To compare the clinical value of preoperative evaluation of gastric cancer beyong the indications of endoscopic with simultaneous treatment using super minimally invasive surgery-Novel combined endoscopic and laparoscopic surgery （NCELS） and sequential endoscopic and laparoscopic treatment， and to optimize the treatment regimen of NCELS.
Method
47 cases of gastric cancer preoperatively evaluated as an indication beyond endoscopic treatment in the First Affiliated Hospital of Army Military Medical University between January 2018 and January 2024 were retrospectively counted，all of which were proposed to be treated with NCELS. There were 24 cases in the simultaneous treatment group and 23 cases in the sequential treatment group， analyzing and comparing the differences in preoperative and postoperative pathological diagnosis and treatment options between simultaneous and sequential treatment.
Results
24 patients in the simultaneous treatment group， of which 21 were diagnosed consistently with preoperative and postoperative beyond endoscopic indications for treatment， 3 were diagnosed postoperatively with endoscopic indications for treatment， and all 24 underwent lymph node dissection. There were 23 patients in the sequential treatment group， among which 7 cases with consistent diagnosis of preoperative and postoperative beyond endoscopic treatment indications supplemented lymph node dissection， and the remaining 16 cases with postoperative pathological diagnosis of endoscopic treatment indications did not undergo lymph node dissection. The factors of gastric cancer lesion size and differentiation degree have a greater influence on preoperative in-depth diagnosis. The operation time， hospitalization cost and complication occurrence in the sequential treatment group were lower than those in the simultaneous treatment group，and there was a significant difference in operation time and hospitalization cost （P ＜0. 01）.
Conclusion
The optimized NCELS endoscopic and sequential treatment is based on the pathology of the postoperative endoscopic resection specimen，which determines whether to supplement the lymph node dissection or not，and avoids surgical laparoscopic intervention in which the indications for preoperative beyond endoscopic treatment are over-judged，making the treatment more precise and minimally invasive.
To compare the therapeutic efficacy of modified endoscopic variceal ligation targetinghigh-risk bleeding sites with conventional ligation methods in patients with cirrhosis-related esophageal varices.
Methods
Prospectively collected 69 patients diagnosed with cirrhosis-related esophageal varices and scheduled for their first EVL from March 2022 to March 2023 at the First Medical Center of Chinese PLA General Hospital were included in the modified lower-middle segment ligation group.Retrospectively collected 271 patients diagnosed with cirrhosis-related esophageal varices and who had undergone their first EVL from February 2018 to February 2022 at the same center were included in the conventional lower segment ligation group. After propensity score matching， the therapeutic effects， adverse events， and other indicators during and after EVL were compared between the two groups. Patients were followed up for 12 months， and the intention-to-treat analysis and Kaplan-Meier method were used to focus on patient survival issues， along with the per-protocol analysis.
Results
After propensity score matching，the baseline data of the two groups were comparable. The number of detached rings during the procedure and the postoperative chest pain VAS scores in the lower-middle segment ligation group were higher than those in the lower segment ligation group， with statistically significant differences （P＜0. 05）. In the intention-totreat （ITT） analysis at the 6-month follow-up， the recurrence-free survival rate of esophageal varices in the lower-middle segment ligation group was greater than that in the lower segment ligation group， with statistically significant differences （P＜0.05）. In the per-protocol （PP） analysis， the esophageal varices recurrence rate at 6 months and the bleeding rate at 12 months in the lower-middle segment ligation group were both lower than those in the lower segment ligation group， with a longer average time to recurrence， and all with statistically significant differences （P ＜0. 05）.
Conclusion
In patients with cirrhosis-related esophageal varices， the modified endoscopic variceal ligation （EVL） targeting high-risk bleeding sites is safe and effective. It extends the time to recurrence and reduces the recurrence rate at 6 months and the bleeding rate at 12 months compared to the conventional ligation method.
Autoimmunegastritis（AIG）isanunderdiagnosed and rare disease. This study aims to summarize the clinical characteristics of patients suspected of AIG through outpatient screening and eventually diagnosed， as well as to stratify patient management to enable personalized follow-up and prevent long-term severe complications that may affect quality of life.
Methods
A retrospective analysis was performed on the clinical data of AIG patients diagnosed via endoscopy at the Endoscopy Center of Tianjin Third Central Hospital between June 2023 and December 2023. Basic information such as gender，reason for consultation， clinical manifestations， and family history were collected， along with laboratory tests including complete blood count， anti-parietal cell antibodies （PCA）， anti-intrinsic factor antibodies（IFA）， thyroid function， gastrin Ⅰ/Ⅱ， G17， folic acid， and vitamin B12 levels. The t-test was used to compare normally distributed quantitative data between two groups， and Fisher's exact test was used for the comparison of categorical data.
Results
A total of 12 patients were diagnosed with AIG through endoscopic screening， with a male-to-female ratio of 1 ∶11 and an average age of 66.08±12.92 years. Three patients（25%） had associated hyperplastic polyps， two patients （16. 7%） had neuroendocrine tumors， and one patient （8. 3%） had early-stage gastric cancer. Seven patients presented with anemia， with an average hemoglobin （Hb） level of （106. 08±30. 85） g/L. The average Hb level in IFA-positive patients was significantly lower than in IFA-negative patients. Thyroid function tests were completed in seven patients，with three cases （42. 9%） showing elevated thyroid-stimulating hormone （TSH）， six cases （85. 7%）positive for thyroid peroxidase antibodies， and five cases （71. 4%） positive for thyroglobulin antibodies.Gastric function tests were completed in nine patients， with abnormal G17 and PGI levels in all cases， and two cases （22.2%） showing abnormal PGII levels.
Conclusion
Among AIG patients diagnosed through combined endoscopy and serology， those in the IFA-positive group are more prone to developing pernicious anemia and associated gastric complications， and therefore require closer attention and follow-up management.
We conducted the clinical comparative studies to clarify the difference in efficacy between elderly patients and non-elderly patients with endoscopic radiofrequency ablation （RFA） for the treatment of gastric low-grade intraepithelial neoplasia （LGIN）， and actively explored the possible causes to provide theoretical basis for further improving the clinical efficacy of RFA.
Methods
A total of 104 patients with gastric LGIN who received RFA at the First Medical Center of the Chinese PLA General Hospital from October 2014 to October 2022 and were followed up for more than 2 year were retrospectively selected， including 51 elderly patients and 53 non-elderly patients.Subsequently， through relevant statistical analysis， the differences in general information， endoscopy-related data，and follow-up results between the two groups were clarified， and the potential causes were explored.
Results
There were significant differences in age，atrophic gastritis and intestinal metaplasia between thetwogroups，but there were no statistically significant differences in gender，course of disease，lesion location，size，surface morphology，helicobacter pylori （Hp） infection，postoperative relapse， recurrence，and progression. Elderly patients are more likely to relapse after RFA， and atrophic gastritis，intestinal metaplasia，Hp infection，and disease duration of more than 1 year may be potential factors leading to relapse.
Conclusion
Elderly patients with gastric LGIN are relatively more likely to relapse after RFA.Effectively control atrophic gastritis and intestinal metaplasia，actively eradicate Hp infection， and receive endoscopic RFA as earlier as possible after the diagnosis of gastric LGIN are expected to further improve the efficacy of RFA.
To investigate the therapeutic value and efficacy of performing ESD guided by EUS for the removal of subepithelial fish bones in esophagus.
Methods
A total of 9 patients diagnosed with esophageal foreign body （fish bone） embedded in the submucosa in our emergency department from January 2017 to March 2024 were retrospectively collected. After relevant conventional gastroscopy and endoscopic ultrasonography examinations， it was confirmed that the foreign bodies were embedded below the esophageal mucosa.
Results
Among the 9 patients with submucosally embedded foreign bodies in the esophagus， there were 3 males and 6 females， with the time of embedding ranging from 2 to 72 hours； CT scans showed that the foreign bodies were lodged in the upper segment of the esophagus in 8 cases， and in the lower segment in 1 case； the main clinical manifestations included a clear sensation of foreign body behind the pharynx and sternum， pharyngeal pain， and retrosternal pain； preoperative endoscopic ultrasonography suggested that the foreign bodies were mainly located in the muscularis mucosae layer in 2 cases， submucosal layer in 5 cases， and muscularis propria layer in 2 cases； all 9 patients successfully underwent ESD guided exploration to locate the embedded fish bones in the mucosa and take out， with a median operation time of 22.33 minutes （range 9-45 minutes）. Intraoperatively， the distance of the foreign bodies （fish bones） from the incisors was 16-22 cm in the upper segment （8/9） and 38 cm in the lower segment （1/9）； regarding the depth of embedding， 2 cases were within the mucosal layer （2/9），5 cases within the submucosal layer （5/9）， and 2 cases within the muscularis propria layer （2/9）， with one case extending to outside the oesophageal cavity （1/9）. Before and during the operation， 2 cases were diagnosed with local small perforations （2/9）， and 2 cases had significant bleeding at the local wound site during the procedure （2/9）； the postoperative hospital stay was 3. 67 days （range 2-7 days）； the follow-up period postoperatively ranged from 41.39 to 86 months （mean 9-86 months） without significant discomfort， and the general condition was good.
Conclusion
ESD guided by EUS for the removal of esophageal subepithelial fish bones in esophagus is safe and effective， offering a new minimally invasive approach for such cases with good clinical application and promotion value.
To explore the influence factors of the acute on alcoholic chronic pancreatitis.
Methods
The clinical data from 15 domestic medical centres and hospitals from January 2010 to January 2024 were collected retrospectively. 183 patients with alcohol chronic pancreatitis who were initially diagnosed at a medical center or hospital were started into two cohorts based on whether they had an acute attack that led to a subsequent visit to the same medical center or hospital.
Results
A total of 53（29%） were collected in the acute attack group and 130 （71%） in the non-acute attack group.Multivariate logistic regression results showed that blood urea nitrogen ＞ 7.2 mmol/L at the first clinic visit，pancreatic duct stenosis， pancreatic pseudocyst，and pancreatic portal hypertension were independent factors affecting the acute on alcoholic chronic pancreatitis （P＜0.05）.
Conclusion
blood urea nitrogen ＞ 7.2 mmol/L at the first clinic visit，pancreatic duct stenosis and pancreatic pseudocyst are independent protective factors for acute on alcoholic chronic pancreatitis，and pancreatic portal hypertension is an independent risk factor.
Colorectal cancer is a highly prevalent malignant tumor globally. Screening by colonoscopy to detect colorectal polyps and removing the polyps can reduce the incidence and mortality of colorectal cancer. The vast majority of colorectal polyps are small polyps with a diameter less than 10 mm.The canceration rate of such polyps is extremely low， and there is a more urgent need for an efficient， safe，and simple endoscopic treatment plan. The cold snare polypectomy does not require electrocoagulation or electrocution， has no damage caused by thermal effects， has almost no perforation， and has an extremely low postoperative bleeding rate， but it has a complete resection rate comparable to that of thermal resection，undoubtedly meeting the above requirements. However， since the cold snare polypectomy is a mechanical cutting， the technique itself also has certain limitations. The recommendations for cold snare polypectomy in the guidelines for colorectal polyp resection have also been continuously updated with the development of technology. This article will review and summarize the latest progress of cold snare polypectomy.
With the development of minimally invasive surgery and the enhancement of people's health awareness， the detection rate of gastrointestinal smooth muscle tumors has increased significantly.Compared with traditional surgical treatment， endoscopic minimally invasive treatment has the characteristics of small trauma and fast recovery which has great advantages in improving the quality of life of patients，reducing the time of diagnosis and treatment of diseases and saving public resources. The domestic and foreign minimally invasive treatment of endoscopic treatment of smooth muscle tumors of the upper gastrointestinal tract is summarized， which provides certain reference significance to operators in choosing the minimally invasive treatment modality. This article summarizes the endoscopic minimally invasive treatment of upper gastrointestinal smooth muscle tumors at home and abroad， which provides certain reference significance for operators to choose minimally invasive treatment.
Due to the increased use of abdominal cross-sectional imaging， the detection rate of pancreaticcysticneoplasm（PCN）is increasing. PCN represent a heterogeneous group of tumors with different biological behaviors and different risks of progression to malignancy. Common PCN include serous cystic neoplasm（SCN）， mucinous cystic neoplasm （MCN） and intraductal papillary mucinous neoplasm， of which SCN and MCN are collectively referred to as pancreatic cystadenoma. SCN and MCN have different risk of progression， which leads to significant differences in their treatment. The diagnosis of pancreatic cystadenoma requires multi-modal diagnostic methods， including radiology， endoscopic ultrasonography and fine needle puncture， small biopsy forceps， cyst fluid analysis， and novel molecular diagnosis. This review will discuss the latest diagnosis and treatment of pancreatic cystadenoma in the light of recent research progress.
Reflux diseases include gastroesophageal reflux disease and laryngopharyngeal reflux disease， which have a high incidence and variable clinical manifestations. Some patients can only show symptoms outside the gastrointestinal tract， which is difficult to diagnose and easy to recur. Reflux diseases have a huge impact on the quality of life of patients and cause heavy social economic burden， so timely diagnosis and early treatment are crucial. Dynamic reflux monitoring is a commonly used test technique for the diagnosis of esophageal-laryngopharyngeal reflux diseases， and has gradually matured in recent years.This article reviews the clinical application of dynamic reflux monitoring technologies in the diagnosis of reflux diseases.
To summarize the perioperative nursing experience of endoscopic submucosal dissection （ESD） for esophageal early cancer and precancerous lesions associated with esophagogastric varices （GOV）.
Methods
Clinical data of patients with esophageal early cancer and precancerous lesions accompanied by GOV undergoing ESD treatment in Department of Gastroenterology， First Medical Center，PLA General Hospital from September 2016 to December 2023 were retrospectively analyzed， and the key points of perioperative nursing were summarized.
Results
All patients were successfully treated with ESD and GOV， and postoperative pathology indicated that all patients achieved curable resection. Among them，2 patients had ESD wound bleeding after operation and were given endoscopic electrocoagulation. During the whole perioperative period， all patients were given comprehensive and meticulous nursing care. All patients recovered well after operation， and no serious complications or death occurred.
Conclusion
ESD is safe and effective in the treatment of esophageal early cancer and precancerous lesions with GOV. Perfect perioperative nursing is helpful to reduce the occurrence of complications and improve the quality of life of patients.
To conduct a realist synthesis of evidence on the training of digestive endoscopy nurses to develop a theory for digestive endoscopy nurse training programs. The aim is to address two questions：Which training methods are useful for training digestive endoscopy nurses？ Under what circumstances do they work and why？
Methods
Determine the theoretical framework through literature review. Systematically search and collate relevant literature on the training of digestive endoscopy nurses at home and abroad. According to the realist synthesis method， summarize and analyze the literature evidence based on the “context-mechanism-outcome” and the selected theoretical framework to fully explain the applicable scenarios， facilitating factors， and hindering factors of digestive endoscopy nurse training.
Results
A total of 20 articles were included， and two major aspects of the “context-mechanism-outcome” explanatory paths related to digestive endoscopy nurse training were analyzed. （1） Under the background of constructing a unified and standardized training system for digestive endoscopy nurses and different baselines of endoscopy nurses， the external performance of nurses promotes the training effect and quality； （2） Under the background of the busy work of digestive endoscopy nurses， leadership attention， the particularity of digestive endoscopy work， department atmosphere， and salary and treatment， the internal performance of nurses promotes or hinders the training effect.
Conclusion
According to the theoretical framework， the training of digestive endoscopy nurses is explained. Taking the two training paths above and below the ice surface as the starting point is beneficial to the training of digestive endoscopy nurses.
