The portable disposable large-channel endoscope was developed in-house by our team. It ensures successful gastroscopic treatment with good image condition, water supply, air supply, suction and maneuverability. In addition, the risk of infection transmission from reusable gastroscopes could be avoided. In conclusion, portable disposable large-channel endoscope and the twin forceps clip are a good choice in emergency treatment and certain circumstances.

Objective:Laparoscopic/robotic radical resection and super minimally invasive surgery(SMIS)are currently the main surgical methods for the treatment of gastric cancer.However, there are the following issues in clinical decision-making before and after surgery: (1)There is still a lack of effective means for accurately determining the scope of lymph node dissection in laparoscopic/robotic radical resection surgery; (2)There are still difficulties in accurately determining the presence of lymph node metastasis around the stomach after non-curative resection of super minimally invasive surgery.Currently, the use of the antigen-specific imaging agent 68Ga-NC-BCH in combination with positron emission tomography-computed tomography (PET/CT) has shown promising results in guiding Chimeric Antigen Receptor T-Cell Immunotherapy (CART) treatment for gastric cancer patients. However, there is no relevant research on whether it can be combined with lymph node immune tracing to guide preoperative and postoperative clinical decisions for gastric cancer patients.Therefore, this study aims to explore the impact of 68Ga-NC-BCH combined with PET-CT lymph node immune tracing on preoperative and postoperative clinical decisions for gastric cancer patients.Methods:From April to September 2023, five cases of advanced gastric cancer patients who received treatment at the First Medical Center of PLA General Hospital were selected. Prior to surgery, abdominal CT scans and 68Ga-NC-BCH combined PET-CT lymph node immune tracing were performed, followed by laparoscopic/robotic gastric cancer resection and extended lymph node dissection.Result:Among the 5 cases, preoperative CT scans indicated enlarged gastric lymph nodes in 3 cases (60%). However, lymph node immunostaining using 68Ga-NC-BCH combined with PET-CT did not reveal any abnormalities. Postoperative pathological examination of the enlarged lymph nodes confirmed the absence of cancer tissue in all 3 cases.The results of preoperative lymph node immunostaining using 68Ga-NC-BCH combined with PET-CT were consistent with postoperative pathological examination results in all 5 cases (100%). These preliminary findings suggest that compared to CT, lymph node immunostaining using 68Ga-NC-BCH combined with PET-CT has higher accuracy in determining gastric lymph node metastasis in patients with gastric cancer.Conclusion:This study preliminarily confirmed the feasibility and safety of using 68Ga-NC-BCH combined with PET-CT lymph node immune tracing to guide preoperative and postoperative clinical decisions for gastric cancer patients. However, further prospective studies with larger sample sizes are needed to confirm the above conclusion.

Objective:In this study, we compared the effectiveness and safety of the portable disposable large-channel endoscope and a conventional gastroscope in hemostasis and endoscopic submucosal dissection (ESD).Methods:Rabbits were treated with debridement and hemostasis after general anesthesia. After constructing the model of gastrorrhagia, the endoscopic surgeons randomly selected a gastroscope to debridement the bleeding site and spray hemostatic powder to achieve hemostasis. We will compare the overall operation time, the amount of hemostatic powder, the success rate of hemostasis and the times of plugging of the powder delivery tube between the two groups. Overall operation time, the amount of hemostatic powder, the success rate of hemostasis and the times of plugging of the powder delivery tube were compared between the 2 types of endoscopes. Bama pigs would receive ESD treatment after general anesthesia. The experiment was completed by experienced endoscopic physicians. Total duration of ESD, success rate of en bloc resection, perforation rate, device failure rate, satisfaction with the use of endoscope system and picture rating were compared between the 2 types of endoscopes.Result:Both groups successfully completed hemostasis. There was no difference between the dosage of hemostatic powder in the experimental group (2.54±0.97) g and that in the control group (2.25±0.79) g. The powder delivery tube in the control group was blocked once. In the overall operation time, the experimental group (86.62±13.68) s was significantly shorter than that in the control group (101.75±17.14) s, with P value=0.004. Both groups completed 16 ESDs. There were no significant differences between the total duration of ESD in the experimental group (19.22±9.50) min and that in the control group (17.72±5.15) min, with P value =0.985. There were no differences in success rate of en bloc resection and picture rating between the 2 types of gastroscopes. Neither of the gastroscopes caused perforation during ESD. There was no failure of the instruments in both groups. The satisfactions evaluation of two groups were basically satisfactory and above.Conclusion:The portable disposable large-channel digestive endoscope could perform gastroscopy and treatment effectively, which is of great significance in reducing infection and breaking the restriction of the use of endoscope.

Mesenteric panniculitis is a chronic non-specific inflammatory disease involving mesenteric adipose tissue. The etiology of the disease is still unclear and is relatively rare in clinical practice. The paper provides a systematic review of its etiology and pathogenesis, clinical manifestations, auxiliary examinations, diagnosis and differential diagnosis, treatment and prognosis, with the aim of providing a more powerful reference for the clinical treatment of the disease.

消化系统的人工智能（AI）包括两大板块，第一个板块是智能识别，原理是基于深度学习的卷积神经网络，主要用于辅助医生提高内镜下的诊断率；另一个板块是消化道机器人，包括消化内镜手术机器人、胶囊机器人、软体微型机器人等，主要用于辅助医生提高诊疗疾病的能力。

超级微创是指在保持人体解剖结构不变的情况下去除疾病，其核心是患者术后恢复原样，治疗前后身体无大差异。超级微创理念下的手术可以达到完美无缺，患者生活质量保持不变，生存时间不受该疾病影响，完全区别于目前传统外科和微创外科以切除器官为代价的手术模式。依照完成手术占用的空间，消化内镜超级微创下的手术通道被分为4类，包括消化自然通道、隧道技术通道、穿刺通道、多腔隙多通道。未来，消化内镜超级微创手术都将在这些通道的前提下，进行手术的创新。创新包括有效通道的扩展、装备器械的发明、临床术式的革新等等。在过去的一年中，人工智能的发展也赋予了超级微创新的生命力。

Objective:To evaluate the efficacy of endoscopic ultrasonography-guided lauromacrogol ablation (EUS-LA) in the treatment of pancreatic cystic tumors (PCNs).Methods:From Apr. 2015 to Jul. 2021, 85 patients treated with EUS-LA were enrolled in the First Medical Center of PLA General Hospital, and 75 of them were followed up for validity analysis based on the new evaluation system. The definitions are as follows, complete disappearance, final volume (FV) = 0; nearly complete disappearance , 0 < FV ≤ 10% original volume (OV); significantly effective, 10%< FV ≤ 25% OV; effective, 25%OV< FV ≤ 75% OV; stabilization, 75%OV< FV ≤ 100% OV; progress > 100% OV.Results:The initial effectiveness of the new evaluation system was as follows: complete disappearance in 25 cases (33.3%), nearly complete disappearance in 12 cases (16.0%), significantly effective in 15 cases (20.0%), effective in 10 cases (13.3%), stabilization in 10 cases (13.3%), progress in 3 cases (4.0%). The overall effectiveness of the new evaluation system was as follows: 28 cases (37.3%) complete disappearance, 15 cases (20.0%) nearly complete disappearance, 12 cases (16.0%) significantly effective, 7 cases (9.3%) effective, 9 cases (12.0%) stabilization, 4 cases (5.3%) progress.Conclusions:Based on the new evaluation system, both the effective rate of initial and total lesion reduction were improved, which could not only evaluate the effect of different degree of lesion reduction, but also describe the progressive trend of lesion enlargement.

目的 分析肝硬化食管胃静脉曲张老年患者的临床特点.方法 回顾性分析2017年1月至2020年1月中国人民解放军总医院第一医学中心消化内科医学部诊疗的168例65岁以上肝硬化食管胃静脉曲张老年患者的一般资料、临床表现、内镜下表现及治疗情况等.结果 纳入研究的168名老年患者的平均年龄为70.8岁,其中男性74例,占44.0％;女性94例,占56.0％.全部老年患者病因的前3位是乙肝肝硬化(26.8％),酒精性肝硬化(14.9％)和原发性胆汁性肝硬化(12.5％).老年患者合并各类基础疾病较多,如合并各类心血管系统疾病(44.0％),合并各类内分泌系统疾病(36.9％).大多数老年患者仅能耐受1-3次内镜下治疗(72.4％).结论 老年人肝硬化食管胃静脉曲张患者的病因复杂,合并基础病较多,治疗相对困难.

超级微创是医学手术史上全新的阶段，也是未来治疗学的终极理念。其原则是基于保持人体解剖结构不变的情况下祛除疾病，核心是患者术后恢复原样，治疗前后整个身体无大差异。超级微创理念下的治疗希望达到完美无缺的程度，患者生活质量保持不变，生存时间不受该疾病影响，完全区别于目前的传统外科和微创外科以切除器官为代价的手术模式。目前对于超级微创不同治疗通道以及相关的研究并没有进行梳理。本文将对消化内镜超级微创不同治疗通道的手术新进展进行综述。超级微创的消化内镜手术通道分为4大类，包括消化管道单通道、多腔隙双通道、隧道技术通道和穿刺通道。未来的超级微创理念手术都将在这些通道内进行新的术式研究。