BACKGROUND Tumor enucleation via thoracoscopic surgery (TS) and submucosal tunneling endoscopic resection are both effective and widely used therapies for resecting most esophageal subepithelial lesions (SELs) originating from the muscularis propria (MP). However, when a lesion exceeds 35 mm in diameter and/or is located in the cervical esophagus, it is classified as a complex esophageal tumor. In such cases, submucosal tunneling endoscopic resection is not feasible due to insufficient tunnel space and the inability to successfully extract the lesion from the tunnel. Exposed endoscopic full-thickness resection (EFTR), which does not require tunnel creation, is a potential alternative treatment for complex esophageal SELs-MP. However, data on esophageally exposed EFTR remain limited. AIM To compare the feasibility and safety of esophageal exposed EFTR with TS for the resection of complex esophageal SELs. METHODS Between November 2016 and October 2023, the clinical records of patients with esophageal SELs-MP who underwent resection at the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed. Patients with lesions larger than 35 mm in diameter and/or located in the cervical esophagus were included in the study. Clinicopathological characteristics, perioperative outcomes, complications, and follow-up data were collected and compared between the EFTR and TS groups. RESULTS A total of 60 patients with complex esophageal SELs-MP were included, with 15 patients in the EFTR group and 45 in the TS group. The EFTR and TS groups demonstrated comparable technical success rates (100% vs 97.8%, P = 0.574) and en bloc resection rates (86.7% vs 75.6%, P = 0.423). Compared to the TS group, the EFTR group had a significantly longer median procedure time (240.0 minutes vs 120.0 minutes, P < 0.001) but a shorter postoperative nasogastric decompression period (5.6 +/- 4.9 days vs 10.7 +/- 13.2 days, P = 0.016). In the EFTR group, complete defect closure was achieved in 3 patients (20.0%), incomplete closure in 8 patients (53.3%), and non-closure in 4 patients (26.7%). Postoperative adverse events occurred in 3 patients in the EFTR group and 4 patients in the TS group. Both groups experienced cases of esophageal stricture and fistula. Notably, chylothorax was observed exclusively in the TS group. CONCLUSION Esophageal-exposed EFTR demonstrated clinical outcomes comparable to those of TS, suggesting that it is a safe and feasible option for the treatment of complex esophageal SEL-MP. Further studies are warranted to validate these findings.

Nowadays, Endoscopic Muscularis Dissection (EMD) and Endoscopic Cap External Snare Resection (ECESR) are utilized as effective techniques for removing small submucosal tumors. Herein, We aimed to clarify the efficacy and outcomes of ECESR vs EMD to determine the optimal minimally invasive approaches for managing small (≤ 12 mm) Gastric Submucosal Tumors (sGSMT) arising from the muscularis propria (MP) layer. This study retrospectively included data from patients who underwent ECESR or EMD to excise sGSMT of 12 mm or less. The propensity score matching (PSM) algorithm mitigated selection bias using age, gender, tumor size, location, and growth patterns for one-to-one matching. Finally, 96 patients were divided into ECESR (48) and EMD (48) groups. Clinicopathologic characteristics, procedural outcomes (procedure time, tumor resection time, and R0 resection), adverse events, length of hospital stay, and costs were compared between the two groups. After PSM, the ECESR group experienced significantly shorter procedure time and tumor resection time (23 [21, 22] vs 47 [40–56] min; 5 [5, 6] vs 27 [26–30] min, P < 0.001). The ECESR group exhibited significantly shorter hospital stays (P < 0.001) and lower operation costs (P < 0.001) compared to the EMD group. Both groups achieved high rates of complete (R0) resection, with no statistically significant difference observed. Importantly, no recurrence or metastasis was observed in either group during follow-up. The incidence of adverse events, including perforation and postoperative complications, was comparable between groups, and no statistically significant differences were identified.. For sGSMT (≤ 12 mm), ECESR exhibits shorter procedure and tumor resection times, speedier recovery, lower operating costs, and shorter hospital stays compared to EMD.

Traditional apprenticeship-based endoscopy training carries patient risk, while existing simulators have notable drawbacks. We developed a CT-derived, openable, 3D-printed gastric simulator that supports both diagnostic and therapeutic training, and evaluated its realism, validity, and educational impact for novices. Endoscopic procedures were recreated via modular tasks within the model. Thirty physicians of varying experience completed simulated operations; metrics included task time, errors, and 7-point Likert ratings of realism and usability. Educational effectiveness was tested in 30 novice trainees randomized to simulator training (Group A) or traditional mentoring (Group B), each receiving 12 h. Outcomes were operation time, DOPS scores across 14 domains, and 5-point Likert self-assessments. All endoscopists rated the simulator highly realistic, easy to use, low in physical/psychological burden, and motivating. Group A showed significantly higher subjective scores than Group B (P < 0.05), particularly for handling endoscopic instruments, clinical gastroscopy operations, understanding gastric anatomy, and confidence in examination. Our novel simulator can accurately replicate fundamental endoscopy techniques and effectively differentiate the varying levels of physician technical proficiency. Additionally, it offers advantages such as low cost, convenient and efficient operation, and reliability and safety, demonstrating a high potential for widespread adoption in gastroscopy teaching and training.

INTRODUCTION:Endoscopic retrograde appendicitis therapy (ERAT) is a new and noninvasive endoscopic technique originally developed by Liu in China for the management of acute appendicitis. Although its safety and efficacy have been extensively validated in adult populations, evidence regarding its use in pediatric patients remains scarce. The aim of this study was to evaluate the clinical outcomes of ERAT in pediatric appendicitis. METHODS:This retrospective study analyzed pediatric patients who underwent ERAT in our hospital between January 2019 and August 2022. Data collected included patient demographics, the success rate of ERAT, and the duration of hospital stay. In addition, recurrence rates were assessed during the follow-up to evaluate the safety and long-term efficacy of the procedure. RESULTS:A total of 73 patients were included in this study. Appendiceal intubation was successfully performed in 72 of 73 patients (98.63%). Among these patients, 72.22% of patients had appendiceal fecal stones or food residue, and the success rate of stone removal was 94.23%. Overall, the clinical success rate of the procedure was 91.78%. The median procedure time was 22 minutes (interquartile range 15-36.5), and the median postoperative hospital stay was 2 days (interquartile range 1-4). During the 1-year follow-up, 14.92% of the patients had recurrent appendicitis. DISCUSSION:ERAT seems to be a safe and effective alternative approach to treat appendicitis in pediatric patients, especially for obstructive appendicitis with appendicolith.

ObjectiveTo evaluate the feasibility, safety, and efficacy of massive continuous irrigation (MCI) and endoscopic debridement for the treatment of refractory abscess–fistula complexes.MethodsThis was a retrospective single‐center observational study involving 12 patients with refractory abscess–fistula complexes. All patients had experienced long‐term treatment failure or had failed multiple treatment modalities. We used over two catheters and inserted them via the gastrointestinal (GI) tract or percutaneously to form a circulation pathway to achieve MCI of normal saline, endoscopic debridement was then performed. The treatment success rate, irrigation volume and treatment duration, time to abscess–fistula complex closure, intra‐treatment complications, and recurrence rate were recorded.ResultsThe treatment success rates were 100%. The median time of previous treatment was 32 days (range 7–912 days). The mean time from the use of the novel treatment strategy to abscess–fistula complex healing was 18.8 ± 11.0 days. The mean volume of irrigation was 10 804 ± 1669 mL/24 h. The mean irrigation time was 16.5 ± 9.2 days, and a median of two irrigation tubes (range 2–5) were used. No complications occurred either during or after the procedure. During the follow‐up of 23.1 ± 18.1 months, no recurrence or adverse events were noted.ConclusionsMCI and endoscopic debridement may be a feasible, safe, and effective alternative treatment for refractory abscess–fistula complexes. Large prospective studies are needed to validate our results.

To investigate the association between disease location and segmental mucosal healing (SMH) following exclusive enteral nutrition (EEN) in children with Crohn's disease (CD). Treatment-naive pediatric patients with endoscopically active CD treated with EEN alone as induction therapy were retrospectively enrolled from January 1, 2017 to June 30, 2022. The simple endoscopic score for CD (SES-CD) was employed to score disease activity in the upper gastrointestinal (GI) tract (esophagus, stomach, duodenum), rectum, left colon, transverse colon, right colon, and terminal ileum. While the Lewis score assessed that of the small bowel from the jejunum to the proximal ileum (except the terminal ileum). The variation in the total scores for each segment and SES-CD subscores for each ileocolonic segment from baseline to 1 year after EEN therapy and the segmental endoscopic outcomes and potential predictors associated with SMH for the segments scored by SES-CD were evaluated. Overall, 82 children with CD were enrolled. Except for the upper GI segment, scores in other segments declined significantly from baseline to EEN completion (all P  < 0.001). We analyzed 486 segments (79, 80, 81, 82, 82 and 82 from upper GI tract, terminal ileum, right colon, transverse colon, left colon, and rectum) and found that the segmental SES-CD at baseline (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.55–0.70, P  < 0.001) and upper GI location (OR 0.25, 95% CI 0.11–0.55, P =  0.001) were associated with SMH at EEN completion. Disease location of the upper GI segment in pediatric CD was associated with SMH following EEN therapy.