Endoscopic ultrasound(EUS) is one of the most important modalities for the diagnosis of digestive tract diseases.EUS has been evolving ever since it was introduced.New techniques such as elastography and contrast enha...Endoscopic ultrasound(EUS) is one of the most important modalities for the diagnosis of digestive tract diseases.EUS has been evolving ever since it was introduced.New techniques such as elastography and contrast enhancement have emerged, increasing the accuracy, sensitivity and specificity of EUS for the diagnosis of digestive tract diseases including pancreatic masses and lymphadenopathy.EUS-elastography evaluates tissue elasticity and therefore, can be used to differentiate various lesions.Contrast-enhanced EUS can distinguish benign from malignant pancreatic lesions and lymphadenopathy using the intravenous injection of contrast agents.This review discusses the principles and types of these new techniques, as well as their clinical applications and limitations.展开更多
Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for t...Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy,prov-iding a new direction for the treatment of gastroparesis.With the recent and rapid development of G-POME therapy technology,progress has been made in the treatment of gastroparesis and other upper digestive tract diseases,such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture,with G-POME.This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.展开更多
With the digestive endoscopic tunnel technique(DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscular...With the digestive endoscopic tunnel technique(DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria(MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal(GI) tract.At present, the tunnel technique application range covers the following:(1)Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis;(2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and(3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment.The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism,and significance of DETT, prevention of infection and concepts of DETTassociated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract(indications and contraindications, procedures, pre-and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).展开更多
Narrow band imaging(NBI) is a new image enhancement system employing optic digital methods to enhance images of blood vessels on mucosal surfaces,allowing improved visualization of mucosal surface structures.Studies h...Narrow band imaging(NBI) is a new image enhancement system employing optic digital methods to enhance images of blood vessels on mucosal surfaces,allowing improved visualization of mucosal surface structures.Studies have progressed over the last several years,and the clinical usefulness has been demonstrated.NBI has become frequently applied for preoperative diagnosis before endoscopic submucosal dissection(ESD) of digestive tract cancers,as well as for assessment of the range of ESD for en-bloc resection of large lesions.Consensus has been reached with regard to the usefulness of NBI for detecting micro-lesions of esophageal squamous cell carcinoma indicated for ESD,for the diagnosis of the range and depth.NBI has also been attracting attention for diagnosing gastric cancer based on the observation of micro blood vessels on the mucosal surface and mucosal surface microstructures.The usefulness of NBI has been reported in relation to various aspects of colon cancer,including diagnoses of the presence,quality,range,and depth of lesions.However,as NBI has not surpassed diagnostic methods based on magnifying observation combined with the established and widely employed dye method,its role in ESD is limited at present.Although NBI is very useful for the diagnosis of digestive tract cancers,comprehensive endoscopic diagnosis employing the combination of conventional endoscopy including dye spraying,EUS,and NBI may be important and essential for ESD.展开更多
文摘Endoscopic ultrasound(EUS) is one of the most important modalities for the diagnosis of digestive tract diseases.EUS has been evolving ever since it was introduced.New techniques such as elastography and contrast enhancement have emerged, increasing the accuracy, sensitivity and specificity of EUS for the diagnosis of digestive tract diseases including pancreatic masses and lymphadenopathy.EUS-elastography evaluates tissue elasticity and therefore, can be used to differentiate various lesions.Contrast-enhanced EUS can distinguish benign from malignant pancreatic lesions and lymphadenopathy using the intravenous injection of contrast agents.This review discusses the principles and types of these new techniques, as well as their clinical applications and limitations.
文摘Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy,prov-iding a new direction for the treatment of gastroparesis.With the recent and rapid development of G-POME therapy technology,progress has been made in the treatment of gastroparesis and other upper digestive tract diseases,such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture,with G-POME.This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.
基金Supported by National Key R and D Program of China,No.2016YFC1303601
文摘With the digestive endoscopic tunnel technique(DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria(MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal(GI) tract.At present, the tunnel technique application range covers the following:(1)Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis;(2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and(3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment.The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism,and significance of DETT, prevention of infection and concepts of DETTassociated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract(indications and contraindications, procedures, pre-and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).
文摘Narrow band imaging(NBI) is a new image enhancement system employing optic digital methods to enhance images of blood vessels on mucosal surfaces,allowing improved visualization of mucosal surface structures.Studies have progressed over the last several years,and the clinical usefulness has been demonstrated.NBI has become frequently applied for preoperative diagnosis before endoscopic submucosal dissection(ESD) of digestive tract cancers,as well as for assessment of the range of ESD for en-bloc resection of large lesions.Consensus has been reached with regard to the usefulness of NBI for detecting micro-lesions of esophageal squamous cell carcinoma indicated for ESD,for the diagnosis of the range and depth.NBI has also been attracting attention for diagnosing gastric cancer based on the observation of micro blood vessels on the mucosal surface and mucosal surface microstructures.The usefulness of NBI has been reported in relation to various aspects of colon cancer,including diagnoses of the presence,quality,range,and depth of lesions.However,as NBI has not surpassed diagnostic methods based on magnifying observation combined with the established and widely employed dye method,its role in ESD is limited at present.Although NBI is very useful for the diagnosis of digestive tract cancers,comprehensive endoscopic diagnosis employing the combination of conventional endoscopy including dye spraying,EUS,and NBI may be important and essential for ESD.
