Gastric cancer remains a common gastrointestinal malignancy and a major contributor to the global cancer burden.Conventional radical surgery has long relied on organ resection and lymph node dissection as its central paradigm, providing an important foundation for the treatment of locally advanced gastric cancer.Super minimally invasive surgery (SMIS) moves beyond a simple resection-oriented logic by emphasizing preservation of anatomical integrity, maintenance of inherent physiological function, and precise eradication of the lesion.This concept offers a potential direction for the evolution of gastric cancer intervention.Meanwhile, gastric cancer should not be regarded solely as a local lesion; its occurrence, progression, and therapeutic response are jointly shaped by the immune microenvironment, cellular lineage states, and molecular heterogeneity. From the perspective of the systemic nature of tumors, this article integrates evidence from precision classification and evolving treatment strategies, analyzes differences in the immune microenvironment and systemic immune status across early, locally advanced, and advanced gastric cancer, and discusses the sequential logic of neoadjuvant therapy followed by SMIS-based local precise eradication. The aim is to outline an integrated treatment model combining organ preservation, lesion eradication, immune reconstruction, and systemic regulation, thereby providing a theoretical and practical reference for individualized and function-oriented management of gastric cancer.

To systematically evaluate the awareness, acceptance, and clinical dissemination status of the super minimally invasive surgery (SMIS) concept among senior experts in the digestive field in China, and to provide evidence-based support for its systematic promotion.

A cross-sectional questionnaire survey was conducted from June to July 2025 using purposive sampling among senior experts in the digestive field across 31 provincial-level administrative regions in China.

The awareness rates of the core SMIS concepts (definition, goal, principle) all exceeded 98%, and over 97% of the experts endorsed its value orientation.The implementation of SMIS techniques showed significant gradient differences: the application rate of natural orifice non-full-thickness resection was the highest (87.2%), while that of puncture channel techniques was the lowest (37.3%).Significant differences were observed in theoretical exposure and implementation of complex techniques across hospitals of different levels (P<0.001), whereas awareness of the core concepts remained highly consistent across different departments and professional titles (P>0.05). Inconsistent medical insurance payment policies were identified as the primary barrier to promotion, and 88.6% of the experts called for the establishment of standardized training courses. Notably, 99.7% of the experts expressed willingness to continue advancing SMIS-related clinical work.

The SMIS concept has gained broad awareness and strong acceptance among senior experts in the digestive field. However, its clinical dissemination faces multiple challenges, including technical complexity, medical insurance policies, training systems, and multidisciplinary collaboration.A systematic promotion strategy is urgently needed to facilitate the translation of SMIS from theoretical consensus to widespread clinical practice.

Based on the Scar-ESD (Scar-endoscopic submucosal dissection) classification, this study aims to explore the safety of re-ESD for early esophageal tumors with scars and evaluate the predictive value of this classification for the operative difficulty.

A retrospective analysis was conducted on the data of patients with early esophageal tumors accompanied by scars from previous treatments who underwent re-ESD at the Digestive Endoscopy Center of Jiangsu Provincial Hospital of Chinese Medicine from February 2017 to February 2024.The safety, dissection rate, intraoperative auxiliary methods, muscular layer injury, specimen damage rate, and treatment outcomes were analyzed.

A total of 47 patients were included, with a mean age of 65.51±6.68 years and a male-to-female ratio of 2.6∶1.According to the Scar-ESD classifications, 14 cases (29.79%) were type A0 (without scars), 16 cases (34.04%) were type A1 (with scars), 11 cases (23.40%) were type A2 (with scars), and 6 cases (12.77%) were type A3 (with scars).The median operative time in the A0 group was 17.50 (15.00; 23.75) min, which was significantly shorter than that in the non-A0 group [32.00 (26.00; 45.00)min, P<0.05].The median dissection rate showed no significant difference between the A0 group and the non-A0 group (A1/A2/A3) (P>0.05).Intraoperative traction assistance was used in 14 cases (29.79%) of the non-A0 group (P<0.05), specifically in 5 cases of A1, 5 cases of A2, and 4 cases of A3.Intraoperative muscular layer injury occurred in 22 cases (46.81%), with the highest incidence in types A1 (8 cases) and A2 (8 cases), followed by A3 (5 cases) (P<0.05).Specimen damage occurred in 6 cases (12.77%), with a ratio of 1∶3∶2 in A1/A2/A3 (P=0.05).There were no intraoperative or postoperative perforations or delayed bleeding in all types.The en bloc resection rate was 100% in both the A0 and non-A0 groups.The R0 resection rate and curative resection rate were both 87.23% (41/47).

Re-ESD for early esophageal tumors with scars is safe and effective.Types A2/A3 in the Scar-ESD classification has a higher tendency of specimen damage, types A1/A2 is prone to intraoperative muscular layer injury, and non-A0 types may consider intraoperative traction assistance for dissection.The Scar-ESD classification helps predict the operative difficulty, the need for intraoperative auxiliary methods, and specimen damage risk, which provides high clinical utility.

To investigate the value of endoscopic ultrasound (EUS)-based deep learning, radiomics, and their combined model in differentiating gastric gastrointestinal stromal tumors (GIST) from leiomyomas.

Clinical and imaging data from 895 patients (totaling 4, 802 EUS images) at the First Medical Center of the Chinese PLA General Hospital between January 2010 and April 2025 were retrospectively analyzed.Cases were randomly divided into training and test sets at an 8∶2 ratio based on lesions.Radiomic features and fine-grained deep learning features based on the Transformer architecture were extracted from EUS images to construct single-modality and combined-modality machine learning classification models (support vector machine, extreme gradient boosting, random forest).Model performance and clinical utility were comprehensively evaluated using receiver operating characteristic (ROC) curves, the DeLong test, calibration curves, and decision curve analysis.

In the test set, both the deep learning model and the combined model demonstrated significantly better diagnostic performance than the traditional radiomics model. Among these, the combined model using the support vector machine achieved the best performance, with an area under the curve (AUC), accuracy, sensitivity, and specificity of 0.852, 0.792, 0.831, and 0.707, respectively.

EUS-based deep learning features serve as the primary driver for differentiating gastric GIST from leiomyomas, with diagnostic performance significantly superior to that of traditional radiomic features.

To investigate the awareness of gastric cancer endoscopic screening among medical staff and residents in Lhasa, Xizang, and to evaluate methods for improving compliance with early gastric cancer screening.

A single-center cross-sectional study was conducted using questionnaires administered to medical staff in Lhasa and patients and their families visiting Lhasa People′s Hospital.

A total of 145 valid questionnaires were collected from medical staff, primarily from gastroenterology (28.3%), other internal medicine departments (33.1%), and general practice (13.1%).The careful reading rate of gastric cancer screening consensus guidelines among gastroenterology staff was below 10%.Gastroenterology staff demonstrated significantly higher awareness than non-gastroenterology staff in distinguishing early from advanced gastric cancer (92.3% vs. 65.6%) and recommending screening for individuals over 45 years (100% vs. 90.3%, P<0.05). A total of 125 valid questionnaires were collected from residents, with Tibetans accounting for 96.8%.Awareness of family gastric cancer history was low (19.2% unaware); 64.0% were unaware of high-incidence cancers in Xizang, with only 17.6% recognizing gastric cancer as high-incidence; 71.2% were unaware of the relationship between Helicobacter pylori and gastric cancer; only 27.2% believed that gastroscopy has a significant role in preventing gastric cancer; 45.6% believed gastric cancer always presents with symptoms; 74.4% were willing to undergo screening.Residents with family history relied more on professional channels (57.1%) and interpersonal networks (42.9%), and showed significantly higher rates of H. pylori testing (57.1% vs. 34.0%) and gastroscopy (57.1% vs. 21.3%) compared to those without family history, with particularly higher acceptance of painless gastroscopy (42.9% vs. 12.8%).

Medical staff in Lhasa demonstrate positive attitudes toward gastric cancer endoscopic screening, but gastroenterology professionals have insufficient mastery of screening guidelines, and non-gastroenterology staff have insufficient understanding of early gastric cancer concepts.Residents have low awareness of gastric cancer risk factors and early cancer screening, but family history significantly improves their screening behavior.Guidelines training for medical staff should be strengthened, with particular emphasis on education for non-gastroenterology professionals, and health education should be conducted in combination with Tibetan cultural characteristics to promote the implementation of gastric cancer screening.

To investigate the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with catheter-directed thrombus aspiration in the treatment of symptomatic portal vein thrombosis (PVT).

A retrospective analysis was performed on the clinical data of 13 patients with symptomatic portal vein thrombosis who underwent TIPS combined with catheter-directed thrombus aspiration at Huai′an First Hospital Affiliated to Nanjing Medical University from March 2020 to December 2023.The surgical success rate, postoperative changes in portal vein pressure, resolution of portal vein thrombosis, improvement of esophagogastric varices and ascites were observed.

TIPS combined with catheter-directed thrombus aspiration was successfully performed in all 13 patients (100%).The postoperative portal vein pressure decreased significantly compared with the preoperative level [(17.51±4.94) mmHg vs. (24.60±5.81) mmHg], with a statistically significant difference (P<0.05). During a mean postoperative follow-up period of 16 months, the complete recanalization rate of thrombosis was 76.9% (10/13), the remission rate of esophagogastric varices was 69.2% (9/13), and the improvement rate of ascites was 71.4% (5/7).The incidence of postoperative hepatic encephalopathy was 23.1%(3/13).No severe complications such as abdominal hemorrhage or acute liver failure occurred in any of the patients.

TIPS combined with catheter-directed thrombus aspiration yields a high success rate and favorable clinical efficacy in the treatment of patients with symptomatic portal vein thrombosis, which is worthy of clinical promotion.

By removing the rotating dial of the endoscope, we developed a flexible microrobotic arm system with master-slave mapping control, and preliminarily evaluated its feasibility using a bionic upper gastrointestinal tract model.

A flexible microrobotic arm system with master-slave mapping control, in which drive steel cables are guided to a rear-mounted drive module, was constructed.Six operators with no prior experience in endoscopy or flexible robotic arm manipulation were recruited.Using a gastroscopy training model fabricated with hydrogel and bionic composite materials, the system was employed to perform upper gastrointestinal examinations. The operational performance of the system was compared with that of conventional endoscopy in lesion sampling and snaring tasks.Statistical analyses were performed using SPSS 27.

The system successfully completed all simulated diagnostic and therapeutic procedures. The learning curve of procedural exploration time showed a declining trend among operators.Paired t-tests revealed no statistically significant differences in the mean time taken for 10 attempts of sampling flat lesions in the gastric antrum between the robotic system (15.19±4.23 s) and conventional endoscopy (15.84±5.19)s, P>0.05.Similarly, no significant differences were observed in the mean time for sampling flat lesions in the gastric body (18.39±3.84)s vs.(19.31±4.05)s, P>0.05 and pedunculated lesions in the gastric body (22.13±2.96)s vs.(22.98±2.00) s, P>0.05.between the two modalities.However, the mean time for 10 attempts of snaring pedunculated gastric lesions was significantly shorter with the robotic system than with conventional endoscopy (33.71±9.84)s vs.(39.62±6.37)s, P<0.05.

The flexible microrobotic arm system with master-slave mapping control demonstrates preliminary feasibility in simulated endoscopic procedures.This study lays a foundation for subsequent in vivo experiments and clinical translation, and provides a novel approach for the intelligent development of digestive endoscopy.

With the development of artificial intelligence (AI), its applications in medicine have expanded significantly.In particular, AI-assisted colonoscopy is becoming more and more common and has received widespread attention.Colorectal cancer (CRC) incidence and mortality continue to rise annually; however, given the prolonged developmental cycle of CRC, there is a critical opportunity for early intervention.Colonoscopy with polyp detection and removal remains a cornerstone of CRC prevention.Nonetheless, missed colorectal lesions during colonoscopy remain a persistent concern.Since the majority of interval colorectal cancers arise from polyps overlooked at the index colonoscopy, effectively reducing the miss rate will directly curtail the incidence and progression of interval CRC.AI-assisted colonoscopy demonstrates substantial advantages in identifying missed polyps, not only by directly decreasing polyp miss rates during procedures but also by enhancing bowel preparation quality and aiding in the training of novice endoscopists.

To construct a systematic nursing protocol for bowel preparation with polyethylene glycol electrolyte powder combined with simethicone in colonoscopy, and to explore its application efficacy.

A total of 92 inpatients who underwent colonoscopy in our hospital from March 2023 to May 2025 were selected and divided into the control group and the study group by the random number table method, with 46 cases in each group.Considering that polyethylene glycol electrolyte powder is commonly used alone without routine defoaming agents and standardized nursing in clinical practice, the control group received the traditional regimen (polyethylene glycol electrolyte powder combined with routine nursing without simethicone); the study group adopted simethicone in accordance with guideline recommendations combined with systematic nursing.The bowel cleansing quality, intra- intestinal defoaming effect, incidence of adverse reactions and nursing satisfaction were compared between the two groups.

In the study group, the effective rate of bowel cleansing and the excellent and good rate of defoaming effect were both 91.30%, which were significantly higher than 65.22% and 60.87% in the control group.The incidence of adverse reactions in the study group was 4.35%, significantly lower than 30.43% in the control group; the nursing satisfaction rate was 97.83%, higher than 86.96% in the control group, with statistically significant differences between groups (P<0.05).

The newly constructed systematic nursing protocol combined with polyethylene glycol electrolyte powder and simethicone can significantly improve bowel cleansing quality and defoaming effect, reduce adverse reactions such as abdominal pain, abdominal distension and nausea, and increase nursing satisfaction.The combination of medication and refined nursing presents a remarkable synergistic effect, which is worthy of clinical promotion.

To explore the perioperative nursing for patients with acute appendicitis undergoing transanal super minimally invasive surgery (SMIS).

The clinical data of 12 patients who received transanal SMIS in the Department of Gastroenterology, the First Medical Center of Chinese PLA General Hospital from April 28, 2020 to May 22, 2025 were retrospectively analyzed.The experience of preoperative nursing, intraoperative cooperation and postoperative nursing was summarized, and patients′ nursing satisfaction was evaluated.

All 12 patients successfully completed SMIS.The immediate relief rate of postoperative abdominal pain was 100%, with an average hospital stay of 3.2 days.No postoperative complications such as bleeding or perforation occurred. All patients showed good perioperative compliance and high nursing satisfaction.During the 1-month postoperative follow-up, appendiceal function was well preserved in all patients, and no recurrence was observed.

Targeted nursing based on the characteristics of super minimally invasive surgery and the pathophysiological features of patients with acute appendicitis plays a vital role in ensuring the smooth implementation of SMIS and improving therapeutic outcomes.