In this survey, we compared endoscopists’ approach to treatment of gastroesophageal varices (GOV) in patients with cirrhosis between developed and developing countries. The objective of this study was to undertake a comparative analysis of the approaches employed by endoscopists in developed and developing countries with regard to the treatment of GOV in patients with cirrhosis. Between Jan 2019 to Aug 2019, we administered a questionnaire-based online survey internationally via e-mail. A total of 148 endoscopists from five countries were invited to participate in the survey, and 93 responses were received (response rate: 62.8

Lung cancer (LC) is the second most commonly diagnosed cancer among both men and women, and it stands as the leading cause of cancer-related mortality, characterized by high rates of morbidity and mortality. Among its subtypes, non-small cell lung cancer (NSCLC) is the most prevalent and one of the most challenging malignant tumors to treat. To date, various therapeutic approaches, including surgery, radiotherapy, and chemotherapy, have been employed in the management of lung cancer; however, due to its aggressive nature, the survival rates remain low. Consequently, exploring novel treatment strategies is of paramount importance. MicroRNAs (miRNAs), a large family of non-coding RNAs, play crucial roles in regulating several key biological processes, including cell proliferation, differentiation, inflammation, and apoptosis. Among these, microRNA155(miR-155) is one of the most conserved and versatile miRNAs, predominantly overexpressed in various diseases, including malignant tumors. This review elucidates the biological functions and roles of miR-155 in NSCLC and discusses its potential significance as a therapeutic target for future research directions and clinical applications.

Objective: The aim of this study was to evaluate the impact of preoperative platelet lymphocyte ratio (PLR) on the prognosis of patients after radical nephrectomy (RNU). Methods: We retrospectively analyzed clinical data from 226 patients without a history of bladder cancer who underwent RNU at Beijing Chaoyang Hospital, Capital Medical University between January 2009 and December 2020. Patients were stratified into two groups (A low PLR group (n = 174) and a high PLR group (PLR >= 169.4) based on an optimal PLR threshold (PLR=169.4). The predictive accuracy of inflammatory biomarkers was assessed using receiver operating characteristic curves. Univariate and multivariate Cox proportional risk analyses were used to estimate the effect of PLR on intravesical recurrence-free survival (IVRFS), recurrence-free survival (RFS), and overall survival (OS). The effect of PLR on IVRFS, RFS and OS was further examined using Kaplan-Meier survival curve analysis. Results: The study cohort comprised 226 individuals with a mean age of 67.2 +/- 9.8, 113 (50%) males and 113 (50%) females, 68 (30.1%) low-grade tumors and 158 (69.9%) high-grade tumors. In this study, 81 patients (36.7%) relapsed and 73 patients (32.3%) died. The area under the curve for PLR prediction of IVRFS was 0.603, superior to other inflammatory biomarkers. Multivariate analysis showed that PLR > 169.4 independently increased the risk of IVR after RNU, resulting in lower IVRFS [2.028 (1.014-4.057), P = 0.046], RFS [1.900 (1.168-3.090), P = 0.010], and OS [1.866 (1.099-3.167), P = 0.021]. In addition, survival analysis showed lower IVRFS [8.815 (62.722-97.278), P = 0.007], RFS [12.084 (44.315-91.685), P = 0.003] and OS RFS [10.165 (62.077-101.923), P = 0.005] in the low PLR group. Conclusion: Elevated preoperative PLR is strongly associated with prognosis in patients with upper urothelial carcinoma (UTUC) after RNU without a history of bladder cancer.

Cervical squamous cell carcinoma (CSCC) represents a malignant subtype of cervical cancer. Identification of novel biomarkers for CSCC development could enhance therapeutic efficiency and improve the patients' outcomes. This study focused on lncRNA EMX2OS, evaluating its expression and significance in the progression of CSCC while exploring its potential as a therapeutic target. A cohort of 135 patients with CSCC were enrolled, and tissue samples were collected for analysis. The expression of EMX2OS in the tissues was quantified by PCR, with its correlation to the clinicopathological features, and prognosis was evaluated by χ2, Kaplan-Meier and Cox regression analyses. The regulatory effects of EMX2OS on CSCC cells were investigated by CCK8 and Transwell assays, while the underlying molecular mechanisms were elucidated by luciferase reporter assays. Significant down-regulation of EMX2OS was observed in CSCC, correlating with advanced FIGO stages, poor differentiation and adverse prognosis of patients. Over-expression of EMX2OS significantly suppressed cell growth and metastasis in CSCC. Negative regulation of miR-574-5p by EMX2OS was observed, and over-expression of miR-574-5p alleviated the inhibition of CSCC cells by EMX2OS. Down-regulated EMX2OS indicates severe disease progression and poor prognosis in CSCC. Over-expression of EMX2OS could inhibit CSCC cell growth and metastasis by negatively modulating miR-574-5p.

BACKGROUND AND AIM:Observational studies have shown that there is a connection between blood biomarkers and the occurrence of acute pancreatitis (AP). Nevertheless, the causal relationships are still not clear. The purpose of this study was to evaluate causal association between biomarkers and AP. METHOD(S):A bidirectional two-sample Mendelian randomization (MR) analysis was applied to investigate the causal association between blood biomarkers and AP. Summary statistics obtained from genome-wide association studies were utilized for this analysis. The primary statistical approach employed was the inverse variance weighted (IVW) method, complemented by sensitivity analyses aimed at assessing heterogeneity and pleiotropy. Furthermore, a multivariable MR (MVMR) analysis was performed to adjust for confounders. RESULTS:A total of 11 red blood cell (RBC) traits, 6 white blood cell traits, platelet count, and 30 blood biomarkers were analyzed in this study. Genetically predicted RBC count (IVW odds ratio [OR] = 1.144, P = 0.004), the high light scatter reticulocyte count (HLSR) (OR = 1.127, P = 0.022), blood glucose (BG) (OR = 1.480, P = 0.019), and leptin (OR = 1.234, P = 0.050) were suggestively associated with an increased risk of AP. Reverse MR analysis showed no causal effect of AP on RBC, HLSR, BG, and leptin (IVW P > 0.05). Sensitivity analyses and MVMR analysis still supported the earlier causality. CONCLUSION(S):Our findings provide evidence of a suggestive association between RBC count, HLSR, BG, and leptin with an increased susceptibility to AP. These findings aid in our comprehension of the cause of AP and may be used as potential prognostic markers or predictors of severity with AP.

Background and Objectives: Gastric varices (GV) with spontaneous portosystemic shunt (SPSS) are associated with ectopic embolism in endoscopic cyanoacrylate. This study targeted to assess the efficacy and safety of EUS-guided coil embolization combined with endoscopic cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration (BRTO) for GV with high-risk ectopic embolism. Materials and Methods: We retrospectively analyzed six tertiary hospitals' 104 patients with GV at high-risk ectopic embolism (the narrowest diameter of SPSS was greater than or equal to 5 mm and the maximum diameter usually > 8 mm) who underwent EUS-guided coil embolization combined with endoscopic cyanoacrylate injection or BRTO from January 2014 to December 2020. The outcomes included rebleeding, survival, and complications. Results: The EUS group and BRTO group contained 59 and 45 patients, respectively. The technical success rate between the two groups was similar (96.6% vs. 95.6%, P = 1.000). During the follow-up, both groups' 5-day rebleeding rate and 6-week mortality rate were 0%. One-year all-cause rebleeding rate (20.0% vs. 18.9%, P = 0.900) and 1-year mortality rate (2.0% vs. 0%, P = 1.000) in the EUS group were similar to the BRTO group. One patient experienced ectopic embolism in the EUS group, while the BRTO group did not. Both groups had similar mean days (16.0 [interquartile range (IQR), 12.0-19.0] vs. 16.5 [IQR, 11.8-26.0], P = 0.165) and cost of hospitalization ( yen 45950.6 [IQR, 39330.2-55768.2] vs. yen 51205.8 [IQR, 31628.8-74251.5], P = 0.680). Multivariate analysis showed that the narrowest diameter of the shunt (odds ratio [OR] = 1.86; 95% confidence interval [CI]: 1.062-3.258; P = 0.03) and content of hemoglobin (OR = 0.941; 95% CI: 0.892-0.992; P = 0.025) were the prognostic factors for survival. Conclusions: The efficacy and safety of EUS-guided coil embolization combined with endoscopic cyanoacrylate injection for GV with high-risk ectopic embolism are comparable to BRTO.

食管胃静脉曲张是肝硬化门脉高压常见的并发症之一.胃静脉曲张(gastric varices,GV)的发生率明显低于食管静脉曲张,在门脉高压症患者中的发生率约10％～50％,出血率约10％～36％,再出血率达34％～89％,但病死率高达25％～55％[1-2].因此根除胃静脉曲张至关重要.目前胃静脉曲张的治疗方法包括药物治疗、内镜治疗、手术治疗和介入治疗,包括经颈静脉肝内门体静脉分流术(transjugular intrahepatic portosystemic shunt ,TIPS)和球囊封堵逆行静脉闭塞术(balloon?occluded retrograde transvenous obliteration,BRTO)[3].

Objective:To investigate the value of emergency gastroscopy in the diagnosis and treatment of patients with cirrhosis complicated with upper gastrointestinal bleeding.Methods:The clinical data and endoscopic findings of patients with cirrhosis with upper gastrointestinal bleeding from January 2019 to December 2019 were retrospectively analyzed.Results:A total of 2 766 patients were enrolled in the study. No bleeding site was observed in 588 cases. Among the rest 2 178 cases, 1 256 cases were diagnosed with EGVB (57.67%), and 1 183 cases were treated with sclerosis, ligation and tissue adhesive embolization, and effective rate was 96.79%(1 145/1 183).Conclusion:Emergency gastroscopy is an effective treatment for cirrhosis with upper gastrointestinal bleeding. After actively improving the general condition and the condition is stable, emergency gastroscopy should be performed as soon as possible, which can quickly clarify the cause and control the bleeding, and obtain good efficacy, which should be promoted in clinical practice.

ObjectiveTo investigate the influencing factors for the clinical effect of emergency endoscopic therapy in the treatment of patients with acute-on-chronic liver failure and gastroesophageal variceal bleeding. MethodsA total of 51 patients with acute-on-chronic liver failure and gastroesophageal variceal bleeding who underwent emergency endoscopic therapy in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to December 2018 were enrolled, among whom 26 had successful hemostasis and 25 had failed hemostasis. The two groups were compared in terms of general information, varices grade and bleeding manifestations under endoscope, blood biochemical parameters, ultrasound findings, Child-Pugh class, and Model for End-Stage Liver Disease (MELD) score, and the influencing factors for the outcome of hemostasis were analyzed. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; the logistic regression model was used to perform the multivariate analysis. ResultsOf all patients, 26 achieved successful hemostasis, with a success rate of hemostasis of 51%. There were no significant differences between the two groups in sex, age, etiology of liver cirrhosis, presence or absence of liver cancer, presence or absence of portal vein thrombosis, bleeding for the first time or not, white blood cell count, hemoglobin, platelet count, prothrombin time activity, alanine aminotransferase, total bilirubin, albumin, cholinesterase, MELD score, and bleeding site and bleeding manifestations under gastroscope (all P＞0.05). Compared with the failed hemostasis group, the successful hemostasis group had a significantly longer course of disease (t=2.760, P=0.008) and significantly larger portal vein diameter and diameter of varicose veins under endoscope (t=-4.847, χ2=-6.590, both P＜0.05), and the failed hemostasis group had a significantly higher proportion of patients with Child-Pugh class C disease than the successful hemostasis group (χ2=5.684, P=0.017). Course of liver cirrhosis (odds ratio ［OR］=0.913, 95% confidence interval ［CI］: 0.838-0.994, P＜0.05), portal vein diameter (OR=1.925,95%CI: 1.516-2.443, P＜0.05), and diameter of varicose veins (OR=23.254, 95%CI: 2.250-240.352, P＜0.05) were independent influencing factors for the clinical effect of endoscopic hemostasis. ConclusionThere is a relatively low success rate of emergency endoscopic hemostasis in patients with acute-on-chronic liver failure, and course of liver cirrhosis, portal vein diameter, and diameter of varicose veins are independent influencing factors for the clinical effect of endoscopic hemostasis.

Objective:To evaluate the efficacy and safety of enteral extended biliary stenting for biliary stricture.Methods:A multicenter retrospective cohort study was conducted on data of 550 patients with obstructive jaundice due to extrahepatic bile duct stricture between February 2006 and April 2020. Patients were assigned to conventional group (undergoing conventional biliary stent placement) and extended group (undergoing enteral extended biliary stent placement). Propensity score was used to match the basic data of patients of the two groups. Then the stent patency time, bilirubin difference before and after 1 week operation, incidence of complications and hospital stay were compared between the two groups.Results:Among the 550 patients, clinical data of 20 cases were missing and 35 failed to be followed up. Finally, 326 patients were enrolled to the study after propensity score matching with 163 cases in each group. The patency time of extended group was 111.0 (82.0, 192.0) days, which was longer than that of conventional group with patency time of 93.0 (70.0, 141.8) days ( Z=3.260, P=0.001). Total bilirubin difference value of pre-operation and post-operation was less in extended group [51.2 (26.0, 114.7) μmol/L VS 46.0 (13.9, 81.1) μmol/L, Z=2.095, P=0.036]. The rate of early adverse events [4.3% (7/163) VS 3.7% (6/163), P=0.079] and median in-patient days (10.0 days VS 10.0 days, P=0.379) were similar in the two groups. Conclusion:Enteral extended biliary stent is effective and safe for treatment of biliary stricture, which can prolong the patency time without increasing postoperative complications and hospital stay.

ObjectiveTo investigate the risk factors for failure in emergency endoscopic injection sclerotherapy (EIS) combined with sequential histoacryl injection (HI) for esophagogastric variceal bleeding (EGVB) with portal vein embolus (PVE). MethodsA total of 109 EGVB patients with PVE who underwent emergency gastroscopy in Beijing Shijitan Hospital, Capital Medical University, and The Fifth Medical Center of Chinese PLA General Hospital from January 2018 to December 2019 were enrolled, and according to the outcome of hemostatic treatment under emergency gastroscopy, the patients were divided into hemostatic failure group with 28 patients and hemostatic success group with 81 patients. The two groups were compared in terms of general information, varices and bleeding manifestations under gastroscopy, blood biochemical parameters, Child-Pugh class, and Model for End-Stage Liver Disease (MELD) score, and the risk factors for hemostatic failure were analyzed. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a logistic regression analysis was used for multivariate analysis. ResultsCompared with the hemostatic success group, the hemostatic failure group had significantly higher peripheral white blood cell count (WBC), total bilirubin (TBil), Child-Pugh class, and MELD score (Z=3.794, Z=4.751, χ2=40.104, Z=6.412, all P＜0001) and significantly lower prothrombin time activity (PTA), albumin (Alb), and cholinesterase (CHE) (t=9.653, Z=3.093, Z=4.092, P＜0.001, P=0.002, and P＜0.001). WBC (odds ratio ［OR］=28.543, 95% confidence interval ［CI］: 1.285-634.113, P＜0.05), PTA(OR=0.194, 95%CI: 0.045-0.835, P＜0.05), TBil (OR=2.197, 95%CI: 1.004-4.810, P＜0.05), Alb (OR=0448, 95%CI: 0.209-0.961, P＜0.05), and Child-Pugh class (OR=5.164, 95%CI: 1.307-20.406, P＜0.05) were independent risk factors for hemostatic failure. ConclusionWBC, PTA, TBil, Alb, and Child-Pugh class are independent risk factors for failure in emergency EIS combined with sequential HI in the treatment of EGVB with PVE, and adequate preoperative evaluation and correction may help to improve the success rate of hemostasis.

目的 观察内镜联合特利加压素或生长抑素治疗食管胃静脉曲张出血(esophageal gastric varices bleeding,EGVB)的效果.方法 回顾性分析我院2015年1月—2018年5月因肝硬化EGVB并给予急诊内镜下硬化治疗或组织粘合剂栓塞治疗的患者128例,分别给予特利加压素和生长抑素治疗,据此分为特利加压素治疗组(n=80)和生长抑素治疗组(n=48).在急诊胃镜治疗后24 h行第2次内镜复查,观察2组的24 h止血率、6周病死率、粪便转黄时间、粪便潜血转阴时间以及并发症的发生情况.结果 2组患者在24 h止血率、粪便转黄时间、粪便潜血转阴时间等方面比较,特利加压素组均优于生长抑素组,差异均有统计学意义(P均<0.05);而2组患者在6周病死率、并发症的发生等方面相比,差异均无统计学意义(P均>0.05).结论 血管活性药物联合内镜治疗是EGVB有效的止血措施,止血24 h复查内镜可以准确判断EGVB控制与否,并可及时给予再次内镜治疗.特利加压素联合内镜治疗可以更快控制急性EGVB,有利于更早进行EGVB二级预防治疗.

ObjectiveTo investigate the clinical manifestations, emergency endoscopic diagnosis and treatment, and prognosis of rebleeding after different secondary prevention measures for esophagogastric variceal bleeding in cirrhotic portal hypertension. MethodsA retrospective analysis was performed for the clinical data of 254 patients with rebleeding after secondary prevention (endoscopic therapy, surgical treatment, or interventional prevention) for esophagogastric variceal bleeding who underwent emergency endoscopic diagnosis and treatment in The Fifth Medical Center of Chinese PLA General Hospital from January 2018 to April 2019, and 419 patients who received medication alone for the prevention of rebleeding during the same period of time were enrolled as controls. Clinical features were observed and compared between groups. An analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis H test was used for comparison of continuous data with heterogeneity of variance between groups. The least significant difference Bonferroni test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. ResultsAmong the 254 patients with rebleeding after secondary prevention, 144 (56.69%) received endoscopic prevention, 40 (15.75%) received surgical prevention, 33 (12.99%) received interventional prevention, and 37(14.57%) received prevention with endoscopy combined with other prevention measures. As for the time from last prevention to bleeding, 57.50% in the surgical prevention group had a time of more than 5 years, and 69.70% in the interventional prevention group experienced bleeding within 1 year after transjugular intrahepatic portosystemic shunt; 40.28% in the endoscopic prevention group and 35.14% in the combined prevention group experienced rebleeding within 1 year after prevention ended. During rebleeding, the interventional prevention group and the combined prevention group had a significantly higher incidence rate of hepatic encephalopathy than the other groups (all P＜0.001), and the interventional prevention group had significantly better controlled ascites than the other groups (all P＜0.05). There were significant differences in various clinical indices between these groups during rebleeding (all P＜0001), and the endoscopic prevention group had significantly higher levels of hemoglobin and albumin than the surgical prevention group (P＜0.001 and P=0.001) and the medication prevention group (P=0.001 and P＜0.001). The surgical prevention group had a significantly higher platelet count than the interventional prevention group (P=0.037), the combined prevention group (P＜0.001), and the medication prevention group (P=0.012). The medication prevention group had a significantly higher level of bilirubin than the endoscopic prevention group (P=0.037), the interventional prevention group (P=0.025), and the combined prevention group (P＜0.001); the surgical prevention group had a significantly higher level of creatinine than the other four groups (all P＜0.05); the combined prevention group had significantly better coagulation parameters prothrombin time and international normalized ratio than the medication prevention group (both P=0.002). The medication prevention group had a significantly higher proportion of patients with active bleeding than the endoscopic prevention group (P＜0.001), the interventional prevention group (P=0.004), and the combined prevention group (P=0.008). The surgical prevention group and the medication prevention group had a significantly higher proportion of patients with esophageal variceal bleeding than the other groups (all P＜005), and the interventional prevention group had a significantly higher proportion of patients with peptic ulcer and bleeding than the other four groups (all P＜0.05). The medication prevention group had significantly higher dissatisfaction rate and failure rate of endoscopic treatment than the endoscopic prevention group (P＜0.001), the interventional prevention group (P=0007), and the combined prevention group (P＜0.001). The medication prevention group had significantly higher rebleeding rate and mortality rate within 42 days than the other four groups (all P＜0.05). Conclusion Compared with medication prevention alone, interventional prevention, endoscopic prevention, or combined secondary prevention can significantly alleviate the degree of esophagogastric variceal rebleeding, improve the hemostatic rate of emergency endoscopy, and significantly reduce rebleeding rate and mortality rate within 42 days. The clinical features of rebleeding after different secondary prevention measures should be considered to perform individualized treatment of patients with rebleeding after secondary prevention for esophagogastric variceal bleeding.

急诊胃镜下止血是治疗食管胃静脉曲张破裂出血的有效方法，止血失败的患者预后差，早期识别止血治疗失败的危险因素尤为重要。本研究通过回顾性分析比较急诊胃镜下止血治疗失败与止血成功的肝硬化食管胃静脉曲张破裂出血患者的临床资料，探究急诊胃镜下止血治疗失败的危险因素。结果表明凝血酶原活动度、血红蛋白降低值、Child-Pugh分级、门静脉栓子形成是肝硬化食管胃静脉曲张破裂出血患者急诊胃镜下止血治疗失败的独立危险因素( P<0.05)。因此，在急诊胃镜检查治疗前应对上述因素进行合理评估，以提高止血成功率。

十二指肠静脉曲张(duodenal varices,DV)是临床少见的、发生于食管、胃底之外的消化道异位静脉曲张.其病因主要有各种原因所致的肝硬化、门静脉高压、肝外门静脉闭塞、血管畸形等[1-2]. 近年来,随着内镜及影像学等相关技术的进步,以及内镜检查的规范化,DV的报道逐渐增多.十二指肠球部静脉曲张比较容易被发现,而降部黏膜皱襞丰富,对静脉曲张及曲张静脉表面糜烂、血栓等有一定的漏诊率.文献报道,DV破裂出血临床相对少见,占所有静脉曲张出血比例约为2％～2.5％,其治疗方法主要包括:内镜下治疗(硬化剂注射治疗、套扎治疗、组织胶注射治疗)、介入治疗、外科手术,均取得不同程度的疗效[2-3].现将解放军总医院第五医学中心肝硬化诊疗一中心收治的1例DV破裂出血患者的临床诊疗情况报告如下.

ObjectiveTo investigate the clinical value of acoustic radiation force impulse (ARFI) elastography in predicting esophageal variceal bleeding in patients with liver cirrhosis. MethodsA retrospective analysis was performed for the clinical data of 271 patients with liver cirrhosis who attended the Fifth Medical Center of Chinese PLA General Hospital from October 2014 to May 2017, and ARFI elastography was performed for all patients to measure the elasticity of the liver and the spleen. According to the presence or absence of esophageal variceal bleeding, the patients were divided into bleeding group and non-bleeding group, and related indices were compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of ARFI elasticity in the diagnosis of esophageal variceal bleeding in liver cirrhosis. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. ResultsThe bleeding group had a significantly higher ARFI elasticity of the spleen than the non-bleeding group ［3.89(349-4.11) m/s vs 3.46(2.93-3.80) m/s, Z=-4.941, P＜0.001］, and there was no significant difference in the ARFI elasticity of the liver between the bleeding group and the non-bleeding group ［2.08 (1.57-2.74) m/s vs 1.98 (1.49-2.70) m/s, Z=-1.025, P=0.305］. The areas under the ROC curve for ARFI elasticity values of the spleen and the liver were 0.714 and 0.544, respectively, in predicting esophageal variceal bleeding in patients with liver cirrhosis (P=0.002 5). At the cut-off value of 3.71 m/s, the ARFI elasticity of the spleen had a sensitivity of 0.68 and a specificity of 0.69 in predicting esophageal variceal bleeding. ConclusionThe ARFI elasticity value of the spleen has a better value than that of the liver in predicting the risk of esophageal variceal bleeding and thus holds promise for clinical application.

ObjectiveTo investigate the basis for the selection of secondary prevention with endoscopy or transjugular intrahepatic portosystemic shunt (TIPS) after esophagogastric variceal bleeding and the value of hepatic venous pressure gradient (HVPG) in clinical decision-making. MethodsA retrospective analysis was performed for 148 patients who had an HVPG of above 12 mm Hg after esophagogastric variceal bleeding and received secondary prevention with endoscopy or TIPS in The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to February 2018. According to related guidelines, HVPG ＞18 mm Hg was a high-risk factor for esophagogastric variceal rebleeding, and the patients were divided into medium pressure group (HVPG 12-18 mm Hg) with 78 patients and high pressure group (HVPG ＞18 mm Hg) with 70 patients. Clinical features and endoscopic findings were summarized for both groups. The patients were further divided into four groups with an HVPG of 12-16 mm Hg, ＞16-18 mm Hg, ＞18-20 mm Hg, and ＞20 mm Hg, respectively, and the four groups were compared in terms of the safety and efficacy of secondary prevention, with focuses on rebleeding and prognosis. The two-independent-samples t test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, the Kruskal-Wallis H test was used for comparison of ranked data between groups. ResultsBefore secondary prevention, there were no significant differences between the medium pressure group and the high pressure group in hemoglobin, platelet, albumin, bilirubin, creatinine, blood ammonia, prothrombin time, Child-Pugh score, and Model for End-Stage Liver Disease score, and the medium pressure group had a significantly higher proportion of patients with opening of collateral circulation than the high pressure group (67.95% vs 50.00%, χ2=11.250,P=0.004). There was no significant difference in the LDRf type of esophageal and gastric varices between the two groups. The high pressure group had a significantly higher proportion of patients who selected TIPS than the medium pressure group (28.57% vs 10.26%, χ2=8.067,P=0.005). After secondary prevention, the mean follow-up time was 28.66±11.20 months, and no serious complications were observed. No patients experienced the progression of liver cirrhosis, and there was an improvement in ascites. Rebleeding rate within 1 year after secondary prevention with endoscopy tended to increase with the increase in HVPG, and 41.03% of the patients with HVPG ＞20 mm Hg underwent the preventive treatment for the second time within 1 year. Secondary prevention with endoscopy had a good clinical effect in the patients with an HVPG of 12-16 mm Hg, with a rebleeding rate of 14.63% within 1 year. The patients with an HVPG of ＞20 mm Hg who underwent secondary prevention with TIPS had a significantly lower rebleeding rate within 1 year than those who underwent secondary prevention with endoscopy (10% vs 34.48%). ConclusionIt is recommended to select secondary prevention for variceal bleeding based on HVPG, develop a follow-up plan for patients with different HVPG values after secondary prevention, and give individualized treatment.

ObjectiveTo investigate the clinical effect of endoscopic variceal ligation (EVL), endoscopic injection sclerotherapy (EIS), and tissue adhesive injection in the treatment of esophagogastric junctional variceal bleeding, and to provide a reference for reasonable selection of different hemostasis methods. MethodsA total of 1264 patients with liver cirrhosis and esophagogastric junctional variceal bleeding who underwent emergency gastroscopic hemostasis in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from June 2017 to June 2019 were enrolled and divided into EVL, EIS, HI groups based on the method of emergency gastroscopic hemostasis. These groups were compared in terms of success rate of operation, success rate of hemostasis, early rebleeding rate, and postoperative complications. The patients were also divided into groups based on bleeding site, and the success rates of different hemostasis methods at different sites were compared. An analysis of variance was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThe success rate of EIS and tissue adhesive injection was significantly higher than that of EVL, and the success rate of EIS was significantly higher than that of tissue adhesive injection (χ2=75.01, P＜0.05). Tissue adhesive injection had a significantly higher success rate of hemostasis than EVL and EIS (χ2=9.885, P＜0.05). There was no significant difference in early rebleeding rate between groups (χ2=0.29，P=0.865). The patients undergoing EVL had a significantly higher incidence rate of aspiration and pneumonia than those undergoing EIS or tissue adhesive injection (χ2=19.08, P＜0.05); the patients undergoing tissue adhesive injection had a significantly higher proportion of patients with postoperative pyrexia than those undergoing EVL or EIS (χ2=23.94, P＜005); the patients undergoing EVL or tissue adhesive injection had a significantly higher incidence rate of postoperative retrosternal discomfort than those undergoing EIS (χ2=19.56, P＜0.05). EIS and EVL had a high success rate of hemostasis for the bleeding sites at 1-5 cm above the esophagogastric junction (EGJ); EIS and tissue adhesive injection had a similar success rate of hemostasis for the bleeding sites from 1 cm above the EGJ to 2 cm below the EGJ; tissue adhesive injection had a high success rate of hemostasis for the bleeding sites at 2-5 cm below the EGJ. ConclusionEVL, EIS, and tissue adhesive injection are effective methods for the treatment of esophagogastric junctional variceal bleeding, and the selection of hemostasis method based on the location of bleeding site can improve the outcome of hemostasis.

Background: Endoscopic biliary stenting by endoscopic retrograde cholangiopancreatography (ERCP) is the most common form of palliation for malignant hilar obstruction. However, ERCP in such cases is associated with a risk of cholangitis. The incidence of post-ERCP cholangitis is particularly high in Bismuth type IV hilar obstruction, and this risk is further increased when the contrast injected for cholangiography is not drained. The present study aims to compare the incidence of cholangitis associated with the use of a contrast agent, air and CO 2 for cholangiography in type IV hilar biliary lesions. Methods: The clinical data of consecutive 70 patients with type IV hilar obstruction, who underwent ERCP from October 2013 to November 2017, were retrospectively analyzed. These patients were divided into three groups based on the agent used for cholangiography: group A, contrast ( n =22); group B, air ( n =18); group C, CO 2 ( n =30). These three methods of cholangiography were chronologically separated. Prior to the ERCP, MRCP was obtained from all patients to guide the endoscopic intervention. Results: At baseline, there was no significant difference in terms of the patient’s age, gender, symptoms and liver function tests among the three groups ( P> 0.05). The complication rates were significantly higher in group A than in groups B and C (63.6% vs. 26.7% and 27.8%, P< 0.05). The incidence of post-ERCP cholangitis was significantly higher in group A ( P< 0.05), while the incidence of post-ERCP pancreatitis and bleeding were similar in the three groups. After the ERCP, the mean hospital stay was shorter in groups B and C, when compared to group A ( P< 0.05). However, there was no significant difference in the 30-day mortality rate among the three groups ( P> 0.05). Furthermore, there was no significant difference between groups B and C in terms of primary end points. Conclusion : CO 2 or air cholangiography during ERCP for type IV hilar obstruction is associated with reduced risk of post-ERCP cholangitis, when compared to conventional contrast agents.

胃静脉曲张是指胃黏膜下的静脉扩张,为门静脉高压症的严重并发症之一,可孤立存在或合并食管静脉曲张.在门静脉高压症患者中,胃静脉曲张的发生率为 10％ ～ 50％,出血率为 15％ ～ 30％,死亡率高达 45％ ～ 55％[1-4].胃静脉曲张 2 年内出血的发生率为 25％,以胃底静脉曲张出血的发生率最高,其危险因素包括胃底曲张静脉的大小(>10mm 为大,5～10mm 为中,<5mm 为小)、Child 分级和内镜下曲张静脉表面红斑征.随着内镜治疗技术的提高,胃静脉曲张的诊治越来越受到重视.内镜检查仍是消化道静脉曲张及其出血诊断的金标准.现根据临床上对胃静脉曲张的诊治经验,结合相关诊疗指南,对胃静脉曲张的诊断及治疗现状进行阐述.