Xiao-Bo Li

Shanghai Jiao Tong University, Shanghai, Shanghai Shi, China

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Publications (15)31.67 Total impact

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    ABSTRACT: The total enteroscopy rate of single-balloon enteroscopy (SBE) using air insufflation is not satisfactory, and whether carbon dioxide (CO2) insufflation increases the total enteroscopy rate of SBE is unknown. This randomised controlled trial aimed to determine whether CO2 insufflation facilitates the intubation depth and total enteroscopy rate of SBE. A total of 214 eligible patients referred for SBE were randomised to receive either air or CO2 insufflation, and included in the intention-to-test (ITT) analysis. In addition, 199 patients in whom enteroscopy was completed were included in the per-protocol (PP) analysis. Both the patients and endoscopists were blinded, and the intubation depth and total enteroscopy rate were defined as the primary outcomes. The CO2 group showed a superiority of intubation in the ITT analysis (oral route: 323.8±64.2 vs 238.3±68.6 cm; anal route: 261.6±74.2 vs 174.7±62.1 cm, both p<0.001), and the total enteroscopy rate (34.9% vs 17.6%, p=0.006). Similar results were obtained in a PP analysis for both outcomes. In addition, in the PP analysis, the addition of circumference after the procedure was less in the CO2 group (0.8±0.6 vs 3.3±1.8 cm, p=0.005) for the oral route. No serious complications were reported. The overall percentage of procedures with significant pathological findings was 52.8%; the rates were 58.5% and 47.2% (p=0.100, ITT analysis) in the CO2 and air groups, respectively. CO2 insufflation improves the intubation depth and total enteroscopy rate in SBE with a good safety profile and acceptability compared with that of air, and thus is recommended for clinical utilisation. ClinicalTrial.gov identifier: NCT01758900.
    Gut 03/2014; · 10.73 Impact Factor
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    ABSTRACT: To investigate the correlations between serum amylase levels, intestinal permeability (IP), and pancreatic injury and to explore the mechanisms responsible for hyperamylasemia in double-balloon enteroscopy (DBE). A prospective study was conducted in 20 patients who underwent DBE from August 1, 2008 to February 28, 2009. Serum amylase was examined 0, 2, 6 and 24 h post-DBE, C-reactive protein and lipase were examined at 24 h, and urine lactulose, mannitol, and trypsinogen-II (TRY-II) levels were measured at 6 h. Lactulose/mannitol ratio indicated IP, and TRY-IIindicated pancreatic injuries. Procedure duration and enteroscope insertion length were recorded. Twelve patients underwent oral DBE (M:F, 5:7; mean age 50.42 ± 11.11 years) and 8 underwent anal DBE (M:F, 5:3; mean age 44.75 ± 12.66 years). They all showed significantly increased post-DBE serum amylase. Amylase and lipase levels were higher in the oral DBE group (P < 0.05). Hyperamylasemia was diagnosed in 9 (75.0%) patients undergoing oral DBE. Only patients receiving oral DBE showed increased post-procedure IP, which correlated with increased serum amylase (r = 0.611, P = 0.035) and procedure duration (r = 0.668, P = 0.018). Adverse events included one oral case with pancreatic injury (elevated TRY-II) and two cases of abdominal discomfort in each group. Pancreatitis was not reported. Hyperamylasemia correlates with increased IP and clinically undetectable pancreatic injuries. DBE could cause intestinal mucosa damage, which may result in IP elevation and increased amylase absorption, necessitating improvements and standardization of DBE methods.
    World Journal of Gastroenterology 01/2014; 20(2):539-45. · 2.55 Impact Factor
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    ABSTRACT: BACKGROUND AND STUDY AIMS: Small bowel Crohn's disease (SBCD) patients are frequently assessed by capsule endoscopy (CE), which enables direct visualization of small bowel mucosal abnormalities; however, the correlations between CE scoring index (CESI), C-reactive protein (CRP) and disease activity indices remain undefined. We aimed to determine correlations between the CESI, clinical disease activity indices and CRP in SBCD patients. PATIENTS AND METHODS: A prospective study was conducted between October 2008 and February 2011 on 58 established SBCD patients and suspected patients who received a definitive SBCD diagnosis during study. Patients underwent complete CE, and were scored according to the CESI and Harvey-Bradshaw index (HBI). Statistical correlation between CESI, HBI and CRP was assessed. RESULTS: Weak, but significant, correlations were found between CESI and HBI (r=0.4, p<0.01). The correlation between CESI and CRP was moderate (r=0.58, p<0.01). The median CRP value was significantly higher in patients with moderate-severe CESI, compared to the mild group (22.60±16.79 mg/L vs. 11.88±8.39 mg/L, p<0.01). Changes between baseline and follow-up CESI failed to correlate with the delta-HBI or delta-CRP (both, p>0.05). CONCLUSIONS: In this cohort of SBCD patients, clinical disease activity index was not reliable predictors of mucosal inflammation. CRP, however, might be a useful inflammatory marker for evaluating the moderate to severe CE activity in SBCD patients. Furthermore, therapy-induced clinical and biological improvement was not associated with repair of SBCD mucosal lesions.
    Journal of Gastroenterology and Hepatology 02/2013; · 3.33 Impact Factor
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    ABSTRACT: BACKGROUND: The usefulness of endoscopy narrow-band imaging (NBI) in differentiating colorectal lesions has been demonstrated. However, the learning curve associated with this technique is a concern for endoscopists. METHODS: Prior to carrying out these colonoscopies, four endoscopists attended a training course designed to teach the principles of NBI and application of the Sano Capillary Pattern (CP) classification criteria. Following a pre-test, endoscopists used NBI with magnification and CP analysis for real-time colonoscopy exams to predict lesion histology. Three sets of 15 lesions were imaged. These three sets included both lesions requiring endoscopic treatment (e.g. target lesions) and lesions that were not, or could not be, treated by endoscopy (e.g. non-target lesions). The diagnostic accuracy of each endoscopist for each set of lesions was evaluated to assess the learning curve associated with the application of NBI. RESULTS: Overall accuracy, sensitivity, and specificity for differentiating neoplastic and non-neoplastic lesions were 95.4%, 98.0%, and 92.0%, respectively. For target lesions versus non-target lesions, the diagnostic accuracy associated with the second set of lesions was better than that achieved with the first set of lesions (78.3% vs 96.7% (P = 0.02) and 70.0% vs 96.7% ( P < 0.01), respectively in each case). In contrast, the difference in diagnostic accuracy between the second and third sets of lesions was not significant. CONCLUSION: NBI with magnification is a useful tool for the diagnosis of colorectal lesions. Moreover, following a short training program and with minimal clinic practice, less experienced endoscopists were able to become competent in the method.
    Digestive Endoscopy 08/2012; · 1.61 Impact Factor
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    ABSTRACT: Narrow band imaging (NBI), in conjunction with magnifying endoscopy (ME), has arisen more and more attention in the area of advanced endoscopy. By enhancing the mucosal microvascular architecture and surface pattern, it is feasible to use ME-NBI to identify subtle changes associated with gastric inflammation, atrophy, intestinal metaplasia, and early gastric cancer. The new technique thus plays a valuable role in therapeutic decision-making, endoscopic treatment process, postoperative evaluation, and follow-up examination. To date, many criteria or evaluation method of ME-NBI has been proposed. This paper aims to summarize the various diagnosing classifications and the current clinical applications of ME-NBI in the stomach.
    Diagnostic and Therapeutic Endoscopy 01/2012; 2012:271914.
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    ABSTRACT: The eradication rates of first-line treatment for Helicobacter pylori infection are not satisfactory. Various regimens including quadruple therapies have been recommended as rescue therapies after the first H. pylori eradication attempt failed. To compare the efficacy and safety between quadruple therapies with medications containing either rufloxacin or levofloxacin in the Chinese nonulcer dyspepsia patients infected with H. pylori. One hundred and thirty-eight patients after an unsuccessful 10-day standard triple therapy were enrolled in this study. They were randomized to receive a 14-day quadruple therapy with pantoprazole, bismuth citrate, and furazolidone in combination with either rufloxacin (Group Ruf, n=70) or levofloxacin (Group Lev, n=68). The H. pylori eradication was evaluated by (13) C-urea breath test 4 and 12 weeks after therapy was completed. One hundred and twenty-seven patients (65 in Group Ruf and 62 in Group Lev) completed the study. The H. pylori eradication rates in Group Ruf were 81.4% for intention-to-treat (ITT) analysis and 87.7% for per-protocol (PP) analysis. The rates were statistically significantly higher than those in Group Lev (66.2% and 72.6%) (p<0.05). There were no severe adverse effects found in these two groups. Fourteen-day quadruple therapy with a combination of proton-pump inhibitor, bismuth citrate, furazolidone, and rufloxacin is considered an effective and safe rescue therapy for H. pylori eradication after failure of standard triple treatment.
    Helicobacter 08/2011; 16(4):284-8. · 3.51 Impact Factor
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    ABSTRACT: Until now, the insertion depth of the enteroscope during double-balloon enteroscopy (DBE) could only be estimated. However, the currently available methods have limitations, and development of newer, simple, and accurate modalities is needed. To evaluate the accuracy of a novel method for evaluation of enteroscope insertion depth during DBE. Prospective, single-center cohort study. Tertiary referral university hospital. Fifty-one patients who had lesions found during 41 antegrade and 10 retrograde DBEs and treated by surgery were enrolled in this study. The length of the ligament of Treitz/ileocecal valve lesion was estimated by adding the forward enteroscope length during each cycle of passage and by calculating the overtube insertion length (every 5 cm of overtube advancement means 40 cm of enteroscope advancement based on preliminary observations) during DBE, respectively, and was evaluated at surgery. The length from the ligament of Treitz/ileocecal valve to the lesion. Surgical evaluation was used as the standard. Regardless of insertion route, the mean difference from surgery in evaluation of enteroscope insertion length between using the enteroscope method and the overtube method was 19 cm (range 0-50 cm) and 17 cm (range 0-60 cm), respectively (P > .05). Small number of patients with a case series study design. Calculating the length of the overtube passage is accurate, and it is simple to estimate the insertion depth of the enteroscope during DBE, which is useful in clinical practice.
    Gastrointestinal endoscopy 11/2010; 72(5):999-1005. · 6.71 Impact Factor
  • Wei-Guang Li, Xiao-Bo Li, Zhi-Zheng Ge
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    ABSTRACT: To investigate the clinical characters and the possible pathogenesis of post-infectious functional dyspepsia (PI-FD). 550 patients suffered with acute gastrointestinal infection were followed-up for half year to evaluate the prevalence and symptoms of PI-FD. Meanwhile, thirty patients with non-special functional despepsra (NS-FD) and twenty healthy volunteers were enrolled. The number of mast cells, the total amount of tryptase and histamine released were determined. Furthermore, the ultra-structure of mast cells was observed by electron microscope, and the number of mast cells located within 5 microm of nerve fibers was also countered. The prevalence of PI-FD is about 6.7% (35/522) after acute gastrointestinal infection in half year. The scores of epigastric pain, epigastric burning sensation and early satiety in patients with PI-FD were significantly higher than those in patients with NS-FD (P < 0.05 for all), so did the scores of histological chronic inflammation in gastric mucosa (P < 0.05). There is no significant difference in the number of mast cells between patients with PI-FD and NS-FD (P > 0.05). However, the number of activated mast cells in patients with PI-FD is significantly higher than that in patients with NS-FD. The total amount of tryptase in gastric mucosa and the histamine released in patients with PI-FD is higher than that in patients with NS-FD and healthy volunteers (P < 0.05 for all). Under the electron microscope, the number of mast cells located within 5 microm of nerve fibers in PI-FD patients was significant higher than that in other two groups (P < 0.05 for all). PI-FD is probably a specific type of functional dyspepsia. Epigastric pain, epigastric burning sensation, and early satiety are the major symptoms in these patients. Mast cells maybe involved in the pathogenesis of PI-FD.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 09/2008; 47(9):739-42.
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    ABSTRACT: To discuss the clinical value of immunofecal occult blood test in screening of colorectal cancer and its precancerous lesions in a large series of health checkup population. Colorectal cancer and its precancerous lesions in 5919 subjects undergoing health checkup in our hospital were screened out by using immunofecal occult blood test from July 2006 to June 2007; positive cases with the test were subjected to colorectal endoscopy or X-ray barium enema examination. Relevant results were analyzed in combination with clinical and pathological data. Positive result was obtained in 314 out of the 5919 subjects undergoing health checkup with immunofecal occult blood test; the positive rate was 5.30%. 241 cases (76.75%) of them accepted colorectal endoscopic examination and 23 cases (7.32%) accepted X-ray barium enema examination. The total follow up rate was 84.08% with 50 cases out of contact. After excluding the cases out of contact, 16 cases of colorectal cancer were found morbidity 2.37 per thousand including 8 (50.00%) cases of Dukes A, 7 cases (43.75%) of Dukes B and 1 case of Dukes C (6.25%). The detection rate of colorectal cancer with positive immunofecal occult blood test was 6.06% (16/264). 94 cases (16.01 per thousand) of adenomatous polyps were found including 55 cases (58.51%) of tubular adenoma, 23 cases (24.47%) of villiform-tubular adenoma and 16 cases (17.02%) of villiform adenoma. Among these cases 55 (58.51%) were solitary and 39 (41.49%) multiple. In addition, 6 cases of ulcerative colitis in active phase were found. Altogether 116 (43.94%) of the 264 cases with positive immunofecal blood test and not out of contact were found to have colorectal cancer or its precancerous lesions. Immunofecal occult blood test is suitable for screening of colorectal cancer and its precancerous lesions in large series of population. Colorectal cancer and its precancerous lesions may be found in relatively early phase and be eradicated in curable stage, thus to reduce the morbidity and mortality.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 09/2008; 47(8):642-5.
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    ABSTRACT: The diagnosis of small bowel diseases remains relatively inefficient using traditional imaging techniques. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are two novel methods of enteroscopy for examining the entire small bowel. The aim of this study was to evaluate the detection rate and diagnostic accuracy of CE and DBE in patients with suspected small bowel diseases and to investigate the clinical significance of combined use of these two novel modalities. Two hundred and eighteen patients were evaluated for suspected small bowel disease, including 116 with obscure gastrointestinal bleeding and 102 with obscure abdominal pain or chronic diarrhea. One hundred and sixty-five out of these patients underwent CE first and 53 patients underwent DBE (under anesthesia with propofol) first. DBE was recommended after negative or equivocal evaluation on CE and vise versa. Introduction of the endoscope during DBE was either orally or anally and the patients were referred for a second procedure using the opposite route several days later when no abnormalities were found on the first procedure. The detection rates, diagnostic accuracy, tolerance and frequency of adverse events of these two modalities were then analyzed. Failure of the procedure was seen in one patient with CE and in two patients with DBE. Sixty-four DBE procedures were carried out in 51 patients; by the oral route in 34 cases, the anal route in 4 and both routes in 13 cases. The overall detection rate of small bowel diseases using CE (72.0%, 118/164) was superior to that with DBE (41.2%, 21/51); chi(2) = 16.1218, P < 0.0001. The diagnostic rate (51.8%, 85/164) was also higher than that with the latter procedure (39.2%, 20/51), but was not significantly different (chi(2) = 2.4771, P > 0.05). Furthermore, the detection rate of small bowel diseases in patients with obscure gastrointestinal bleeding using CE (88.0%, 88/100) was superior to that of DBE (60.0%, 9/15); chi(2) = 7.7457, P = 0.0054. Lesions were detected by DBE in 1 out of 4 patients in whom CE had a negative result. Suspected findings by CE were confirmed by DBE combined with biopsy in 12 out of 15 patients. On the other hand, small bowel lesions were identified by CE in all 3 patients after negative evaluations by DBE. There were no severe complications during or after either of the two procedures. The detection rate of small bowel diseases by CE is very high. CE should be selected for the initial diagnosis in patients with suspected small bowel diseases, especially in patients with obscure gastrointestinal bleeding. DBE appears to be inferior to CE in the diagnosis of small bowel diseases. However, it was shown that abnormalities could still be identified by DBE in patients with normal images or used to confirm suspected findings from CE. DBE can also serve as a good complementary approach after an initial diagnostic imaging using CE.
    Chinese medical journal 02/2007; 120(1):30-5. · 0.90 Impact Factor
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    ABSTRACT: To investigate the effects of Helicobacter pylori (Hp) infection on neural expression in stomach and spinal cord, and to investigate the mechanism of functional dyspepsia after Hp infection. Thirty-five female C57BL/6 mice were randomly divided into three groups: Group A (acute infection group, undergoing intragastric gavage of Hp suspension every other day for 3 times and then observed for 2 weeks, 15 mice), Group B (chronic infection group, undergoing intragastric gavage of Hp suspension every other day for 3 times and then observed for 2 weeks, 15 mice) and control group (undergoing intragastric gavage of normal saline every other day for 3 times and then observed for 2 weeks, 5 mice). After the observation the mice were killed and their stomachs were taken out to undergo gastric histology and bacterial colonization by HE staining and Warthin-Starry staining respectively. Their spinal cords of thoracic and lumbar segments were taken out too. Immunohistochemistry was used to detect the expression of Fos, vasoactive intestinal polypeptide (VIP), and calcitonin gene-related peptide (CGRP) in the stomach and spinal cord. Three mice died 12 weeks after Hp infection. The rate of Hp colonization, mainly localized in pyloric gland region, was greater in Group B than in Group A, and was 0 in the control group. The severity of inflammation as shown by mononuclear cell infiltration, and activity of inflammation as shown by polymorphonuclear cell infiltration, in the pyloric gland region, proventriculus-glandular stomach region, and corpus gland region were more pronounced in Groups A and B, especially in Group B, than in the control group. The expression values of Fos, VIP, and CGRP in the stomach of Group A were 3.1 +/- 1.4, 4.5 +/- 1.8, and 2.4 +/- 0.8 respectively, all not significantly different from those of Group B (3.1 +/- 1.3, 3.5 +/- 1.6, and 2.2 +/- 0.8, all P > 0.05). The expression values of Fos, VIP, and CGRP in the spinal cord of Group A were 3.8 +/- 1.2, 3.2 +/- 1.5, and 2.2 +/- 0.6, all not significantly different from those of Group B (3.4 +/- 0.7, 2.6 +/- 1.2, and 2.5 +/- 1.1, all P > 0.05 for all). However, the neural expression values in both acute and chronic infection groups were significantly higher than those in the control group (2.4 +/- 0.9, 1.6 +/- 0.9, and 1.2 +/- 0.8 in stomach; and 2.0 +/- 1.6, 1.2 +/- 1.1, and 1.2 +/- 1.1 in spinal cord, P < 0.05 for all). Hp infection, both acute and chronic, induces gastric histological changes such as inflammation and activity, and enhances the Fos, VIP, and CGRP expression in stomach and spinal cord, which can be a basis for symptom generation in dyspeptic patients with Hp infection.
    Zhonghua yi xue za zhi 01/2006; 86(4):255-9.
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    ABSTRACT: The safety of Helicobacter pylori "test-and-treat" and "test-and-endoscopy" strategies for the management of young patients with uninvestigated dyspepsia has not been evaluated in Shanghai. A total of 14,101 consecutive patients with dyspepsia receiving endoscopy in our hospital from October 2002 to December 2003 were retrospectively studied. The detection rates of esophageal or gastroduodenal malignancies and alarm symptoms were investigated, and H. pylori status was assessed. A total of 202 (1.4%) gastrointestinal (GI) malignancies were found, including 162 cases (1.15%) of gastric cancer, 4 of gastric lymphoma, 35 (0.25%) of esophageal cancer and 1 case of duodenal cancer. Among those patients with GI malignancies, 99 (49.0%) were infected with H. pylori and 108 (53.5%) presented with alarm symptoms. Eighteen patients (0.46%, 18/3952) under 45 years of age were diagnosed as having gastric cancer. Of these patients, 5 (27.8%) presented with alarm symptoms and 13 (72.2%) were infected with H. pylori. If the H. pylori "test-and-treat" strategy were used in dyspeptic patients under the age of 45 years without alarm symptoms in the Shanghai region, then 13 cases (72.2%) of gastric cancer would be missed. If the H. pylori "test-and-endoscopy" strategy were applied, then 3 cases (16.7%) of gastric cancer would be missed. H. pylori "test-and-treat" and "test-and-endoscopy" strategies are both not suitable for the management of patients with uninvestigated dyspepsia in Shanghai. For most Shanghai dyspeptic patients, prompt endoscopy should be recommended as the first-line initial management option.
    Scandinavian Journal of Gastroenterology 10/2005; 40(9):1028-31. · 2.33 Impact Factor
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    ABSTRACT: To verify the safety of Helicobacter pylori (Hp) 'test-and-treat' and 'test-and-endoscopy' strategies for management of uninvestigated dyspepsia in Shanghai patients. 14,101 consecutive patients presented with dyspepsia receiving endoscopy during Oct. 2002 to Dec. 2003 were retrospectively analyzed in this study. The detective rate of esophageal or gastroduodenal malignancies and alarm symptoms were investigated and Hp status was assessed. Total 202 (1.43%) malignancies were found, including gastric cancer in 162 (1.15%), malignant gastric lymphoma in 4, esophageal cancer in 35 (0.25%) and duodenal cancer in 1. Among those patients with malignancies, ninety-nine (49.0%) patients were infected with Hp and 108 (53.5%) presented with alarm symptoms. Eighteen patients (0.46%) under the age of 45 years were diagnosed as gastric cancer. Among these patients, 5 (27.8%) presented with alarm symptoms and 13 (72.2%) were infected with Hp. If the Hp 'test-and-treat'strategy was used in dyspeptic patients under the age of 45 years without alarm symptoms in Shanghai region, then 13 cases (72.2%) of gastric cancer would be missed. If the Hp 'test-and-endoscopy' strategy was applied, then 3 cases (16.7%) of gastric cancer would be missed. Hp 'test-and-treat' and 'test-and-endoscopy' strategies are all not suitable for the management of uninvestigated dyspepsia in Shanghai patients. For most Shanghai adult dyspeptic patients, prompt endoscopy should be recommended as the first-line initial management option.
    Zhonghua nei ke za zhi [Chinese journal of internal medicine] 04/2005; 44(3):195-7.
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Publication Stats

42 Citations
31.67 Total Impact Points

Institutions

  • 2012–2013
    • Shanghai Jiao Tong University
      • • Department of Gastroenterology (Children's)
      • • Department of Gastroenterology and Hepatology (Renji)
      Shanghai, Shanghai Shi, China
  • 2005–2011
    • Renji Hospital
      Shanghai, Shanghai Shi, China