitis B

AIM: Hepatitis B virus (HBV) re-activation often occurs spontaneously or after withdrawal of immunosuppressive therapy in patients with chronic hepatitis B. Severe exacerbation, sometimes developing into fulminant hepatic failure, is at high risk of mortality. The efficacy of corticosteroid therapy in "clinically severe" exacerbation of chronic hepatitis B has not been well demonstrated. In this study we evaluated the efficacy of early introduction of high-dose corticosteroid therapy in patients with lifethreatening severe exacerbation of chronic hepatitis B.METHODS: Twenty-two patients, 14 men and 8 women,were defined as "severe" exacerbation of chronic hepatitis B using uniform criteria and enrolled in this study. Eleven patients were treated with corticosteroids at 60 mg or more daily with or without anti-viral drugs within 10 d after the diagnosis of severe disease ("early high-dose"group) and 11 patients were either treated more than 10 d or untreated with corticosteroids ("non-early high-dose"group).RESULTS: Mean age, male-to-female ratio, mean prothrombin time (PT) activity, alanine transaminase (ALT)level, total bilirubin level, positivity of HBeAg, mean IgMHBc titer, and mean HBV DNA polymerase activity did not differ between the two groups. Ten of 11 patients of the "early high-dose" group survived, while only 2 of 11 patients of the "non-early high-dose" group survived (P＜0.001). During the first 2 wk after the introduction of corticosteroids, improvements in PT activities and total bilirubin levels were observed in the "early high-dose"group. Both ALT levels and HBV DNA polymerase levels fell in both groups.CONCLUSION: The introduction of high-dose corticosteroid can reverse deterioration in patients with "clinically lifethreatening" severe exacerbation of chronic hepatitis B,when used in the early stage of illness.

Effect of Clostridium butyricum on fecal flora in Helicobacter pylori eradication therapy

AIM: To investigate the effect of probiotic bacterium,Clostridium butyricum MIYAIRI 588 strain (CBM) on the changes of the fecal flora in Helicobacter pylori(H pylori)treatment.METHODS: Thirty-five patients with gastric or duodenal ulcers positive for Hpylori were randomized either to 1 wk amoxicillin, clarithromycin, lansoprazole (Group 1) or to the same regimen supplemented with CBM 7 dahead of the triple therapy (Group 2). Stool samples were collected before and 2, 4, 7, 15, and 22 d after the starting eradication therapy, and were examined intestinal flora. Patients were required to keep a diary record of their condition. RESULTS: Obligate anaerobes decreased significantly on d 2, 4, 8 and 15 in Group 1. On the other hand, they did not decrease significantly in Group 2. The Escherichiacoli was dominant bacterium in Enterobacteriaceae, butthat was replaced by other species such as Klebsiella and Enterobacter after eradication in Group 1. The change was suppressed in Group 2. Abdominal symptoms were less frequent in Group 2 than in Group 1.CONCLUSION: The combined use of CBM reduced the changes in the intestinal flora and decreased the incidence of gastrointestinal side effects.

Is ERCP really necessary in case of suspected spontaneous passage of bile duct stones?

AIM:To investigate the usefulness of magnetic resonance cholangiopancreatography (MRCP) and the need for endoscopic retrograde cholangiopancreatography (ERCP) in cases of suspected spontaneous passage of stones into the common bile duct.METHODS:Thirty-six patients with gallbladder stones were clinically suspected of spontaneous passage of stones into the common bile duct because they presented with clinical symptoms such as abdominal pain and fever,and showed signs of inflammatory reaction and marked rise of hepatobiliary enzymes.These symptoms resolved and they showed normalized values of blood biochemical parameters after conservative treatment without evidence of stones in the common bile duct on MRCP.All these patients were subjected to ERCP within 3 d of MRCP to check for the presence of stones.RESULTS:No stones were detected by ERCP in any patient,confi rming the results of MRCP.CONCLUSION:When clinical symptoms improve,blood biochemical parameters have normalized,and MRCP shows there are no stones in the common bile duct,it can be considered the stone has spontaneously passed and thus ERCP is not necessary.

Significance of a novel sucrose permeability test using serum in the diagnosis of early gastric cancer

AIM: To investigate the usefulness of sucrose permeability test using serum in the diagnosis of gastric diseases, with special reference to early gastric cancer (EGC).METHODS: A total of 63 subjects, including 11patients with gastric ulcer, 20 patients with gastric cancer (13, early; 7, advanced) and 32 healthy controls,were studied. Blood and urine samples were collected repeatedly for 5 h before and after the sucrose loading.Sucrose levels were measured by a newly developed enzymatic method.RESULTS: Serum sucrose levels started to increase15 min after loading, and peaked at 60 min in the gastric disease groups. The levels for gastric ulcer, EGC and advanced gastric cancer (AGC) at 60 min were significantly higher than that in the healthy controls(26.9±2.4, 34.4±5.0, and 71.8±15.6 vs 7.9±0.7 mol/L,respectively, P＜0.01). The cut-off level set at 15.4 mol/L(60 min) offered the best distinction between EGC patients and healthy controls; and the sensitivity and specificity were 92.3% and 93.8%, respectively, while those of the urine method were 76.9% and 93.8%,respectively.CONCLUSIONS: The gastric permeability test using serum is reliable for the detection of EGC, and this test can provide results much earlier than the conventional urine method. This test may offer a useful alternative to more invasive tests for EGC.

Long-term outcome of endoscopic metallic stenting for benign biliary stenosis associated with chronic pancreatitis

瞄准：内视镜的金属小型机关枪的一种叮当响(他们) 提供好结果在对为与慢性胰炎(CP ) 联系的胆汁管狭窄的中等学期后续短；然而，更长的后续被需要决定是否他们有潜力成为第一种选择的处理。方法：他们由于 CP 与严重胆总管狭窄在八个病人被执行。当时，在由内视镜的 naso 胆汁的排水的胆汁郁积的决定以后，三个病人受到他们，另外的五经历了他们后面的塑料试管小型机关枪的一种叮当响。病人被跟随在上面为通过期刊实验室测试和成像技术的超过 5 年。结果：他们成功地在所有病人被执行。二个病人由于对过程无关的原因死了：有有在在他们以后的 2.8 和 5.5 年的颚的癌的尖锐心肌的梗塞和其它的分别地。因为在他们以后堵塞 3.6 年的他们，一个病人与胆管炎死了。任何一个都没在后续时期期间这三个病人显示出胆汁郁积的症状。二个病人开发了胆总管石病，二在小型机关枪的一种以后由于在 4.8 和 7.3 年之间的斯滕特氏印模膏的赶出受不了十二指肠溃疡叮当响；然而，他们是成功地对待的内视镜的联盟者。因此，八个病人中的五个在 7.4 年的一个吝啬的后续时期以后目前是活着的。结论：他们显然，为胆汁管狭窄的有希望的治疗选择之一与 CP 联系了，如果病人仔细被跟随起来；因此在紧急情况上将一个系统放为他们的迅速的管理是合乎需要的。

Consensus of primary care in acute pancreatitis in Japan

在日本的尖锐胰腺炎的发生正在增加并且每百万张人口从 187 ～ 347 个盒子。盒子命运是 0.2% 为对温和中等，并且 9.0% 为在在 2003 的日本的严重尖锐胰腺炎。在日本的胰腺炎的专家做了与尖锐胰腺炎在病人的早管理集中于实际方面的这个文件。尖锐胰腺炎和严厉层化的正确诊断应该为尖锐胰腺炎的诊断用标准在所有病人被做并且多，因素得分系统尽早由胰的难处理的疾病的研究委员会求婚了。与尖锐胰腺炎诊断的所有病人应该在医院里被管理。血压监视，脉搏和呼吸率，体温，时时尿的体积，和血氧饱和水平在如此的病人的管理是必要的。早精力旺盛的静脉内的水和具有最前的重要性稳定循环动力学。有鸦片剂的足够的疼痛地势也是重要的。在严重尖锐胰腺炎，在一个早阶段的抗菌素的预防静脉内的管理被推荐。一旦尖锐胰腺炎的诊断被证实，朊酶禁止者的管理应该被开始。如果没有肠塞痛并且胃肠的流血的清楚的症状，从早舞台用非肠道的营养喂的肠内的联合被推荐。有严重尖锐胰腺炎的病人应该尽早被转移到 ICU 执行象朊酶的连续地区性的动脉的注入那样的特殊措施禁止者和抗菌素，和连续牙齿过敏过滤。日本政府为难处理的疾病作为关于措施的研究的工程之一为严重尖锐胰腺炎盖住医疗保健开销。

Signaling pathway of insulin-like growth factor-Ⅱ as a target of molecular therapy for hepatoblastoma

AIM: To address the possibility that insulin-like growth factor (IGF)-Ⅱ is a growth factor and its signaling pathway so as to develop a molecular therapy for hepatoblastoma. METHODS: Huh-6 and HepG2, human hepatoblastoma cell lines, were used. IGF-Ⅱ was added to the medium deprived of serum. Western blot analysis was performed to clarify the expression of IGF-I receptor (IGF-IR). Inhibitors of IGF-IR (piclopodophyllin, PPP), phosphatidyl-inositol (PI) 3-kinase (LY294002 and Wortmannin), or mitogen-activated protein (MAP) kinase (PD98059) were added to unveil the signaling pathway of IGF-Ⅱ. Cells were analyzed morphologically with hematoxylin-eosin staining to reveal the mechanism of suppression of cell proliferation.RESULTS: IGF-Ⅱ stimulated cells proliferated to 2.7 (269% ± 76%) (mean ± SD) (Huh-6) and 2.1 (211% ± 85%) times (HepG2). IGF-IR was expressed in Huh-6 and HepG2. PPP suppressed the cell number to 44% ± 11% (Huh-6) and 39% ± 5% (HepG2). LY294002 and Wortmannin suppressed the cell number to 30% ± 5% (Huh-6), 44% ± 0.4% (HepG2), 49% ± 1.0% (Huh-6) and 46% ± 1.1% (HepG2), respectively. PD98059 suppressed the cell number to 33% ± 11% for HepG2 but not for Huh-6. When cell proliferation was prohibited, many Huh-6 and HepG2 cells were dead with pyknotic or fragmented nuclei, suggesting apoptosis.CONCLUSION: IGF-Ⅱ was shown to be a growth factor of hepatoblastoma via IGF-I receptor and PI3 kinase which were good candidates for target of molecular therapy.

Serum-free culture of H pylori intensifies cytotoxicity

AIM: To perform a long culture passage of H pylori without serum, taking into account its cytotoxicity and the presence of the probable new cytotoxic factor. METHODS: One sample of H pylori 60190 (ATCC 49503) was grown on Brain Heart Infusion (BHI) agar containing 0.5% 2,6-di-O-methyl-β-cyclodextrin without any serum, being passaged 70-100 times every 3-4 d for approximately 2 h, while another sample of H pylori contained 70 mL/L fetal calf serum without 2,6-di-O- methyl-β-cyclodextrin. Their supernatant and extract after 16 h in culture were evaluated for changes in cell morphology and for cell viability using HeLa cells. Furthermore, the characteristics of the probable cytotoxic factor in the extract were examined on partial purification studies and its cytotoxicity was evaluated in various human cells. RESULTS: The supernatant and the extract of the bacterium grown on serum-free medium had strong cytotoxicity compared with those grown on serum- containing medium. They irreversibly damaged HeLa cells without vacuolation that was altogether different from that of the bacterium when grown with serum. Their cytotoxicity was easily measured by cell viability assay. The probable cytotoxic factor partially purified and detected by chromatography had characteristics difference from that of vacuolating toxin and a broad cytotoxicity toward various cell lines. CONCLUSION: Serum-free long culture method of H pylori makes its supernatant and its extract cytotoxic enough to be easily measured by cell viability assay. The probable cytotoxic factor has a unique characteristic and might be a new cytotoxin.

在有阴暗胃肠的流血的病人的囊内视镜检查法的计算图象修正的功效

AIM:To investigate whether flexible spectral color enhancement(FICE) improves diagnostic yields of capsule endoscopy(CE) for obscure gastro-intestinal bleeding(OGIB).METHODS:The study subjects consisted of 81 patients.Using FICE,there were three different sets with different wavelengths.Using randomly selected sets of FICE,images of CE were evaluated again by two individuals who were not shown the conventional CE reports and findings.The difference between FICE and conventional imaging was examined.RESULTS:The overall diagnostic yields in FICE sets 1,2,3 and conventional imaging(48.1%) were 51.9%,40.7%,51.9% and 48.1%,respectively,which showed no statistical difference compared to conventional imaging.The total numbers of detected lesions per examination in FICE imaging and conventional imaging were 2.5 ± 2.1 and 1.8 ± 1.7,respectively,which showed a significant difference(P = 0.01).CONCLUSION:The diagnostic yield for OGIB is not improved by FICE.However,FICE can detect significantly more small bowel lesions compared to conventional imaging.

肝内微泡聚集形成的信号强度对鉴别特发性门静脉高压与肝硬化的作用

目的研究使用对比剂一增强超声（US）鉴别特发性门静脉高压（IPH）与肝硬化的可能性。材料与方法本研究得到学术委员会批准并取得书面知情同意书。23例[平均年龄（60±11）岁，37-85岁1活检证实的肝硬化病人与10例[平均年龄（65±8）岁，51～78）岁]IPH病人被纳入研究，27例[平均年龄（46±17）岁，26～82岁1无任何肝局灶性病变或门静脉血栓的病人作为对照。

Prolonged acute hepatitis A mimicking autoimmune hepatitis

AIM: We report a case with a prolonged course of hepatitisA, with alanine aminotransferase (ALT) higher than 500 IU/Lfor more than 2 mo.METHODS: A middle-aged woman had an elevated IgG level of more than 2 000 mg/dL, positive arti-nudear antibodies (ANA) and anti-smooth muscle antibodies (ASMA), but no evidence of persistent hepatitis A virus (HAV) infection. Liver biopsy findings were compatible with prolonged acute hepatitis, although acute onset of autoimmune hepatitis could not be ruled out.RESULTS: It was assumed that she developed a course of hepatitis similar to autoimmune hepatitis triggered by HAV infection. Ursodeoxycholic acid (UDCA) treatment was initiated and a favorable outcome was obtained. CONCLUSION: We describe a case of a middle-aged woman who showed a prolonged course of acute hepatitis A mimicking autoimmune hepatitis. Treatment with UDCAproved to be effective.

New cannulation method for pancreatic duct cannulationbile duct guidewire-indwelling method

The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis.Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice,endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus.Pancreatogram was slightly and insuff iciently obtained by injecting the contrast media via the common channel of the duodenal main papilla.We tried to cannulate selectively into the pancreatic duct for a clear image.However,the selective cannulation of the pancreatic duct was difficult because of instability of the papilla.On the other hand,selective cannulation of the bile duct was relatively easily achieved.Therefore,after the imaging of the bile duct,a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted.As a result,selective pancreatic duct cannulation became possible.It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is diff icult("selective pancreatic duct diff icult cannulation case").

S型支架治疗慢性胰腺炎患者主胰管狭窄的效果

Objective. Stents have been used to relieve pancreatic duct stricture and upstream dilatation. However,many of these stents are straight-type stents originally manufactured for biliary use. A plastic stent that was developed for use in the pancreatic duct was used in this study and its usefulness investigated. Material and methods. The stent (s-type stent: 10 Fr in diameter) has two alternate flexions and the shape resembles the tilde mark “～" in appearance. After obtaining informed consent, stents were placed in 20 patients with abdominal pain caused by chronic pancreatitis and stricture of the distal main pancreatic duct. The stents were removed according to the clinical manifestations and replaced with new ones if the stricture persisted. Results. In total, 33 stents were placed in 20 patients. Pain relief was attained in 19 patients (95%). The stricture improved after one stenting in 8 patients (40%). Owing to persistent stricture, the stenting was repeated in 11 patients. The 50%stent indwelling period was 369.0 days. No proximal or distal migration of the stent occurred and there were no serious complications. Conclusions. In view of its long durability as a stent and no migration, the s-stent is safe and useful for the management of pancreatic ductal strictures in patients with chronic pancreatitis.

内镜下静脉曲张结扎术与乙醇硬化治疗后门体分流的血流动力学变化以及与静脉曲张复发的关系

Background:Among the factors influencing variceal relapse after endoscopic treatment,portal hemodynamic changes,especially in portal systemic shunts,could be the most important factor because hemodynamics are directly related to the development of esophageal varices.We aimed to clarify the influence of endoscopic treatment for esophageal varices on portal systemic shunts as well as its predictive value for variceal relapse.Methods:Fifty patients who underwent combined endoscopic variceal ligation and injection sclerotherapy were examined with sonography and portography.Results:Decrease of diameter,hepatopetal flow direction in the left gastric vein,or the presence of non-varices portal systemic shunt were sonographic findings related to a low incidence of variceal relapse.The presence of blood flow in and around the esophagus on venograms was highly predictive for variceal relapse.In patients with such venograms,non-varices portal systemic shunts did not develop.Conclusions:Sonographic assessment of hemodynamic changes in portal systemic shunt could be useful for estimating the results of endoscopic treatment for esophageal varices.

经口胆管镜检查对各种胆管病变的诊断效用

Background: We evaluated the utility of peroral cholangioscopy (POCS) for distinguishing malignant from benign biliary disease to cover low sensitivity of tissue sampling. Methods: From February 1992 to April 2004, all consecutive patients who underwent POCS to confirm the etiology of biliary disorders were included in this study. Brushing cytology or endobiliary forceps biopsy also was performed. We analyzed the diagnostic accuracy of tissue sampling with or without POCS diagnosis. Results: A total of 97 patients (66 men, 31 women; mean age 64.2 years) were included. The final diagnosis was confirmed by surgical resection in 44, clinical follow-up in 52, and cytologic study of ascitic fluid in one. On the basis of ERCP findings, there were 76 strictures and 21 filling defects. Forceps biopsy was performed in 25 patients, and brush cytology was performed in 68 patients. In the remaining 4 patients (4 filling defects, which were identified as stones by POCS), tissue samplings were not carried out. ERCP/tissue sampling correctly identified 22 of 38 malignant strictures and all 35 benign lesions except in 3 patients with inadequate samples (accuracy, 78.0% ; sensitivity, 57.9% ; specificity, 100% ). The addition of POCS correctly identified all 38 malignant strictures and 33 of 38 benign lesions (accuracy, 93.4% ; sensitivity, 100% ; specificity, 86.8% ). For the 21 filling defects observed by ERCP, POCS correctly diagnosed all 8 malignant diseases and 13 benign lesions. Conclusions: The addition of POCS to tissue sampling improves the diagnostic ability and covers for insufficient sensitivity. POCS is especially useful for diagnosing a filling defect.