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Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.
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The incidence of gastroparesis is increasing,and its treatment mainly includes drug conservative treatment,gastric electrical stimulation,pyloroplasty,botulinum toxin injection,and pyloric stent placement.Gastric peroral endoscopic pyloromyotomy(G-POEM)is a new procedure for the treatment of refractory gastroparesis,which has the advantages of minimally invasive,safe and effective.This article reviewed the progress of research in G-POEM in treatment of refractory gastroparesis.
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Objective To discuss how to preven wrong absorption of pancreatic pseudocyst using guided transmural drainage under endoscopic ultrasonography.Methods Retrospectively analyzed the clinical data of patients with pancreatic pseudocysts underwent operations of Endoscopic ultrasonography guided transmural drainage.Results 16 cases of pancreatic pseudocysts were finished with guided transmural drainage under endoscopic ultrasonography using needling to place bypass grafting with successful rate 100.0% of guided transmural drainage by needling. After needling, 2 cased happened regurgitation which led to wrongly absorbed, rate of occurrence is 12.5%. Generally, pancreatic pseudocysts of 16 cases disappeared completely with cure rate 100.0%. From above, stents were pulled out by endoscope in 3 cases while stents were removed voluntarily in another 13 cases.Conclusion Dorsal elevated position, detailed operation and esophageal annular tubes can effectively prevent wrong absorption of guided transmural drainage under endoscopic ultrasonography of pancreatic pseudocysts.
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Objective To investigate the therapeutic value of duodenoscopy in the treatment of acute obstructive suppurative cholangitis without X-ray guided. Methods Clinical data of acute obstructive suppurative cholangitis were collected continuously in our hospital which can be used to analyze the safety and efficacy of duodenoscopy in treatment without X-ray guided. Results 146 patients were successfully treated with ERCP in bile duct cannulation, the successful rate was 93.6 % (146/156), all the patients' bilirubin decreased, the successful rate of endoscopic treatment was 93.6% (146/156), while minor pancreatitis, hyperamylasemia, cholangitis, duodenal perforation and other complications occurred in 18 patients, the incidence rate was 11.5% (18/156). 13 patients infected with obstructive suppurative cholangtis were successfully treated with duodenoscopy without X-ray guided, and the successful rate in bile duct cannulation was 86.7%(13/15), bilirubin decreased in 12 cases, the successful rate in endoscopic treatment was 80.0%(12/15), 3 patients suffered from complications, the incidence rate was 20.0% (3/15). Conclusions The bile duct cannulation technique without X-ray guided has progressed, it can be applied to cure several patients with biliary obstruction, especially in AOSC patients, and pregnant patients, and patients who are not suitable for the X-ray radiation.