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Difficult common bile duct (CBD) stones are difficult to remove using conventional stone clearance methods such as endoscopic papillary sphincterotomy. In this guideline, we present several recommendations and relevant information on the endoscopic treatment of difficult CBD stones. For the primary treatment of large CBD stones in patients without distal bile duct stricture, we recommend limited endoscopic sphincterotomy followed by endoscopic papillary large balloon dilation. For large CBD stones that are difficult to remove with conventional endoscopic treatment methods, we recommend electrohydraulic or laser lithotripsy under cholangioscopy. Short-term biliary stenting is recommended in patients with CBD stones that are difficult to remove by these methods. Finally, endoscopic treatment via small bowel enteroscopy or percutaneous transhepatic cholangioscopy may be an option in patients with surgically altered anatomy. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the efficacy and further analyze the application prospects of the combined multitarget fecal FIT-DNA assay in the early screening of colorectal cancer. MethodsSubjects were selected from a population attending the Inner Mongolia Medical University Hospital. Each subject underwent a combined multi-target fecal FIT-DNA test (experimental group), a serum tumor marker test and enteroscopy (control group). The pathological results were used as the gold standard to evaluate the efficacy of novel fecal molecular testing techniques for colorectal cancer screening with timely intervention given to screen positive individuals. ResultsThe data of 115 individuals were analyzed. Serum tumor markers test had a sensitivity of 63.2% (43/68) and a specificity of 74.5% (35/47). The enteroscopy had a sensitivity of 97.1% (66/68) and a specificity of 80.7% (38/47); the combined multitarget fecal FIT-DNA test had a sensitivity of 89.7% (61/68) and a specificity of 87.2% (41/47). ConclusionThe sensitivity and specificity of multitarget fecal FIT-DNA combined detection are better than those of serum tumor marker detection. Although its sensitivity is lower than enteroscopy, its operation is simpler and can be tested at home.

Objective To evaluate the efficacy and further analyze the application prospects of the combined multitarget fecal FIT-DNA assay in the early screening of colorectal cancer. Methods Subjects were selected from a population attending the Inner Mongolia Medical University Hospital. Each subject underwent a combined multi-target fecal FIT-DNA test (experimental group), a serum tumor marker test and enteroscopy (control group). The pathological results were used as the gold standard to evaluate the efficacy of novel fecal molecular testing techniques for colorectal cancer screening with timely intervention given to screen positive individuals. Results The data of 115 individuals were analyzed. Serum tumor markers test had a sensitivity of 63.2% (43/68) and a specificity of 74.5% (35/47). The enteroscopy had a sensitivity of 97.1% (66/68) and a specificity of 80.7% (38/47); the combined multitarget fecal FIT-DNA test had a sensitivity of 89.7% (61/68) and a specificity of 87.2% (41/47). Conclusion The sensitivity and specificity of multitarget fecal FIT-DNA combined detection are better than those of serum tumor marker detection. Although its sensitivity is lower than enteroscopy, its operation is simpler and can be tested at home. [ABSTRACT FROM AUTHOR]

In 2023, multiple important discoveries and breakthroughs have been made in the field of small intestine diseases, and database-based global epidemiological study on small intestinal cancer was first released. It showed that the global incidence rate of small intestinal cancer in 2020 was 0.6/100 000, which was on an upward trend compared with the average incidence rate from 2010 to 2020 (average annual change percentage in different continents, 2.20% to 21.67%). The burden of small intestinal cancer was geographic disparity, and age-standardized incidence rate (1.4/100 000) was highest in North America. The incidence rate of small intestinal cancer in China was 0.32/100 000 for men and 1.95/100 000 for women. Risk factors for small bowel cancer (β = 0.008 to 0.198; OR = 1.07 to 10.01) included higher human development index and gross domestic product; smoking and drinking habits; lack of exercise, obesity, diabetes, and lipid metabolism disorders; history of inflammatory bowel diseases. Therapeutically, the combined use of sulindac and erlotinib has been effective in reducing the polyp burden in patients with familial adenomatous polyposis. For Crohn’s disease in the small intestine, in terms of software, AI-assisted endoscopic recognition has been proven to reduce misdiagnosis ，improving medical quality. In terms of hardware, the electric spiral enteroscopy is a double-edged sword. Although it has a higher rate of completing entire small intestine examination, it cannot be widely used in clinical practice until its safety is fully guaranteed. In terms of drugs, with the in-depth understanding of the pathogenesis of the disease, targeted therapy for the inflammatory process has gradually become a research hotspot. Clinical data on small-molecule agents such as upadacitinib and filgotinib are continuously accumulating. In terms of surgery, the latest evidence supports that surgery may become a first-line treatment for specific Crohn’s disease. The diagnosis and treatment of small intestine bleeding are also continuously improving. Thalidomide, as a drug used to treat small intestine bleeding caused by capillary malformations, has brought good news to a large number of patients. In addition, the surgical treatment for small intestine obstruction is gradually being updated, and there are now more accurate prediction models for treatment decisions in patients with small intestine obstruction. Looking ahead, with the continuous development and innovation of medical technology, and artificial intelligence, the diagnosis and treatment of small intestinal diseases will become more precise and efficient.

Benign biliary stricture is a common complication of cholecystojejunostomy and is hard to handle. Ente-roscopy ERCP possesses the advantages such as repeatability, minimally invasive, and compliance with normal physiological structures in treatment. We shared our experiences of enteroscopy ERCP in benign biliary stricture after cholecystojejunostomy, hoping to improve the success rate of this treatment.

Objective To explore the anesthetic efficacy and safety of remimazolam in painless gastrointestinal en‑ doscopy for obese patients. Methods Eighty obese patients undergoing painless gastrointestinal endoscopy were enrolled and then were randomly divided into two groups: the remimazolam group and the propofol group, with 40 in each. The peripheral intravenous access was established. Fentanyl was injected intravenously for analgesic pretreatment, patients in the remazolam group were given 5 mg remimazolam, and patients in the propofol group were given 1. 5 mg/kg propofol medium/long-chain fat emulsion injection, and anesthetic drugs were added according to the situation during the operation. We monitored the intraoperative vital signs, including mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO2 )]. Hypoxia, apnea and subclinical respiratory depression were recorded. The Ramsay Sedation Scale was em‑ ployed to assess the anesthesia effect. Anesthesia time, duration of endoscopic procedure, and postoperative recovery time were recorded. The adverse events such as coughing, nausea, vomiting, movement, injection pain, and hypotension were also recorded. Results Both groups achieved Ramsay scores of 4 to 6, with no statistically significant difference between groups (P>0. 05). There was no statistically significant difference in sedation time or duration of endoscopic procedure be‑ tween the two groups (both P<0. 05). However, the postoperative recovery time was significantly shorter in the remimazolam group in comparison with that of the propofol group (P<0. 01). No statistically significant differences were observed in pre-anesthetic and post-awakening MAP, HR, and SpO2 between the two groups (all P>0. 05). In comparison with the remimazolam group, the propofol group exhibited decreased intraoperative MAP and SpO2 (both P<0. 05), with no significant change in HR (P>0. 05). During the painless gastrointestinal endoscopy procedure, the remimazolam group demon‑ strated lower incidences of hypoxia, respiratory pauses, and subclinical respiratory depression than the propofol group (all P<0. 05). Compared with the propofol group, the remimazolam group exhibited lower rates of nausea, vomiting, movement, and injection pain, as well as hypotension (all P<0. 05). The incidence of coughing did not show a statistically significant difference between the two groups (P>0. 05). Conclusion The utilization of remimazolam for painless gastrointestinal endoscopy in obese patients yields favorable anesthesia efficacy and safety, and can reduce the occurrence of intraoperative and postoperative adverse events. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the effects of Saccharomyces boulardii combined with sulfasalazine on Baron endoscopy score and intestinal mucosal barrier function in patients with ulcerative colitis. METHODS: A total of 184 ulcerative colitis patients admitted into our hospital from Jan. 2020 to Jan. 2022 were randomly divided into the control group and study group, with 92 cases in each group. Patients in both groups received conventional treatment, the control group received sulfasalazine treatment, while the study group was given S. boulardii combined with sulfasalazine, with continuous treatment for 1 month. The treatment effect, symptom improvement, recurrence, Baron endoscopy score before and after treatment, the number of intestinal flora, and intestinal mucosal barrier function indicators [diamine oxidase ( DAO), endotoxin lipopolysaccharide ( LPS), D-lactate ( DLA)], peripheral blood leptin (LP), T helper 17 / regulatory T cell (Th17 / Treg) levels of two groups were compared. RESULTS: The total effective rate of the study group was 93. 48% (86 / 92), significantly higher than that 82. 61% (76 / 92) of the control group, the difference was statistically significant (P<0. 05). The disappearance time of fever, diarrhea, abdominal pain and mucus, mucus pus and blood stool in the study group was significantly shorter than that in the control group, the differences were statistically significant ( P < 0. 05 ). After treatment, the number of Bifidobacterium and Lactobacillus in the study group was higher than that in the control group, while the number of enterobacterium and Baron endoscopy score in the study group were lower than that in the control group; the levels of DAO, LPS and DLA in the study group were lower than those in the control group after treatment; the levels of LP, Th17 and Th17 / Treg in peripheral blood of the study group were lower than those of the control group, and the levels of Treg were higher than those of the control group, with statistically significant differences (P<0. 05). The recurrence rate of the study group was 2. 13% ( 1 / 47 ), significantly lower than that of the control group ( 17. 50%, 7 / 40 ), the difference was statistically significant (P<0. 05). CONCLUSIONS: The efficacy of f S. boulardii combined with sulfasalazine in the treatment of ulcerative colitis is significant with lower recurrence rate. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of video education retelling intestinal preparation process based on QR code on the quality of colonoscopy intestinal preparation. Methods A total of 498 patients who met the inclusion criteria for colonoscopy in this hospital were randomly divided into the routine group (248 cases) and the video group (250 cases).The routine group received oral and written education on intestinal preparation. On the basis of the two, the video group jointly scanned the prefabricated two-dimensional code related intestinal preparation propaganda video. The same standard regimen of 3 L polyethylene glycol electrolyte powder was used for intestinal preparation in both groups. The colonoscopy insertion time, medication time, correct rate of medication and correct rate of meal preparation were recorded in two groups. Boston score was used to evaluate the quality of intestinal preparation. Results The correct rates of medication use and diet preparation were higher than those in the control group (P<0.05).The insertion time and withdrawal time of colonoscopy were significantly shorter than those of the control group (P<0.05). The cleanliness of the left, middle, and right segments in the video group were better than those in the control group (P<0.05). The score of Boston intestinal preparation scale in the observation group was higher than that in the control group (P<0.05). Conclusion Using conventional oral and written form with a short video to educate patients on colonoscopy preparation can improve their intestinal preparation ability and compliance, and shorten the colonoscopy time. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the short-term effect comparison between combined approach and page-turning laparoscopic-assisted radical resection of right colon cancer and open radical resection. Methods: Patients with right colon cancer diagnosed by CT and electronic enteroscopy in the Affiliated Tumor Hospital of Nantong University from April 2019 to March 2021 were selected. All patients were selected for radical right hemicolectomy (D2). Finally, 77 subjects were included in the study, including 39 male patients and 38 female patients, aged 37-75 years old. According to the surgical plan, the patients were divided into 40 cases of combined approach and page-turning laparoscopic assisted surgery and named the observation group. The remaining 37 cases underwent open radical surgery and served as the control group.All patients provided informed consent. Collect general patient information based on clinical data. The perioperative outcome was recorded as the operation time of laparotomy or laparoscopic surgery, blood loss, anal exhaust time, fluid diet time, hospital stay, and complications and mortality within 30 days. Polo-like kinase (Polo-like Kinase 1, Plk1), Thymidine Kinase 1 (TK1), X-linked inhibitor of apoptosis (X-linked inhibitor of apoptosis) were analyzed by western blotting in patients' serum 7 days after surgery . protein, XIAP) vitality. Results: There was no difference in general information between the two groups of patients (P>0.05). Compared with the control group, the observation group had shorter operation time, less blood loss, and lower incidence of Vascular risk factors (P<0.05).There was no difference in the amount of lymph node acquisition between the two groups (P>0.05). Compared with the control group, the observation group had shorter hospital stay, first anal exhaust time, infusion days and gastrointestinal function recovery time (P<0.05). 0.05). Compared with the control group, the observation group had no difference in the incidence of anastomotic leakage, chyle leakage, postoperative abdominal bleeding and paralytic intestinal obstruction (P>0.05), and the observation group had a higher overall incidence of adverse events than the control group (P<0.05). The protein expressions of Plk1, TK1, and XIAP in the observation group were lower than those in the control group (P<0.05). Conclusion: The combined approach of page-turning laparoscopic assisted right colon cancer is safe and feasible,and has low surgical difficulty, shortens the operation time, and reduces the operation time. The advantages of bleeding and speeding up postoperative recovery. [ABSTRACT FROM AUTHOR]

Objective: To explore the effectiveness and safety of balloon-assisted embolization in the treatment of unruptured intracranial aneurysms. Methods: From January 2014 to January 2019, 540 patients who received interventional therapy in the interventional department of our hospital were selected as the research subjects. According to the treatment plan, it was divided into two groups, namely, balloon-assisted embolization group(340 cases) and simple embolization group(200 cases). We retrospectively analyzed the general information, clinical data, and surgical complications of all patients. Results: The balloon-assisted embolization group and the simple embolization group were not statistically significant in terms of gender composition, age, nature, location of intracranial aneurysm,Hunt-Hess classification(P>0.05). The results of angiography immediately after operation and 6 months after operation showed that the embolization degree of the balloon-assisted embolization group was significantly better than that of the simple embolization group, the difference was statistically significant(P<0.05). The modified Rankin of the balloon-assisted embolization group The scale score was significantly better than the simple embolization group, the difference was statistically significant(P=0.005). The prognosis rate of the balloon-assisted embolization group was significantly higher than that of the simple embolization group, the difference was statistically significant(P<0.001). During the operation In the balloon-assisted embolization group, 2 cases of rupture and bleeding, 2 cases of cerebral vasospasm, and 1 case of coil displacement occurred. In the simple embolization group, 2 cases of rupture and bleeding, 1 case of embolization, 2 cases of cerebral vasospasm, and 3 cases of coil displacement. The incidence of complications in the balloon-assisted embolization group was significantly lower than that in the simple embolization group, and the difference was statistically significant(P<0.001). Conclusion: In the treatment of unruptured intracranial aneurysms, the effectiveness and safety of balloon-assisted embolization technology is significantly better than simple embolization interventional therapy, and it is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Objective: To explore the difference of small bowel CT and double-balloon enteroscopy in the diagnosis of Crohn's disease. Method: Choose 60 patients with Crohn's disease who were treated in our hospital from April 2017 to March 2019, and perform small bowel CT and double-balloon enteroscopy respectively, and compare the two detection methods to accurately diagnose Crohn's disease patients Rate and detection difference of lesion range, lesion location, mobility and complications. Results: The accuracy rate of CT in detecting Crohn's disease was 96.67%, and the accuracy of detecting Crohn's disease by double-balloon enteroscopy was 93.33%, and the difference was not statistically significant (P>0.05). Small bowel CT mainly showed 50 cases of intestinal stenosis (83.33%), 52 cases of intestinal wall thickening (86.67%), 46 cases of extraintestinal lymph nodes (76.67%), 21 cases of mesenteric edema and vascular changes (35.00%), extraintestinal Inflammation in 10 cases (16.67%), fistula in 3 cases (5.00%), fistula in 1 case (1.67%); double balloon enteroscopy showed ring ulcers, irregular ulcers, ring ulcers, etc., a total of 46 cases (76.67%), 22 cases (36.67%) of aphthous ulcers, 26 cases (43.33%) of mucosal hyperemia and edema, 6 cases (10.00%) of nodular hyperplasia, 16 cases (26.67%) of intestinal segmental stenosis of the small intestine, pseudo 9 cases of polyps (15.00%); pathological examination showed inflammatory infiltration of lymphocytes, neutrophils, eosinophils, and hyperplasia of lymphoid tissues and granulation tissues. CT showed extraintestinal inflammation, fistulas, fistulas, etc. There were 14 cases in total, and no complications were found with double balloon enteroscopy. Conclusion: Compared with double-balloon enteroscopy, small bowel CT can more accurately determine whether patients with Crohn’s disease are in an inflammatory state, and can more effectively detect the presence of extraintestinal complications, but small bowel CT and double-balloon enteroscopy are combined The application monitoring effect is better. [ABSTRACT FROM AUTHOR]

Objective: To study Application of dexmedetomidine combined with propofol in painless gastroenteroscopy and its effect on cognitive function of patients. Methods: 90 cases of painless gastroenteroscopy patients admitted to our hospital from August2015 to August 2018 were selected as research objects, the observation group(n=47) and control group(n=43) were randomly divided according to the number table. The control group was treated with propofol for anesthesia, and the observation group was treated with dexmedetomidine combined with propofol for anesthesia. The anesthetic effect, induction time, awake time, ventricular departure time,preoperative and postoperative MMSE score and adverse reactions were compared between the two groups. Results: The excellent and good rates of anesthesia in the two groups were 97.87% and 76.74%, respectively. The observation group was significantly higher than the control group(P<0.05). There was no significant difference in induction time between the two groups. Patients in the observation group had significantly shorter awake time and time away from the room than those in the control group(P<0.05). At 30 min, 3 h and 6 h after surgery, MMSE scores of patients in the observation group were all higher than those in the control group(P<0.05). The overall incidence of adverse reactions in the observation group was 10.64%, significantly lower than 30.23% in the control group(P<0.05).Conclusion: Dexmedetomidine hydrochloride combined with propofol for painless gastroenteroscopy is significantly better than propofol alone, and can effectively improve the cognitive function of patients. [ABSTRACT FROM AUTHOR]

Small bowel disease is one of the difficulties in the diagnosis and treatment of digestive system diseases, and limited examination techniques seriously restrict the diagnosis and treatment level of digestive tract diseases in children. With the wide clinical application of enteroscopy in pediatrics and the optimization of enteroscopy equipment and accessories, enteroscopy technique provides a new method for the diagnosis and treatment of pediatric digestive tract diseases, but there are still many issues and challenges in the standardization of clinical operation and endoscopic treatment. In order to standardize the diagnosis and treatment techniques for enteroscopy in children and improve the diagnosis and treatment level of small bowel disease, the Subspecialty Group of Gastroenterology, the Society of Pediatrics, Chinese Medical Association organized experts to fully discuss and formulate the expert consensus on the clinical application management of enteroscopy in children, with reference to the latest advances in the application of enteroscopy in children.