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endoscopy-assisted purely total outer wall excision for pediatric Sylvian arachnoid cysts

Chinese Neurosurgical Journal 2023年第4期9卷 326-332页

作者： Mingxing Wu Fei Di Mingle Ma Jiye Li Yanbin Li Bingke Zhang Department of Neurosurgery The Affiliated Children’s HospitalCapital Institute of PediatricsBeijingChina

Background To present a novel endoscopy-assisted surgical strategy of Sylvian arachnoid cysts(ACs).Case presentation endoscopy-assisted surgery was performed on 9 children(May 2019-December 2021).All patients were evaluated with CT and/or MRI and had regular follow-up examinations.The procedure consisted of performing a small temporal craniotomy(2 cm)behind the hairline.After dural opening,the surgery was performed with the assistance of a rigid 30-degree transcranial endoscope,self-irrigating bipolar forceps,and other standard endoscopic instruments.Steps included total excision of the AC outer wall and dissection of arachnoid adhesion around the cystic edge to communicate the residual cyst cavity with subdural space.Compared with the microscopical procedure,a 30-degree transcranial endoscope provides a wider view,especially for the lateral part exposure of the outer wall.The average age of the patients was 27.7 months(range 13-44 months).The Sylvian AC was in the right hemisphere in three patients and six in the left,respectively.1 patient suffered transient postoperative epilepsy.There was no mortality or additional postoperative neurological deficit in this series.All of the patients achieved significant clinical improvement after surgery.Radiological examination after the operation showed a significant reduction in all cases(100%,9/9)and disappearance in one case(11.1%,1/9).Postoperative subdural fluid collection occurred in six cases and completely resolved spontaneously in 9 months.Conclusion The study demonstrated the minimally invasive,safety,and effectivity of the endoscopy-assisted purely total outer wall excision.

关键词： Arachnoid cysts endoscopy Treatment

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Third-space endoscopy:the final frontier

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Gastroenterology Report 2023年第1期11卷 14-23页

作者： Maham Hayat Dennis Yang Peter V.Draganov Center for Interventional endoscopy AdventHealthOrlandoFLUSA Division of Gastroenterology Hepatologyand NutritionUniversity of FloridaGainesvilleFLUSA

Over the years,our growing experience with endoscopic submucosal dissection along with technological advances has so-lidiﬁed our comfort and knowledge on working in the submucosa,also referred to as the“third space.”Per-oral endoscopic myotomy(POEM)was theﬁrst prototype third-space endoscopy(TSE)procedure,demonstrating the feasibility and clinical utility of endoscopic esophagogastric myotomy via submucosal tunneling.The launch of POEM accelerated the evolution of TSE from a vanguard concept to an expandingﬁeld with a wide range of clinical applications.In this review,we discuss the status and future directions of multiple TSE interventions.

关键词： endoscopy final frontier therapeutic endoscopy third-space endoscopy submucosal endoscopy

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Influence of anesthesia on gastrointestinal endoscopy:A large-scale survey of 50 public hospitals in China

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Chinese Medical Journal 2023年第12期136卷 1509-1511页

作者： Haijun Hou Ming Tian Fukun Liu Fushan Xue Shutian Zhang Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Department of Gastroenterology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

To the Editor:In recent years,anesthesia for gastrointestinal endoscopy(GIE)has been widely used for early gastrointestinal cancer screening.Approximately 82%of gastroscopies are performed under sedation/anesthesia in Germany,and 98%of colonoscopies are performed under sedation/anesthesia in the United States.[1,2]Increasingly,more studies are proving the beneficial effects of anesthesia on GIE.Nevertheless,patients and even endoscopists still have concerns about performing GIE under anesthesia.We performed a multicenter prospective observational cohort study to identify the effect of anesthesia on compliance,satisfaction,and safety in Chinese patients undergoing GIE.

关键词： anesthesia gastrointestinal endoscopy

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endoscopy in inflammatory bowel disease: Role in diagnosis, management, and treatment

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World Journal of Gastroenterology 2018年第35期24卷 4014-4020页

作者： Clayton M Spiceland Nilesh Lodhia Division of Gastroenterology and Hepatology Medical University of South Carolina Division of Gastroenterology and Hepatology University of North Carolina

endoscopy plays a fundamental role in the diagnosis, management, and treatment of inflammatory bowel dis-ease(IBD). Colonoscopy, flexible sigmoidoscopy, and esophagogastroduodenoscopy have long been used in the care of patients with IBD. As endoscopic technologies have progressed, tools such as endoscopic ultrasound, capsule endoscopy, and balloon-assisted enteroscopy have expanded the role of endoscopy in IBD. Furthermore, chromoendoscopy has enhanced our ability to detect dys-plasia in IBD. In this review article, we will focus on the roles, indications, and limitations of these tools in IBD. We will also discuss the most commonly used endoscopic scoring systems, as well as special considerations in post-surgical patients. Lastly, we will discuss the role of endoscopy in the diagnosis and management of fistulae and strictures.

关键词： endoscopy Inflammatory bowel disease Crohn’s disease Ulcerative colitis Colonoscopy Capsule endoscopy Dysplasia detection Stricture dilation Fistula management

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Artificial intelligence in gastrointestinal endoscopy:general overview

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Chinese Medical Journal 2020年第3期133卷 326-334页

作者： Ahmad El Hajjar Jean-Frangois Rey Department of Gastroenterology and Digestive endoscopy Arnault Tzanck InstituteSaint-Laurent du Var 06700France

Artificial intelligence(AI)is now a trendy subject in clinical medicine and especially in gastrointestinal(GI)endoscopy.AI has the potential to improve the quality of GI endoscopy at all levels.It will compensate for humans’errors and limited capabilities by bringing more accuracy,consistency,and higher speed,making endoscopic procedures more efficient and of higher quality.AI showed great results in diagnostic and therapeutic endoscopy in all parts of the GI tract.More studies are still needed before the introduction of this new technology in our daily practice and clinical guidelines.Furthermore,ethical clearance and new legislations might be needed.In conclusion,the introduction of AI will be a big breakthrough in the field of GI endoscopy in the upcoming years.It has the potential to bring major improvements to GI endoscopy at all levels.

关键词： Artificial intelligence Computer-assisted diagnosis Deep learning Gastrointestinal endoscopy

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Novel endoscopic findings as visualized by non-magnification endoscopy with linked color imaging are indicative of gastric intestinal metaplasia

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Chinese Medical Journal 2019年第7期132卷 782-788页

作者： Min Min Teng-Hui Dong Yan Liu Yi-Liang Bi Cui-Yun Ma Department of Gastroenterology and Hepatology Affiliated Hospital of Academy of Military Medical SciencesBeijing 100071China

Background:Gastric intestinal metaplasia(GIM)is generally considered to be the main mucosal background for the develop gastric adenocarcinomas.Using linked color imaging(LCI),we noticed that the color pattern in areas of GIM was purple mixed with white on the epithelium with signs of mist that were detected by the non-magnifying LCI observation.We have termed this endoscopic finding wPurple in Mist"(PIM).The aim of this study was to investigate whether PIM could be a useful optical sign for predicting GIM.Methods:We prospectively evaluated consecutive patients undergoing endoscopy for various indications.The endoscopist used the LCI system to carefully observe the gastric antrum,body and angulus.When a PIM was identified in the surface layer,targeted biopsies were subsequently taken from this part.If the suspected area had no PIM on the surface,targeted biopsies were also taken.Results:Sixty-three consecutive patients were included in this study.The prevalence of intestinal metaplasia(IM)was 29/63(46%).In PIM-positive patients,the prevalence of IM was 23/26(89%).Of these patients,146 biopsy specimens were included in this study.For the diagnosis of IM,compared to histological assessment,the LCI finding had an accuracy of 91.1%(95%CI:86.5%-95.7%),a sensitivity of 89.8%(95%CI:81.3%-98.3%),a specificity of 91.8%(95%CI:86.3%-97.2%),a positive predictive value of 84.6%(95%CI:74.8%-94.4%),and a negative predictive value of 94.7%(95%CI:90.1%-99.2%).Conclusions:A positive PIM finding in a suspicious lesion on LCI would complement LCI diagnosis of possible IM because of the positive predictive value of PIM.PIM could be a novel endoscopic marker for IM.

关键词： Gastric intestinal metaplasia Linked color imaging Non-magnification endoscopy

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Prevention program for the COVID-19 in a children’s digestive endoscopy center

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World Journal of Clinical Cases 2020年第8期8卷 1343-1349页

作者： Xiao-Peng Ma Huan Wang Da-Ming Bai Yu Zou Shao-Ming Zhou Fei-Qiu Wen Dong-Ling Dai Digestive endoscopy Center Department of GastroenterologyShenzhen Children's HospitalShenzhen 518036Guangdong ProvinceChina Pediatric Committee of Shenzhen Medical Association Shenzhen 518036Guangdong ProvinceChina Shenzhen Pediatric Medical Quality Control Center Shenzhen 518036Guangdong ProvinceChina

The pneumonia caused by the coronavirus disease-2019(COVID-19)outbreak in Wuhan,China constitutes a public health emergency of international concern.The gastrointestinal symptoms of vomiting,diarrhea and abdominal pain and the detection of COVID-19 nucleic acid from fecal specimens in a small number of patients suggest the possibility of transmission via the gastrointestinal tract.People of all ages are vulnerable to this virus,including children.Digestive endoscopy is an invasive procedure during which children cannot wear masks;therefore,they have higher risks of exposure to COVID-19,and the digestive endoscopy center is a relatively high-risk area for COVID-19 infection.Based on these factors and in combination with related policies and regulations,a prevention and control program for the COVID-19 pneumonia in a children's digestive endoscopy center was established to prevent the COVID-19 nosocomial infection.

关键词： Digestive endoscopy Disinfection COVID-19 Nosocomial infection Pediatrics Prevention

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基于网络的上消化道内镜SAFE-T工具:实时评估胃肠专科医生内镜培训效果

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Gastroenterology Report 2020年第6期8卷 431-436,I0001,I0002页

作者： Navin L.Kumar Guillaume Kugener Kelly E.Hathorn Molly L.Perencevich Kunal Jajoo John R.Saltzman Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalBostonMAUSA Harvard Medical School BostonMAUSA Massachusetts Institute of Technology CambridgeMAUSA

背景:导师评估是胃肠专科医生内镜培训的一个关键部分。本研究旨在建立和验证一个简明的、基于网络的上消化道内镜培训效果实时评估工具。方法:我们建立了针对上消化道内镜的专科医生内镜培训技能评估(SAFE-T)工具,在一个5部分的问卷中... 详细信息

背景:导师评估是胃肠专科医生内镜培训的一个关键部分。本研究旨在建立和验证一个简明的、基于网络的上消化道内镜培训效果实时评估工具。方法:我们建立了针对上消化道内镜的专科医生内镜培训技能评估(SAFE-T)工具,在一个5部分的问卷中获取总结性和格式化的反馈。该工具与既往已获验证的结肠镜SAFE-T相似,是基于网络开展应用的。我们应用该工具对2018-2019学年的15名胃肠专科医生(培训期1、2、3年各5名)。为确保评估的可靠性,由一名独立评审人对不同的上消化道内镜操作技术进行评估,完成SAFE-T和内镜能力评估(ACE)两份量表。结果:20名高年资医生在研究期间对15名专科医生进行了413次SAFE-T评估。不同培训学年的专科医生平均SAFE-T评分存在显著差异,第一学年医生的评分低于第二学年(3.31 vs 4.25,P<0.001),第二学年低于第三学年(4.25 vs 4.56,P<0.001)。随着内镜操作难度的增加,平均SAFE-T评分下降,简单操作的评分高于中等操作(3.98 vs 3.39,P<0.001),中等操作高于困难操作(3.39 vs 2.84,P=0.042)。导师与独立评审人同时观察评估一项内镜操作,其SAFE-T评分一致性良好(Kappa=0.815,P=0.001)。SAFE-T评分与ACE评分高度相关(r=0.76,P=0.011)。结论:我们建立并验证了SAFE-T这种简明的、基于网络的工具,用以实时评估胃肠专科医生上消化道内镜培训效果的有效性。

关键词： endoscopy education assessment tool fellowship trainee

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Development of Bariatric and Metabolic endoscopy

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Chinese Medical Journal 2018年第1期131卷 88-94页

作者： Shi-Han Li Yong-Jun Wang Shu-Tian Zhang Department of Gastroenterology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

Objective： With the evolution of society and changes in human lifestyle, obesity is becoming increasingly prevalent worldwide, and obesity-related comorbidities such as diabetes, hyperlipidemia, hypertension, and coronary heart disease are more common. As a result, new devices and methods for bariatric and metabolic endoscopy are being developed for clinical use, offering new options for patients. This review discussed the progress in bariatric and metabolic endoscopy. Data Sources： This review was based on data in articles published in the PubMed database up to September 2017, with the following keywords：＂obesity＂, ~＇endoscopy＂, ＂weight loss＂, and ＂metabolism＂. Study Selection： Original articles about various endoscopic methods of weight loss and other reviews ofbariatric and metabolic endoscopy were included and analyzed. Results： The technology of bariatric and metabolic endoscopy has advanced rapidly in recent years. The intragastric balloon （IGB）, with its comparatively long period of development, is the most mature and widely used instrument. Multiple new endoscopic devices have been created in recent years, with different targets to achieve weight loss. Despite the proliferation of new devices, the lack of clinical data results in a shortage of clinical experience and instruction in the use of this new equipment. Conclusions： Bariatric and metabolic endoscopy would help obese people lose weight or prepare lbr bariatric surgery and hopefully alleviate some of the complications of bariatric procedures. Adequate studies and data are still needed for the new endoscopic devices.

关键词： endoscopy Metabolism Obesity Weight Loss

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Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!

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World Journal of Gastroenterology 2020年第9期26卷 984-991页

作者： Mitchell S Cappell Division of Gastroenterology & Hepatology William Beaumont Hospital Oakland University William Beaumont School of Medicine

BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy.Yet gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday.CASE SUMMARIES Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy.Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall.endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager.She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical evaluation.Both endoscopists complied.In-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger.Endoscopists rapidly recovered with medical therapy.CONCLUSION This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.Recommended management(followed in both cases):1

关键词： endoscopy Iatrogenic injury Medical ethics Hippocratic Oath Quality improvement Medical malpractice Morbidity and mortality

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