2017年 · 第37卷第10期

Portal hypertension is an important pathophysiological link in the development of liver cirrhosis, and it is also an important clinical manifestation of decompensated liver cirrhosis. esophageal and gastric varices bleeding (EGVB) is the most common acute and severe complication in patients with liver cirrhosis and portal hypertension, with a mortality rate of 15% to 25%. If no measures are taken to prevent re-bleeding after bleeding stops, 60% to 70% of patients will develop EGVB again within 1 to 2 years^[1]。 Although drugs, endoscopy, interventional therapy and surgery (splenectomy combined with portosystemic collateral vein devascularization, extrahepatic portosystemic shunt and liver transplantation) are the methods to treat and prevent cirrhotic EGVB, recent international guidelines emphasize more on drugs (non-selective beta blockers, terlipressin, somatostatin and their derivatives), endoscopic therapy (endoscopic ligation therapy, tissue adhesive injection) and interventional therapy mainly transjugular intrahepatic portosystemic shunt (TIPS).^[2,3]。 Therefore, how to reasonably give full play to the advantages of TIPS, at the same time minimize the complications during and after TIPS treatment, and finally obtain satisfactory medium and long-term survival rate and quality of life is still an urgent topic to be studied.

The management of portal hypertension varicose bleeding is still a problem that clinicians, especially digestive endoscopists, will face in the future. On the one hand, the number of patients with liver cirrhosis is difficult to reduce in the short term. Although the effect of hepatitis B control has gradually appeared, the liver damage caused by alcoholic liver disease, non-alcoholic fatty liver disease, drugs and immune factors is increasing; On the other hand, due to the advantages of minimally invasive treatment techniques such as endoscopic therapy and the rare occurrence of adverse events, it is more acceptable to clinicians and patients than transjugular intrahepatic portosystemic shunt (TIPS) therapy, more suitable for grass-roots units, and still recommended by national guidelines. Cirrhotic portal hypertension leads to gastro-esophageal varices (GOV). Although the bleeding rupture is mostly in the esophageal vein, simultaneous treatment of esophageal and gastric varices is more beneficial to prevent re-bleeding and improve the prognosis than treatment of esophageal varices alone. Endoscopic tissue glue injection in the treatment of gastric varices has become an important method at present. How to improve the clinical efficacy of endoscopic tissue glue injection therapy technology, increase the safety of operation and reduce the occurrence of adverse events has become the current exploration direction.

The most characteristic manifestation of decompensated cirrhosis is the formation of collateral circulation, and spontaneous spleno-renal shunts (SSRS) are a relatively common type of collateral circulation. The incidence of SSRS was higher, ranging from 13.8% to 21.0%^[1,2]。 SSRS mainly occurs retroperitoneally, and only a small part is involved in the formation of gastric varices. SSRS can significantly reduce portal pressure, relieve the symptoms of portal hypertension, reduce the occurrence of esophageal varices rupture bleeding and ascites formation. However, a large number of SSRS do not flow through the liver, and the toxins directly enter the systemic circulation without detoxification, which can lead to or aggravate hepatic encephalopathy. The purpose of this study was to investigate the clinical characteristics of patients with liver cirrhosis complicated with SSRS, and to analyze the relationship between SSRS and the degree of esophageal varices and bleeding rate, ascites formation, portal vein thrombosis rate, liver function grade, portal vein diameter change, hepatic encephalopathy, etc.

ectopic varices (EV) refer to varices in other parts than portal hypertension esophageal gastric varices (EGV)^[1,2]。 Its essence is the opening of portal collateral circulation caused by portal hypertension. The mechanism of occurrence mainly includes portal collateral shunt formed by portal hypertension caused by liver cirrhosis or extrahepatic portal vein occlusion and adhesion of intestine and abdominal wall or other structures caused by surgery^[3]。 It is mainly distributed in the digestive tract such as gastric antrum, duodenum, jejunum, ileum, colon, rectum, etc. It can also be distributed in the biliary tract, vagina and bladder^[3]EGV may be present alone or in combination with EGV. ectopic variceal bleeding (EVB) accounts for 1% to 5% of all portal hypertensive variceal bleeding^[1,4]。 So far, EVB studies are mainly case reports or small sample case summaries, and there is a lack of high-evidence clinical studies. Therefore, there is no clear treatment strategy for EVB in the existing relevant guidelines. In this study, the data of 6 patients with cirrhotic EVB treated with transjugular intrahepatic portosystemic shunt (TIPS) were retrospectively analyzed in the Gulou Hospital affiliated to Nanjing University School of Medicine.

Colorectal cancer is a serious danger to human health. About 1 million new cases occur worldwide every year, and about 500,000 patients die from the disease^[1]。 The incidence of colorectal cancer has ranked third among malignant tumors in China. With the change of diet structure and the improvement of living standard, the incidence of colorectal cancer is increasing year by year^[2,3]。 To date, surgery remains the main treatment for colorectal cancer, and its efficacy depends on the early detection, early diagnosis and early treatment of the tumor. Therefore, it is of great clinical significance to find tumor markers closely related to the occurrence and development of colorectal cancer. In this study, the gene expression profile of colorectal cancer patients was analyzed by using human whole genome expression profiling technology, and the differentially expressed genes were screened to find markers related to the occurrence and development of colorectal cancer, which provided theoretical basis for early diagnosis, prognosis and new drug development of colorectal cancer.

The small intestine is the longest section of the human digestive tract, and the total length of the small intestine in adults is 5~7 m. The main clinical manifestations of small intestinal diseases are bleeding and abdominal pain. The lesions mainly include benign small intestinal ulcer (CD, etc.), small intestinal tumor (small intestinal adenocarcinoma, lymphoma, gastrointestinal stromal tumor), chronic inflammatory reaction, vascular malformation, small intestinal polyp, diverticulum, etc.^[1]。 However, small intestinal diseases are difficult to diagnose due to their low incidence, hidden onset and special anatomical structure, such as deep location, free in the peritoneum and restrained by the mesenteric membrane to form multiple compound intestinal haptics. In 2013, the magnetic capsule endoscope independently developed by China entered the clinic, creating a new era for the diagnosis of small intestine diseases. The Department of Gastroenterology of the Sixth Affiliated People's Hospital of Shanghai Jiaotong University took the lead in using this magnetic capsule endoscopy to diagnose small intestinal diseases in 2014. In this study, 226 patients with suspected small intestinal disease who underwent magnetic control capsule endoscopy were analyzed, so as to clarify the safety and diagnostic value of magnetic control capsule endoscopy in the examination of small intestinal disease.

From September 14 to 16, 2017, The 17th Congress of Gastroenterology China (CGC 2017) and The 2017 Chinese Congress of Digestive Diseases (CCDD 2017) were held by The Chinese Medical Association It was successfully held in Xi'an Qujiang International Convention Center. CGC 2017 was sponsored by Gastroenterology Branch of Chinese Medical Association, and CCDD 2017 was jointly sponsored by Gastroenterology Branch of Chinese Medical Association, Digestive Endoscopy Branch of Chinese Medical Association, Hepatology Branch of Chinese Medical Association and Gastroenterology Branch of Chinese Medical Equipment. Shaanxi Medical Association hosted the conference. The congress registered 4,800 delegates, with 15,584 live webcast viewers and 46,134 hits. More than 20,000 people attended the academic exchange and study of this conference, a record high. At present, it is the largest academic event with first-class academic level in the digestive field of China. World Gastroenterology Organization (WGO), World Endoscopy Organization (WEO), Asia Pacific Association of Gastroenterology (APAGE), Asia Pacific Society of Digestive Endoscopy (APSDE), Presidents and representatives of organizations and societies such as the Asian Pacific Digestive Week Federation (APDWF), the American Gastroenterological Association (AGA), the United European Gastroenterology Federation (UEGF), the Functional Gastroenterology Rome Foundation, and the Taiwan, Hong Kong and Macao Digestive Societies of China, as well asGutThe editor-in-chief attended the event. At the opening ceremony of the conference held on September 15th, Professor Wu Kaichun, Secretary-General of the conference, announced the national anthem, Professor Yang Yunsheng, Chairman of the conference, announced the opening of the conference, Rao Keqin, Vice President and Secretary-General of Chinese Medical Association, and An Haiyan, Director of Medical Administration and Hospital Administration Bureau of Shaanxi Provincial Health and Family Planning Commission, attended the conference to congratulate and deliver speeches.

Cirrhosis complicated with duodenal ectopic variceal bleeding is rare in clinical practice, but the mortality rate is as high as 40%. Among cirrhotic variceal bleeding, ectopic variceal veins account for 2% ~5%, and 17% occur in duodenum^[1]。 Treatment methods include endoscopic ligation of varicose veins, sclerosing agent and tissue glue injection, as well as vascular intervention and surgical treatment, but most of them are case reports, and no guidelines recommend the preferred treatment measures. This patient with liver cirrhosis and duodenal ectopic variceal bleeding has achieved good curative results after multidisciplinary consultation and discussion. Now, his diagnosis and treatment are summarized to provide reference for the treatment of liver cirrhosis and duodenal ectopic variceal bleeding.

The patient, a 54-year-old male, was seen in Wuhan University People's Hospital on November 17, 2015 due to right upper abdominal pain for more than 1 year and recurrent aggravation for 1 day. One year ago, the patient had intermittent dull pain and discomfort in the right upper abdomen without obvious trigger, and no diagnosis and treatment were given. After eating greasy food 1 day ago, the symptoms worsened, showing paroxysmal colic, accompanied by nausea and vomiting, no shoulder and back radiation pain, no fear of cold, fever, no anorexia, constipation, no melena and bloody stool. In March 2015, he underwent emergency endoscopic treatment for esophageal mucosal tears (Mallory-Weiss syndrome), and there was no other special medical history.

percutaneous liver biopsy (PLB) is an important method in the diagnosis of chronic liver disease. When it is difficult to confirm the diagnosis of liver disease by non-invasive examination, or when the diagnosis has been confirmed but the treatment plan needs to be adjusted, liver biopsy is recommended^[1]。 In the advanced stage of some chronic liver diseases, blood biochemical indexes and imaging manifestations often change little. At this time, by observing the pathological changes of liver tissue, we can further judge whether the treatment effect is effective, whether the disease has progressed, and whether the treatment plan needs to be adjusted. In addition, liver biopsy pathology can effectively assess liver fibrosis stage and inflammation grade. Liver puncture is an invasive procedure with certain risks, so preoperative evaluation and postoperative monitoring are particularly important. This paper reviews the recent research progress of PLB, focusing on preoperative preparation, requirements for submitting specimens for examination, the impact of puncture on complications, and serious complications such as postoperative hemorrhage and biliary peritonitis, aiming to help clinicians better conduct patient screening and safely and effectively carry out PLB.

transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive interventional therapy, which is recommended by several international liver association clinical practice guidelines as one of the alternative treatments after failure of ascites extraction combined with protein transfusion. TIPS can effectively control the recurrence of ascites, but it increases the risk of hepatic encephalopathy, and whether it can prolong survival is still controversial. With the deepening of understanding of TIPS, the maturity of surgical techniques, the renewal of stent materials and the completion of new randomized controlled studies, it is urgent to re-evaluate the position of TIPS in the field of treatment of refractory ascites. The status of TIPS in the treatment of refractory ascites is reviewed by comparing the efficacy of TIPS with ascites extraction combined with protein supplementation, comparing the covered stent with the bare stent, and the risk stratification of patients with refractory ascites.

cyclooxygenase is an important rate-limiting enzyme for the synthesis of prostaglandin and thromboxane in vivo. Cell membrane phospholipids in phospholipase A₂arachidonic acid (AA) is released under the action of cyclooxygenase, and AA produces the preceding adenine H through the action of cyclooxygenase₂, Precedent Aglandine H₂Generation of precedent adenine I under the action of different enzymes₂Thromboxane A₂Precedent Aglandine D₂Previous Aglandine F₂And the preceding glanduline E₂etc. (Figure 1)。 There are 3 isoforms of cyclooxygenases: cyclooxygenase-1, cyclooxygenase-2, and cyclooxygenase-3. Cyclooxygenase-3 is one of the targets of antipyretic and analgesic drugs recently discovered. There are few studies in cirrhotic portal hypertension, but more studies focus on cyclooxygenase-1 and cyclooxygenase-2. Cyclooxygenase-1 is a housekeeping gene, which is stably expressed in stomach, blood vessels and kidney. It is mainly involved in the regulation of various physiological functions such as vasomotor, platelet aggregation, gastric mucosal blood flow and renal function. Cyclooxygenase-2 is an inducible enzyme, and its expression can be induced by growth factors, inflammatory factors, hormones and other cellular stress. Cyclooxygenase-2 is mainly expressed in kidney, lung and heart. Mature hepatocytes do not express cyclooxygenase-2, while Kupfer cells, hepatic stellate cells (HSC), immature hepatocytes and hepatocellular carcinoma cells can induce the production of cyclooxygenase-2 under the stimulation of lipopolysaccharides and inflammatory factors. Studies have shown that cyclooxygenase plays an important role in inflammatory response, cell proliferation, tumor development and other processes^[1]。 In addition, cyclooxygenase and its catalytic products are also involved in the occurrence and development of liver cirrhosis and portal hypertension.