上海市消化内镜诊疗现状分析

通过全面了解上海市消化内镜诊疗工作现状,为上海市消化内镜诊疗规范和质控标准的修订提供决策支持。此次调查针对上海市145家开展消化内镜诊疗工作的医院,调查采用网络填报方式,调查对象通过调查网页填报各项条目,调查内容主要包括消化内镜从业人员情况、诊疗技术开展情况和质量安全情况。结果显示：2019年上海市消化内镜医师数量为1 212名,占全部执业医师比率（1.59%）居全国第一。全年内镜诊疗共开展190.26万例,医师工作压力较大。从单病种质控指标来看,各类消化道早期癌检出率和肠腺瘤检出率保持在较高水准。以上结果提示,2019年上海市消化内镜医师数量、诊疗量和单病种质控指标在全国处于领先地位。     

云南省县域医院消化内镜诊疗现状调查及建议

目的　综合分析云南省县域医院消化内镜中心（室）的基本情况、诊疗现状等信息,为提高与规范云南省消化内镜诊疗水平提供依据。方法　采用网络调查方式开展,对2019年1月—2020年1月期间云南省县域医院消化内镜中心（室）的医疗质量相关数据信息,包括内镜中心（室）设置、人员配置、诊疗技术及诊疗量、质量控制指标等进行统计分析。结果　共有143家县域医院参加调查统计,消化内镜中心（室）平均仅1.74个操作间,内镜主机平均1.42台,胃肠镜数量平均4条,143家县域医院内镜中心（室）的超声内镜主机共10台,小肠镜主机仅2台,经内镜逆行胰胆管造影术仅4家县域医院在开展。省内县域医院专职消化内镜医师共392名,能够完成四级手术的医师仅占医师总人数的18.62%（73/392）,其中掌握内镜黏膜下剥离术的医师比例仅6.12%（24/392）。省内县域医院消化道癌早期诊断率仅19.48%（1 133/5 817）,其中食管癌早期诊断率21.04%（276/1 312）、胃癌早期诊断率19.53%（397/2 033）、结直肠癌早期诊断率18.61%（460/2 472）。结直肠腺瘤检出率12.83%（12 207/95 148）,盲肠插管成功率70.49%（67 067/95 148）,内镜黏膜下剥离术完整切除率为12.54%（221/1 763）。结论　云南省县域医院消化内镜中心（室）配置、诊疗技术水平、质量控制指标整体水平较低下,仍需要在完善消化内镜质量控制体系的基础上,提升县域医疗机构消化内镜服务能力、诊疗技术水平。     

贵州省消化内镜从业人员诊疗的现状

目的:了解贵州省消化内镜从业人员诊疗技术水平状况,为提高贵州省消化内镜从业人员诊疗水平及培训模式提供参考依据.方法:通过向参会的医师发放调查表,进行现场问卷调查.结果:贵州省消化内镜从业人员诊疗技术力量较为薄弱,诊疗知识不足,并存在明显的院级差异,与发达省份存在较大的差距;而继续教育项目的设置、开展较不合理,贵州省消化内镜从业人员的培养状况及诊疗水平有待提高.结论:为提高贵州省消化内镜从业人员诊疗水平,在二级医院应设置独立的消化内镜室和配置专业人员,同时加强三级和二级医院的联合,改进继续教育项目的内容及形式,完善消化内镜从业人员进修制度,强化从业人员的规范化培训,加大财政支持,缩小与发达省份在消化内镜诊疗技术的差距.     

上海市消化内镜调查报告

目的：通过消化内镜开展情况调查,为今后制定上海市内镜质量控制标准打下基础。方法：对上海市各级医院发放调查表,统计内镜工作量、 开展项目、内镜室设置、内镜数量及消毒情况。结果;在开展胃镜检查的医院中,约2／3也进行肠镜检查,1／2医院开展逆行胰胆管造影;在治疗内镜中,开展最多的是止血治疗,其次是狭窄扩张,开展乳头切开取石者仅占7．2％;多数医院存在胃镜室面积过小、胃镜数量不足、消毒不严等问题。结论：制订内镜室设施基本标准、内镜消毒规范和培训内镜医师及护士是提高内镜检查质量的主要措施。     

我国消化内镜传统诊治项目开展现状与分析:169家医院调查报告

目的 调查分析我国消化内镜传统诊治项目(常规胃肠镜检查、息肉切除等)开展状况.方法 以国内不同省份的各级医院消化内镜单元(室)为调查对象,采用电子邮件或电话问卷方式对我国消化内镜传统诊治项目开展状况进行调查分析.率的比较采用X2检验.结果 自2010年5月至11月,共有169家医院纳入本次调查,分布于28个省,占国内大陆省份的90.3％ (28/31),其中147家医院可开展消化内镜操作,占87.0％.在这147家医院中,所有医院(100％)均可开展常规胃镜检查,93.9％(138/147)的医院可开展肠镜检查,二、三级医院肠镜开展率(97.8％、100％)高于一级医院(25.0％,x2=60.9,P＜0.01);所有三级医院(100％)和79.8％(71/89)的二级医院能开展内镜下息肉切除术,明显高于一级医院(16.7％,x2=20.0,P＜0.01);在147家医院中,共有74家开展经内镜逆行胰胆管造影(ERCP),占50.3％,其中76.1％(35/46)的三级医院、43.8％(39/89)的二级医院可开展ERCP,三级医院高于二级医院(x2=12.7,P＜0.01);12家已开展消化内镜操作的一级医院中,均未开展ERCP、超声内镜检查(EUS)及食管静脉套扎+硬化(EVL+ EVS)治疗.结论 常规胃肠镜检查在我国二、三级医院已普及,一级医院还有较大提升空间;ERCP术及EVL+ EVS等传统消化内镜介入操作在三级医院较普及,二级医院有待提高.     

新时代消化内镜技术培训和内镜医师培养

我国消化内镜技术近年来发展迅速,但内镜医师培训发展相对缓慢,未形成与人民诊疗需求相适应的内镜医师培训体系。美国、日本和英国等发达国家均形成了相对完善的内镜医师培训体系,对我国内镜医师培训工作具有重要借鉴意义。学习国际先进理念,结合我国实际国情,实现内镜医师培训统一报名准入、管理部署、课程学习、考核认证、监督质控,系统性地培养一大批合格、优秀的消化内镜医师,是提升我国新时代消化内镜诊疗水平的必由之路。本文就内镜医师成长轨迹,合格、优秀内镜医师应具备的能力素质和国内外消化内镜医师培训进展作一述评。     

2021国家消化内镜诊疗服务与质量安全报告

目的　评价2020年我国消化内镜诊疗服务质量。方法　纳入国家医疗质量信息网络收集的2020年消化内镜相关数据,进行数据质量评价和筛选后,对我国整体和不同类型医院消化内镜中心基本情况、消化内镜诊疗情况、消化内镜过程与结果指标进行分析和比较。结果　调查共纳入3 714家医院,各医院完成消化内镜诊疗例次3 562.5（1 299.75,8 426.75）例次,消化内镜医师数4（2, 7）名,人均年完成内镜操作900（500,1 452）例次。消化道早期癌内镜检出率为17.46%（110 069/630 265）,结肠镜盲肠插管成功率为95.43%（6 976 521/7 310 970）,经内镜逆行胰胆管造影术选择性深插管成功率为94.21%（121 666/129 149）,内镜黏膜下剥离术完全切除率为92.68%（93 536/100 924）。消化内镜诊疗相关严重并发症发生率［0.05‰（1 316/26 499 108）］及死亡率［0.003‰（80/26 499 108）］保持在较低水平。结论　2020年我国消化内镜诊疗质量及安全性整体较高,但仍存在消化内镜人力资源短缺、内镜医师消化道早期肿瘤诊断能力较差的问题。     

关于消化内镜基础操作与诊断的培训

消化内镜是目前诊治消化道疾病最常用、最直观的检查手段,被视为许多消化道疾病诊断的金标准.我国消化内镜诊治技术近年来发展迅速,很多消化内镜诊治项目已普及到基层医疗单位.根据我们2010年开展的全国消化内镜诊治项目调查,县级以上医院100％开展了胃镜检查、88.2％的县级医院开展了结肠镜检查,并且内镜的治疗技术如息肉切除在省级医院开展率为100％、地市级医院为78.0％、县级医院也已达到41.2％[1].但是,目前国内在消化内镜诊治操作方面仍存在重内镜操作、轻理论学习,重内镜检查数量、轻内镜诊治质量,以及缺乏规范化内镜基础操作和诊断技术培训等问题.这些问题的存在将直接影响对消化道疾病的正确诊断和治疗,必将影响、甚至阻碍该技术在我国的长期发展和提高.     

新型冠状病毒肺炎疫情期间全国儿科消化内镜开展情况调查

目的总结新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）疫情期间全国儿科消化内镜开展诊疗经验,为下一步临床诊疗工作提供防控指导。方法中华医学会消化内镜学分会儿科协作组对全国47所儿科消化内镜中心2020年1月24日—3月1日内镜诊治开展情况以问卷调查表的形式进行了调查。结果疫情期间,儿科消化内镜中心采用了停止常规内镜诊疗、严格术前流行病学排查、增加特殊术前检查、术前内镜医师会诊制度、候诊区管理、精简工作人员、不同岗位不同防护级别、特殊麻醉管理、重视诊疗区域消毒、加强内镜清洗消毒及医疗废物管理等防控措施。47所医院在2020年1月24日—3月1日38 d内共完成536例儿科消化内镜诊疗,其中治疗210例（39.2%）,诊断326例（60.8%）,未发生一例院内感染。结论COVID-19疫情期间,全国儿科消化内镜中心根据国家疫情防控政策及相关指南要求,结合儿科特点及医院实际情况,在严格把握内镜诊疗指征、严密防护的前提下,安全开展了儿科消化内镜诊疗。     

陕西省消化内镜现况调查分析

随着科技及医疗技术水平的发展,消化内镜这项侵入性微创性诊疗技术在我国发展较为全面和成熟,已成为消化内科疾病诊治最重要的手段之一.但是,我们还不是很了解陕西省各级医院消化内镜的具体情况.为了推动陕西省消化内镜更好的发展,了解不同级别、不同规模陕西省内医院消化内镜工作量、开展项目、内镜人员的配备及内镜消毒等现状,我们在中华医学会陕西消化内镜学会的领导下,调查了2009年1月至2010年1月年陕西省不同地区不同等级医院的消化内镜的诊治现况,报道如下.一、对象与方法1.对象:陕西省医院120家.调查内容包括:拥有消化内镜的数量及种类;内镜专业医疗人员配比情况;内镜下开展的诊疗项目,如进行常规胃肠镜检查的工作量,内镜下开展介入治疗项目等情况;内镜检查工作量;胃镜消毒方法、消毒剂的种类、消毒时间等消毒情况.     

Endoscopic complications--avoidance and management

The frequency of endoscopic complications is likely to rise owing to the increased number of indications for therapeutic procedures and also to the increased complexity of endoscopic techniques. Informed patient consent should be obtained as part of the procedure. Prevention of endoscopic adverse events is based on knowledge of the relevant risk factors and their mechanisms of occurrence. Thus, suitable training of future gastroenterologists and endoscopists is required for these complex procedures. When facing a complication, appropriate management is generally provided by an early diagnosis followed by prompt therapeutic care tailored to the situation. The most common complications of diagnostic and therapeutic upper gastrointestinal endoscopy, retrograde cholangiopancreatography, small bowel endoscopy and colonoscopy are reviewed here. Different modalities of medical, endoscopic or surgical management are also considered.     

Training in endoscopic submucosal dissection from a Western perspective

Endoscopic submucosal dissection (ESD) is a mature endoscopic procedure that was developed in Japan to enable the en bloc, curative resection of superficial dysplastic lesions in the luminal gastrointestinal tract that have a low risk of lymph node metastasis. ESD requires a cognitive understanding of endosurgical principles, the ability to apply advanced optical imaging techniques to diagnose and stage lesions, and a high degree of endoscopic skill. Training in ESD should ideally begin with small lesions in the distal stomach, but such an approach is not applicable to endoscopists who are trying to learn and perform ESD in Western countries; as such, a “prevalence-based approach” is required that might vary from country to country. Proposed thresholds for attaining and maintaining competence in ESD, particularly for Western endoscopists, include rates of en bloc resection ≥80% and adverse events ≤10%. Endoscopists skilled in ESD should achieve rates of en bloc resection ≥90% and adverse events ≤5%. In order to offer ESD on a national level, a critical mass of endoscopists proficient in ESD is required who can then establish regional or national training centers and teach others with the requisite endoscopic skill and experience how to perform this elegant procedure. In the United States, ESD-specific billing codes are required to defray the procedural cost for endoscopy centers and health systems and to adequately compensate those endoscopists who offer this procedure as a life-saving alternative to more invasive surgical resection.     

Procedure-related musculoskeletal symptoms in gastrointestinal endoscopists in Korea

AIM： To determine the prevalence and risk factors of work-related musculoskeletal disorders in gastrointestinal endoscopists in Korea. METHODS： A survey of musculoskeletal symptoms, using a self-administered questionnaire, was conducted on 55 endoscopists practicing in general hospitals or health promotion centers. RESULTS： Forty-nine （89.1%） endoscopists reported musculoskeletal pain on at least one anatomic location and 37 （67.3%） endoscopists complained of pain at rest. Twenty-six （47.3%） endoscopists had severe musculoskeletal pain defined as a visual analogue score greater than 5.5. Factors related to the development of severe pain were （1） standing position during upper endoscopy, （2） specific posture/ habit during endoscopic procedures, and （3） multiple symptomatic areas. Finger pain was more common in beginners, whereas shoulder pain was more common in experienced endoscopists. Sixteen percent of symptomatic endoscopists have modified their practice or reduced the number of endoscopic examinations. Only a few symptomatic endoscopists had sought professional consultation with related specialists. CONCLUSION： The prevalence of musculoskeletal pain in endoscopists is very high. The location of pain was different between beginners and experienced endoscopists. Measures for the prevention and adequate management of endoscopy-related musculoskeletal symptoms are necessary.     

Technology insight: endoscopic submucosal dissection of gastrointestinal neoplasms

Gastrointestinal neoplasms can be cured by local resection as long as the lesions are in the early stage and have not metastasized. Endoscopic resection is a minimally invasive treatment for early-stage gastrointestinal neoplasms, and endoscopic submucosal dissection (ESD) is one type of endoscopic resection that has been developed in the past 10 years. For ESD to be a reliable, curative treatment for gastrointestinal neoplasms, it is necessary for the endoscopist to detect the lesion early, make a precise pretreatment diagnosis, ensure that the patient has the correct indication for endoscopic resection, and have the skill to perform ESD. For early lesion detection, endoscopists should pay attention to subtle changes in the surface structure, the color of the mucosa and the visibility of underlying submucosal vessels. Chromoendoscopy and magnifying endoscopy are useful for determining the margin of the lesions for pretreatment diagnosis, and endoscopic ultrasonography and magnifying endoscopy are useful for determining the depth of invasion. For ESD to be successful, local injection of sodium hyaluronate helps maintain mucosal elevation during dissection. Selecting the appropriate knife, using transparent hoods wisely, employing a good strategy that uses gravity, and having good control of bleeding are all needed to make ESD reliable.     

Endoscopic therapy in early adenocarcinomas (Barrett's cancer) of the esophagus

The incidence of early esophageal adenocarcinoma has been increasing significantly in recent decades. Prognosis depends greatly on the choice of treatment. Early cancers can be treated by endoscopic resection, whereas advanced carcinomas have to be sent for surgery. Esophageal resection is associated with high perioperative mortality (1–5%) even in specialized centers. Early diagnosis enables curative endoscopic treatment option. Patients with gastrointestinal symptoms and a familial risk for esophageal cancer should undergo upper gastrointestinal endoscopy. High‐definition endoscopes have been developed with technical add‐on that helps endoscopists to find fine irregularities in the esophageal mucosa, but interpreting the findings remains challenging. In this review we discussed novel and old diagnostic procedures and their values, as well as our own recommendations and those of the authors discussed for the diagnosis and treatment of early Barrett's carcinoma. Endoscopic resection is the therapy of choice in early esophageal adenocarcinoma. It is mandatory to perform a subsequent ablation of all residual Barrett's mucosa to avoid metachronous lesions.     

Characteristics of Australian after-hours emergency endoscopy services

BACKGROUND AND AIM: Early endoscopic intervention reduces morbidity and mortality for patients with high-risk gastrointestinal hemorrhage and gallstones causing pancreatitis or ascending cholangitis. For low-risk bleeds 'after-hours' endoscopy services allow risk stratification and early, safe discharge leading to reduced length of stay. Recognized standards for these services include availability of endoscopically trained medical and nursing staff, access to a specialized endoscopy unit and full availability of the service. The aim of the present study was to assess 'after-hours' endoscopy services at Australian teaching hospitals using the British Society of Gastroenterology (BSG) criteria. METHODS: A standardized questionnaire based on the BSG guidelines was developed. The Gastroenterology Society of Australia provided a list of accredited sites for gastroenterology training. An advanced gastroenterology trainee at each hospital was interviewed by telephone. RESULTS: Thirty-four centers (100%) provided complete data. Gastroscopy, colonoscopy and endoscopic retrograde cholangiopancreatography were provided in 100, 58 and 84% of centers, respectively. The operation suite followed by endoscopy unit was the most frequently used site. However, one-third of centers performed procedures at the bedside, including the emergency department or ward. Support staff were not consistently trained endoscopically and, in 15 centers (44%), the advanced trainees participated in the 'on call' roster with a consultant present for the procedure, although this was not consistently the case. CONCLUSIONS: Most Australian hospitals offer comprehensive emergency endoscopy services. However, few centers fulfill all BSG recommendations. The registrar training and patient safety implications of emergency endoscopic services need to be considered in the light of these findings.     

Artificial intelligence and upper gastrointestinal endoscopy: Current status and future perspective

With recent breakthroughs in artificial intelligence, computer‐aided diagnosis (CAD) for upper gastrointestinal endoscopy is gaining increasing attention. Main research focuses in this field include automated identification of dysplasia in Barrett's esophagus and detection of early gastric cancers. By helping endoscopists avoid missing and mischaracterizing neoplastic change in both the esophagus and the stomach, these technologies potentially contribute to solving current limitations of gastroscopy. Currently, optical diagnosis of early‐stage dysplasia related to Barrett's esophagus can be precisely achieved only by endoscopists proficient in advanced endoscopic imaging, and the false‐negative rate for detecting gastric cancer is approximately 10%. Ideally, these novel technologies should work during real‐time gastroscopy to provide on‐site decision support for endoscopists regardless of their skill; however, previous studies of these topics remain ex vivo and experimental in design. Therefore, the feasibility, effectiveness, and safety of CAD for upper gastrointestinal endoscopy in clinical practice remain unknown, although a considerable number of pilot studies have been conducted by both engineers and medical doctors with excellent results. This review summarizes current publications relating to CAD for upper gastrointestinal endoscopy from the perspective of endoscopists and aims to indicate what is required for future research and implementation in clinical practice.