The mode of organ resection and reconstruction that has been used to treat digestive tumors can cure the disease. However, it involves the surgical resection of critical structures (such as the cardia, pylorus, and anus) and gastrointestinal reconstruction, which alter the physiological anatomy of the digestive system. These changes often lead to numerous postoperative complications and severely affect the patient's quality of life (e.g., refractory gastroesophageal reflux following proximal gastrectomy, dumping syndrome after subtotal gastrectomy, loss of anal function after low rectal surgery). For the defect of this mode, in 2016, professor Linghu Enqiang proposed the new mode that was "curing the disease and restoring normal function", we named this new mode: Super Minimally Invasive Surgery (SMIS)^[1]. To accomplish various types of SMIS, four operative channels were developed: the natural cavity channel, the tunnel channel, the puncture channel, and the multi-cavity channel. SMIS, with its advantages of minimal trauma and organ function preservation, has been recognized by authoritative domestic and international organizations and has developed rapidly. Based on its clinical value and the need for wider application, there is an urgent need to establish standardized guidelines to guide practice. This guideline was developed by leading organizations such as the SMIS Committee of World Endoscopy Organization and Chinese Society of Digestive Endoscopy (CSDE), in collaboration with multidisciplinary experts from gastroenterology, surgery, and pathology. Systematic searches were conducted in nine major databases, including PubMed, Embase, and China National Knowledge Infrastructure (CNKI), for both Chinese and English literature published before 2025.Evidence from randomized controlled trials, observational studies, and case series was included, with the quality of evidence and recommendation strength evaluated using the GRADE system (high-level evidence: randomized controlled trials; low-level evidence: observational studies). The recommendations were refined through multiple rounds of expert discussion and voting and reported according to AGREE II and RIGHT standards. The guideline has been registered on the International Practice Guidelines Platform (PREPARE, registration number PREPARE-2024CN1183). This consensus addresses 15 issues related to SMIS treatment for esophageal cancer, gastric cancer, colorectal cancer, their corresponding precancerous lesions, and precancerous lesions of the duodenal papilla. It provides corresponding recommendations in three main areas: (1) Definitions and principles: SMIS should meet ten core criteria, including organ preservation, complete resection(R0), and sterile procedures. It also standardizes naming conventions (e.g., "Super minimally invasive non-full-thickness resection of lower esophageal squamous carcinoma via the oral cavity" ). (2) Surgical recommendations: Esophageal cancer: For early and precancerous lesions, SMIS of non-full-thickness resection is preferred. For circumferential involvement ≥1/2, SMIS of tunnel approach for non-full-thickness resection is recommended. If the wound circumference is ≥75%, the use of corticosteroids or stents to prevent stenosis is advised. Gastric cancer: For T1a-T1b stage and precancerous lesions, SMIS non-full-thickness or full-thickness resection is preferred, with individualized plans based on the risk of lymph node metastasis (LNM). Colorectal cancer: SMIS of non-full-thickness or full-thickness resection is recommended as the first-line treatment for T1a-T1b stage and precancerous lesions. For locally advanced rectal cancer that achieves clinical remission after neoadjuvant therapy, SMIS of full-thickness resection can be considered to assess pathological remission. Duodenal papilla precancerous lesions: SMIS resection via the oral cavity is preferred. Postoperatively, whether to add pancreaticoduodenectomy and follow-up strategies should be determined based on pathology.(3) Postoperative management: A SMIS treatment cure evaluation system for early gastric cancer was established, divided into SMIS-Cure A (cured), SMIS-Cure B (clinically cured), and SMIS-Cure C (surgical reassessment), which guides follow-up. For colorectal cancer or precancerous lesions, R0 resection is the standard for cure, and follow-up plans are developed according to risk stratification. This guideline systematically integrates the evidence from SMIS in the treatment of gastrointestinal tumors with expert consensus, establishing a standardized pathway centered on organ function preservation. It shifts the treatment model from "cure first" to "cure-function balance". Its application is expected to reduce overtreatment, improve the patient′s quality of life, and provide a framework for future technological iterations and the expansion of indications. It should be continuously optimized with multi-center clinical data and long-term follow-up results to achieve more precise, individualized treatment.

To compare the efficiency and safety between ligation-assisted endoscopic submucosal resection (ESMR-L) without submucosa injection and endoscopic submucosal dissection (ESD) in resecting rectal neuroendocrine neoplasm with a diameter no more than 10 mm.

From January 2023 to April 2025, a prospective randomized controlled study was conducted at the Digestive Disease Hospital of Heilongjiang Provincial Hospital.Patients admitted to our department for endoscopic resection of rectal neuroendocrine tumors (with a diameter ≤10 mm, single lesion) were enrolled.Using a random number table, patients were evenly divided into the ESMR-L group and the ESD group in a 1∶1 ratio.All procedures were performed by senior endoscopists, and the procedure-related outcomes were compared between the two groups.

A total of 81 cases were included in the analysis, including 40 in the ESMR-L group and 41 in the ESD group.Postoperative pathology confirmed that the lesion was limited to the mucosal layer and submucosal layer, without lymphatic vascular invasion, and all were grade G1.The complete resection rate in both groups was 100%.The horizontal margins were negative, but 14 cases in the ESD group and 3 cases in the ESMR-L group had lesions close to the vertical margins (34.15% vs. 7.50%, P=0.004). The ESMR-L group had a shorter operation time than the ESD group (24 minutes vs. 39 minutes, P<0.001) and lower operation cost than the ESD group (3 760 RMB vs. 7 070 RMB, P<0.001). No complications or recurrence of lesions were observed in the two groups during the follow-up period (median 11 months).

For RNET with a diameter ≤10 mm, the efficacy and safety of the two resection methods are comparable, while ESMR-L without submucosa injection can improve the resection efficiency, significantly shorten the operation time and lower the cost.

To compare the efficacy of different ligation methods in the treatment of acute esophageal variceal bleeding.

A retrospective analysis was performed on the clinical data of 168 patients who underwent emergency endoscopic esophageal variceal ligation (EVL) in the Department of Gastroenterology, the Second Hospital of Tianjin Medical University, between January 2019 and December 2024.According to the ligation method, the patients were divided into targeted ligation group (n=116) and dense ligation group (n=52). The number of ligation points, heart rate and systolic blood pressure at 24 hours postoperatively, rebleeding rates within 72 hours and within 2 weeks, and the incidence of complications were compared between the two groups.

The number of ligation points in the targeted ligation group was significantly lower than that in the dense ligation group (2.3±1.3 vs.10.3±1.4, P<0.01). There were no significant differences in heart rate (68±13 vs. 71±11) or systolic blood pressure (126±15 mmHg vs. 131±12 mmHg) between the two groups at 24 hours after ligation (P>0.05). Within 72 hours after ligation, the rebleeding rate in the targeted ligation group was 0 (0/116), which was significantly lower than 5.8% (3/52) in the dense ligation group (P<0.01). There was no significant difference in the rebleeding rate between the two groups from 72 hours to 2 weeks after ligation (0 vs. 4.1%, P>0.05). No complications such as cardiovascular or cerebrovascular diseases or acute kidney injury occurred within 2 weeks postoperatively in both groups.

For acute esophageal variceal bleeding, targeted ligation has unique advantages for reducing the risk of early rebleeding. The whitening of the ligated variceal ball can be a sign of successful hemostasis.

To explore the characteristics of O-glycosylation in the cystic fluid of pancreatic cystic neoplasms (PCNs), providing a direction for further exploring new biomarkers and studying the mechanism of PCNs.

The cystic fluid of serous cystadenoma (SCN), mucinous cystic neoplasm (MCN), and intraductal papillary mucinous neoplasm (IPMN) was detected by liquid chromatography- tandem mass spectrometry (LC-MS/MS). Bioinformatics analysis technology was used to analyze the differential glycoproteins, preliminarily exploring the possible mechanism of PCNs.Meanwhile, combined with clinical data and current research status, the potential biomarkers were explored.

According to the mass spectrometry detection, there were significant differences in protein O-glycosylation between IPMN, SCN, and MCN.A total of 156 up-regulated and 17 down-regulated differential glycopeptides were discovered between IPMN and SCN.Meanwhile, between IPMN and MCN, there were 145 up-regulated glycopeptides and 2 down-regulated.The results of gene ontology (GO) analysis and Kyoto encyclopedia of genes and genomes (KEGG) analysis showed that the differential glycoproteins were mainly located in the extracellular matrix, zymogen granule membrane, Golgi cavity, blood microparticles, etc., which were mainly involved in the maintenance of gastrointestinal epithelium, negative regulation of inflammatory response, acute phase response, intracellular iron homeostasis, and other biological processes.The main related pathways include complement and coagulation cascade, pancreatic secretion, IL-17 signaling pathway, neuroactive ligand-receptor interaction, ECM-receptor interaction, cholesterol metabolism etc.Finally, eight characteristic glycoproteins were selected.

(1) There were differences in the O-glycosylation of protein among IPMN, MCN, and SCN; (2) The mechanism of PCNs may be related to immune response, signal transduction, gastrointestinal epithelial maintenance, and pancreatic secretion, etc.; (3) MUC-5AC, MUC-5B, MUC-2, FN, Elastase-3A, Elastase- 3B, Alpha-2-M and PL-RP2 could be used as potential biomarkers to identify different types of PCNs.

Super-Microscopic Full-Thickness Resection (SMIS-EFTR), an innovative surgical modality for early gastric cancer, is characterized by unique demands in specimen handling and pathological assessment. This study aims to establish standardized protocols for processing gastric cancer specimens following SMIS-EFTR and to define key elements of full-layer pathological diagnosis, with the goal of enhancing the precision of pathological evaluation.

A retrospective analysis was conducted on 8 cases of total gastrectomy conducted at the Department of Gastroenterology, First Medical Center of the PLA General Hospital, between February 2022 and November 2024.The primary objective was to optimize standardized protocols for managing "full-thickness-non-full-thickness" mixed resection margins during specimen processing, while also establishing specific evaluation metrics for the serosal surface.

All 8 surgical specimens demonstrated a well-preserved "inner full-thickness resection+ outer non-full-thickness dissection" mixed resection configuration.The mean longitudinal diameter of the specimens was (4.76±1.30) cm, while the tumors measured a mean longitudinal diameter of (1.46±0.96) cm.The average thickness of the full-thickness regions was (0.24±0.12) cm, and the mean distance from the non-full-thickness resection margin was(1.5±0.8)cm.Malignant involvement was observed in all specimens: 2 cases exhibited tumor invasion limited to the submucosa (SM1), 1 case reached SM3, and all achieved R0 resection (complete microscopic resection).

To address the "mixed resection" characteristic intrinsic to SMIS-EFTR, we developed specialized specimen processing protocols and a dual-layer (mucosal and serosal layers) evaluation system, thereby establishing a critical technical framework for precise pathological diagnosis.

Colonoscopy is the preferred method for screening colorectal cancer. Adequate bowel preparation is essential for ensuring high-quality colonoscopy outcomes.In China, polyethylene glycol electrolyte powder is the most commonly used agent for intestinal cleansing drug. However, patient compliance is often hindered due to the large volume of liquid required and its unpleasant taste.This review summarizes and discusses the current status of polyethylene glycol electrolyte powder in bowel preparation prior to colonoscopy, as well as various improvement strategies.

To explore the application and effectiveness of a comprehensive high-quality nursing model during endoscopic super-minimally invasive surgery (SMIS) for patients with early gastric cancer.

A total of 100 patients with early gastric cancer treated at the First Medical Center of Chinese PLA General Hospital from November 2023 to April 2025 were enrolled as the research cohort.They were divided into two groups based on different nursing approaches: the control group received conventional nursing, while the experimental group received a comprehensive high-quality nursing model, which features standardized nursing procedures, optimized service details, and the provision of continuous, comprehensive, and personalized nursing care for patients.Outcomes compared included the incidence of adverse reaction rates, patient satisfaction with nursing services, and postoperative Self-Rating Anxiety Scale (SAS) scores.

Statistical analysis revealed significant advantages in the experimental group across primary endpoints: (1)The postoperative adverse reaction rates was 14% in the experimental group versus 32% in the control group, with a statistically significant difference (P<0.05); (2)Regarding psychological intervention effects, the Self-Rating Anxiety Scale (SAS) showed the experimental group's average score at 48 hours postoperatively (49.4±7.79) was significantly lower than the control group's (56.6±8.96), with statistical significance (P<0.05); (3)Nursing satisfaction surveys indicated a 98% satisfaction rate in the experimental group compared to 84% in the control group, with a significant difference (P<0.05).

Implementing a comprehensive high-quality nursing model during SMIS for early gastric cancer patients can reduce adverse reaction rates, alleviate anxiety, and improve nursing satisfaction, making it worthy of clinical promotion.