功能性胃肠病与器质性疾病鉴别的临床思维

临床医学是实践性科学,规范疾病的诊断与诊疗是提高医师临床专业水平的必要环节。为了提高医师队伍的临床诊疗水平和医疗服务质量,促进消化医学事业的健康发展,中国医师协会消化医师分会已于2009年开展了对消化专科医师《消化疾病诊治规范》的培训活动。为进一步深入开展这项活动,中国医师协会消化医师分会将自2010年始在《中国实用内科杂志》设立中国医师协会消化医师规范化培训专栏,邀请国内有影响的消化病专家对常见消化疾病进行专题讲座,解读疾病诊治和诊疗操作技术指南和(或)专家共识,规范消化疾病的诊断与治疗,使消化医师学会并掌握合理的、正确的临床思维方法,提高对疾病的诊治水平,更好地为广大患者服务。     

2011北京多镜联合模拟教学与临床应用研讨会通知

由北京市医学会消化内镜分会主办，北京平谷区医院、北京平谷动物模拟医院协办的2011北京多镜联合模拟教学与临床应用研讨会，将于2011年08月26—28日在首都北京召开，该会将邀请国内外著名消化与腹部外科内镜医师讲解并演示最新的消化内镜、腹部外科内镜等的新技术、新方法，特别强调常规内镜技术的动物模拟培训和内外科多镜联合技术的基础与临床应用与演示，给您一种全新的理念，     

新型冠状病毒肺炎疫情防控期间ERCP 诊疗专家共识

为降低新型冠状病毒肺炎疫情防控期间经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）诊疗工作中医患感染的风险,国家消化内镜专业质控中心联合中国医师协会内镜医师分会、中华医学会消化内镜学分会组织相关专家制定了《新型冠状病毒肺炎疫情防控期间ERCP诊疗专家共识》,旨在规范诊疗流程、防控与洗消措施,确保医患双方的诊疗安全。     

空军特色医学中心消化内科简介

正空军特色医学中心(原空军总医院)内科消化学组始建于1956年,1979年正式成立消化专科。在国内较早开展了纤维胃镜、纤维结肠镜及ERCP等技术。本世纪初,科室成为国内最早引进双气囊小肠镜和胶囊内镜的单位之一。2008年成为全军小肠疾病内镜诊疗中心,2017年成为中国医师协会首批小肠镜医师培训中心之一。近十余年来,科室集中力量专注于小肠疾病的临床诊治及基础研究,在小肠疾病内镜诊治领域开展了较多探索性工作,形成了鲜明专科特色,累积完成500余例黑斑息肉综合征患者2000余例次小肠息肉镜下治疗术。另外,在国际上率先或较早开展了小肠血管畸形镜下治疗术、小肠镜黏膜下剥离术(ESD)、小肠镜下狭窄扩张及切开术,小肠金属支架放置术、小肠镜下经皮空肠造瘘术等新技术。近年来,科室在小肠疑难罕见疾病诊治、尤其是小肠出血性疾病诊治方面积累了丰富经验。通过定期召开小肠疾病学术会议,举办小肠镜诊治技术培训班、进修班、网络授课等方式,促进了国内小肠疾病的临床诊治研究及学术交流,推动了小肠镜规范化培训,为国家培养了近百名合格的小肠镜医师。     

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内镜下逆行胰胆管造影(endoscopic retrograde cholan-giopancreatography,ERCP)是技术要求最高、风险最大的消化内镜操作,为保证操作成功及患者的安全,需要对进行ERCP操作的医师进行严格培训。中国医师协会消化医师分会以国外有关指南为蓝本,结合我国实际制订了《内镜下逆行胰胆管造影操作指南(讨论稿)》,并在第四界北京国际消化疾病论坛期间经过与会专家和代表的广泛讨论。该指南从ERCP操作术前、术中和术后3个阶段分别进行阐述。术前阶段主要涉及检查的适应证、知情同意及必要的抗生素预防等方面;术中阶段包括内镜检查和治疗的完成…     

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.     

中国医师协会消化医师分会年会暨十一届北京国际消化疾病论坛通知

由中国医师协会消化医师分会、首都医科大学附属北京友谊医院、中国医学科学院北京协和医院、首都医科大学消化病学系、北京市消化疾病中心共同主办的“中国医师协会消化医师分会年会暨第十一届北京国际消化疾病论坛”将于2014年6月13日至15日在北京召开。本次论坛在秉承消化、内镜、肝病和外科相结合以及现场直播内镜、腔镜手术操作等特色的基础上,继续开展联合、专题论坛,     

结肠镜检查肠道准备专家共识意见(2023, 广州)

自2019年中国医师协会内镜医师分会消化内镜专业委员会、中国抗癌协会肿瘤内镜学专业委员会发布《中国消化内镜诊疗相关肠道准备指南(2019, 上海)》以来, 随着国内人群对于结肠镜检查的需求普遍加大, 国内消化内镜技术得以飞速发展, 质量控制体系逐渐健全, 人工智能评价领域逐渐开展。为进一步更新相关进展, 中华医学会消化内镜学分会结直肠学组牵头拟定本共识意见, 聚焦结肠镜检查前的肠道准备, 借鉴国内外最新的相关研究, 并邀请国内消化领域专家进行讨论及修改, 对各推荐意见的证据质量及推荐强度进行评估并投票。本共识意见主要从结肠镜检查前肠道准备的必要性、质量控制及质量评分、常用肠道清洁剂的推荐使用策略、提高肠道准备质量的有效措施、肠道准备的个体化应用、肠道准备的宣教方式共6个方面分别进行阐述, 对结肠镜检查前相关肠道准备的实施与策略提供指导性建议, 供临床医师参考。     

结肠镜检查肠道准备专家共识意见（2023，广州）

自2019年中国医师协会内镜医师分会消化内镜专业委员会、中国抗癌协会肿瘤内镜学专业委员会发布《中国消化内镜诊疗相关肠道准备指南（2019,上海）》以来,随着国内人群对于结肠镜检查的需求普遍加大,国内消化内镜技术得以飞速发展,质量控制体系逐渐健全,人工智能评价领域逐渐开展。为进一步更新相关进展,中华医学会消化内镜学分会结直肠学组牵头拟定本共识意见,聚焦结肠镜检查前的肠道准备,借鉴国内外最新的相关研究,并邀请国内消化领域专家进行讨论及修改,对各推荐意见的证据质量及推荐强度进行评估并投票。本共识意见主要从结肠镜检查前肠道准备的必要性、质量控制及质量评分、常用肠道清洁剂的推荐使用策略、提高肠道准备质量的有效措施、肠道准备的个体化应用、肠道准备的宣教方式共6个方面分别进行阐述,对结肠镜检查前相关肠道准备的实施与策略提供指导性建议,供临床医师参考。     

中国消化内镜诊疗中心安全运行指南（2021）

消化内镜是诊治消化道疾病的重要手段和筛查消化道早期癌的金标准,近年来在全国各级医疗机构和健康管理中心得到广泛开展。国家消化内镜专业质控中心联合中国医师协会内镜医师分会和中华医学会消化内镜学分会,组织相关专家,参考国内外相关文献,结合我国实际情况,共同讨论制定本指南。本指南内容涵盖消化内镜诊疗中心功能区域设置、设施管理、人员配置、教育培训等方面要求,旨在规范内镜中心建设和运行,提升消化内镜诊疗质量和安全性。     

Current status of endoscopic resection in China

The early diagnosis of early gastrointestinal (GI) diseases is becoming easier than ever before, due to the rapid development of all kinds of endoscopic techniques, including chromoendoscopy, narrowband imaging, magnifying endoscopy, confocal microscopy and autofluorescence imaging. Endoscopic resection is gradually becoming the optimal choice, which is significantly less invasive than conventional surgical interventions. In China, endoscopic resection techniques have been developed very quickly after several pioneers learned from Japanese gastroenterologists. Endoscopic submucosal dissection (ESD) has achieved remarkable initial outcomes, however, large-scale, multicenter, retrospective studies of the long-term follow up of ESD outcomes in China are still lacking. New endoscopic interventions are also being developed from the ESD technique, namely, endoscopic full-thickness resection of gastric submucosal tumors, peroral endoscopic myotomy and submucosal tunneling endoscopic resection techniques. Here, we discuss the current status of endoscopic resection in China and several problems: (i) the lack of guideline or consensus from academic society; (ii) approximately half of the ESD are performed on benign submucosal tumors, so the diagnosis of mucosal cancers needs to be increased; (iii) the standard technique used, results, management of complications and follow-up should be standardized; and (iv) the minimum training requirements, the step-by-step approach should also need to be standardized.     

Training pathways and competency assessment in peroral endoscopic myotomy (POEM)

Peroral endoscopic myotomy (POEM) is a minimally invasive natural orifice endoscopic surgical procedure initially developed for treatment of achalasia. Recent studies have shown excellent clinical and safety outcomes in all types of achalasia, and even spastic esophageal disorders. POEM is a complex and technically challenging procedure with risk of potentially serious adverse events. Hence, appropriate training is essential for POEM, even for advanced endoscopists with extensive experience in interventional endoscopy. A few studies have suggested preclinical training using ex vivo and live animal models, with successful transition to human cases but standardized training pathways have not been defined yet. As with other new techniques, there is a learning curve for training in POEM and the number of procedures required to master the technique varies depending on prior endoscopic experience and skill. Procedure time has been shown to improve with case volume, though competence may not be defined only by procedure time and number of procedures performed. In this report, we evaluate training avenues for POEM and suggest competency assessment metrics. Further studies are required to define objective measures of performance and quality metrics for this new endoscopic surgical procedure.     

中国小肠出血内镜诊治专家共识意见（2023版）

随着胶囊内镜及器械辅助小肠镜等技术的临床推广应用，小肠出血诊治效率较前明显提高，但小肠出血依然是困扰临床的难题。如何规范小肠出血诊治流程及优化诊断策略，进一步提高诊治效率具有重要现实意义，有必要制定中国小肠出血内镜诊治专家共识意见。该共识基于循证医学依据及专家经验，紧紧围绕小肠出血的相关定义、病因、诊断流程（策略）、内镜治疗、药物治疗及随访等临床问题进行梳理及充分讨论，形成相关推荐意见，以便规范小肠出血诊治流程，提高诊治效率并最终改善患者预后。     

Perforation due to ERCP

Iatrogenic duodenal and pancreaticobiliary perforations associated with endoscopic retrograde cholangiopancreatography (ERCP) are rare but associated with a significant morbidity and mortality. Perforations can be caused by the endoscope itself, secondary to endoscopic sphincterotomy, or related to the use of accessories (guidewires and stents). There is no consensus to direct the clinician on proper management of ERCP-related perforation. Traditionally perforations were classified according to their etiology and anatomical site and managed accordingly. Recently, the time to diagnosis, clinical state of the patient, and results of imaging studies have been shown to better predict the need for surgical intervention. This review summarizes perforations related to ERCP, with an emphasis on the criteria to determine if medical or surgical intervention is the appropriate management strategy.     

Endoscopy in Canada: Proceedings of the National Roundtable: Toronto,Ontario, February 7, 2014

This 2014 roundtable discussion, hosted by the Canadian Association of General Surgeons, brought together general surgeons and gastroenterologists with expertise in endoscopy from across Canada to discuss the state of endoscopy in Canada. The focus of the roundtable was the evaluation of the competence of general surgeons at endoscopy, reviewing quality assurance parameters for high-quality endoscopy, measuring and assessing surgical resident preparedness for endoscopy practice, evaluating credentialing programs for the endosuite and predicting the future of endoscopic services in Canada. The roundtable noted several important observations. There exist inadequacies in both resident training and the assessment of competency in endoscopy. From these observations, several collaborative recommendations were then stated. These included the need for a formal and standardized system of both accreditation and training endoscopists.     

Application of single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients after bilioenteric Roux-en-Y anastomosis: Experience of multi-disciplinary collaboration

BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography(ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown.AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted(SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China.METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated.RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60(93.8%) cases and successful diagnosis in 59(92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation,and no post-ERCP pancreatitis occurred.CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.     

中国胆瘘消化内镜诊治专家共识（2020，北京）

如何开展胆瘘的规范化内镜诊断和治疗，以保证胆瘘患者有良好预后，是越来越多的消化内镜医师关注的焦点。目前，对于胆瘘的病因、诊断和处理等问题均尚无明确的指南参考和统一的专家共识。为此，由中华医学会消化内镜学分会与中国医师协会内镜医师分会牵头，组织国内相关领域专家参考相关的最新研究进展，通过集体讨论与投票等方式，共同制定中国胆瘘消化内镜诊治专家共识。本共识内容分为胆瘘的发生原因、诊断、分级与分型及治疗，共13条陈述建议。     

减重与代谢外科加速康复外科原则中国专家共识（2021版）

目的近年加速康复外科（ERAS）在外科领域得以广泛应用,减重与代谢外科有其特殊性,建立适合中国国情的减重与代谢外科ERAS原则专家共识十分必要。 方法参照改良Delphi方法建立《减重与代谢外科加速康复外科原则中国专家共识（2021版）》。由20位从事减重与代谢外科的专家组成专家组,提出、审核EARS原则条目,由专家组邀请56位有经验的减重与代谢外科医师,共76位专家对42项ERAS原则条目进行投票,经两轮投票赞成率≥70%的条目为达成共识。 结果经第一轮投票,42项ERAS原则条目中,14项赞成率<80%;经第二轮投票,最终36项ERAS原则条目达成共识,6项条目未达成共识。 结论结合文献证据及中国减重与代谢外科具体情况,建立《减重与代谢外科加速康复原则中国专家共识（2021版）》,供减重与代谢外科医师临床实践中参考。     

原发性肝癌二级预防共识(2021年版)

为了规范原发性肝癌危险人群的有效预防、早期筛查及诊断,中华医学会肝病学分会组织国内有关专家,以国内外原发性肝癌的基础、临床、预防研究进展为依据,结合现阶段我国的实际情况,制定《原发性肝癌二级预防共识(2021年版)》,为慢性肝病人群原发性肝癌的预防、筛查及早期诊断提供重要依据。     

老年人经皮内镜下胃造瘘术中国专家共识（2022版）

我国逐步进入老龄化社会,很多老年患者因疾病无法进食,导致生活质量急剧下降。经皮内镜下胃造瘘术（percutaneous endoscopic gastrostomy,PEG）对于营养物质的供给具有不可替代的优势。中华医学会消化内镜学分会老年内镜协作组组织本协作组专家,参考最新研究进展,通过集体讨论与投票等方式,共同制定本共识。本共识就PEG的适应证、禁忌证、术前准备、操作规范、并发症等共列有11条陈述建议。