The global prevalence of obesity continues to rise, while traditional therapies face challenges due to limited efficacy, invasiveness, and economic burdens. Endoscopic bariatric and metabolic therapies (EBMTs) have emerged as novel approaches to obesity management, characterized by their minimally invasive nature, reversibility, and targeted therapeutic mechanisms. This review systematically expounds the technical classifications and mechanisms of EBMTs, focusing on the clinical value of gastric and small intestinal intervention techniques. Gastric intervention techniques primarily comprise space-occupying devices and anatomical reconstruction: the former achieves short-term weight reduction through physical volume restriction but exhibits device-dependent efficacy, while the latter sustains long-term outcomes via endoscopic suturing or folding that induces durable morphological changes. Small intestinal intervention techniques improve metabolic regulation via gut-pancreas axis modulation, encompassing digestive diversion-driven alterations in chyme transit patterns and mucosal ablation-activated regeneration of endocrine microenvironments. Future studies should prioritize large-scale longitudinal studies to validate the efficacy and safety of EBMTs, thereby establishing evidence-based support for the precision management of obesity and related metabolic disorders.
Objective To investigate the severe complications recently after endoscopic sphincterotomy (EST) and related risk factors. Methods Two thousands one hundred and twenty patients after EST in People’s Hospital of Leshan city in recent 15 years were collected to be analyzed. The incidence rates of severe complications were observed and related risk factors were analyzed. Results Thirty four cases (1.60%) in 2 120 patients presented severe complications in 72 h after EST: Nine were with hemorrhage, 23 with acute pancreatitis, 1 with duodenum perforation and 1 with septicemia. Acute pancreatitis was the most remarkable severe complication. The duodenal papilla with tumor or inflammation, and oddi dysfunction were the primary risk factors of hemorrhage or acute pancreatitis, respectively. The rate of oddi dysfunction patients with acute pancreatitis reached up to 44.68% (21/47). Conclusions Acute pancreatitis is the most common severe complications recently after EST and sphincter of oddi dysfunction is the most remarkable risk factor.
Esophageal cancer is a serious threat to the health of Chinese people. The key to solve this problem is early diagnosis and early treatment, and the most important method is endoscopic screening. The rapid development of artificial intelligence (AI) technology makes its application and research in the field of digestive endoscopy growing, and it is expected to become the "right-hand man" for endoscopists in the early diagnosis of esophageal cancer. Currently, the application of multimodal and multifunctional AI systems has achieved good performance in the diagnosis of superficial esophageal squamous cell carcinoma and precancerous lesions. This study summarized and reviewed the research progress of AI in the diagnosis of superficial esophageal squamous cell carcinoma and precancerous lesions, and also explored its development direction in the future.
Esophageal diseases include esophageal malignant diseases and benign diseases, with a high incidence in our country. Along with the development of the endoscopic technique, many of them which required medical treatment or surgery in the past can now be cured by endoscopic surgery. This article is an overview of long-term follow-up of endoscopic surgery for the common esophageal disease, such as early squamous cell carcinoma, esophageal stricture, achalasia and submucosal tumor of the esophagus.
Esophageal cancer is an aggressive malignancy with high morbidity and poor prognosis. Symptoms of early esophageal cancer are insidious and difficult to detect, while advanced esophageal obstruction, lesion infiltration and metastasis seriously affect patients’ quality of life. Early detection and treatment can help to increase the survival chance of patients. Recently, artificial intelligence (AI) has shown remarkable success in diagnosis of esophageal cancer, highlighting the great potential of new AI-assisted diagnostic modalities. This paper aims to review recent progress of AI in the diagnosis of esophageal cancer and to prospect its clinical application.
Objective To evaluate the therapeutic effects of endoscopic treatment on biliary tract complications after liver transplantation. Methods The clinical data of 55 patients with biliary tract complications after liver transplantation undergoing endoscopic treatment from January 2006 to June 2009 were analyzed retrospectively. Results Ninety-eight times of endoscopic treatment were performed in 55 patients. There were 11 cases of biliary fistula, 4 cases of bile duct stricture with biliary fistula, 21 cases of bile duct stricture, 12 cases of bile duct stricture with biliary sludge or stones, 3 cases of biliary sludge or stones, 2 cases of angular distortion of the bile duct and papilla duodeni stenosis in 2 cases. Different procedures including biliary tract dilation, endoscopic nasobiliary drainage, endoscopic sphincterotomy, stone extraction technique and biliary stent placement were performed in different biliary tract complications. The endoscopic treatments were successful in 46 cases (83.6%). The procedure related complications were found in 13 times (13.3%). Conclusion Endoscopy may serve as the primary modality for treating biliary tract complications after liver transplantation with safety and effectiveness.
ObjectiveTo evaluate the application of dexmedetomidine for moderate sedation in patients undergoing endoscopic ultrasonography.MethodsPatients who were planned to undergo endoscopic ultrasonography in West China Hospital of Sichuan University from February to June 2019 were randomly divided into dexmedetomidine group (trial group) and propofol group (control group). The basic conditions, success rate of endoscopic ultrasound diagnosis and treatment, sedation-related adverse events, implementation of airway management, postoperative comfort evaluation and endoscopic physician satisfaction score of the two groups were compared.ResultsA total of 120 patients were eventually enrolled, 60 in each group. There was no significant difference in the basic conditions of the two groups (P>0.05). The success rate of endoscopic ultrasound diagnosis and treatment in two groups were 100%. There was no significant difference in the incidence of bucking, apnea and bradycardia between the two groups (P>0.05). The incidence of hypotension (15.0% vs. 31.7%), hypoxemia (6.7% vs.20.0%) in the trial group was lower than those in the control group, the differences were statistically significant (P<0.05). The proportion of patients in the trial group who performed airway management was lower than that in the control group (1.7% vs. 28.3%), and the difference was statistically significant (P<0.05). There was no significant difference in postoperative pain score, the first time to get out of bed and postoperative 15-item quality of recovery questionnaire score between the two groups (P>0.05). The incidence of nausea and vomiting at 6 hours after operation (48.3% vs. 3.3%) and 24 hours after operation (10.0% vs. 0.0%) and the time required for recovery of gastrointestinal function ［(201.4±178.4) vs. (148.5±75.7) min］ in the trial group were higher than those in the control group (P<0.05). The median (the lower and upper quartile) of comfort score of patients and satisfaction score of endoscopic physicians were 8 (6, 10) and 8 (7, 9) in the trial group, respectively, and were 10 (9, 10) and 9 (8, 10) in the control group, with statistically significant differences (P<0.05).ConclusionModerate sedation with dexmedetomidine could provide good sedative and analgesic effects in endoscopic ultrasonography. It has little effect on respiration and blood pressure, but the incidence of postoperative nausea and vomiting were higher than deep sedation with propofol. And patient comfort and endoscopic physician satisfaction also need to be improved.
Objective To evaluate the safety and effect of early therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and interventional treatment for acute biliary pancreatitis. Methods Eighty-seven hospitalized patients with acute biliary pancreatitis were divided into endoscopic therapy group and conservative therapy group according to the treatment methods. ERCP examination and treatment were used in the endoscopic therapy group, medical conservative treatments were used in the conservative therapy group. The efficacy such as blood amylase recovery time, abdominal pain relief time, blood white blood cell recovery time, liver function recovery time, hospital stay, and complications were observed. Results Blood amylase recovery time, abdominal pain relief time, blood white blood cell recovery time, liver function recovery time, and hospital stay in the endoscopic therapy group were significantly shorter than those in the conservative therapy group (Plt;0.05). There were no ERCP related severe complications or aggrevated symptoms. Conclusion Early endoscopic therapy is a safe and effective method for acute biliary pancreatitis and can prevent further progression to severe status.
Objective To describe the development trend of clinical symptoms, pulmonary function and chest imaging examination of COVID-19 discharged from Xinyang from January 2020 to June 2020, and analyze the related risk factors. Methods This study was a prospective, longitudinal and cohort study. The survivors of COVID-19 hospitalized in Xinyang Fifth People's Hospital and Xinyang Central Hospital from January to June, 2020 were prospectively followed up 12 months and 24 months after discharge. Patients who refused to participate in the study and suffered from cancer and chronic respiratory diseases, including asthma or chronic obstructive pulmonary disease, were excluded. During the follow-up period, the patients who meet the research conditions were asked about clinical symptoms, routine and biochemical blood tests, pulmonary function and chest high-resolution CT (HRCT) and 6-minute walking distance test, and were evaluated with the Dyspnea Scale (mMRC). Results It was found that from January to June, 2020, among 207 eligible patients, 169 patients participated in this study, including 126 cases of mild and ordinary type (74.6%) and 43 cases of severe and critical type (25.4%). There were 100 males (59.2%) and 69 females (40.8%), aged 20 - 78 years old (50±15). It was found that more than half of COVID-19 patients had one or more symptoms at the end of 12 months after rehabilitation, including fatigue (90 cases, 53.3%), insomnia (43 cases, 25.4%), anxiety (24 cases, 14.2%), chest tightness (29 cases, 17.2%) and alopecia (35 cases, 20.7%). Two years after discharge, 52 patients (30.8%) still had at least one clinical symptom. The quality of life, cardiopulmonary function and exercise ability of COVID-19 patients in rehabilitation period decreased to varying degrees. Most patients' lung function and CT results returned to normal, but a few patients still had persistent lung function and imaging abnormalities 12 months and 24 months after discharge. Pulmonary function was mainly manifested as diffuse function injury, and the predicted value of carbon monoxide diffusion capacity (DLCO) was less than 80% in 44 cases (26.0%). Pulmonary HRCT mainly showed chronic inflammation in one lung/both lungs (28 cases, 41.2%), multiple nodules in one lung/both lungs (23 cases, 33.8%) and ground glass shadow (10 cases, 14.7%), etc. Multivariate logistic regression analysis showed that female COVID-19 patients with old age were more likely to have anxiety symptoms after discharge, which had nothing to do with the severity of acute disease. Older female patients with severe COVID-19 were more likely to have symptoms of DLCO damage during the recovery period, and their lung function gradually recovered with time. Conclusions Most of COVID-19 patients in Xinyang recovered well during the rehabilitation period, but some patients still had clinical symptoms such as fatigue, insomnia, anxiety, etc. The absorption of lung lesions was slow and some patients were accompanied by impaired pulmonary diffusion function. With the extension of rehabilitation time, the above symptoms have been significantly improved.
Endoscopic resection and surgical resection are the two major therapeutic methods for early esophageal cancer. Endoscopic resection is safe and minimally invasive, but lymph node dissection can not be performed. Although surgery provides a rather thorough resection of the lesions and affected lymph nodes, surgical trauma brings certain negative impact on patients' long-term life quality. A comprehensive assessment of the patient's general condition, the risk of diseased lymph node metastasis, and the risk of the treatment itself is an important measure to optimize treatment decisions and formulate personalized treatment plans.