Nowadays, endoscopic submucosal dissection (ESD) is commonly performed for the removal of large gastrointestinal lesions. Endoscopic mucosal defect closure after ESD is vital to avoid adverse events. In recent years, many innovative instruments have emerged and proved to be beneficial. In this paper, we conducted a thorough literature review and summarized the closure methods for large-size post-ESD mucosal defects over decades. We separated these methods into five categories based on the operational principle: "side closure" method, "ring closure" method, "layered closure" method, "hand suturing closure" method, and "specially designed device closure" method. Side closure with clips assisted by instruments such as threads or loops is applicable for each segment of the gastrointestinal tract to prevent postoperative bleeding. If the defect tension is too large to close with the traditional side closure methods, zigzag closure and ring closure could be applied to gather the bilateral defect edges together and achieve continuous closure. In the stomach and rectum with a high risk of submucosal dead space between the submucosa and muscular layers, side closure methods with muscle layer grasping clip or layered closure methods could enable the involvement of the deep submucosa and muscle layers. The ring closure method and specially designed devices including over-the-scope clip, Overstitch, and X-tack could resolve perforation effectively. Individual closure method requires endoscope reinsertion or sophisticated operation, which may be limited by the deep location and the narrow lumen, respectively. Although specially designed devices are expected to offer promising prospectives, the cost-effectiveness remains to be a problem.

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.

Background: Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory disease that results in the tissue destruction of multiple organs. IgG4-RD is often underdiagnosed or misdiagnosed as malignant, infectious, or other inflammatory disorder. Case presentation: We describe a 56-year -old woman presented with jaundice and weight loss. Radiological imaging showed common hepatic duct wall thickening and nodular lesions in the pancreas, which was highly suspicious of malignancy. However, she was contra-indicated for biopsy; hence, the diagnosis of IgG4-RD was made based on her high serum IgG4 level, multiorgan involvement, and steroid response. The effect of steroid therapy was significant, although the disease relapsed during the maintenance treatment. The dosage of steroid was re-increased, and the patient was under close follow-up. Conclusions: The diagnosis of IgG4-RD is challenging due to its diverse manifestations. Therefore, a careful systematic assessment is necessary to improve the accuracy of IgG4-RD diagnosis, and a close follow-up is important to monitor the disease development as well as adjust the treatment strategy accordingly.

Background:Paraneoplastic cerebellar degeneration (PCD), which displays ataxia and other cerebellar symptoms, is the most common paraneoplastic neurological syndrome (PNS). PCD is more likely to occur in individuals with small cell lung cancer (SCLC), gynecological malignancies, and Hodgkin disease, but it is rarely associated with non-Hodgkin lymphoma (NHL).Case Description:We report a case of PCD accompanying high-grade B-cell lymphoma embedded in an individual's stomach and duodenum, who also presented with acute onset of gait ataxia and slurred speech. The results of the common laboratory tests for neurological disorders, including the paraneoplastic antibody test, were negative. The key to the accurate diagnosis was the positron emission tomography/computed tomography findings. The final diagnosis of high-grade B-cell lymphoma was unclear until the performance of repeated esophagogastroscopy with multipoint deep excavation biopsies. After standard chemotherapy, the patient's gastric tumor was significantly alleviated and cerebellar syndrome was significantly improved.Conclusions:This case highlights the challenges of diagnosing PNS associated with occult malignancy. PNS patients may present with a variety of neurological disorders; Thus, if any unexplained neurological symptoms appear after a series of specific laboratory and imaging tests, a diagnosis of PNS should be taken into consideration in the differential diagnosis list, as it may help clinicians identify asymptomatic malignancies and ensure patients receive correct treatments in a timely manner. A high-quality endoscopic biopsy is essential, as it helps hematologists make an accurate diagnosis of lymphoma with gastroduodenal involvement based on pathology.

目的 探讨院内巡讲对非消化科患者结肠镜检查肠道准备效果的影响.方法 选取2020年8月1日至9月15日在首都医科大学附属北京友谊医院接受结肠镜检查的非消化科住院患者49例作为对照组,常规进行结肠镜检查前的健康宣教;以2020年10月1日至11月15日在首都医科大学附属北京友谊医院接受结肠镜检查的非消化科住院患者51例作为干预组,干预前由消化科护师对非消化科护理人员进行为期15d的院内巡讲,内容包括《中国消化内镜诊疗相关肠道准备指南(2019,上海)》解读,指导及观察患者规范服用缓泻剂的要点,对患者进行结肠镜检查健康宣教的要点,结肠镜检查肠道准备前由非消化科室护理人员对患者进行评估和健康宣教,并指导患者进行肠道准备.比较两组患者的肠道清洁情况、不良反应发生率、结肠镜检查感受、患者接受健康宣教的方式及理解程度.结果 两组患者肠道准备的不良反应、结肠镜检查感受等方面差异无显著性(P>0.05).对照组肠道清洁度评分为(6.45±2.01)分,低于干预组的(7.10±1.02)分,差异有显著性(t=2.021,P=0.047);对照组肠道清洁度合格患者38例(77.6％),低于干预组的51例(100％),差异有显著性(χ2=12.864,P<0.001).对照组患者肠腔内气泡评分为(0.83±0.60)分,干预组为(0.75±0.59)分,差异无显著性(t=0.658,P=0.512).对照组14例(28.6％)发生不良反应,干预组8例(15.7％)发生不良反应,两组不良反应发生率差异无显著性(χ2=2.418,P=0.120).对照组36例(73.5％)患者接受了口头健康宣教,13例(26.5％)患者接受了其他形式的健康宣教;干预组49例(96.1％)接受了口头健康宣教,2例(3.9％)接受了其他形式的健康宣教,两组差异有显著性(χ2=10.020,P=0.002).对照组11例(22.4％)患者对健康宣教内容的理解程度为基本理解,38例(77.6％)为清楚明白,干预组51例(100.0％)患者对健康宣教内容的理解程度均为清楚明白,两组差异有显著性(χ2=12.864,P<0.001).结论 对非消化科室护理人员进行结肠镜检查肠道准备相关内容的院内巡讲,可显著提高非消化科室住院患者肠道准备的清洁度.

目的:初步评价一次性电子胃镜和一次性结肠镜用于消化道检查及配合手术器械进行诊治的性能和安全性。方法:应用EndoFresh ?一次性电子内镜系统对拟行消化道检查的2例患者行消化道内镜检查，同时进行规范化采图，对内镜操作性能、内镜图像质量以及并发症进行评估。 结果:2例患者在静脉全身麻醉状态应用一次性胃镜和一次性结肠镜成功完成上消化道及全结肠检查。应用一次性内镜顺利完成规范图像采集，内镜吸气、送气及送水，大小钮弯曲以及镜身旋转等动作。利用配套的主机系统可进行图像拍照、视频录像、图文报告以及数据的传输。2例患者的胃镜及结肠镜检查过程顺利，术中、术后均未发生内镜操作相关的不良事件和并发症，操作时间和普通内镜检查相近。结论:一次性电子消化内镜系统初步临床应用安全可行，操作性能及内镜图像质量良好，值得进一步研究。