This article comments on the article by Du et al,who conducted a randomized controlled trial aiming at evaluating the effectiveness of a novel spray flushing system in cleaning flexible endoscopes while minimizing dam...This article comments on the article by Du et al,who conducted a randomized controlled trial aiming at evaluating the effectiveness of a novel spray flushing system in cleaning flexible endoscopes while minimizing damage to the working channels.We share our perspective on the importance of improving endoscope reprocessing methods.The findings highlight the spray flushing system's capacity to improve cleaning efficacy while minimizing damage,suggesting that it might be important in enhancing endoscope reprocessing procedures.展开更多
BACKGROUND Current disinfection methods for gastrointestinal endoscopes consume a significant amount of water resources and produce a large volume of waste.AIM To achieve the objectives of efficiency,speed,and cost-ef...BACKGROUND Current disinfection methods for gastrointestinal endoscopes consume a significant amount of water resources and produce a large volume of waste.AIM To achieve the objectives of efficiency,speed,and cost-effectiveness,this study utilized vaporized hydrogen peroxide(VHP)generated from sodium percarbonate granules to conduct an anhydrous disinfection test on gastrointestinal endoscopes.METHODS The experimental device rapidly converts sodium percarbonate granules into VHP,and performs disinfection experiments on gastrointestinal endoscope models,disposable endoscopes,and various types of reusable gastrointestinal endoscopes.Variables such as the intraluminal flow rate(FR),relative humidity(RH),exposure dosage,and organic burden are used to explore the factors influencing the disinfection of long and narrow lumens with VHP.RESULTS The device generates a certain concentration of VHP that can achieve high-level disinfection of endoscope models within 30 minutes.RH,exposure dosage,and organic burden significantly affect the disinfection efficacy of VHP,whereas the intraluminal FR does not significantly impact disinfection efficacy.All ten artificially contaminated disposable endoscopes achieved satisfactory disinfection results.Furthermore,when this device was used to treat various types of reusable endoscopes,the disinfection and sterilization effects were not significantly different from those of automatic endoscope disinfection machines(using peracetic acid disinfectant solution)(P>0.05),and the economic cost of disinfectant required per endoscope was lower(1.5 China Yuan),with a shorter disinfection time(30 minutes).CONCLUSION The methods and results of this study provide a basis for further research on the use of VHP for the disinfection of gastrointestinal endoscopes,as well as for the development of anhydrous disinfection technology for gastrointestinal endoscopes.展开更多
Objective:To evaluate the application value of lean management in the management of flexible endoscopes.Methods:From January to December 2023,routine management was implemented,and 200 flexible endoscopes used for exa...Objective:To evaluate the application value of lean management in the management of flexible endoscopes.Methods:From January to December 2023,routine management was implemented,and 200 flexible endoscopes used for examination and treatment were included in the control group;from January to December 2024,lean management was implemented,and 200 flexible endoscopes used for examination and treatment were included in the observation group.The average daily usage frequency,management effectiveness,and failure rate of flexible endoscopes were compared between the two groups.Results:The average daily usage frequency of flexible endoscopes in the observation group was higher than that in the control group(P<0.05);the 3S retrieval rate and spot-check qualification rate of endoscopes in the observation group were higher than those in the control group(P<0.05);the failure rate of flexible endoscopes in the observation group was lower than that in the control group(P<0.05).Conclusion:Implementing lean management during the management of flexible endoscopes can improve the efficiency of endoscope retrieval,increase the average daily usage frequency of flexible endoscopes,and reduce endoscope failures.展开更多
Objectives： This pilot study of employing chlorine dioxide （CD） gas to disinfect gastrointestinal endoscopes was conducted to meet the expectations of many endoscopy units in China for a high-efficiency and low-cos...Objectives： This pilot study of employing chlorine dioxide （CD） gas to disinfect gastrointestinal endoscopes was conducted to meet the expectations of many endoscopy units in China for a high-efficiency and low-cost disin- fectant. Methods： An experimental prototype with an active circulation mode was designed to use CD gas to disinfect gastrointestinal endoscopes. One type of testing device composed of polytetrafluoroethylene （PTFE） tubes （2 m long, inner diameter 1 mm） and bacterial carrier containers was used to simulate the channel of the endoscope. PTFE bacterial carriers inoculated with Bacillus atrophaeus with or without organic burden were used to evaluate the spor- icidal activity of CD gas. Factors including exposure dosage, relative humidity （RH）, and flow rate （FR） influencing the disinfection effect of CD gas were investigated. Moreover, an autoptic disinfecting test on eight real gastrointestinal endoscopes after clinical use was performed using the experimental prototype. Results： IRH, exposure dosage, or- ganic burden, and the FIR through the channel significantly （P〈0.05） affected the disinfection efficacy of CD gas for a long and narrow lumen. The log reduction increased as FR decreased. Treatment with 4 mg/L CD gas for 30 min at 0.8 L/min FR and 75% IRH, resulted in complete inactivation of spores. Furthermore, all eight endoscopes with a maximum colony-forming unit of 915 were completely disinfected. The cost was only 3 CNY （0.46 USD） for each endoscope. Conclusions： The methods and results reported in this study could provide a basis for further studies on using CD gas for the disinfection of endoscopes.展开更多
BACKGROUND Commonly used cleaning brushes in the reprocessing of flexible endoscopes often cause damage within the working channels.AIM To develop a spray flushing system to achieving effective cleaning of the working...BACKGROUND Commonly used cleaning brushes in the reprocessing of flexible endoscopes often cause damage within the working channels.AIM To develop a spray flushing system to achieving effective cleaning of the working channels while minimizing damage.METHODS This prospective study included 60 used endoscopes and 60 Teflon tubes randomly divided into a control group(n=30)and an experimental group(n=30).The material of Teflon tubes was the same as that of the endoscope working channel.Endoscopes in the control group were manually cleaned using traditional cleaning brushes,while those in the experimental group were cleaned using the newly developed spray flushing system.ATP levels,cleanliness,and microbiological testing of the working channels were measured.Additionally,Teflon tubes in the control group underwent 500 passes with a cleaning brush,while those in the experimental group were subjected to the spray flushing system,and channel damage was evaluated.RESULTS The ATP levels(RLU)in the two groups were 32.5(13-66)and 26(16-40),respectively(P>0.05).Cleanliness scores were 1.5(1-2)and 1(1-2),respectively(P>0.05).Debris was found in 73.3%of the control group,which was significantly higher than 46.7%in the experimental group(P<0.05).Microbiological tests for both groups yielded negative results.Teflon tube damage in the control group was rated at 4(4-5.25),which was significantly higher than in the experimental group 4(3-4)(P<0.01).CONCLUSION The spray flushing system demonstrated superior efficacy in removing debris and resulted in less damage to the endoscope working channels compared with traditional cleaning brushes.展开更多
AIM To correlate the length of endoscope hang time and number of bacteria cultured prior to use.METHODS Prospectively,we cultured specimens from 19 gastroscopes,24 colonoscopes and 5 side viewing duodenoscopes during ...AIM To correlate the length of endoscope hang time and number of bacteria cultured prior to use.METHODS Prospectively,we cultured specimens from 19 gastroscopes,24 colonoscopes and 5 side viewing duodenoscopes during the period of 2011 to 2015.A total of 164 results had complete data denoting date of cleansing,number of days stored and culture results.All scopes underwent initial cleaning in the endoscopy suite utilizing tap water,and then manually cleaned and flushed.High level disinfection was achieved with a Medivator~?DSD(Medivator Inc.,United States)automated endoscope reprocessor following manufacturer instructions,with Glutacide~?(Pharmax Limited,Canada),a 2%glutaraldehyde solution.After disinfection,all scopes were stored in dust free,unfiltered commercial cabinets for up to 7 d.Prior to use,all scopes were sampled and plated on sheep blood agar for 48 h;the colony count was obtained from each plate.The length of endoscope hang time and bacterial load was analyzed utilizing unpaired t-tests.The overall percentage of positive and negative cultures for each type of endoscope was also calculated.RESULTS All culture results were within the acceptable range(less than 200 cfu/mL).One colonoscope cultured 80 cfu/mL after hanging for 1 d,which was the highest count.ERCP scopes cultured at most 10 cfu,this occurred after 2 and 7 d,and gastroscopes cultured 50 cfu/mL at most,at 1 d.Most cultures were negative for growth,irrespective of the length of hang time.Furthermore,all scopes,with the exception of one colonoscope which had two positive cultures(each of 10 cfu/mL),had at most one positive culture.There was no significant difference in the number of bacteria cultured after 1 d compared to 7 d when all scopes were combined(day 2:P=0.515;day 3:P=identical;day 4:P=0.071;day 5:P=0.470;day 6:P=0.584;day 7:P=0.575).There was also no significant difference in the number of bacteria cultured after 1 day compared to 7 d for gastroscopes(day 2:P=0.895;day 3:P=identical;day 4:P=identical;day 5:P=0.893;day 6:P=identical;day 7:P=0.756),colonoscopes(day 2:P=0.489;day 4:P=0.493;day 5:P=0.324;day 6:P=0.526;day 7:P=identical),or ERCP scopes(day 2:P=identical;day 7:P=0.685).CONCLUSION There is no correlation between hang time and bacterial load.Endoscopes do not need to be reprocessed if reused within a period of 7 d.展开更多
AIM: To analyze the diagnostic utility of a small-caliber endoscope(SC-E) and clinicopathological features of false-negative gastric cancers(FN-GCs). METHODS: A total of 21638 esophagogastroduodenoscopy(EGD) gastric c...AIM: To analyze the diagnostic utility of a small-caliber endoscope(SC-E) and clinicopathological features of false-negative gastric cancers(FN-GCs). METHODS: A total of 21638 esophagogastroduodenoscopy(EGD) gastric cancer(GC) screening examinations were analyzed. Secondary endoscopic examinations(n = 3352) were excluded because most secondary examinations tended to be included in the conventional endoscopy(C-E) group. Detection rates of GCs and FN-GCs were compared between SC-E and C-E groups. FN-GC was defined as GC performed with EGD within the past 3 years without GC detection. Macroscopic types, histopathological characteristics and locations of FN-GCs were compared with firstly foundgastric cancers(FF-GCs) in detail. RESULTS: SC-E cases(n = 6657) and C-E cases(n = 11644), a total of 18301 cases, were analyzed. GCs were detected in 16(0.24%) SC-E cases and 40 C-E(0.34%) cases(P = 0.23) and there were 4 FN-GCs(0.06%) in SC-E and 13(0.11%) in C-E(P = 0.27), with no significant difference. FN-GCs/GCs ratio between SC-E and C-E groups was not significantly different(P = 0.75). The comparison of endoscopic macroscopic types of FN-GCs tended to be a less advanced type(P = 0.02). Histopathologically, 70.6% of FN-GCs were differentiated and 29.4% undifferentiated type. On the other hand, 43.0% of FF-GCs were differentiated and 53.8% undifferentiated type, so FN-GCs tended to be more differentiated type(P = 0.048). CONCLUSION: The diagnostic utility of SC-E for the detection of GCs and FN-GCs was not inferior to that of C-E. Careful observation for superficially depressed type lesions in the upper lesser curvature region is needed to decrease FN-GCs.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.展开更多
Rectal neuroendocrine tumors(NETs)are increasingly detected and are the most common gastrointestinal NET sites.Often discovered incidentally during endoscopy,most are small,well differentiated,and have an excellent pr...Rectal neuroendocrine tumors(NETs)are increasingly detected and are the most common gastrointestinal NET sites.Often discovered incidentally during endoscopy,most are small,well differentiated,and have an excellent prognosis.Local resection is typically considered curative.Several guidelines,namely the European Neuroendocrine Tumor Society guidelines 2023,National Comprehensive Cancer network 2025,and the Polish Network of Neuroendocrine Tumors(2017)emphasize the use of endoscopic and endoscopic ultrasound staging to select the appropriate therapy,ranging from resection to advanced techniques for larger or metastatic diseases,highlighting the need for an accurate initial assessment.展开更多
BACKGROUND Digestive tract subepithelial lesions(SELs)are relatively common,and early diagnosis and treatment are critical for improving patient quality of life and prognosis.However,diagnostic uncertainty often leads...BACKGROUND Digestive tract subepithelial lesions(SELs)are relatively common,and early diagnosis and treatment are critical for improving patient quality of life and prognosis.However,diagnostic uncertainty often leads to negative psychological effects,including anxiety and depression.AIM To investigate the prevalence of anxiety and depressive symptoms and identify associated factors among patients with digestive tract SELs.METHODS This retrospective study included 296 consecutive patients diagnosed with digestive tract SELs at the Affiliated Hospital of North Sichuan Medical College Endoscopy Center between October 2024 and April 2025.Demographic and clinical data were collected through standardized questionnaires.Anxiety and depression were assessed using the Self-Rating Anxiety Scale and the Self-Rating Depression Scale,respectively,while sleep quality was evaluated using the Pittsburgh Sleep Quality Index.Participants were classified into anxiety vs nonanxiety and depression vs non-depression groups based on established cutoff scores,and potential determinants were examined.RESULTS Anxiety symptoms were observed in 35.8%of cases(mean Self-Rating Anxiety Scale score:46.56±9.13)and depressive symptoms in 33.1%(mean Self-Rating Depression scale score:48.64±8.30).Pittsburgh Sleep Quality Index scores were positively correlated with both anxiety and depression(P<0.05).Univariate analysis identified age,annual income,sleep disorders,and endoscopic ultrasonography(EUS)evaluation status as significant factors(P<0.05).Multivariable analysis revealed that low annual income(<10000 Chinese yuan)and sleep disorders were independent risk factors,whereas undergoing EUS examination and having disease awareness were protective factors against anxiety and depression(P<0.05).CONCLUSION Patients with digestive tract SELs are at increased risk for anxiety and depression,with poor sleep strongly linked to worsening psychological symptoms.Early diagnostic assessment with EUS appears to serve a protective role against the onset of these psychological disorders.展开更多
Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally adv...Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.展开更多
BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidec...BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.展开更多
BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate se...BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.展开更多
In the practice of clinical endoscopy,the precise estimation of the lesion size is quite significant for diagnosis.In this paper,we propose a three-dimensional(3D)measurement method for binocular endoscopes based on d...In the practice of clinical endoscopy,the precise estimation of the lesion size is quite significant for diagnosis.In this paper,we propose a three-dimensional(3D)measurement method for binocular endoscopes based on deep learning,which can overcome the poor robustness of the traditional binocular matching algorithm in texture-less areas.A simulated binocular image dataset is created from the target 3D data obtained by a 3D scanner and the binocular camera is simulated by 3D rendering software to train a disparity estimation model for 3D measurement.The experimental results demonstrate that,compared with the traditional binocular matching algorithm,the proposed method improves the accuracy and disparity map generation speed by 48.9%and 90.5%,respectively.This can provide more accurate and reliable lesion size and improve the efficiency of endoscopic diagnosis.展开更多
Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is importan...Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.展开更多
BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD....BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.展开更多
Gastric polyps are commonly detected during upper gastrointestinal endoscopy.They are most often benign and rarely become malignant.Nevertheless,adequate knowledge,diagnostic modalities,and management strategies shoul...Gastric polyps are commonly detected during upper gastrointestinal endoscopy.They are most often benign and rarely become malignant.Nevertheless,adequate knowledge,diagnostic modalities,and management strategies should be the endoscopist’s readily available“weapons”to defeat the potentially malignant“enemies”.This article sheds light on the valuable effort by Costa et al to generate a new classification system of gastric polyps as“good”,“bad”,and“ugly”.This comprehensive overview provides clinicians with a simplified decision-making process.展开更多
Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopi...Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic colonoscopies.The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased risk.The incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe cases.Recently,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports.This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations.These insights are from the perspectives of endoscopists and gastroenterologists.We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency Surgery.We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.展开更多
文摘This article comments on the article by Du et al,who conducted a randomized controlled trial aiming at evaluating the effectiveness of a novel spray flushing system in cleaning flexible endoscopes while minimizing damage to the working channels.We share our perspective on the importance of improving endoscope reprocessing methods.The findings highlight the spray flushing system's capacity to improve cleaning efficacy while minimizing damage,suggesting that it might be important in enhancing endoscope reprocessing procedures.
基金Supported by the Joint Logistics Support Force Comprehensive Equipment Research Project,No.LB2023B010100-09.
文摘BACKGROUND Current disinfection methods for gastrointestinal endoscopes consume a significant amount of water resources and produce a large volume of waste.AIM To achieve the objectives of efficiency,speed,and cost-effectiveness,this study utilized vaporized hydrogen peroxide(VHP)generated from sodium percarbonate granules to conduct an anhydrous disinfection test on gastrointestinal endoscopes.METHODS The experimental device rapidly converts sodium percarbonate granules into VHP,and performs disinfection experiments on gastrointestinal endoscope models,disposable endoscopes,and various types of reusable gastrointestinal endoscopes.Variables such as the intraluminal flow rate(FR),relative humidity(RH),exposure dosage,and organic burden are used to explore the factors influencing the disinfection of long and narrow lumens with VHP.RESULTS The device generates a certain concentration of VHP that can achieve high-level disinfection of endoscope models within 30 minutes.RH,exposure dosage,and organic burden significantly affect the disinfection efficacy of VHP,whereas the intraluminal FR does not significantly impact disinfection efficacy.All ten artificially contaminated disposable endoscopes achieved satisfactory disinfection results.Furthermore,when this device was used to treat various types of reusable endoscopes,the disinfection and sterilization effects were not significantly different from those of automatic endoscope disinfection machines(using peracetic acid disinfectant solution)(P>0.05),and the economic cost of disinfectant required per endoscope was lower(1.5 China Yuan),with a shorter disinfection time(30 minutes).CONCLUSION The methods and results of this study provide a basis for further research on the use of VHP for the disinfection of gastrointestinal endoscopes,as well as for the development of anhydrous disinfection technology for gastrointestinal endoscopes.
文摘Objective:To evaluate the application value of lean management in the management of flexible endoscopes.Methods:From January to December 2023,routine management was implemented,and 200 flexible endoscopes used for examination and treatment were included in the control group;from January to December 2024,lean management was implemented,and 200 flexible endoscopes used for examination and treatment were included in the observation group.The average daily usage frequency,management effectiveness,and failure rate of flexible endoscopes were compared between the two groups.Results:The average daily usage frequency of flexible endoscopes in the observation group was higher than that in the control group(P<0.05);the 3S retrieval rate and spot-check qualification rate of endoscopes in the observation group were higher than those in the control group(P<0.05);the failure rate of flexible endoscopes in the observation group was lower than that in the control group(P<0.05).Conclusion:Implementing lean management during the management of flexible endoscopes can improve the efficiency of endoscope retrieval,increase the average daily usage frequency of flexible endoscopes,and reduce endoscope failures.
基金Project supported by the National High-Tech R&D Program(863)of China(No.2014AA021405)
文摘Objectives： This pilot study of employing chlorine dioxide （CD） gas to disinfect gastrointestinal endoscopes was conducted to meet the expectations of many endoscopy units in China for a high-efficiency and low-cost disin- fectant. Methods： An experimental prototype with an active circulation mode was designed to use CD gas to disinfect gastrointestinal endoscopes. One type of testing device composed of polytetrafluoroethylene （PTFE） tubes （2 m long, inner diameter 1 mm） and bacterial carrier containers was used to simulate the channel of the endoscope. PTFE bacterial carriers inoculated with Bacillus atrophaeus with or without organic burden were used to evaluate the spor- icidal activity of CD gas. Factors including exposure dosage, relative humidity （RH）, and flow rate （FR） influencing the disinfection effect of CD gas were investigated. Moreover, an autoptic disinfecting test on eight real gastrointestinal endoscopes after clinical use was performed using the experimental prototype. Results： IRH, exposure dosage, or- ganic burden, and the FIR through the channel significantly （P〈0.05） affected the disinfection efficacy of CD gas for a long and narrow lumen. The log reduction increased as FR decreased. Treatment with 4 mg/L CD gas for 30 min at 0.8 L/min FR and 75% IRH, resulted in complete inactivation of spores. Furthermore, all eight endoscopes with a maximum colony-forming unit of 915 were completely disinfected. The cost was only 3 CNY （0.46 USD） for each endoscope. Conclusions： The methods and results reported in this study could provide a basis for further studies on using CD gas for the disinfection of endoscopes.
基金West China Nursing Discipline Development Special Fund Project,No.HXHL21029。
文摘BACKGROUND Commonly used cleaning brushes in the reprocessing of flexible endoscopes often cause damage within the working channels.AIM To develop a spray flushing system to achieving effective cleaning of the working channels while minimizing damage.METHODS This prospective study included 60 used endoscopes and 60 Teflon tubes randomly divided into a control group(n=30)and an experimental group(n=30).The material of Teflon tubes was the same as that of the endoscope working channel.Endoscopes in the control group were manually cleaned using traditional cleaning brushes,while those in the experimental group were cleaned using the newly developed spray flushing system.ATP levels,cleanliness,and microbiological testing of the working channels were measured.Additionally,Teflon tubes in the control group underwent 500 passes with a cleaning brush,while those in the experimental group were subjected to the spray flushing system,and channel damage was evaluated.RESULTS The ATP levels(RLU)in the two groups were 32.5(13-66)and 26(16-40),respectively(P>0.05).Cleanliness scores were 1.5(1-2)and 1(1-2),respectively(P>0.05).Debris was found in 73.3%of the control group,which was significantly higher than 46.7%in the experimental group(P<0.05).Microbiological tests for both groups yielded negative results.Teflon tube damage in the control group was rated at 4(4-5.25),which was significantly higher than in the experimental group 4(3-4)(P<0.01).CONCLUSION The spray flushing system demonstrated superior efficacy in removing debris and resulted in less damage to the endoscope working channels compared with traditional cleaning brushes.
文摘AIM To correlate the length of endoscope hang time and number of bacteria cultured prior to use.METHODS Prospectively,we cultured specimens from 19 gastroscopes,24 colonoscopes and 5 side viewing duodenoscopes during the period of 2011 to 2015.A total of 164 results had complete data denoting date of cleansing,number of days stored and culture results.All scopes underwent initial cleaning in the endoscopy suite utilizing tap water,and then manually cleaned and flushed.High level disinfection was achieved with a Medivator~?DSD(Medivator Inc.,United States)automated endoscope reprocessor following manufacturer instructions,with Glutacide~?(Pharmax Limited,Canada),a 2%glutaraldehyde solution.After disinfection,all scopes were stored in dust free,unfiltered commercial cabinets for up to 7 d.Prior to use,all scopes were sampled and plated on sheep blood agar for 48 h;the colony count was obtained from each plate.The length of endoscope hang time and bacterial load was analyzed utilizing unpaired t-tests.The overall percentage of positive and negative cultures for each type of endoscope was also calculated.RESULTS All culture results were within the acceptable range(less than 200 cfu/mL).One colonoscope cultured 80 cfu/mL after hanging for 1 d,which was the highest count.ERCP scopes cultured at most 10 cfu,this occurred after 2 and 7 d,and gastroscopes cultured 50 cfu/mL at most,at 1 d.Most cultures were negative for growth,irrespective of the length of hang time.Furthermore,all scopes,with the exception of one colonoscope which had two positive cultures(each of 10 cfu/mL),had at most one positive culture.There was no significant difference in the number of bacteria cultured after 1 d compared to 7 d when all scopes were combined(day 2:P=0.515;day 3:P=identical;day 4:P=0.071;day 5:P=0.470;day 6:P=0.584;day 7:P=0.575).There was also no significant difference in the number of bacteria cultured after 1 day compared to 7 d for gastroscopes(day 2:P=0.895;day 3:P=identical;day 4:P=identical;day 5:P=0.893;day 6:P=identical;day 7:P=0.756),colonoscopes(day 2:P=0.489;day 4:P=0.493;day 5:P=0.324;day 6:P=0.526;day 7:P=identical),or ERCP scopes(day 2:P=identical;day 7:P=0.685).CONCLUSION There is no correlation between hang time and bacterial load.Endoscopes do not need to be reprocessed if reused within a period of 7 d.
文摘AIM: To analyze the diagnostic utility of a small-caliber endoscope(SC-E) and clinicopathological features of false-negative gastric cancers(FN-GCs). METHODS: A total of 21638 esophagogastroduodenoscopy(EGD) gastric cancer(GC) screening examinations were analyzed. Secondary endoscopic examinations(n = 3352) were excluded because most secondary examinations tended to be included in the conventional endoscopy(C-E) group. Detection rates of GCs and FN-GCs were compared between SC-E and C-E groups. FN-GC was defined as GC performed with EGD within the past 3 years without GC detection. Macroscopic types, histopathological characteristics and locations of FN-GCs were compared with firstly foundgastric cancers(FF-GCs) in detail. RESULTS: SC-E cases(n = 6657) and C-E cases(n = 11644), a total of 18301 cases, were analyzed. GCs were detected in 16(0.24%) SC-E cases and 40 C-E(0.34%) cases(P = 0.23) and there were 4 FN-GCs(0.06%) in SC-E and 13(0.11%) in C-E(P = 0.27), with no significant difference. FN-GCs/GCs ratio between SC-E and C-E groups was not significantly different(P = 0.75). The comparison of endoscopic macroscopic types of FN-GCs tended to be a less advanced type(P = 0.02). Histopathologically, 70.6% of FN-GCs were differentiated and 29.4% undifferentiated type. On the other hand, 43.0% of FF-GCs were differentiated and 53.8% undifferentiated type, so FN-GCs tended to be more differentiated type(P = 0.048). CONCLUSION: The diagnostic utility of SC-E for the detection of GCs and FN-GCs was not inferior to that of C-E. Careful observation for superficially depressed type lesions in the upper lesser curvature region is needed to decrease FN-GCs.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.
文摘Rectal neuroendocrine tumors(NETs)are increasingly detected and are the most common gastrointestinal NET sites.Often discovered incidentally during endoscopy,most are small,well differentiated,and have an excellent prognosis.Local resection is typically considered curative.Several guidelines,namely the European Neuroendocrine Tumor Society guidelines 2023,National Comprehensive Cancer network 2025,and the Polish Network of Neuroendocrine Tumors(2017)emphasize the use of endoscopic and endoscopic ultrasound staging to select the appropriate therapy,ranging from resection to advanced techniques for larger or metastatic diseases,highlighting the need for an accurate initial assessment.
基金Supported by Nanchong Social Science Research“14^(th) Five-Year Plan”2025 Annual Project,No.NC25B244.
文摘BACKGROUND Digestive tract subepithelial lesions(SELs)are relatively common,and early diagnosis and treatment are critical for improving patient quality of life and prognosis.However,diagnostic uncertainty often leads to negative psychological effects,including anxiety and depression.AIM To investigate the prevalence of anxiety and depressive symptoms and identify associated factors among patients with digestive tract SELs.METHODS This retrospective study included 296 consecutive patients diagnosed with digestive tract SELs at the Affiliated Hospital of North Sichuan Medical College Endoscopy Center between October 2024 and April 2025.Demographic and clinical data were collected through standardized questionnaires.Anxiety and depression were assessed using the Self-Rating Anxiety Scale and the Self-Rating Depression Scale,respectively,while sleep quality was evaluated using the Pittsburgh Sleep Quality Index.Participants were classified into anxiety vs nonanxiety and depression vs non-depression groups based on established cutoff scores,and potential determinants were examined.RESULTS Anxiety symptoms were observed in 35.8%of cases(mean Self-Rating Anxiety Scale score:46.56±9.13)and depressive symptoms in 33.1%(mean Self-Rating Depression scale score:48.64±8.30).Pittsburgh Sleep Quality Index scores were positively correlated with both anxiety and depression(P<0.05).Univariate analysis identified age,annual income,sleep disorders,and endoscopic ultrasonography(EUS)evaluation status as significant factors(P<0.05).Multivariable analysis revealed that low annual income(<10000 Chinese yuan)and sleep disorders were independent risk factors,whereas undergoing EUS examination and having disease awareness were protective factors against anxiety and depression(P<0.05).CONCLUSION Patients with digestive tract SELs are at increased risk for anxiety and depression,with poor sleep strongly linked to worsening psychological symptoms.Early diagnostic assessment with EUS appears to serve a protective role against the onset of these psychological disorders.
文摘Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.
文摘BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.
基金Supported by China Health&Medical Development Foundation,No.M2021551.
文摘BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.
基金supported by the National Key Research and Development Program of China(No.2019YFC0119502)the Key Research and Development Program of Zhejiang Province,China(No.2018C03064)+1 种基金the Fundamental Research Funds for the Central Universities,China(No.2019FZA5016)the Zhejiang Provincial Natural Science Foundation,China(No.LGF20F050006)。
文摘In the practice of clinical endoscopy,the precise estimation of the lesion size is quite significant for diagnosis.In this paper,we propose a three-dimensional(3D)measurement method for binocular endoscopes based on deep learning,which can overcome the poor robustness of the traditional binocular matching algorithm in texture-less areas.A simulated binocular image dataset is created from the target 3D data obtained by a 3D scanner and the binocular camera is simulated by 3D rendering software to train a disparity estimation model for 3D measurement.The experimental results demonstrate that,compared with the traditional binocular matching algorithm,the proposed method improves the accuracy and disparity map generation speed by 48.9%and 90.5%,respectively.This can provide more accurate and reliable lesion size and improve the efficiency of endoscopic diagnosis.
文摘Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.
基金Supported by Science and Technology Department of Sichuan Province,No.2020YFS0376National Natural Science Foundation of China,No.81900599Science and Technology Program of Hospital of TCM,Southwest Medical University,No.2022-CXTD-01.
文摘BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.
文摘Gastric polyps are commonly detected during upper gastrointestinal endoscopy.They are most often benign and rarely become malignant.Nevertheless,adequate knowledge,diagnostic modalities,and management strategies should be the endoscopist’s readily available“weapons”to defeat the potentially malignant“enemies”.This article sheds light on the valuable effort by Costa et al to generate a new classification system of gastric polyps as“good”,“bad”,and“ugly”.This comprehensive overview provides clinicians with a simplified decision-making process.
文摘Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases.During the last few years,the incidence rate of perforations in colonoscopic procedures has increased,especially in therapeutic colonoscopies.The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection,endoscopic full-thickness resection,and endoscopic submucosal dissection(ESD)could be a risk factor for this increased risk.The incidence rate of mortality of serious colonoscopic perforations is 7.1%.The management plan for these perforations starts with conservative treatment in mild cases,endoscopic closure,and surgical management in severe cases.Recently,endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports.This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations.These insights are from the perspectives of endoscopists and gastroenterologists.We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy,the American Gastroenterological Association,and the World Society of Emergency Surgery.We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.
