Background and Objectives: Despite surgical intervention for remission, recurrence is nearly inevitable in patients with Crohn's disease (CD). While several maintenance therapies are available, the optimal strategy for preventing postoperative recurrence remains uncertain. Materials and Methods: This systematic review and network meta-analysis included placebo-controlled or head-to-head randomized controlled trials (RCTs) from MEDLINE, Embase, and Cochrane Central up to 4 July 2024. Studies assessed maintenance therapies for CD after curative resection. Data were extracted from intention-to-treat (ITT) and per-protocol (PP) analyses separately. The primary outcomes were endoscopic and clinical relapse. A Bayesian network meta-analysis provided risk ratios (RRs) and 95% confidence intervals (CIs). This study is registered with PROSPERO (CRD42024629013). Results: From 1492 screened records, 45 randomized controlled trials met the inclusion criteria. Compared with placebo, clinically significant prevention of clinical recurrence was achieved with adalimumab (RR = 0.17; GRADE High), nitroimidazoles (RR = 0.35; High), infliximab (RR = 0.59; Moderate), thiopurine analogs (RR = 0.41; Moderate), and high-dose mesalamine (RR = 0.74; High), while azathioprine-metronidazole combination therapy demonstrated superior efficacy to azathioprine monotherapy. For endoscopic recurrence mitigation, therapeutic efficacy was confirmed for adalimumab (RR = 0.24; Low), infliximab (RR = 0.32; Moderate), vedolizumab (RR = 0.36; Low), and thiopurine analogs (RR = 0.64; Moderate). Conclusions: This network meta-analysis establishes pharmacological hierarchies for preventing postoperative Crohn's disease recurrence. Adalimumab is the most effective monotherapy for clinical recurrence prevention, while combination therapies of adalimumab/azathioprine plus nitroimidazole show superior efficacy. For endoscopic recurrence prevention, adalimumab also ranks as the most effective intervention. These findings guide therapy selection but require validation for newer agents through randomized trials.

INTRODUCTION:X842 is a new type of gastric acid-suppressing agent with a rapid onset of action and a long duration of effect. We aim to investigate the efficacy and safety of different doses of X842 vs lansoprazole in the treatment of patients with erosive esophagitis (EE). METHODS:This phase 2 study included 90 patients with EE (Los Angeles grades A-D) who were randomized (1:1:1) to receive oral low-dose X842 (50 mg/d, n = 31), high-dose X842 (100 mg/d, n = 31), or lansoprazole (30 mg/d, n = 30) for 4 weeks. The main efficacy end point was the EE healing rate, which was the proportion of patients who achieved endoscopic healing after 4 weeks of treatment. RESULTS:For intention-to-treat analysis, the EE healing rates at 4 weeks were 93.6% (29/31), 79.3% (23/29), and 80.0% (24/30) for the X842 50 mg, the X842 100 mg, and the lansoprazole 30 mg groups. For per-protocol analysis, the EE healing rates at 4 weeks were 93.6% (29/31), 80.8% (21/26), and 82.1% (23/28) in the 3 groups, respectively. The EE healing rate did not significantly differ among the 3 groups in either the intention-to-treat ( P = 0.2351) or per-protocol ( P = 0.3320) analysis. The incidence of drug-related treatment-emergent adverse events did not differ among groups. No severe drug-related treatment-emergent adverse events occurred in the X842 group. DISCUSSION:Our findings confirmed that X842 had efficacy and a favorable safety profile similar to those of lansoprazole. Therefore, X842, a novel potassium-competitive acid blocker, is expected to become a promising therapeutic agent for EE.

Plecanatide is a novel guanylate cyclase-C agonist for the treatment of functional constipation (FC). Its efficacy may vary across different racial populations. This study aimed to comprehensively evaluate the efficacy, safety, and pharmacokinetics of plecanatide in Chinese patients with FC. This phase III, randomized, double-blind, placebo-controlled trial was conducted across 40 hospitals in China. A total of 648 patients with FC were randomly assigned in a ratio of 1:1 to receive either plecanatide 3 mg or placebo for 12 weeks, followed by a 2-week follow-up. The primary efficacy endpoint was the durable overall complete spontaneous bowel movement (CSBM) response rate. Data on adverse events were collected. A post hoc logistic regression analysis was performed to identify predictors of durable overall CSBM response. After 12 weeks of continuous treatment, the durable overall CSBM response rates were 23.5

OBJECTIVE:The objective of this study is to compare the efficacy and safety of lubiprostone (Lub) with osmotic laxatives in the treatment of chronic idiopathic constipation (CIC). METHODS:A comprehensive literature search was conducted using PubMed, EMBASE, and the Cochrane Library in May 2024. Studies that met the inclusion criteria were manually searched by two independent reviewers. The efficacy was assessed by the proportion of patients with spontaneous bowel movements (SBMs) within 24 h after the first administration of the medication and SBMs in Weeks 1 and 4. Safety was evaluated based on adverse events including nausea, diarrhea, and abdominal distension. Optimal probability values and the surface under the cumulative ranking area (SUCRA) were also calculated for all interventions. Higher SUCRA values indicate better efficacy and safety of the intervention. RESULTS:Following a thorough search and screening process, 25 articles were included. Among the selected trials, 8 compared Lub to placebo, 10 compared polyethylene glycol (PEG) to placebo, 4 compared lactulose (Lac) to placebo, and 3 compared PEG to Lac. The meta-analysis results indicated that Lub and osmotic laxatives were significantly more effective than placebo. According to the SUCRA results, the highest rank probabilities were for Lub in increasing the SBMs and reducing abdominal distension. CONCLUSION:Lubiprostone is more effective than PEG and Lactulose for treating CIC, with comparable safety profiles. However, this conclusion requires further validation through large-scale, high-quality studies.

ObjectiveTegoprazan represents a newly developed potassium-competitive acid blocker utilized for the treatment of acid-related disorders. The present study aimed to explore the therapeutic effectiveness of tegoprazan in Chinese individuals with duodenal ulcers (DU).MethodsIn the current multicenter, randomized, double-blind, double-dummy, parallel-group, non-inferiority, phase III clinical trial, individuals with DU underwent randomization 1:1 to be administered tegoprazan 50 mg or lansoprazole 30 mg once daily. The primary efficacy endpoint was the 6-week cumulative endoscopic ulcer healing rate. Secondary endpoints included 4-week endoscopic ulcer healing rate and relief of DU-related gastrointestinal symptoms at weeks 2, 4, and 6. Safety analysis encompassed adverse events (AEs) and laboratory indexes.ResultsThe 6-week cumulative endoscopic ulcer healing rates were 96.9% (188/194) and 99.0% (189/191) in the tegoprazan and lansoprazole groups, respectively, indicating a difference of -2.0% (95% confidence interval (CI) = -4.9 to 0.8) in the full analysis set (FAS). The corresponding healing rates were 98.4% (185/188) and 99.5% (183/184) in the per-protocol set, respectively, indicating a difference of -1.1% (95% CI = -3.1 to 1.0). The 4-week healing rates in the tegoprazan and lansoprazole groups were 89.2% (173/194) and 88.5% (169/191) in the FAS, respectively, with a difference of 0.7% (95% CI = -5.6 to 7.0). Treatment-related AEs, all mild-to-moderate, were reported in 38.2% (78/204) and 48.2% (94/195) of participants in the tegoprazan and lansoprazole groups, respectively.ConclusionsTegoprazan 50 mg once daily is effective and non-inferior to lansoprazole 30 mg once daily in Chinese patients with DU, showing a promising safety and tolerability profile.ClinicalTrials.gov registration numberNCT05010954.

The coexistence of adenocarcinoma and neuroendocrine neoplasm (NEN) in the same tumor is rare. What is rarer is that the neuroendocrine component is a well-differentiated neuroendocrine tumor (NET) Grade (G) 1. Most colorectal NETs are single, but multiple neuroendocrine tumors (M-NETs) are rare. Well-differentiated NETs rarely metastasize. Here, we present a unique case of a synchronous sigmoid tumor and multiple colorectal NETs with lymph node metastases. The sigmoid tumor consisted of adenocarcinoma and NET G1. The metastatic component was NET G1. A 64-year-old man underwent a colonoscopy for persistent changes in bowel habits and positive fecal occult blood for 1 year. An ulcerative lesion, which was diagnosed as colon cancer, was seen in the sigmoid colon. In addition, scattered lesions could be seen in the colon and rectum. Surgical resection was performed. Pathological findings suggested that the ulcerative lesion was composed of 80% adenocarcinoma and 20% neuroendocrine component (NET G1), while the remaining lesions were consistent with NET G1. At the same time, 11 lymph nodes around the resected intestinal segment were invaded by NET G1. The prognosis of the patient was good. After 13 months of follow-up, no recurrence and no metastasis were found. We hope to provide a reference and improve our understanding of the clinicopathological features and biological behavior of these unique tumors. We also aim to emphasize the importance of radical surgery and individualized treatment.

Objective To analyze the risk factors associated with recurrence of achalasia(AC)treated with peroral endoscopic myotomy(POEM).Methods The data of 81 patients diagnosed with AC and underwent POEM at Beijing Friendship Hospital from 2014 to 2019 were collected retrospectively,and multivariate Logistic regression analysis was conducted to analyze the risk factors of recurrence after POEM.Results Postoperative recurrence occurred in 6 patients,recurrence rate was 7.41%and the medium recurrence duration was 3 years.Gender(P =0.04)and smoking(P=0.02)were related to the recurrence of AC after POEM.There was no significant difference between the groups in age,disease duration,drinking,integrated relaxation pressure(IRP),esophageal diameter and muscularis propria layer thickness.Further COX regression analysis showed that the smoking was an independent risk factor for recurrence of AC after POEM(HR=10.84,P =0.04).Conclusion Smoking was an independent risk factor for recurrence of AC after POEM.

This pilot study aimed to evaluate the efficacy and safety of domperidone for the treatment of Chinese patients with functional dyspepsia (FD) who were diagnosed according to the Rome IV criteria and to identify the FD subtypes that potentially responded better to domperidone. This multicenter prospective study was conducted in China from August 2018 to July 2020, consisting of a 1-week screening phase and a 2-week double-blind treatment phase. Participants were randomized to receive domperidone 10 mg or matching placebo tablets thrice daily for 14 days. The primary end-point was the overall treatment effect (OTE) response rate after 2-week therapy. Altogether 160 patients were included, with 80 patients in each group. The OTE response rate after 2-week therapy was significantly higher for domperidone compared with placebo (60.7% vs 46.0%; relative risk [RR] 1.318, 95% confidence interval [CI] 0.972–1.787). Moreover, the OTE response rate after 2-week domperidone or placebo treatment was 60.3% versus 54.9% for postprandial distress syndrome (PDS) (RR 1.098, 95% CI 0.750–1.607) and 60.6% versus 35.2% for overlapping PDS–epigastric pain syndrome (EPS) (RR 1.722, 95% CI 0.995–2.980). Adverse events were reported by seven patients in the domperidone group and 12 patients in the placebo group. None of the adverse events in the domperidone group were serious. Domperidone showed a positive pattern regarding OTE response rates after 2-week therapy compared to placebo in patients with FD, as well as in subtypes of PDS and overlapping PDS–EPS. No new safety issue was observed.

探索经口内镜下肌切开术(peroral endoscopic myotomy，POEM)治疗贲门失弛缓症（achalasia,AC)术后复发的危险因素。方法 回顾性分析2014年至2019年因AC就诊于首都医科大学附属北京友谊医院并成功行POEM治疗的81例患者的临床资料，应用多因素COX回归分析POEM术后AC复发的危险因素。结果 6例（7.41%)患者POEM术后出现AC复发，中位复发时间为3年。与未复发组相比，性别（P =0.04)及吸烟史（P =0.02)差异有统计学意义。而发病年龄、病程、饮酒史、综合松弛压（integrated relaxation pressure，IRP)、术前食管宽度及食管贲门固有肌层厚度在两组中差异均无统计学意义。进一步多因素COX回归分析显示，吸烟史是POEM术后AC复发的独立危险因素（HR =10.84，P=0.04)。结论 吸烟史是POEM术后AC复发的独立危险因素。

ObjectiveThis pilot study aimed to evaluate the efficacy and safety of domperidone for the treatment of Chinese patients with functional dyspepsia (FD) who were diagnosed according to the Rome IV criteria and to identify the FD subtypes that potentially responded better to domperidone.MethodsThis multicenter prospective study was conducted in China from August 2018 to July 2020, consisting of a 1-week screening phase and a 2-week double-blind treatment phase. Participants were randomized to receive domperidone 10 mg or matching placebo tablets thrice daily for 14 days. The primary end-point was the overall treatment effect (OTE) response rate after 2-week therapy.ResultsAltogether 160 patients were included, with 80 patients in each group. The OTE response rate after 2-week therapy was significantly higher for domperidone compared with placebo (60.7% vs 46.0%; relative risk [RR] 1.318, 95% confidence interval [CI] 0.972-1.787). Moreover, the OTE response rate after 2-week domperidone or placebo treatment was 60.3% versus 54.9% for postprandial distress syndrome (PDS) (RR 1.098, 95% CI 0.750-1.607) and 60.6% versus 35.2% for overlapping PDS-epigastric pain syndrome (EPS) (RR 1.722, 95% CI 0.995-2.980). Adverse events were reported by seven patients in the domperidone group and 12 patients in the placebo group. None of the adverse events in the domperidone group were serious.ConclusionDomperidone showed a positive pattern regarding OTE response rates after 2-week therapy compared to placebo in patients with FD, as well as in subtypes of PDS and overlapping PDS-EPS. No new safety issue was observed. This pilot study aimed to evaluate the safety and efficacy of domperidone in the treatment of Chinese patients with functional dyspepsia (FD) who were diagnosed according to the Rome IV criteria, including identification of FD subtypes that potentially respond better to domperidone. Among the 160 patients enrolled, domperidone showed a positive pattern regarding overall treatment effect (OTE) response rate after 2-week therapy compared to placebo in patients with FD as well as those with FD subtypes of postprandial distress syndrome (PDS) and overlapping PDS-epigastric pain syndrome (EPS). No new safety issues were observed.image

Background::Endoscopic retrograde cholangiopancreatography (ERCP) is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases. However, patients with cirrhosis, particularly those with decompensated cirrhosis, are believed to be at increased risk for complications associated with ERCP. There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis. This study aimed to investigate the outcomes of ERCP for cirrhosis patients, especially adverse events, and evaluated its safety and efficacy.Methods::We performed a multicenter, retrospective study of all patients at Beijing Friendship Hospital affiliated to Capital Medical University, Xijing Hospital affiliated to Air Force Military Medical University, Beijing Youan Hospital affiliated to Capital Medical University, and the Fifth Medical Center of the People’s Liberation Army General Hospital from June 2003 to August 2019. The adverse events of inpatient ERCP for patients with ( n = 182) and without liver cirrhosis (controls; n = 385) were compared. Results::A total of 567 patients underwent ERCP between January 2003 and December 2019 were enrolled in this study. Compared to patients without cirrhosis, patients with cirrhosis were at higher risk for postoperative complications (odds ratio [OR], 4.172; 95% confidence interval [CI], 1.232–7.031; P < 0.001) such as postoperative pancreatitis (OR, 2.026; 95% CI, 1.002–4.378; P= 0.001) and cholangitis (OR, 3.903; 95% CI, 1.001–10.038; P= 0.036). The main indications for ERCP for patients with cirrhosis in this study included choledocholithiasis (101 cases; 55.5%), benign bile duct strictures (46 cases; 25.3%), and malignant bile duct strictures (28 cases; 15.4%). Among them, 23 patients (12.6%) underwent balloon dilation and 79 patients (43.4%) underwent sphincterotomy. Of the patients with cirrhosis, delayed bleeding occurred in ten patients (5.5%), postoperative pancreatitis occurred in 80 patients (44.0%), and postoperative cholangitis occurred in 25 patients (13.7%). An additional multivariate analysis showed that the total bilirubin (TBIL) level (OR, 4.58; 95% CI, 2.37–6.70) and Child-Pugh score of C (OR, 3.11; 95% CI, 1.04–5.37) were risk factors for postoperative complications in patients with cirrhosis. Conclusions::Compared with the general population of patients undergoing ERCP, patients with cirrhosis were more prone to postoperative pancreatitis and cholangitis. TBIL levels and Child-Pugh scores were risk factors for postoperative complications in patients with cirrhosis.

Objective:To evaluate the effects of single spay of L-menthol (NPO-11) on suppressing gastric peristalsis during upper gastrointestinal endoscopy and the influencing factor.Methods:This study was a multicenter, randomized, double-blind, placebo-parallel controlled study. The eligible patients were randomly divided into two groups by randomized blocks. Patients received local spray of either NPO-11 (160 mg L-menthol) or placebo 20 mL during upper gastrointestinal endoscopy. The gastric peristalsis was recorded and evaluated before, 2 minutes after and at the end of endoscopy. The complexity of the procedure was evaluated by the researchers. The influencing factors for antiperistaltic effect of NPO-11 were analyzed.Results:A total of 220 patients were enrolled from five research centers. There were 109 cases in the NPO-11 group and 111 cases in the placebo group. The baseline data of the two groups were similar and comparable. The proportion of patients with grade 1 peristalsis at 2 minutes after the treatment and at the end of endoscopy was significantly higher in the NPO-11 group than that in the placebo group [40.37% (44/109) VS 16.22% (18/111), χ2=15.93, P<0.001]. Compared with the placebo group, the proportions of weak peristalsis (grade 1 and 2) were higher in the NPO-11 group at 2 minutes after the treatment [67.89% (74/109) VS 46.85% (52/111)] and at the end of endoscopy [79.82% (87/109) VS 48.65% (54/111)]. Subgroup analysis showed that the inhibitory effect of NPO-11 on gastric peristalsis was more significant in Helicobacter pylori antibody positive group. Conclusion:Local spray of NPO-11 can effectively inhibit gastric peristalsis during upper gastrointestinal endoscopy, and its effect is more significant in Helicobacter pylori antibody positive group. It could be recommended for no obvious adverse reactions , its safety, and the convenient procedure.

From January 2016 to December 2020, 6 cases of polyps in the appendix cavity with a diameter of 0.3-1.3 cm were treated by endoscopy in the Department of Gastroenterology of Beijing Friendship Hospital, Capital Medical University. All 6 cases underwent endoscopic treatment successfully, including 3 cases of en bloc endoscopic mucosal resection (EMR), 1 case of piecemeal EMR, 1 case of endoscopic submucosal dissection (ESD), and 1 case of removed by cold forceps. No complications such as bleeding, perforation, infection or acute appendicitis occurred.The wound healed well with no recurrence after re-examination in 3 cases, and 3 others were not re-examined by colonoscopy yet. The results preliminarily confirmed that endoscopic treatment of intraluminal polyps in the appendix cavity is safe and effective.

Cholelithiasis is a common disease in clinical practice. Endoscopic retrograde cholangiopancreatography (ERCP) is a standard treatment for common bile duct stones (CBDS). Approximately 10%–18% of patients who undergo cholecystectomy for gallstones have CBDS,1 which is generally managed by peri-ERCP laparoscopic cholecystectomy (LC). Theoretically, ERCP is also technically possible for gallbladder (GB) drainage. However, extraction of GB stones through the tortuous cystic duct is often difficult during ERCP. Here we reported a case of cholecystolithiasis with CBDS that was successfully managed using ERCP. This letter was approved by the Ethical Committee of Beijing Friendship Hospital, Capital Medical University (Beijing, China) (no. 2021-P2-423-01). A 30-years-old man was admitted to the Department of Gastroenterology, Beijing Friendship Hospital on 5 September 2017, complaining of abdominal pain after satiation for 3 days and yellow-dyed skin and sclera observed the day before the admission. Abdominal computed tomography in another hospital before this admission had shown choledocholithiasis and cholecystolithiasis. Considering significant surgical trauma of LC or laparoscopic common bile duct (CBD) exploration, the patient gave consent to endoscopic treatment. On the same day, ERCP was performed and a small number of sediment stones were removed from the bile duct. The patient was then discharged after symptom relief. On 29 July 2020 the patient was re-admitted to the hospital due to abdominal pain after intermittent greasy food consumption during the past two 2 years. The patient was diagnosed with GB stones and chronic cholecystitis. The patient again refused surgery and asked for endoscopic treatment. On 30 July 2020 ERCP was performed, showing multiple GB stones; a plastic stent was placed in the cystic duct under ERCP (Figure 1A). In detail, one end of the stent was located in the GB and the other end at the oral side of the duodenal papilla, through which the obstruction was resolved and the drainage of bile and fine stones from the GB was carried out. The patient was asked to readmit for the removal of the cystic duct stent 3 months after the ERCP. Owing to the COVID-19 pandemic, the patient was admitted 9 months later and ERCP was performed on 13 April 2021. Under duodenoscope, the plastic stent was observed in the descending duodenum (Figure 1B). However, the duodenal incision knife with a guidewire along the stent had difficulty in entering the GB. Therefore, a sliding guidewire thread was used, with radiography showing multiple flocculent stone shadows in the GB. The guidewire was then retained, the double-pigtail plastic stent was removed, and a 10-Fr fully covered self-expandable metal stent (SEMS) of 12 cm in length was placed in the cystic duct. The bile duct was successfully located using the guidewire with an angiography tube to prevent poor intrahepatic bile outflow, and a 7-Fr double-pigtail plastic stent (12 cm in length) was placed along the guidewire to the porta hepatis (Figure 2A,B). SpyGlass was directed through the metal stent to enter the GB, and yellowish-green siltlike stones were observed. In addition, normal saline was used to flush the GB repeatedly, but no massive stones or masses were found. Cholecystography was then performed; no obvious abnormal stone shadow was found in the entire GB. Mild hyperemia of local mucosa of the GB wall was observed, and biopsy forceps was used to obtain tissue sample for histopathology (Video S1), showing that the mucosa of GB was covered with columnar epithelium, with scattered inflammatory cell infiltration and massive lymphocytes; some tissues were squeezed and deformed by the biopsy forceps. After surgery, the patient was treated with antibiotics and fluid infusion and discharged the next day. On 22 June 2021, the patient was admitted to the hospital to remove the metal stent from the GB. SpyGlass was used to enter the GB through the metal stent (Figure 3A), with multiple flocculent stones found in the GB again (Figure 3B). Repeated saline irrigation showed that the flocculent stones were discharged; larger stones were removed with biopsy forceps (Video S2). The metal stent in the GB duct was removed with a snare device once floccus in the GB was no longer observed. The patient was discharged the next day. A follow-up phone call was made on 18 April 2022, the patient reported no discomfort such as abdominal distention or abdominal pain. Cholecystolithiasis with choledocholithiasis is characterized by a short course of disease and rapidly changing condition, which can easily cause acute cholangitis and cholecystitis that require emergency ERCP or surgical treatment. Thanks to the continuous advances in endoscopic technology in recent years, cholecystolithiasis with choledocholithiasis can be treated with endoscopy and minimally invasive endoscopic technology, achieving satisfactory prognosis.2, 3 At present, the treatment for cholecystolithiasis with choledocholithiasis has gradually changed from open cholecystectomy plus common bile duct exploration and T-tube drainage to LC in combination with ERCP or endoscopic sphincterotomy and lithotomy, and LC and laparoscopic CBD exploration. Both treatment strategies can be used to treat cholecystolithiasis complicated with CBDS. Rogers et al4 and Ding et al5 reported no significant differences between ERCP in combination with LC and LC alone in terms of stone clearance, complication, patient acceptance, and quality of life score. ERCP choledocholithotomy with LC was preferred for patients with choledocholithiasis with cholecystolithiasis as recommended by the Chinese guidelines for ERCP (2018).6 For our patients, a less invasive holistic approach was used. First, ERCP was used to remove CBDS, and a plastic cystic duct stent was placed. After the cystic duct was fully expanded, the plastic stent was replaced with a metal stent with a wider inner diameter. Then SpyGlass was used to remove GB stones. Storm et al7 reported 51 patients with acute cholecystitis who could not undergo cholecystectomy. ERCP-guided transpapillary GB drainage with transpapillary GB double-pigtail stent placement has proven to be a safe and effective long-term therapy for poor surgical candidates with acute cholecystitis. A study in Japan8 showed a successful placement of plastic stents in the GB and bile duct in an elderly patient with cholecystolithiasis complicated by acute cholecystitis. Compared with previous case reports,7,8 we not only applied both cystic duct plastic stent and metal stent but also used a cystic duct metal stent and SpyGlass, which guaranteed further stone removal and direct biopsy of the GB wall. After the metal stent was placed in the bile duct, the gallstones could be extracted spontaneously or washed out with normal saline under SpyGlass. We also used biopsy forceps to remove massive flocculent stones, which is suitable for relatively small calculi. For large calculi, we speculated that it was possible to use a choledochoscope for laser/electrohydraulic lithotripsy via the cystic duct metal stent or basket extraction for small calculi with a fully covered SEMS. At present, LC is the standard treatment for gallstones. Although the complication rate of LC is relatively low, bile duct injury, bile fistula, gastrointestinal injury, choledocholithiasis, and abdominal infection can still occur.8 Functional complications, such as postcholecystectomy syndrome,9, 10 can also occur after LC, causing epigastric pain, diarrhea, dyspepsia, constipation, etc. However, using endoscopic lithotomy, not only can the GB be preserved but organic injury can also be reduced. In addition, the GB wall can be observed directly through SpyGlass. For GB polyps, adenomas and cancers, not only can the nature of lesions be determined under direct endoscopic view, but the “target” can also be accurately biopsied under direct vision, thereby providing pathological evidence for the identification of benign and malignant GB diseases. The most significant difficulty with ERCP is the physiological and anatomical characteristics of the cystic duct, whose diameter is spiral and twisted. Therefore, making the guidewire enter the GB through the tortuous and small cystic duct has always been difficult for clinicians. The success achieved in our patient makes it possible to promote endoscopic diagnosis and treatment of GB diseases in clinical practice. This case paves the way for the endoscopic resection of gallstones, benign GB adenoma, and even early cancer. However, ERCP is related to complications such as postoperative pancreatitis, bleeding, perforation, and infection, in which postoperative pancreatitis is the most common complication with a reported incidence of up to 9.7%, and even 14.7% for high-risk groups.11 However, as an endoscopic technique, ERCP maintains the physiological and anatomical structure of the patient, thereby avoiding surgical complications and reducing the risk of infection. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) can also be considered for symptomatic patients with cholelithiasis or acute cholecystitis who still encounter unresolved bile duct obstruction after ERCP, although adverse reactions have been noted following EUS-GBD. In a systematic review of 189 patients with acute cholecystitis treated with EUS-GBD, the recurrence rate of postoperative cholecystitis was 5.1%, the incidence of gastrointestinal bleeding and stent displacement was 2.6% and 1.1%, respectively.12 A study13 reported a preliminary discussion on the removal of biliary lithotomy through gastric endoscopy in treating GB calculi. Endoscopic transgastric GB–preserving cholecystolithotomy proved to be an effective and safe way to treat cystic stones that can preserve GB function and is minimally invasive. However, dealing with calculi and avoiding residues and recurrence require further exploration. In addition, long-term curative effects require further observation. ERCP stone removal using a cystic duct metal stent, endoscopic stone removal via gastric GB preservation, and EUS-GBD are all minimally invasive. Large trials with long-term postoperative follow-up are warranted in the future. ERCP may replace LC and other treatment strategies, both surgical or non-surgical, for cholecystolithiasis with choledocholithiasis in the future. In addition, endoscopic GB wall biopsy not only provides pathological support for the differentiation of benign and malignant diseases of the GB but also offers the possibility of endoscopic resection of GB lesions. Video S1 Observation of gallbladder mucosa by using SpyGlass and tissue sample was obtained for histopathological examination. Video S2 Stones were removed by repeated saline irrigation. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. 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Multiple neuroendocrine tumors (M-NETs) are rare in the rectum and there is no consensus on their characteristics and treatments. Here, we report 15 cases of rectal M-NETs and review the previous literature. We discuss the clinical characteristics, endoscopic features and pathological features of rectal M-NETs, aiming to analyze the treatments and follow-up strategies in combination with these characteristics. We retrospectively reviewed and analyzed the data of 15 patients with rectal M-NETs who were diagnosed and treated at Beijing Friendship Hospital, Capital Medical University. Their clinical data, endoscopic findings, pathological features and treatments were analyzed. Follow-up evaluations and literature review were performed. In all, 14 male (93.3%) and 1 female (6.7%) were recruited. The average age at diagnosis was 55.7 years. The clinical manifestations include asymptomatic in 9 patients (60.0%), defecation habits changes in 2 patients (13.3%), anal distension in 2 patients (13.3%), and abdominal distension in 2 patient (13.3%). The largest tumor diameter ≤10mm was found in 13 patients (86.7%) and >10mm in 2 patients (13.3%). All of the lesions originated from the mucous or submucosa layer. WHO grades were all NET G1. The number of tumors diagnosed by pathology in 13 patients was consistent with that observed by endoscopy, while more lesions were observed by pathology than endoscopy in two patients. Lymph node metastasis occurred in 1 patient (6.7%), and vascular or lymphatic invasion occurred in 9 patients (60.0%). Among the 13 patients with the largest tumor diameter being ≤10mm, lymphovascular invasion occurred in 8 patients (61.5%). And among the 2 patients with the largest tumor diameter of >10mm, lymphovascular invasion occurred in 1 patient (50.0%). 14 patients underwent endoscopic resection and 1 underwent surgical excision. Postoperative follow-up was achieved in 13 patients and no recurrence or metastasis was found. The true number of rectal M-NETs may be more than seen under endoscopy. Rectal M-NETs is associated with a high risk of metastasis; therefore, treatment and surveillance strategies should be more radical than single lesion.

目的 评价经十二指肠副乳头插管置入胰管支架的安全性.方法 回顾性分析2016年1月至2021年8月于首都医科大学附属北京友谊医院行十二指肠乳头插管置入胰管支架治疗胰腺疾病的114例患者的临床资料.其中经主乳头插管88例,经副乳头插管26例.比较两组患者年龄、性别、既往病史、内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)手术史、术者、术前凝血功能、经胰管括约肌切开术、困难插管、置入胰管支架个数、术后并发症发生率、术后住院时间的差异,并采用二分类Logistic回归法分析术后并发症的独立危险因素.结果 两组患者术后并发症发生率和术后住院时间的差异无统计学意义(P>0.05),二分类Logistic回归法显示,副乳头插管与术后并发症的无关联(P>0.05).结论 根据目前有限的数据,经十二指肠副乳头插管置入胰管支架与经主乳头插管相比,不会增加术后并发症的发生率和术后住院时长.