Objective:To analyze the therapeutic effect of high-frequency electrosurgical knife surgery guided by painless digestive endoscopy(PDE)in elderly patients with gastrointestinal polyps(GP).Methods:A total of 100 elderl...Objective:To analyze the therapeutic effect of high-frequency electrosurgical knife surgery guided by painless digestive endoscopy(PDE)in elderly patients with gastrointestinal polyps(GP).Methods:A total of 100 elderly GP patients admitted between June 2021 and December 2022 were selected.Patients were randomly divided into two groups:the painless group(50 cases)underwent high-frequency electrosurgical knife surgery guided by PDE,while the conventional group(50 cases)underwent the same surgery guided by traditional digestive endoscopy(DE).The total treatment efficacy,perioperative indicators,gastrointestinal hormone levels,oxidative stress(OS)markers,and complication rates were compared between the two groups.Results:The total treatment efficacy in the painless group was higher than that in the conventional group,and perioperative indicators were superior in the painless group(P<0.05).One week after treatment,the gastrointestinal hormone levels and OS-related markers in the painless group were better than those in the conventional group(P<0.05).The complication rate in the painless group was lower than in the conventional group(P<0.05).Conclusion:High-frequency electrosurgical knife surgery guided by PDE improves the effectiveness of polyp removal in elderly GP patients and accelerates postoperative recovery.It also protects gastrointestinal function,reduces postoperative OS,and ensures higher surgical safety.展开更多
As a new type of pollutant,the harm caused by microplastics(MPs)to organisms has been the research focus.Recently,the proportion of MPs ingested through the digestive tract has gradually increased with the popularity ...As a new type of pollutant,the harm caused by microplastics(MPs)to organisms has been the research focus.Recently,the proportion of MPs ingested through the digestive tract has gradually increased with the popularity of fast-food products,such as takeout.The damage to the digestive system has attracted increasing attention.We reviewed the literature regarding toxicity of MPs and observed that they have different effects on multiple organs of the digestive system.The mechanism may be related to the toxic effects of MPs themselves,interactions with various substances in the biological body,and participation in various signaling pathways to induce adverse reactions as a carrier of toxins to increase the time and amount of body absorption.Based on the toxicity mechanism of MPs,we propose specific suggestions to provide a theoretical reference for the government and relevant departments.展开更多
Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly u...Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly utilized,particularly for hepatobiliary and pancreatic diseases.However,only a limited number of gastroenterologists are trained and experienced to perform endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in pediatric patients.While GI endoscopic emergencies in children are uncommon,they can be serious.Effective care demands true multidisciplinary teamwork,with close and ongoing collaboration between gastroenterologists,anesthetists,and the pe-diatric team especially in centres where pediatric endoscopy specialists are not available.This mini-review outlines current practices in pediatric digestive endoscopy and explores recent advances in interventional endoscopy compared to adult patients.展开更多
Background:To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy(CTMCE)system for upper gastrointestinal examination.Methods:Twenty-six participants(19 healthy v...Background:To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy(CTMCE)system for upper gastrointestinal examination.Methods:Twenty-six participants(19 healthy volunteers and seven patients with gastrointestinal symptoms)willing to undergo upper gastrointestinal endoscopy were recruited.Each participant underwent CT-MCE followed by conventional gastroscopy within 24 h.Maneuverability and visibility of the CT-MCE capsule in the upper gastrointestinal tract,adverse events,and discomfort during the procedure were evaluated.The sensitivity and specificity of CT-MCE for diagnosing upper gastrointestinal lesions were evaluated using conventional gastroscopy findings as the standard.Results:Maneuverability was graded as“good”for all segments of the esophagus.The percentage of participants in which maneuverability was good according to gastric region was as follows:cardia(100.00%),pylorus(96.15%),angulus(92.31%),antrum(88.46%),fundus(84.62%),and body(73.08%).In the duodenal bulb and descending duodenum,it was good in only 20.83% and 16.67% of participants,respectively.Visibility was graded as“excellent”or“good”in the esophagus,Z line,and duodenal bulb in all participants;excellent/good visibility was achieved in the stomach and descending duodenum in 96.15% and 79.17% of participants,respectively.Forty-one lesions were detected overall.The sensitivity and specificity of CT-MCE in diagnosing upper gastrointestinal lesions were 85.00% and 98.15%,respectively.The CT-MCE capsule was successfully removed through the mouth in all participants.No serious adverse events or capsule retention occurred.Conclusions:CT-MCE showed good feasibility and safety for upper gastrointestinal examination.The system was effective in examining the esophagus and stomach with no risk of capsule retention.展开更多
Digestive system diseases seriously threaten human physical and mental health,with their incidence remaining persistently high.The NLRP3 inflammasome is a core multiprotein complex of the innate immune system,regulati...Digestive system diseases seriously threaten human physical and mental health,with their incidence remaining persistently high.The NLRP3 inflammasome is a core multiprotein complex of the innate immune system,regulating the maturation and release of pro-inflammatory factors such as IL-1βand IL-18.The NLRP3 inflammasome,as a key innate immune sensor,plays a significant role in the occurrence and development of various digestive system diseases.This paper reviewed the research progress on the NLRP3 inflammasome in digestive system diseases,and explored the relationship between the NLRP3 inflammasome and these diseases,aiming to provide a theoretical basis for the treatment of digestive system diseases.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased morta...BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.展开更多
BACKGROUND Small-bowel disorders,including obscure gastrointestinal bleeding(OGIB),Crohn's disease,and tumors,require accurate diagnostic approaches for effective treatment.Video capsule endoscopy(VCE)and simple b...BACKGROUND Small-bowel disorders,including obscure gastrointestinal bleeding(OGIB),Crohn's disease,and tumors,require accurate diagnostic approaches for effective treatment.Video capsule endoscopy(VCE)and simple balloon enteroscopy(SBE)are widely used;however,each modality has limitations,particularly regarding therapeutic intervention and diagnostic yield.AIM To evaluate diagnostic yields of various modalities for small bowel bleeding,analyze factors affecting heterogeneity,and improve understanding of clinical outcomes associated with different diagnostic approaches.METHODS A comprehensive search of four databases(PubMed,Embase,Cochrane Library,and Scopus)revealed over 600 citations related to the use of capsule endoscopy and balloon enteroscopy for diagnosing small intestine disorders with wall thickening.Based on predetermined eligibility criteria,seven moderateto-high-quality retrospective studies were analyzed to evaluate the diagnostic performance of VCE and SBE in patients with small bowel disorders.Quality Assessment of Diagnostic Accuracy Studies was applied to evaluate the risk of bias and overall methodological quality.RESULTS Analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between VCE and SBE.VCE demonstrated superior performance in detecting vascular lesions.Conversely,SBE exhibited a higher efficacy in detecting ulcerative lesions.The overall diagnostic yield varied across studies,with VCE showing a range of 32%–83%for small bowel bleeding,whereas SBE demonstrated a higher overall detection rate of 69.7%compared to 57.6%for VCE(P<0.05).Notably,SBE showed superior performance in diagnosing Crohn's disease,with a detection rate of 35%,compared to 11.3%for VCE(P<0.001).The diagnostic concordance between VCE and SBE was influenced by the lesion type.Strong agreement was observed for inflammatory lesions(κ=0.82,95%CI:0.75-0.89),whereas moderate agreement was noted for tumors(κ=0.61,95%CI:0.52-0.70)and angiectasias(κ=0.58,95%CI:0.49-0.67).SBE demonstrated significant advantages in therapeutic interventions,particularly in overt bleeding.Patient tolerability was generally higher for VCE,with a completion rate of 95%(95%CI:92%-98%),compared to 85%for SBE(95%CI:80%-90%).However,the capsule retention rate for VCE was 1.4%(95%CI:0.8%-2.0%),necessitating subsequent intervention.CONCLUSION VCE and SBE are complementary techniques for evaluating small intestinal disorders.Although VCE remains the initial test of choice for patients with stable OGIB,SBE should be considered in patients requiring therapeutic intervention.Thus,combining both modalities enhances diagnostic accuracy and patient management.展开更多
BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as exp...BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as expanding treatment indications,which affect the fair distribution of medical resources.There is limited research on ethical issues in the field of digestive endoscopy.AIM To investigate the level of ethical awareness among gastrointestinal endoscopy practitioners and analyze the ethical issues involved in gastrointestinal endoscopy technology.METHODS A questionnaire survey was performed to collect relevant data(gender,age,degree of education,professional title,personnel category,the level of understanding medical ethical principles,ethics training and its learning pathways)from gastrointestinal endoscopy practitioners at the Second Hospital of Dalian Medical University and Dalian Friendship Hospital,including licensed physicians and nurses(including trainees and graduate students).RESULTS The majority of gastrointestinal endoscopy practitioners have received training on ethics,but there is still considerable room for improvement in their ethical awareness.Different learning pathways may affect the mastery of ethical principles, and understanding of ethical principles is more easily achieved through hospital ethics institutions.CONCLUSIONTo address the ethical issues in gastrointestinal endoscopy technology, it is necessary to enhance the humanisticeducation of gastrointestinal endoscopy practitioners, incorporate ethical standards into the technology assessmentprocess, and establish a patient-centered diagnostic and treatment model to improve the ethical awareness of practitionersand achieve a balance between technology and ethics.展开更多
BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector compu...BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.展开更多
This review comprehensively summarized the potential of artificial intelligence(AI)in the management of esophageal cancer.It highlighted the significance of AI-assisted endoscopy in Japan where endoscopy is central to...This review comprehensively summarized the potential of artificial intelligence(AI)in the management of esophageal cancer.It highlighted the significance of AI-assisted endoscopy in Japan where endoscopy is central to both screening and diagnosis.For the clinical adaptation of AI,several challenges remain for its effective translation.The establishment of high-quality clinical databases,such as the National Clinical Database and Japan Endoscopy Database in Japan,which covers almost all cases of esophageal cancer,is essential for validating multimodal AI models.This requires rigorous external validation using diverse datasets,including those from different endoscope manufacturers and image qualities.Furthermore,endoscopists’skills significantly affect diagnostic accuracy,suggesting that AI should serve as a supportive tool rather than a replacement.Addressing these challenges,along with country-specific legal and ethical considerations,will facilitate the successful integration of multimodal AI into the management of esophageal cancer,particularly in endoscopic diagnosis,and contribute to improved patient outcomes.Although this review focused on Japan as a case study,the challenges and solutions described are broadly applicable to other high-incidence regions.展开更多
Coronavirus disease 2019(COVID-19)is caused by infection of the coronavirus severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)with typical respiratory symptoms.SARS-CoV-2 invades not only the respiratory syst...Coronavirus disease 2019(COVID-19)is caused by infection of the coronavirus severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)with typical respiratory symptoms.SARS-CoV-2 invades not only the respiratory system,but also other organs expressing the cell surface receptor angiotensin converting enzyme 2.In particular,the digestive system is a susceptible target of SARS-CoV-2.Gastrointestinal symptoms of COVID-19 include anorexia,nausea,vomiting,diarrhea,abdominal pain,and liver damage.Patients with digestive damage have a greater chance of progressing to severe or critical illness,a poorer prognosis,and a higher risk of death.This paper aims to summarize the digestive system symptoms of COVID-19 and discuss fecal-oral contagion of SARS-CoV-2.It also describes the characteristics of inflammatory bowel disease patients with SARSCoV-2 infection and discusses precautions for preventing SARS-CoV-2 infection during gastrointestinal endoscopy procedures.Improved attention to digestive system abnormalities and gastrointestinal symptoms of COVID-19 patients may aid health care providers in the process of clinical diagnosis,treatment,and epidemic prevention and control.展开更多
Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucos...Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.展开更多
In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions duri...In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy(CE).CE was first presented in 2000 and was approved by the Food and Drug Administration in 2001.The indications of CE overlap with those of regular diagnostic endoscopy.However,in clinical practice,CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional endoscopy.Since the emergence of CE,many physiological and technical challenges have been faced and addressed.In this letter,we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question:Do we still need CE?展开更多
Background Currently,many simulator systems for medical procedures are under development.These systems can provide new solutions for training,planning,and testing medical practices,improve performance,and optimize the...Background Currently,many simulator systems for medical procedures are under development.These systems can provide new solutions for training,planning,and testing medical practices,improve performance,and optimize the time of the exams.However,to achieve the best results,certain premises must be followed and applied to the model under development,such as usability,control,graphics realism,and interactive and dynamic gami-fication.Methods This study presents a system for simulating a medical examination procedure in the nasal cavity for training and research purposes,using a patient′s accurate computed tomography(CT)as a reference.The pathologies that are used as a guide for the development of the system are highlighted.Furthermore,an overview of current studies covering bench medical mannequins,3D printing,animals,hardware,software,and software that use hardware to boost user interaction,is given.Finally,a comparison with similar state-of-the-art studies is made.Results The main result of this work is interactive gamification techniques to propose an experience of simulation of an immersive exam by identifying pathologies present in the nasal cavity such as hypertrophy of turbinates,septal deviation adenoid hypertrophy,nasal polyposis,and tumor.展开更多
BACKGROUND Dental injury is the leading cause of litigation in anaesthesia but an underrecognized preventable complication of endoscopy.AIM To determine frequency and effects of dental injury in endoscopy,we present f...BACKGROUND Dental injury is the leading cause of litigation in anaesthesia but an underrecognized preventable complication of endoscopy.AIM To determine frequency and effects of dental injury in endoscopy,we present findings from an audit of outpatient endoscopy procedures conducted at a tertiary university hospital and a systematic review of literature.METHODS Retrospective review of 11265 outpatient upper endoscopy procedures over the period of 1 June 2019 to 31 May 2021 identified dental related complications in 0.284%of procedures.Review of literature identified a similar rate of 0.33%.RESULTS Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected.Pre-endoscopic history and tooth examination are key for risk stratification and may be conducted succinctly with limited time outlay.Tooth retrieval should be prioritized in the event of dental injury to minimize aspiration and be followed by prompt dental consultation for specific management.CONCLUSION Dental complications occur in approximately 1 in 300 of upper endoscopy cases.These are easily preventable by pre-endoscopy screening.Protocols to mitigate dental injury are also suggested.展开更多
Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire mucosa.This has led,together with new technical advances,to the cr...Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire mucosa.This has led,together with new technical advances,to the creation of two new models(PillCam ESO and PillCam Colon)for the study of esophageal and colonic diseases.These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts,because traditional endoscopy is often unpleasant and uncomfortable for the patient,can be painful,often requires moderate or deep sedation and is not without complications(hemorrhage,perforation,etc.).PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps,and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening,even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy.This article discusses the advantages of capsule endoscopy over conventional endoscopy,its current application possibilities and indications in routine clinical practice.In the various sections of the work,we assess the application of endoscopic capsule in different sections of the digestive tract(esophagus,stomach,and colon)and finally the potential role of panendoscopy with PillCam Colon.展开更多
AIM: To evaluate the hemostatic effect of topical hemocoagulase spray in digestive endoscopy.METHODS: Eighty-nine patients who developed oozing bleeding during endoscopic treatment from September 2014 to October 2014 ...AIM: To evaluate the hemostatic effect of topical hemocoagulase spray in digestive endoscopy.METHODS: Eighty-nine patients who developed oozing bleeding during endoscopic treatment from September 2014 to October 2014 at Center for Digestive Endoscopy, Tianjin Medical University General Hospital were randomly divided into either a study group(n = 39) or a control group(n = 50). The study group was given topical hemocoagulase spray intraoperatively, while the control group was given traditional 8% norepinephrine spray. Hemostatic efficacy was compared between the two groups. Bleeding site, wound cleanliness and perforation were recorded, and the rates of perforation and late bleeding were compared.RESULTS: Successful hemostasis was achieved in 39(100%) patients of the study group and in 47(94.0%) patients of the control group, and there was no significant difference in the rate of successful hemostasis between the two groups. Compared with the control group, after topical hemocoagulase spray in the study group, the surgical field was clearer, the bleeding site was more easily identified, and the wound was cleaner. There was no significant difference in the rate of perforation between the study and control groups(16.7% vs 35.0%, P = 0.477), but the rates oflate bleeding(0% vs 15.8%, P = 0.048) and overall complications(P = 0.032) were significantly lower in the study group.CONCLUSION: Topical hemocoagulase spray has a definite hemostatic effect for oozing bleeding in digestive endoscopy, and this method is convenient, safe, and reliable. It is expected to become a new method for endoscopic hemostasis.展开更多
Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation ...Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.展开更多
AIM:To assess the adoption of Carbon dioxide(CO2)insufflation by endoscopists from various European countries,and its determinants.METHODS:A survey was distributed to 580 endoscopists attending a live course on digest...AIM:To assess the adoption of Carbon dioxide(CO2)insufflation by endoscopists from various European countries,and its determinants.METHODS:A survey was distributed to 580 endoscopists attending a live course on digestive endoscopy.RESULTS:The response rate was 24.5%.Fewer than half the respondents(66/142,46.5%)were aware of the fact that room air can be replaced by CO2 for gut distension during endoscopy,and 4.2%of respondents were actually using CO2 as the insufflation agent.Endoscopists aware of the possibility of CO2 insufflation mentioned technical difficulties in implementing the system and the absence of significant advantages of CO2 in comparison with room air as barriers to adoption in daily practice(84%and 49%of answers,respectively;two answers were permitted for this item).CONCLUSION:Based on this survey,adoption of CO2 insufflation during endoscopy seems to remain relatively exceptional.A majority of endoscopists were not aware of this possibility,while others were not aware of recent technical developments that facilitate CO2 implementation in an endoscopy suite.展开更多
BACKGROUND Propofol is commonly used for sedation during endoscopic procedures.Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of ac...BACKGROUND Propofol is commonly used for sedation during endoscopic procedures.Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved postprocedure recovery times for patients.However,Propofol requires administration by trained healthcare providers,has a narrow therapeutic index,lacks an antidote and increases risks of cardio-pulmonary complications.AIM To compare,through a systematic review of the literature and meta-analysis,sedation with propofol to traditional sedatives with or without propofol during endoscopic procedures.METHODS A literature search was performed using MEDLINE,Scopus,EMBASE,the Cochrane Library,Scopus,LILACS,BVS,Cochrane Central Register of Controlled Trials,and The Cumulative Index to Nursing and Allied Health Literature databases.The last search in the literature was performed on March,2019 with no restriction regarding the idiom or the year of publication.Only randomized clinical trials with full texts published were included.We divided sedation therapies to the following groups:(1)Propofol versus benzodiazepines and/or opiate sedatives;(2)Propofol versus Propofol with benzodiazepine and/or opioids;and(3)Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and opioid.The following outcomes were addressed:Adverse events,patient satisfaction with type of sedation,endoscopists satisfaction with sedation administered,dose of propofol administered and time to recovery post procedure.Meta-analysis was performed using RevMan5 software version 5.39.RESULTS A total of 23 clinical trials were included(n=3854)from the initial search of 6410 articles.For Group I(Propofol vs benzodiazepine and/or opioids):The incidence of bradycardia was not statistically different between both sedation arms(RD:-0.01,95%CI:-0.03–+0.01,I2:22%).In 10 studies,the incidence of hypotension was not statistically difference between sedation arms(RD:0.01,95%CI:-0.02–+0.04,I2:0%).Oxygen desaturation was higher in the propofol group but not statistically different between groups(RD:-0.03,95%CI:-0.06–+0.00,I2:25%).Patients were more satisfied with their sedation in the benzodiazepine+opioid group compared to those with monotherapy propofol sedation(MD:+0.89,95%CI:+0.62–+1.17,I2:39%).The recovery time after the procedure showed high heterogeneity even after outlier withdrawal,there was no statistical difference between both arms(MD:-15.15,95%CI:-31.85–+1.56,I2:99%).For Group II(Propofol vs propofol with benzodiazepine and/or opioids):Bradycardia had a tendency to occur in the Propofol group with benzodiazepine and/or opioidassociated(RD:-0.08,95%CI:-0.13–-0.02,I2:59%).There was no statistical difference in the incidence of bradycardia(RD:-0.00,95%CI:-0.08–+0.08,I2:85%),desaturation(RD:-0.00,95%CI:-0.03–+0.02,I2:44%)or recovery time(MD:-2.04,95%CI:-6.96–+2.88,I2:97%)between sedation arms.The total dose of propofol was higher in the propofol group with benzodiazepine and/or opiates but with high heterogeneity.(MD:70.36,95%CI:+53.11–+87.60,I2:61%).For Group III(Propofol with benzodiazepine and opioid vs benzodiazepine and opioid):Bradycardia and hypotension was not statistically significant between groups(RD:-0.00,95%CI:-0.002–+0.02,I2:3%;RD:0.04,95%CI:-0.05–+0.13,I2:77%).Desaturation was evaluated in two articles and was higher in the propofol+benzodiazepine+opioid group,but with high heterogeneity(RD:0.15,95%CI:0.08–+0.22,I2:95%).CONCLUSION This meta-analysis suggests that the use of propofol alone or in combination with traditional adjunctive sedatives is safe and does not result in an increase in negative outcomes in patients undergoing endoscopic procedures.展开更多
文摘Objective:To analyze the therapeutic effect of high-frequency electrosurgical knife surgery guided by painless digestive endoscopy(PDE)in elderly patients with gastrointestinal polyps(GP).Methods:A total of 100 elderly GP patients admitted between June 2021 and December 2022 were selected.Patients were randomly divided into two groups:the painless group(50 cases)underwent high-frequency electrosurgical knife surgery guided by PDE,while the conventional group(50 cases)underwent the same surgery guided by traditional digestive endoscopy(DE).The total treatment efficacy,perioperative indicators,gastrointestinal hormone levels,oxidative stress(OS)markers,and complication rates were compared between the two groups.Results:The total treatment efficacy in the painless group was higher than that in the conventional group,and perioperative indicators were superior in the painless group(P<0.05).One week after treatment,the gastrointestinal hormone levels and OS-related markers in the painless group were better than those in the conventional group(P<0.05).The complication rate in the painless group was lower than in the conventional group(P<0.05).Conclusion:High-frequency electrosurgical knife surgery guided by PDE improves the effectiveness of polyp removal in elderly GP patients and accelerates postoperative recovery.It also protects gastrointestinal function,reduces postoperative OS,and ensures higher surgical safety.
文摘As a new type of pollutant,the harm caused by microplastics(MPs)to organisms has been the research focus.Recently,the proportion of MPs ingested through the digestive tract has gradually increased with the popularity of fast-food products,such as takeout.The damage to the digestive system has attracted increasing attention.We reviewed the literature regarding toxicity of MPs and observed that they have different effects on multiple organs of the digestive system.The mechanism may be related to the toxic effects of MPs themselves,interactions with various substances in the biological body,and participation in various signaling pathways to induce adverse reactions as a carrier of toxins to increase the time and amount of body absorption.Based on the toxicity mechanism of MPs,we propose specific suggestions to provide a theoretical reference for the government and relevant departments.
文摘Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly utilized,particularly for hepatobiliary and pancreatic diseases.However,only a limited number of gastroenterologists are trained and experienced to perform endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in pediatric patients.While GI endoscopic emergencies in children are uncommon,they can be serious.Effective care demands true multidisciplinary teamwork,with close and ongoing collaboration between gastroenterologists,anesthetists,and the pe-diatric team especially in centres where pediatric endoscopy specialists are not available.This mini-review outlines current practices in pediatric digestive endoscopy and explores recent advances in interventional endoscopy compared to adult patients.
基金supported by the National Key Research and Development Program(2019YFC0120303)and was sponsored by the Beijing Nova Program(20240484678).
文摘Background:To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy(CTMCE)system for upper gastrointestinal examination.Methods:Twenty-six participants(19 healthy volunteers and seven patients with gastrointestinal symptoms)willing to undergo upper gastrointestinal endoscopy were recruited.Each participant underwent CT-MCE followed by conventional gastroscopy within 24 h.Maneuverability and visibility of the CT-MCE capsule in the upper gastrointestinal tract,adverse events,and discomfort during the procedure were evaluated.The sensitivity and specificity of CT-MCE for diagnosing upper gastrointestinal lesions were evaluated using conventional gastroscopy findings as the standard.Results:Maneuverability was graded as“good”for all segments of the esophagus.The percentage of participants in which maneuverability was good according to gastric region was as follows:cardia(100.00%),pylorus(96.15%),angulus(92.31%),antrum(88.46%),fundus(84.62%),and body(73.08%).In the duodenal bulb and descending duodenum,it was good in only 20.83% and 16.67% of participants,respectively.Visibility was graded as“excellent”or“good”in the esophagus,Z line,and duodenal bulb in all participants;excellent/good visibility was achieved in the stomach and descending duodenum in 96.15% and 79.17% of participants,respectively.Forty-one lesions were detected overall.The sensitivity and specificity of CT-MCE in diagnosing upper gastrointestinal lesions were 85.00% and 98.15%,respectively.The CT-MCE capsule was successfully removed through the mouth in all participants.No serious adverse events or capsule retention occurred.Conclusions:CT-MCE showed good feasibility and safety for upper gastrointestinal examination.The system was effective in examining the esophagus and stomach with no risk of capsule retention.
基金Supported by Guangxi Science and Technology Program(AD22035130)Project for Enhancing Young and Middle-aged Teacher s Research Basis Ability in Colleges of Guangxi(2021KY0497).
文摘Digestive system diseases seriously threaten human physical and mental health,with their incidence remaining persistently high.The NLRP3 inflammasome is a core multiprotein complex of the innate immune system,regulating the maturation and release of pro-inflammatory factors such as IL-1βand IL-18.The NLRP3 inflammasome,as a key innate immune sensor,plays a significant role in the occurrence and development of various digestive system diseases.This paper reviewed the research progress on the NLRP3 inflammasome in digestive system diseases,and explored the relationship between the NLRP3 inflammasome and these diseases,aiming to provide a theoretical basis for the treatment of digestive system diseases.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.
文摘BACKGROUND Small-bowel disorders,including obscure gastrointestinal bleeding(OGIB),Crohn's disease,and tumors,require accurate diagnostic approaches for effective treatment.Video capsule endoscopy(VCE)and simple balloon enteroscopy(SBE)are widely used;however,each modality has limitations,particularly regarding therapeutic intervention and diagnostic yield.AIM To evaluate diagnostic yields of various modalities for small bowel bleeding,analyze factors affecting heterogeneity,and improve understanding of clinical outcomes associated with different diagnostic approaches.METHODS A comprehensive search of four databases(PubMed,Embase,Cochrane Library,and Scopus)revealed over 600 citations related to the use of capsule endoscopy and balloon enteroscopy for diagnosing small intestine disorders with wall thickening.Based on predetermined eligibility criteria,seven moderateto-high-quality retrospective studies were analyzed to evaluate the diagnostic performance of VCE and SBE in patients with small bowel disorders.Quality Assessment of Diagnostic Accuracy Studies was applied to evaluate the risk of bias and overall methodological quality.RESULTS Analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between VCE and SBE.VCE demonstrated superior performance in detecting vascular lesions.Conversely,SBE exhibited a higher efficacy in detecting ulcerative lesions.The overall diagnostic yield varied across studies,with VCE showing a range of 32%–83%for small bowel bleeding,whereas SBE demonstrated a higher overall detection rate of 69.7%compared to 57.6%for VCE(P<0.05).Notably,SBE showed superior performance in diagnosing Crohn's disease,with a detection rate of 35%,compared to 11.3%for VCE(P<0.001).The diagnostic concordance between VCE and SBE was influenced by the lesion type.Strong agreement was observed for inflammatory lesions(κ=0.82,95%CI:0.75-0.89),whereas moderate agreement was noted for tumors(κ=0.61,95%CI:0.52-0.70)and angiectasias(κ=0.58,95%CI:0.49-0.67).SBE demonstrated significant advantages in therapeutic interventions,particularly in overt bleeding.Patient tolerability was generally higher for VCE,with a completion rate of 95%(95%CI:92%-98%),compared to 85%for SBE(95%CI:80%-90%).However,the capsule retention rate for VCE was 1.4%(95%CI:0.8%-2.0%),necessitating subsequent intervention.CONCLUSION VCE and SBE are complementary techniques for evaluating small intestinal disorders.Although VCE remains the initial test of choice for patients with stable OGIB,SBE should be considered in patients requiring therapeutic intervention.Thus,combining both modalities enhances diagnostic accuracy and patient management.
文摘BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as expanding treatment indications,which affect the fair distribution of medical resources.There is limited research on ethical issues in the field of digestive endoscopy.AIM To investigate the level of ethical awareness among gastrointestinal endoscopy practitioners and analyze the ethical issues involved in gastrointestinal endoscopy technology.METHODS A questionnaire survey was performed to collect relevant data(gender,age,degree of education,professional title,personnel category,the level of understanding medical ethical principles,ethics training and its learning pathways)from gastrointestinal endoscopy practitioners at the Second Hospital of Dalian Medical University and Dalian Friendship Hospital,including licensed physicians and nurses(including trainees and graduate students).RESULTS The majority of gastrointestinal endoscopy practitioners have received training on ethics,but there is still considerable room for improvement in their ethical awareness.Different learning pathways may affect the mastery of ethical principles, and understanding of ethical principles is more easily achieved through hospital ethics institutions.CONCLUSIONTo address the ethical issues in gastrointestinal endoscopy technology, it is necessary to enhance the humanisticeducation of gastrointestinal endoscopy practitioners, incorporate ethical standards into the technology assessmentprocess, and establish a patient-centered diagnostic and treatment model to improve the ethical awareness of practitionersand achieve a balance between technology and ethics.
文摘BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.
基金Supported by Japan Society for the Promotion of Science,No.24K11935.
文摘This review comprehensively summarized the potential of artificial intelligence(AI)in the management of esophageal cancer.It highlighted the significance of AI-assisted endoscopy in Japan where endoscopy is central to both screening and diagnosis.For the clinical adaptation of AI,several challenges remain for its effective translation.The establishment of high-quality clinical databases,such as the National Clinical Database and Japan Endoscopy Database in Japan,which covers almost all cases of esophageal cancer,is essential for validating multimodal AI models.This requires rigorous external validation using diverse datasets,including those from different endoscope manufacturers and image qualities.Furthermore,endoscopists’skills significantly affect diagnostic accuracy,suggesting that AI should serve as a supportive tool rather than a replacement.Addressing these challenges,along with country-specific legal and ethical considerations,will facilitate the successful integration of multimodal AI into the management of esophageal cancer,particularly in endoscopic diagnosis,and contribute to improved patient outcomes.Although this review focused on Japan as a case study,the challenges and solutions described are broadly applicable to other high-incidence regions.
文摘Coronavirus disease 2019(COVID-19)is caused by infection of the coronavirus severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)with typical respiratory symptoms.SARS-CoV-2 invades not only the respiratory system,but also other organs expressing the cell surface receptor angiotensin converting enzyme 2.In particular,the digestive system is a susceptible target of SARS-CoV-2.Gastrointestinal symptoms of COVID-19 include anorexia,nausea,vomiting,diarrhea,abdominal pain,and liver damage.Patients with digestive damage have a greater chance of progressing to severe or critical illness,a poorer prognosis,and a higher risk of death.This paper aims to summarize the digestive system symptoms of COVID-19 and discuss fecal-oral contagion of SARS-CoV-2.It also describes the characteristics of inflammatory bowel disease patients with SARSCoV-2 infection and discusses precautions for preventing SARS-CoV-2 infection during gastrointestinal endoscopy procedures.Improved attention to digestive system abnormalities and gastrointestinal symptoms of COVID-19 patients may aid health care providers in the process of clinical diagnosis,treatment,and epidemic prevention and control.
文摘Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.
文摘In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy(CE).CE was first presented in 2000 and was approved by the Food and Drug Administration in 2001.The indications of CE overlap with those of regular diagnostic endoscopy.However,in clinical practice,CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional endoscopy.Since the emergence of CE,many physiological and technical challenges have been faced and addressed.In this letter,we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question:Do we still need CE?
文摘Background Currently,many simulator systems for medical procedures are under development.These systems can provide new solutions for training,planning,and testing medical practices,improve performance,and optimize the time of the exams.However,to achieve the best results,certain premises must be followed and applied to the model under development,such as usability,control,graphics realism,and interactive and dynamic gami-fication.Methods This study presents a system for simulating a medical examination procedure in the nasal cavity for training and research purposes,using a patient′s accurate computed tomography(CT)as a reference.The pathologies that are used as a guide for the development of the system are highlighted.Furthermore,an overview of current studies covering bench medical mannequins,3D printing,animals,hardware,software,and software that use hardware to boost user interaction,is given.Finally,a comparison with similar state-of-the-art studies is made.Results The main result of this work is interactive gamification techniques to propose an experience of simulation of an immersive exam by identifying pathologies present in the nasal cavity such as hypertrophy of turbinates,septal deviation adenoid hypertrophy,nasal polyposis,and tumor.
文摘BACKGROUND Dental injury is the leading cause of litigation in anaesthesia but an underrecognized preventable complication of endoscopy.AIM To determine frequency and effects of dental injury in endoscopy,we present findings from an audit of outpatient endoscopy procedures conducted at a tertiary university hospital and a systematic review of literature.METHODS Retrospective review of 11265 outpatient upper endoscopy procedures over the period of 1 June 2019 to 31 May 2021 identified dental related complications in 0.284%of procedures.Review of literature identified a similar rate of 0.33%.RESULTS Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected.Pre-endoscopic history and tooth examination are key for risk stratification and may be conducted succinctly with limited time outlay.Tooth retrieval should be prioritized in the event of dental injury to minimize aspiration and be followed by prompt dental consultation for specific management.CONCLUSION Dental complications occur in approximately 1 in 300 of upper endoscopy cases.These are easily preventable by pre-endoscopy screening.Protocols to mitigate dental injury are also suggested.
文摘Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire mucosa.This has led,together with new technical advances,to the creation of two new models(PillCam ESO and PillCam Colon)for the study of esophageal and colonic diseases.These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts,because traditional endoscopy is often unpleasant and uncomfortable for the patient,can be painful,often requires moderate or deep sedation and is not without complications(hemorrhage,perforation,etc.).PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps,and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening,even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy.This article discusses the advantages of capsule endoscopy over conventional endoscopy,its current application possibilities and indications in routine clinical practice.In the various sections of the work,we assess the application of endoscopic capsule in different sections of the digestive tract(esophagus,stomach,and colon)and finally the potential role of panendoscopy with PillCam Colon.
文摘AIM: To evaluate the hemostatic effect of topical hemocoagulase spray in digestive endoscopy.METHODS: Eighty-nine patients who developed oozing bleeding during endoscopic treatment from September 2014 to October 2014 at Center for Digestive Endoscopy, Tianjin Medical University General Hospital were randomly divided into either a study group(n = 39) or a control group(n = 50). The study group was given topical hemocoagulase spray intraoperatively, while the control group was given traditional 8% norepinephrine spray. Hemostatic efficacy was compared between the two groups. Bleeding site, wound cleanliness and perforation were recorded, and the rates of perforation and late bleeding were compared.RESULTS: Successful hemostasis was achieved in 39(100%) patients of the study group and in 47(94.0%) patients of the control group, and there was no significant difference in the rate of successful hemostasis between the two groups. Compared with the control group, after topical hemocoagulase spray in the study group, the surgical field was clearer, the bleeding site was more easily identified, and the wound was cleaner. There was no significant difference in the rate of perforation between the study and control groups(16.7% vs 35.0%, P = 0.477), but the rates oflate bleeding(0% vs 15.8%, P = 0.048) and overall complications(P = 0.032) were significantly lower in the study group.CONCLUSION: Topical hemocoagulase spray has a definite hemostatic effect for oozing bleeding in digestive endoscopy, and this method is convenient, safe, and reliable. It is expected to become a new method for endoscopic hemostasis.
文摘Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.
文摘AIM:To assess the adoption of Carbon dioxide(CO2)insufflation by endoscopists from various European countries,and its determinants.METHODS:A survey was distributed to 580 endoscopists attending a live course on digestive endoscopy.RESULTS:The response rate was 24.5%.Fewer than half the respondents(66/142,46.5%)were aware of the fact that room air can be replaced by CO2 for gut distension during endoscopy,and 4.2%of respondents were actually using CO2 as the insufflation agent.Endoscopists aware of the possibility of CO2 insufflation mentioned technical difficulties in implementing the system and the absence of significant advantages of CO2 in comparison with room air as barriers to adoption in daily practice(84%and 49%of answers,respectively;two answers were permitted for this item).CONCLUSION:Based on this survey,adoption of CO2 insufflation during endoscopy seems to remain relatively exceptional.A majority of endoscopists were not aware of this possibility,while others were not aware of recent technical developments that facilitate CO2 implementation in an endoscopy suite.
文摘BACKGROUND Propofol is commonly used for sedation during endoscopic procedures.Data suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved postprocedure recovery times for patients.However,Propofol requires administration by trained healthcare providers,has a narrow therapeutic index,lacks an antidote and increases risks of cardio-pulmonary complications.AIM To compare,through a systematic review of the literature and meta-analysis,sedation with propofol to traditional sedatives with or without propofol during endoscopic procedures.METHODS A literature search was performed using MEDLINE,Scopus,EMBASE,the Cochrane Library,Scopus,LILACS,BVS,Cochrane Central Register of Controlled Trials,and The Cumulative Index to Nursing and Allied Health Literature databases.The last search in the literature was performed on March,2019 with no restriction regarding the idiom or the year of publication.Only randomized clinical trials with full texts published were included.We divided sedation therapies to the following groups:(1)Propofol versus benzodiazepines and/or opiate sedatives;(2)Propofol versus Propofol with benzodiazepine and/or opioids;and(3)Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and opioid.The following outcomes were addressed:Adverse events,patient satisfaction with type of sedation,endoscopists satisfaction with sedation administered,dose of propofol administered and time to recovery post procedure.Meta-analysis was performed using RevMan5 software version 5.39.RESULTS A total of 23 clinical trials were included(n=3854)from the initial search of 6410 articles.For Group I(Propofol vs benzodiazepine and/or opioids):The incidence of bradycardia was not statistically different between both sedation arms(RD:-0.01,95%CI:-0.03–+0.01,I2:22%).In 10 studies,the incidence of hypotension was not statistically difference between sedation arms(RD:0.01,95%CI:-0.02–+0.04,I2:0%).Oxygen desaturation was higher in the propofol group but not statistically different between groups(RD:-0.03,95%CI:-0.06–+0.00,I2:25%).Patients were more satisfied with their sedation in the benzodiazepine+opioid group compared to those with monotherapy propofol sedation(MD:+0.89,95%CI:+0.62–+1.17,I2:39%).The recovery time after the procedure showed high heterogeneity even after outlier withdrawal,there was no statistical difference between both arms(MD:-15.15,95%CI:-31.85–+1.56,I2:99%).For Group II(Propofol vs propofol with benzodiazepine and/or opioids):Bradycardia had a tendency to occur in the Propofol group with benzodiazepine and/or opioidassociated(RD:-0.08,95%CI:-0.13–-0.02,I2:59%).There was no statistical difference in the incidence of bradycardia(RD:-0.00,95%CI:-0.08–+0.08,I2:85%),desaturation(RD:-0.00,95%CI:-0.03–+0.02,I2:44%)or recovery time(MD:-2.04,95%CI:-6.96–+2.88,I2:97%)between sedation arms.The total dose of propofol was higher in the propofol group with benzodiazepine and/or opiates but with high heterogeneity.(MD:70.36,95%CI:+53.11–+87.60,I2:61%).For Group III(Propofol with benzodiazepine and opioid vs benzodiazepine and opioid):Bradycardia and hypotension was not statistically significant between groups(RD:-0.00,95%CI:-0.002–+0.02,I2:3%;RD:0.04,95%CI:-0.05–+0.13,I2:77%).Desaturation was evaluated in two articles and was higher in the propofol+benzodiazepine+opioid group,but with high heterogeneity(RD:0.15,95%CI:0.08–+0.22,I2:95%).CONCLUSION This meta-analysis suggests that the use of propofol alone or in combination with traditional adjunctive sedatives is safe and does not result in an increase in negative outcomes in patients undergoing endoscopic procedures.
