Clinical, endoscopic, and pathological analyses of 14 cases of gastric adenocarcinoma of the fundic gland type / 中华内科杂志

Objective:Gastric adenocarcinoma of the fundic gland type (GA-FG) is rare and often occurs in patients who are not infected with Helicobacter pylori. The current study analyzed and summarized the clinical, endoscopic, and pathological features of GA-FG, in an effort to improve its diagnosis. Methods:Patients who were diagnosed with GA-FG and treated with endoscopic submucosal dissection (ESD) resection at the Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University from January 1st 2020 to October 1st 2022 were included in the study. Their clinical manifestations, endoscopic features, pathological immunohistochemistry, and other characteristics were analyzed.Results:A total of 14 patients with GA-FG were included in the study, 5 males and 9 females, with a mean age of 59 years. Most had no substantial clinical manifestations. Twelve patients were H. pylori-negative, all patients underwent ESD resection, and all patients survived during the follow-up period of 13±9 months. Eleven patients had postoperative endoscopic follow-up records, and no recurrence was detected. Fifteen lesions were detected (2 were present in 1 patient). Twelve were located in the upper 1/3 of the stomach, 10 were ≤ 1 cm in diameter, 12 had a morphology of type 0-Ⅱa, 8 had visible discoloration changes, and 12 had visible vasodilation on the surface. Magnified endoscopy and narrow-band imaging indicated that 12 of the lesions had enlarged marginal crypt epithelium, without any obvious microvascular pattern abnormalities and no obvious borderline. After resection the pathological specimens were all without vascular infiltration, and there was no atrophy of the mucosa at the edge of the lesion. In immunohistochemistry analyses MUC-2 was negative in all cases. MUC5AC was negative in 11 cases, MUC-6 was positive in all cases, and Ki-67 was ≤ 5% in 12 cases. Conclusions:GA-FG is a newly identified type of gastric cancer with low malignancy and a good prognosis. Characteristic discoloration and surface dilated vessels are often evident endoscopically. Enlarged marginal crypt epithelium and no visible boundary lines are often apparent in magnification endoscopy and narrow band imaging.

Application of 8-ring traction-assisted endoscopic submucosal dissection for gastric lesions / 中华消化内镜杂志

To evaluate the effectiveness and safety of 8-ring assisted traction in endoscopic submucosal dissection (ESD), a total of 13 patients with 15 gastric lesions who underwent 8-ring traction-assisted ESD in Nanjing Drum Tower Hospital from July 2021 to January 2022 were included in the retrospective cohort study. All patients successfully completed the operation. The median procedure time was 56 min, and the dissected area per unit time was 0.20±0.02 cm 2/min. The en bloc resection rate, the complete resection rate and the curative resection rate were 93.3% (14/15), 80.0% (12/15) and 80.0% (12/15), respectively. There were no ESD-related complications, such as delayed bleeding or intraperative and postoperative perforation. No deaths occurred. As a novel internal traction technology, 8-ring traction method is simple to operate, providing a good field of vision during ESD to improve the dissection efficiency and reduce complications, which is worthy of further clinical research and promotion.

Influence of automated flexible endoscope channel brushing system on endoscopic cleaning quality / 中华消化内镜杂志

Objective:To evaluate the effect of automated flexible endoscope channel brushing system (AFECBS) on endoscope reprocessing.Methods:A prospective randomized controlled study was conducted. The used endoscopes were divided into automatic group and manual group by random number table method, 200 in each group. In the automatic group, the AFECBS was used to scrub each tube 3 times during endoscope cleaning; and in the manual group, scrubbing and disinfection personnel routinely brushed each pipeline for 3 times. The primary end point was the qualified rate of endoscopic cleaning quality in the two groups, and the secondary end point was the time spent by the scrubbing and disinfection personnel on the two groups.Results:The qualified rate of overall cleaning in the automatic group was 90.0% (180/200), and in the manual group was 81.0% (162/200). The qualified rate of the automatic group was higher than that of the manual group ( χ2=6.534, P=0.011). The qualified rate of gastroscope cleaning in the automatic group was higher than that in the manual group [92.0% (127/138) VS 81.6% (120/147), χ2=6.658, P=0.010]. There was no significant difference in the qualified rate of colonoscope cleaning between the automatic group and the manual group [85.5% (53/62) VS 79.2% (42/53), χ2=0.774, P=0.379]. When the cleaning personnel scoured 5 endoscopes in each of the two groups, the time of the automatic group (5.17±0.42 min) was shorter than that of the manual group (9.60±0.53 min) ( t=92.644, P<0.001). Conclusion:Compared with manual scrubbing, AFECBS can improve the qualified rate of endoscope cleaning and the work efficiency of scrubbing and disinfection personnel, which is worthy of clinical application.

Safety and efficacy of a compound endoscopic dissection knife in animal models / 中华消化内镜杂志

The safety and efficacy of a compound endoscopic dissection knife were evaluated in animal models. The compound endoscopic dissection knife can readily switch between Dual knife mode and IT knife mode. Vitro experiments were done on 30 mucosal lesion models and 30 submucosal lesion models, respectively, of pig stomach tissue. In vivo experiments, mucosal lesion resection were performed on each 10 lesions of gastrointestinal tract in 6 porcine models. The compound endoscopic dissection knife were used in the experimental group, and Dual knife combined with IT knife were used in the control group. Dissection time were recorded. The wounds were biopsied to evaluate muscle damage. The results of vitro experiment showed the dissection time of mucosal and submucosal lesions in the experiment group was significantly shorter than that in the control group (17.93±2.52 min VS 21.07±3.58 min, t=-2.774, P=0.010; 25.73±2.66 min VS 31.80±3.78 min, t=-5.081, P<0.001). The results of vivo experiment showed the dissection time in the experiment group was significantly shorter than that in the control group (21.67±4.10 min VS 25.36±3.83 min, t=-3.602, P=0.001). The muscle damage rate was lower in the experimental group, but the difference was not statistically significant [3.3% (1/30) VS 10.0% (3/30), χ2=1.071, P=0.612]. The compound endoscopic dissection knife is both safe and effective in animal models.

Progress of gastrointestinal endoscopy linked color imaging in colorectal cancer screening / 肿瘤研究与临床

Colonoscopy is an important diagnostic tool for colorectal cancer. Traditional white light endoscopy has a high underdiagnosis rate, and linked color imaging (LCI) as a kind of image-enhanced endoscopy can effectively improve the detection of early colorectal cancer. LCI can improve the detection of adenoma, and it contributes to the detection and evaluation of sessile serrated lesions, ulcerative colitis and Lynch syndrome lesions. In addition, LCI combined with staining and artificial intelligence can predict the histopathologic type and invasion depth of colorectal lesions, and guide the selection of treatment. This paper reviews the characteristics of LCI and progress of its application in colorectal cancer screening.

Application and development of endoscopic techniques in the diagnosis and treatment of liver diseases / 临床肝胆病杂志

Liver disease is one of the most important health problems around the world， and early diagnosis and timely intervention and treatment are the key to preventing liver-related morbidity and mortality rates. The development of endoscopic techniques has provided new diagnostic and intervention methods for liver diseases. This article reviews the application and development of endoscopic techniques in liver diseases from the following aspects： the technical advances and advantages of endoscopic ultrasound-guided liver biopsy； the application and development of endoscopic techniques in the treatment of portal hypertension caused by liver abscess/hepatic cyst and liver diseases， as well as interventional techniques in the treatment of liver tumors； the efficacy and prospects of the endoscopic techniques for weight loss， which are relatively new in China， in the treatment of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Endoscopic techniques may hold promise for wide clinical application and exploration in in liver-related diseases in China， so as to provide more options for patients and doctors.

Endoscopic or Microscopic Tympanoplasty Advantages and Disadvantages: A Theory Domain Systematic Review

Abstract Introduction Tympanoplasty is a reparative surgery that has multiple indications. The aid of a microscope or an endoscope is necessary to carry out the procedure. The classic method utilizes the microscope; however, in the recent decades, the endoscope has been popular. Although many articles try to compare these two techniques, there is still no robust evidence that confirms the superiority of either technique. In the present work, we seek to perform a systematic review contribute with this discussion. Objectives The present systematic review attempted to compare endoscopic and microscopic surgery techniques and to discover whether there would be superiority in the results of any of them, based on data currently available in the literature. Data Synthesis The objectives of the present review were organized according to the PICO planning and strategy adapted for systematic reviews. The inclusion and exclusion criteria were established aiming to select only select primary data. The main medical databases were searched usingan optimized search string with appropriate descriptors. The searched databases were MEDLINE, LILACS, SciELO, and EMBASE. A total of 99 studies were selected and 38 were fully assessed after the inclusion criteria were applied. All included articles were reviewed by all authors and their results were discussed and summarized. Conclusion The endoscopic technique was shown to be a safer technique comparable in effectiveness to the use of microscopy. In addition, it provides possible advantages such as shortening the surgical time and better postoperative pain outcomes.

Clinical efficacy of super-mini-percutaneous nephroscope combined with flexible ureteroscopic lithotripsy in oblique supine lithotomy position in the treatment of 2.0-3.0 cm renal calculi / 现代泌尿外科杂志

【Objective】 To compare the clinical safety and effectiveness of super-mini-percutaneous nephroscope (SMP) combined with flexible ureteroscopic lithotripsy (FURL) in oblique supine lithotomy position and FURL alone in the treatment of 2.0-3.0 cm renal calculi. 【Methods】 Clinical data of 55 patients treated during Jan.2018 and May 2021 were retrospectively analyzed, including 47 cases complicated renal calculi, and 14 cases of lower calyceal calculi with infundibulopelvic angle ≤30°. SMP combined with FURL was performed in 23 cases (combined group), and FURL alone was performed in 32 cases (FURL group). The operation time, hemoglobin reduction, postoperative hospital stay, hospitalization expenses, stone-clearance rate and complications were compared. 【Results】 All operations were successful. Compared with the FRUL group, the combined group had significantly more hemoglobin reduction [(16.30±10.17) g/L vs. (6.94±6.61) g/L], longer postoperative hospital stay [(5.35±1.61) d vs. (3.19±1.26) d], and higher hospitalization expenses [(22 481±2 234) yuan vs. (18 209±2 584) yuan] (P0.05]. One month after surgery, CT results showed that the combined group had higher stone-clearance rate (91.30% vs. 65.63%, P=0.027). There was no difference in the complication rate (21.74% vs. 21.88%, P>0.05). One case (4.35%) in the combined group and 5 cases (15.63%) in the FURL group received retreatment (P>0.05). 【Conclusion】 SMP combined with FURL in oblique supine lithotomy position is safe and effective in the treatment of 2.0-3.0 cm renal calculi, with high stone-clearance rate and low complication rate.

Clinical progress in percutaneous unilateral biportal endoscopic surgery for degenerative lumbar diseases / 中华创伤骨科杂志

Unilateral biportal endoscopic surgery, micro-endoscopic discectomy, micro-endoscopic laminoplasty, and Destandau mobile endoscopic discectomy have been described as four major techniques in the field of endoscopic spine surgeries. Compared with the coaxial endoscopy, the unilateral biportal endoscopic surgery is characterized by separated channels for observation and operation, making operative procedures more flexible, vision field wider, and requirements for surgical instruments less demanding. Although the anatomical basis of its surgical approach is similar to that of micro-endoscopic spine surgery, this technique can significantly reduce the injury to the paravertebral muscle and protect the stability of the surgical segment of the spine, leading to quick and wide applications in the clinical treatment of degenerative lumbar diseases with good clinical efficacy. The present article reviews this surgical technique from the aspects of technological development, anatomical basis, clinical application, complications, and prospects.

Development and primary evaluation of a minimally invasive surgical robot system in endoscopic submucosal dissection: an ex vivo feasibility study / 中华消化内镜杂志

Objective:To develop a novel, flexible, dual-arm, master-slave digestive endoscopic minimally invasive surgical robot system named dual-arm robotic endoscopic assistant for minimally invasive surgery (DREAMS) and to evaluate its feasibility for endoscopic submucosal dissection (ESD) by using ex vivo porcine stomachs.Methods:A novel endoscopic robot (DREAMS) system was developed which was composed of a flexible two-channel endoscope, two flexible robotic manipulators, a master controller, a robotic arm, and a control system. A total of 10 artificial round-like lesions with diameters ranging from 15 to 25 mm were created (5 in gastric antrum and 5 in gastric body) by using fresh peeled stomach of healthy pigs as the model. Submucosal dissection was performed with the assistance of the DREAMS system by two operators. The main outcome was submucosal dissection speed, and the secondary outcomes included muscular injury rate, perforation rate, and grasping efficiency of the robot.Results:All 10 lesions were successfully dissected en bloc by using the DREAMS system. The diameter of the artificial lesions was 22.34±2.39 mm, dissection time was 15.00±8.90 min, submucosal dissection speed was 141.79±79.12 mm 2/min, and the number of tractions required by each ESD was 4.2 times. Muscular injury occurred in 4/10 cases of ESD. No perforation occurred. Conclusion:The initial animal experiment shows the DREAMS system is safe and effective.

Effectiveness of S-curve leakage testing method on flexible endoscope / 中华消化内镜杂志

To investigate the effects of the S-curve leakage testing method on the detection of flexible endoscope and occurrence of medium to high-level faults of flexible endoscope. A convenience sampling method was used to study the information of endoscopic leak detection at the digestive endoscopic centre of the First Affiliated Hospital of Air Force Medical University. From July 2016 to December 2017, 58 endoscopes which received conventional leakage testing were set as the control group (29 116 tests). From January 2018 to June 2019, 56 endoscopes which received S-curve leakage testing were set as the observation group (28 112 tests). The results showed that the detection proportion of angular abnormalities in the observation group was higher than that in the control group [65.6% (59/90) VS 40.4% (36/89), χ2=11.330, P<0.001]. However, the detection proportion of medium to high-grade faults such as damaged charge coupled device (CCD) components and broken insertion section in the observation group was lower than that in the control group [0.04% (10/28 112) VS 0.08% (23/29 116), χ2=4.680, P=0.030]. Moreover, the overall maintenance cost was lower in the observation group than that in the control group (313.7 thousand yuan VS 942.6 thousand yuan). It is indicated that the S-curve leakage testing method can detect low-level endoscopic faults early such as angular abnormalities, and reduce the occurrence of medium to high-level endoscopic faults, which contributes to cost reduction and efficiency increase.

Comparison of magnetically controlled capsule gastroscopy and conventional gastroscopy for gastric and duodenal examination of children / 中华消化内镜杂志

Objective:To investigate the clinical application value and safety of magnetically controlled capsule gastroscopy (MCCG) in gastric and duodenal examination of children in comparison with conventional gastroscopy.Methods:Data of 160 outpatients or inpatients with abdominal pain accompanied by Helicobacter pylori infection aged 8-16 who underwent either MCCG or conventional gastroscopy in Shanghai Children's Hospital from March 2020 to March 2022 were retrospectively analyzed. Children were divided into the MCCG group ( n=80) and the conventional gastroscopy group ( n=80) according to different examination methods. The detection and examination time of lesions in upper gastrointestinal tract, tolerance and safety between the two groups were analyzed. Results:MCCG was successfully performed in 79 children and conventional gastroscopy was successfully performed in 78 children, respectively. The positive detection rates were 1.3% (1/79) and 1.3% (1/78) in the esophagus ( χ2=0.000, P>0.999), 87.3% (69/79) and 91.0% (71/78) in the stomach ( χ2=0.552, P=0.327) , 15.2% (12/79) and 19.2% (15/78) in duodenum ( χ2=0.450, P=0.533) with no significant difference between the two groups. There was no significant difference in the examination time [72.0 (41.0, 109.5) min VS 6.0 (4.3, 7.0) min, U=24, P<0.001] in the MCCG group and the conventional gastroscopy group. No adverse event occurred in either group. Conclusion:There is no significant difference in the detection rate of gastric and duodenal lesions between the MCCG group and the conventional gastroscopy group. MCCG is safe and stable, and can be used as an diagnostic tool for gastric and duodenal diseases in children.

Influencing factors for cardia morphology under magnetically controlled capsule gastroscopy / 中华消化内镜杂志

Objective:To investigate the relationship between the cardia morphology under magnetically controlled capsule gastroscopy and the clinical characteristics of subjects.Methods:A total of 216 subjects with gastrointestinal symptoms or receiving physical examination who underwent magnetically controlled capsule gastroscopy at the Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University from August 2022 to November 2022 were enrolled. All subjects took gastroesophageal reflux disease questionnaire (Gerd-Q) survey. Clinical data of subjects were collected, and images of cardia morphology under magnetically controlled capsule gastroscopy were recorded. The subjects were divided into 4 groups according to differrent cardia morphology based on the degree of relaxation. The clinical characteristics of each group were compared, and the influencing factors for cardia morphology were analyzed.Results:In non-swallowing state, 116 subjects showed good continuous closure of the cardia in plum shape (group A), 33 subjects radial closure of cardia (group B), 46 subjects slightly relaxed linear cardia (group C) and 21 subjects relaxed and continuous opening of cardia in the shape of cave (group D). The ages of subjects in group A, B, C and D were 35.00 (31.00, 42.00) years, 53.00 (37.50, 60.50) years, 61.50 (41.50, 68.25) years and 52.00 (39.00, 70.00) years, respectively, with significant differences ( H=44.348, P<0.001). The Gerd-Q scores of subjects in group A, B, C and D were 1.50 (1.00, 2.00), 3.00 (2.00, 6.50), 8.00 (5.75, 9.00) and 8.00 (7.50, 9.00), respectively, with significant differences ( H=90.788, P<0.001). The body mass index (BMI) of subjects in group A, B, C and D were 22.66 (19.53, 24.70) kg/m 2, 23.44 (21.41, 27.05) kg/m 2, 23.77 (21.19, 26.93) kg/m 2 and 23.73 (19.63,24.79) kg/m 2, respectively, with significant differences ( H=8.114, P=0.044). The degree of cardia relaxation was positively correlated with the age ( rs=0.456, P<0.001), Gerd-Q score ( rs=0.648, P<0.001) and BMI ( rs=0.146, P=0.032) of subjects. Conclusion:The magnetically controlled capsule gastroscopy provides good visualisation of cardia morphology in non-swallowing state. There is a positive correlation between the degree of cardia relaxation under magnetically controlled capsule gastroscopy in non-swallowing state and the subjects' age, Gerd-Q score, and BMI.

Analysis of the effect of intestinal preparation with dimethicone oil combined with polyethylene glycol electrolyte powder in painless gastrointestinal endoscopy / 中国医师进修杂志

Objective:To analyze the intestinal preparation effect of dimethicone oil combined with polyethylene glycol electrolyte powder in painless gastrointestinal endoscopy.Methods:The study included 380 patients undergoing painless gastrointestinal endoscopy in Nanjing Qixia District Hospital from January 2020 to June 2021. They were randomly grouped into observation group and control group, with 190 patients in each group. The control group was given polyethylene glycol electrolyte powder + 0.9% sodium chloride for intestinal preparation before gastrointestinal endoscopy, and the observation group was given polyethylene glycol electrolyte powder + dimethicone silicone oil. The intestinal cleanliness, antifoam effect, colonoscopy index, detection rate of polyps, adenomas and advanced adenomas, and adverse drug reactions were compared between the two groups.Results:The satisfaction rates of intestinal cleaning and defoaming in the observation group were 92.11% (175/190) and 90.53% (172/190) respectively, which were obviously higher than those in the control group: 84.71% (161/190) and 83.16% (158/190) ( P>0.05). The entering time of colonoscopy and the time of colonoscopy inspection in the observation group were obviously shorter than those in the control group: (3.35 ± 1.05) min vs. (6.02 ± 1.68) min, (11.86 ± 1.93) min vs. (15.22 ± 2.10) min. The rinsing amount of 0.9% sodium chloride was obviously reduced: (35.68 ± 7.64) ml vs. (50.34 ± 10.30) ml ( P<0.05). The detection rate of <5 mm polyps in the observation group was obviously higher than that in the control group: 15.79% (30/190) vs. 5.79% (11/190) ( P<0.05). The detection rate of adenomas in the observation group was obviously higher than that in the control group: 24.74% (47/190) vs. 15.79% (30/190) ( P<0.05). The detection rate of advanced adenomas in the observation group was obviously higher than that in the control group: 20.53% (39/190) vs. 9.47% (18/190) ( P<0.05). The total incidences of abdominal distension and adverse reactions in the observation group were obviously lower than those in the control group: 1.05% (2/190) vs. 5.26% (10/190), 9.47% (18/190) vs. 18.42% (35/190) ( P<0.05). Conclusions:The application of polyethylene glycol electrolyte powder combined with dimethicone oil in painless gastrointestinal endoscopy can effectively improve the intestinal cleanliness, the satisfaction of removing bubbles and the detection rate of polyps and adenomas, reduce the incidence of adverse reactions, and have high clinical application value.

Clinical efficacy and safety of non-submucosal injection in endoscopic submucosal excavation for small gastric muscularis propria tumors / 中华消化内镜杂志

Objective:To evaluate the efficacy and safety of non-submucosal injection in endoscopic submucosal excavation (ESE) for small submucosal tumors originating in the muscularis propria of the stomach.Methods:A total of 138 patients diagnosed as having small gastric muscularis propria tumors (≤2 cm) at Digestive Endoscopy Center of Zhejiang Provincial Hospital of Chinese Medical from November 2018 to October 2020 were randomly divided into the observation group with non-submucosal injection of ESE and the control group with submucosal injection of ESE for a randomized controlled trial. The exposure time, tumor removal time, operation cost, hospitalization period, numbers of metal clips and complications of the two groups were analyzed and compared.Results:A total of 138 patients were enrolled, including 76 patients in the observation group and 62 patients in the control group. All lesions were successfully and completely removed. Compared with the control group, the observation group had shorter median tumor exposure time [2.00 min VS 3.30 min, Z=-2.426, P =0.045], shorter median tumor removal time [16.8 min VS 34.4 min, Z=-4.324, P<0.001], less median surgical cost [2 903 yuan VS 3 178 yuan, Z=-5.112, P<0.001], and fewer metal clips used (4.0±0.6 VS 5.1±1.3, t=1.452, P=0.003). The incidence of postoperative abdominal distension of the observation group was lower [9.2% (7/76) VS 22.6% (14/62), χ2=2.512, P=0.049], the incidence of postoperative abdominal pain of this group was lower too [11.8% (9/76) VS 32.3% (20/62), χ2=4.242, P=0.014], but there was no significant difference in the period of hospitalization, incidence of postoperative fever or perforation ( P>0.05). Conclusion:Non-submucosal injection of ESE is safe and effective for submucosal tumors smaller than 2.0 cm originating from the muscularis propria of the stomach , which might be more advantageous than traditional ESE.

Serviços de endoscopia gastrointestinal em Salvador, Bahia: análise à luz da segurança do paciente / Gastrointestinal endoscopy services in Salvador, Bahia: analysis in the light of patient safety / Servicios de endoscopia gastrointestinal en Salvador, Bahia: análisis a la luz de la seguridad del paciente

Objetivo: Analisar a incidência de eventos adversos relacionados aos procedimentos endoscópicos gastrointestinais. Método: Estudo de casos múltiplos em serviços ambulatoriais de endoscopia gastrointestinal Tipo III, na cidade de Salvador, Bahia, analisando: Núcleos de Segurança do Paciente; eventos adversos e descontaminação dos endoscópicos. Resultados: Participaram 28,5% dos serviços ambulatoriais de endoscopia gastrointestinal da cidade estudada. Existem Núcleos de Segurança do Paciente, que atuam segundo Planos de Segurança do Paciente, mas sem profissional com dedicação exclusiva. Apenas um serviço monitora pacientes após a endoscopia, fato que dificulta a identificação dos efeitos adversos após procedimentos nessas organizações. Existem protocolos básicos de segurança do paciente na maioria dos serviços. A incidência total de efeitos adversos é 0,3%; e 0,8% para a endoscopia digestiva alta e colonoscopias. Bacteremias, dor abdominal, sangramento e perfuração intestinal são os danos mais frequentes. Todos os ser-viços possuem boa estrutura organofuncional para a realização dos processos de limpeza e desinfecção dos endoscópios. Conclusão: Os serviços pos-suem Núcleos de Segurança do Paciente, e implementam protocolos de segurança recomendados. Os efeitos adversos identificados estão em consonân-cia com a literatura; entretanto, esses dados podem estar subnotificados, uma vez que esses serviços não dispõem de um sistema ativo de vigilância de eventos adversos após exames endoscópicos.

Objective: To analyze the incidence of adverse events related to gastrointestinal endoscopic procedures. Method: Multiple case study in Type III gastrointestinal endoscopy outpatient services, in the city of Salvador, Bahia, analyzing: Patient Safety Centers (Núcleos de Segurança do Paciente ­ NSP); adverse events and endoscopic decontamination. Results: 28.5% of the gastrointestinal endoscopy outpatient services in the city participated in the study. There are NSPs, which work according to Patient Safety Plans, but without a dedicated professional. Only one service monitors patients after endoscopy, which makes it difficult to identify adverse effects after procedures in these organizations. Basic patient safety protocols exist in most services. The total incidence of adverse effects is 0.3%; and 0.8% for upper digestive endoscopy and colonoscopies. Bacteremia, abdominal pain, bleeding, and intestinal per-foration are the most frequent damages. All services have a good organofunctional structure for cleaning and disinfecting endoscopes. Conclusion: The services have NSPs and implement recommended safety protocols. The adverse effects identified are in line with the literature; however, these data may be underreported, since these services do not have an active surveillance system for adverse events after endoscopic examinations.

Objetivo: Analizar la incidencia de eventos adversos (EA) relacionados con los procedimientos endoscópicos gastrointestinales. Método: Estudio de casos múltiples en servicios ambulatorios de endoscopia digestiva tipo III (SAEG), en Salvador, BA, analizando: Centros de Seguridad del Paciente (CSP); eventos adversos y descontaminación endoscópica. Resultados: Participó el 28,5% de la SAEG. Hay CSP, que funcionan según Planes de Seguridad del Paciente, pero sin un profesional con dedicación exclusiva. Solo un servicio monitorea a los pacientes después de la endoscopia, hecho que dificulta la identificación de EA después de los procedimientos en estas organizaciones. En la mayoría de los servicios existen protocolos básicos de seguridad del paciente. La incidencia total de EA es del 0,3% y del 0,8% para endoscopias digestivas altas y colonoscopias. La bacteriemia, el dolor abdominal, el san-grado y la perforación intestinal son los daños más frecuentes. Todos los servicios cuentan con una buena estructura órgano-funcional para la limpieza y desinfección de endoscopios. Conclusión: Los servicios cuentan con CSP e implementan los protocolos de seguridad recomendados. Los EA identifica-dos están en línea con la literatura, sin embargo, estos datos pueden estar subreportados, ya que estos servicios no cuentan con un sistema de vigilancia activa de eventos adversos después de los exámenes endoscópicos.

The effect of endoscopic retrograde appendicitis therapy in the treatment for children's acute uncomplicated appendicitis / 中华普通外科杂志

Objective:To evaluate endoscopic retrograde appendicitis therapy in treatment of children with acute uncomplicated appendicitis.Methods:Sixty children patients were admitted at the Affiliated Hospital of Zhengzhou University from Oct 2019 to Jun 2021 and were divided into ERAT group ( n=30) and LA group ( n=30). Results:All operations were successfully performed . ERAT children started oral feeding earlier [(6.8±2.0) h vs. (12.3±2.0) h, t=-10.636, P<0.001], postoperative hospital stay was shorter [(3.2±1.3) d vs. (5.0±1.3) d, t=-5.360, P<0.001]. After 14 months follow up, the recurrence rate in the ERAT group was 6%. The complication rate of LA was 10%. Conclusion:ERAT is a safe and effective therapy in treating children with acute uncomplicated appendicitis with low,acceptable recurrence rate.

Research advances in endoscopic interventional treatment of acute cholecystitis / 临床肝胆病杂志

Acute cholecystitis is a common acute abdominal disease, and it can be classified into grade Ⅰ (mild), grade Ⅱ (moderate), and grade Ⅲ (severe) based on severity. Gallbladder drainage is an important treatment method for patients with severe disease conditions and a high surgical risk. Percutaneous transhepatic gallbladder drainage is commonly used in clinical practice and has a clinical success rate of more than 65%. With the development of endoscopic technology, some centers in China and globally have begun to apply endoscopic gallbladder drainage to the management of acute cholecystitis. This article introduces the methods of gallbladder drainage commonly used in clinical practice, such as percutaneous hepatic gallbladder drainage, endoscopic ultrasound-guided gallbladder drainage, endoscopic transpapillary gallbladder drainage, as well as the progress in endoscopic interventional treatment of acute cholecystitis in recent years.

A novel portable endoscopy system for upper gastrointestinal examination: a multicenter clinical study / 中华消化内镜杂志

Objective:To evaluate the performance, efficacy and safety of a novel portable endoscopy system for upper gastrointestinal examination.Methods:A multicentered, open-label, randomized, non-inferiority controlled study was conducted in 3 clinical research centers from June 2019 to June 2020, and a total of 90 outpatients admitted to Department of Gastroenterology were randomly assigned to the trial group ( n=44) undergoing portable endoscopy and the control group ( n=46) undergoing Olympus endoscopy. The examination success rate, image quality, performance, overall operation satisfaction rate, biopsy success rate and adverse events of the two groups were compared. Results:The examination success rates of the trial group and the control group were 97.73% (43/44) and 100.00% (46/46) respectively with a difference of -2.27% (95% CI: -6.68%-2.13%), higher than the set non-inferiority margin of -10%. Rates of good and excellent image quality were 100% in both groups, and the difference of 0 was higher than the set non-inferiority margin of -10%. There was no significant difference in the rate of good and excellent performance of the operating system between the two groups [97.67% (42/43) VS 100.00% (46/46), P=0.483]. There was significant difference in the overall satisfactory rate of the operation between the two groups [86.05% (37/43) VS 100.00% (46/46), P=0.011]. A total of 9 cases underwent endoscopic biopsy, including 5 cases in the trial group and 4 cases in the control group. The biopsy channels in both groups were smooth and the biopsy were successfully completed. There was no significant difference in adverse event rate between the two groups [25.00% (11/44) VS 10.87%(5/46), χ2=3.07, P=0.080]. All adverse events disappeared in 48 hours, and no severe adverse events or device defect events occurred. Conclusion:The novel portable endoscopic system is comparable to Olympus endoscopic system in terms of the operating performance, the image quality and safety. Therefore, this system is safe and effective for upper gastrointestinal examination.

Effects of the optimization and upgrading of auxiliary tools on transaxillary dual-plane breast augmentation / 中华医学美学美容杂志

Objective:To improve the multiple-link operation efficiency, effect and satisfaction of transaxillary dual-plane breast augmentation by optimizing and upgrading the configuration of auxiliary tools.Methods:From January 2019 to May 2021, breast augmentation was performed in 130 female patients (aged 32±8 years) in the Cosmetic and Plastic Center of the First Affiliated Hospital of Harbin Medical University. The study was conducted among 63 patients who were eligible for the criteria of high configuration surgery. 67 patients underwent standard configuration surgery. The average operation time, intraoperative blood loss, drainage volume (24 hours after operation), postoperative visual analog scale (VAS) pain score and satisfaction were statistically analyzed.Results:The data of high configuration method and standard configuration method were compared as follows: average operation time was (78.6±12.2) min / (93.1±12.1) min ( t=15.73, P<0.05); the average intraoperative blood loss was (3.1±1.0) ml / (14.4±3.5) ml ( t=13.83, P<0.05); the drainage volume (24 hours after operation) was (37.2±8.2) ml / (61.4±10.9) ml ( t=20.82, P<0.05); the pain score on the first day after surgery was (6.1±1.7) points / (7.5±1.6) points ( t=8.57, P<0.05). The overall satisfaction rate was 97.1±1.6 / 95.6±2.0 ( t=5.58, P>0.001), at 6 months after operation. No severe complications were found during the follow-up period, such as capsular contracture, hematoma, infection and double bubble deformity. Conclusions:The use of ultrasonic knife with delivery bag is an effective optimization and upgrade of the endoscopic assisted transaxillary dual plane breast augmentation. The advantages of this method are obvious, highly efficient, safe, effective and satisfactory. It is worthy of clinical application and promotion.