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。     

中国县域医院消化内镜学科现状：一项横断面研究

目的　调查我国县域医院消化内镜学科发展现状,推动全国县域医院消化内镜学科能力提升。方法　以网络填报的方式,对2019年我国20个省、自治区、直辖市的县域医院消化内镜学科进行调查,调查内容包含科室规模、消化内镜中心基本情况、临床诊疗能力、教学及学术能力4个方面。结果　共纳入114家县域医院数据进行分析。2019年,我国县域医院消化内科平均拥有床位38.9张、医师8.6名、内镜护士6.4名。消化内镜中心平均拥有主机3.1台、消化内镜11.0条。2019年平均每家县域医院消化专科门诊量2.2万例次、病房出院人数0.23万例次,消化内镜诊疗量0.78万例次,53家（46.5%）医院向上级医院转诊率<3%。在教学、学术能力方面,114家医院中,5家（4.4%）为中国医师协会消化内镜医师培训基地,52家（45.6%）举办过地市级及以上学术会议,21家（18.4%）在SCI收录期刊发表论文,67家（58.8%）在核心期刊发表论文。结论　大部分地区县域医院硬件设施齐全,具备良好的医疗能力、管理水平和良好的科研团队建设,达到县域医院医疗服务能力推荐标准。     

中国小肠胶囊内镜临床应用指南（2021，上海）

小肠胶囊内镜在临床实践过程中应用越来越广泛,已成为小肠疾病检查的一线检查方式。为进一步规范小肠胶囊内镜的检查流程和对检查适应证、禁忌证的把握,在结合我国临床实践的基础上,国家消化系统疾病临床医学研究中心（上海）、国家消化内镜质控中心、中华医学会消化内镜学分会胶囊内镜协作组、上海市医学会消化内镜专科分会胶囊内镜学组,基于现有证据,采用推荐意见分级的评估、制订及评价系统,遵循国际指南报告规范,制定我国小肠胶囊内镜指南,以期为临床医师提供指导与决策依据。     

下消化道出血诊治指南（2020）

下消化道出血（lower gastrointestinal bleeding, LGIB）的定义为屈氏韧带以远的肠道出血,包括小肠出血和结直肠出血。LGIB临床常见,占全部消化道出血的20%～30%。但由于各种原因,对LGIB的研究却不及上消化道出血深入,相关指南和共识亦较少。此外,近年来内镜和影像技术快速发展,逐渐发现小肠出血的临床特点、诊疗方法和转归均不同于结直肠出血。因此,由中华医学会消化内镜学分会结直肠学组、中国医师协会消化医师分会结直肠学组、国家消化系统疾病临床医学研究中心牵头制定了《下消化道出血诊治指南（2020）》,本指南结合最新的国内外临床研究结论及专家意见,结合我国实际,分别对小肠出血和结直肠出血的临床诊治进行了规范和推荐,旨在进一步规范LGIB的诊治流程。     

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。     

药源性消化不良反应

药源性消化系统不良反应较为常见,发病机制可分为中毒性机制及过敏机制两类。前者与长期或过量用药有关,后者与用药剂量无关。药源性不良反应可累及消化系统各部分,导致消化管运动、腺体分泌等功能障碍,影响营养物质的消化和吸收。治疗非消化道疾病及消化道本身疾病的药物,尤其对消化道有刺激或毒性作用的口服药物,直接引起消化系统不良反应。     

高分辨率肛门直肠测压临床操作与分析指南(成人)

肛门直肠测压是评估肛门直肠动力与感觉功能的重要技术。目前, 我国有数百家医疗机构相继开展了高分辨率肛门直肠测压(HR-ARM)技术, 为规范该技术的操作与应用, 中华医学会消化病学分会及其胃肠动力学组、胃肠功能性疾病协作组、食管疾病协作组与中国健康促进基金会共同开展胃肠动力诊疗质控评估建设专科协作公益项目(GIMQCC), 牵头制定本指南内容。本指南制定过程中邀请国内相关领域专家对国内外相关文献进行检索、梳理、讨论, 并召开多次专家研讨会, 确定指南内容。本指南涉及HR-ARM的适应证、禁忌证、详细的操作流程, 以及数据分析与解读。     

中国结直肠癌县域医师诊疗指南-外科部分（2019版草案）

我国县域级医院发展不平衡，因设备、人员、科室、资金配置相对落后，无法严格按照国际的结直肠癌诊疗指南进行诊治。而县域级医院服务人群基数大，为多数结直肠癌患者的初诊单位，因此制定适合于县域级医院的结直肠癌诊疗指南显得极为重要。本指南以2017年国家卫计委发布的《中国结直肠癌诊疗规范》为参照，通过问卷调查的形式调研了覆盖我国东、中、西部地区共计71所县域级医院的结直肠癌手术开展、诊断设备、科室配套、诊疗过程障碍等方面情况，汇总后进行归纳分析，结合现有诊疗新进展，根据我国县域级医院现有状况，在原有指南基础上做出适应于县域级医院诊疗的改动。希望该版指南可规范、提高我国基层医院结直肠癌诊治水平。     

2016南方消化疾病及消化内镜国际论坛征文通知

正为展示国内外消化系统疾病的最新研究成果,帮助国内广大消化以及消化内镜专业同仁了解消化疾病基础与临床以及消化内镜诊断与治疗技术的最新进展,推动了我国消化疾病诊治水平的发展。将于2016年7月8-10日在广州白云国际会议中心召开"2016南方消化疾病及消化内镜国际论坛"。大会由广东省医学会主办、南方医科大学南方医院承办。将分消化内镜以及消化疾病两个会场,采取专题讲座与内镜操作表演的形式进行。会议专题包括:消化道早癌诊断和治疗、消化内镜微创治疗、炎     

中国早期结直肠癌筛查流程专家共识意见（2019，上海）

中国结直肠癌负担沉重,严重威胁人民群众的生命健康。为改变我国结直肠癌高发病率、高死亡率和低早期诊断率的现状,推进我国的结直肠癌筛查计划,2019年由国家消化系统疾病临床医学研究中心（上海）牵头,依托国家消化道早癌防治中心联盟,联合多个相关学会,组织我国消化、内镜、肿瘤、健康管理和内镜质控等多学科专家联合制定本共识意见,以期确立并细化适合我国实际情况的早期结直肠癌筛查流程,为筛查工作提供指导和参考。     

Education in gastroenterology at a Japanese hospital. Medical and surgical aspects

Admission to a standard 6-year university course in medicine is very competitive in Japan. Medical practice is dominated economically by a national health service and epidemiologically by diseases of the upper gastrointestinal tract. Gastric cancer is very common, although diseases familiar to Western society are increasing. A detailed examination of the educational program in gastroenterology at the Kitasato University Hospital, one of the newer private teaching hospitals in Japan, reflects the cultural and environmental differences from an American experience. A residency system on the American model has been developed at this hospital. The extensive training in gastroenterological diagnostic techniques, including contrast radiography and endoscopy, is most striking. The ability to describe pathological abnormalities with precision is given great emphasis. Subspecialty training in medical or surgical gastroenterology is not standardized and is oriented primarily toward research and the development of expertise in a limited academic area.     

PREFACE

The present paper discusses where endoscopic diagnosis and treatment will be in 10 years. The demand for gastroenterologist services is growing, driven partly by the aging population and the popularity of screening colonoscopy. Hopefully, along with better genetic and fecal markers, it will allow colonoscopy to be used much more efficiently in patients who really need it. Innovations in reduction of pressure on patients by decreasing the diameter of the electron endoscope, particularly the transnasal endoscope, are continued, in parallel with the development and research of capsule endoscopy as a tentative measure. There will be issues regarding will perform the screening test, and how the medical expenses should be established. In contrast, highly precise imaging techniques are progressing. The most important theme of endoscopic medicine is the further prevalence of and development of therapeutic endoscopy in such situation as gastroesophageal reflux disease, obesity, hemostasis, luminal stenosis, endoscopic submucosal dissection for early gastrointestinal cancer, stenting, endoscopic shincterotomy and natural orifice translumenal endoscopic surgery for pancreatic biliary or other diseases. In addition, the field of gastroenterology and gastrointestinal endoscopy will need to evolve into one of the digestive health sciences, a new multidisciplinary specialty. It will be required to have a department of digestive diseases integrating all specialists in this field.     

Future expectations in digestive endoscopy: competition with other novel imaging techniques

Digestive endoscopy has been evolving from primary diagnostic to extensive therapeutic modalities in the management of gastrointestinal diseases. The present endoscopic imaging includes (A) standard endoscopy alone and /or with adjunct technologies such as point enhancement, e.g. confocal endomicroscopy and field enhancement technologies such as chromoendoscopy, NBI and FICE and (B) endoscopic ultrasound. Other novel imaging technologies including virtual colonoscopy or CT/MR colonography, CT or MRI enterography and capsule endoscopy have also been developed. This article reviews the diagnostic and therapeutic role of digestive endoscopy and future directions of digestive endoscopy are discussed. Digestive endoscopy is also compared with emerging novel imaging techniques in gastrointestinal diseases such as capsule endoscopy and CT colonography. The fact that digestive endoscopy has become a multidisciplinary specialty combining advances in all fields (radiology, bioengineering, surgery and gastroenterology) is highlighted.     

新中国70周年消化内科事业之发展

新中国成立70周年，我国消化内科事业取得翻天覆地的变化。消化内科学科本身日益发展和壮大，消化系疾病谱和诊疗理念日新月异，消化内镜诊疗器械和技术迅猛发展，我国消化学者如火如荼参与国际交流。通过上述内容的回顾和学习，致敬我国消化前辈为消化病学发展做出的业绩。     

河南省市县级医院消化内镜医师内镜诊疗水平现况调研

目的了解河南省市县级医院消化内镜医师的内镜诊疗水平及现状。 方法采用自行设计的调查问卷,对2016年1月至2017年1月参加河南省人民医院消化内科内镜培训的市县级医院的内镜医师进行调查问卷,统计内镜诊疗开展情况、工作量及内镜医师参加培训情况。 结果共有114人参与调查,其中有效调查问卷104份。参与调查的医师来自三级医院者占54.8%、二级医院者占45.2%,有10年以上内镜工作经验者占47.1%。均已开展胃肠镜检查技术的市县级医院,分别有26.9%、23.1%、58.7%和87.5%的内镜医师未开展内镜下止血治疗、高频电切除胃肠道息肉、EMR法切除胃肠道息肉和ESD术。并且,参加内镜培训的医师中,仅有19.4%能被提供急诊胃镜下止血的操作机会。 结论我省市县级医院消化内镜诊疗技术水平参差不齐且整体水平较低下,建立并完善适合市县级医院消化内镜医师操作水平的有效的培训模式迫在眉睫。     

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。     

Sustainability in gastroenterology and digestive endoscopy: Position Paper from the Italian Association of Hospital Gastroenterologists and Digestive Endoscopists (AIGO)

Climate crisis is dramatically changing life on earth. Environmental sustainability and waste management are rapidly gaining centrality in quality improvement strategies of healthcare, especially in procedure-dominant fields such as gastroenterology and digestive endoscopy. Therefore, healthcare interventions and endoscopic procedures must be evaluated through the ‘triple bottom line’ of financial, social, and environmental impact. The purpose of the paper is to provide information on the carbon footprint of gastroenterology and digestive endoscopy and outline a set of measures that the sector can take to reduce the emission of greenhouse gases while improving patient outcomes. Scientific societies, hospital executives, single endoscopic units can structure health policies and investment to build a “green endoscopy”. The AIGO study group reinforces the role of gastrointestinal endoscopy professionals as advocates of sustainability in digestive endoscopy. The “green endoscopy” can shape a more sustainable health service and lead to an equitable, climate-smart, and healthier future.     

全民健康助力全面小康背景下消化疾病防治理念的思考

全面建成小康社会是实现中华民族伟大复兴中国梦的关键一步。党的十八大以来,国家卫生与健康事业取得巨大成就。全民健康助力全面小康布局下,通过反思消化疾病防治现况,对防治新理念和策略提出了建议。明确了基层和偏远地区依旧是疾病防治重点,鼓励切实践行早诊早治消化道肿瘤,力荐全社会联动重视慢性肝病规范化治疗,强调了消化病学和心身医学密切结合防治功能性胃肠病的迫切性和重要性。     

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.     

Management of antiplatelet or anticoagulant therapy in endoscopy:A review of literature

Endoscopic procedures hold a basal risk of bleeding that depends on the type of procedure and patients’ comorbidities. Moreover, they are often performed in patients taking antiplatelet and anticoagulants agents, increasing the potential risk of intraprocedural and delayed bleeding. Even if the interruption of antithrombotic therapies is undoubtful effective in reducing the risk of bleeding,the thromboembolic risk that follows their suspension should not be underestimated. Therefore, it is fundamental for each endoscopist to be aware of the bleeding risk for every procedure, in order to measure the risk-benefit ratio for each patient. Moreover, knowledge of the proper management of antithrombotic agents before endoscopy, as well as the adequate timing for their resumption is essential.This review aims to analyze current evidence from literature assessing, for each procedure, the basal risk of bleeding and the risk of bleeding in patients taking antithrombotic therapy, as well as to review the recommendation of American society for gastrointestinal endoscopy, European society of gastrointestinal endoscopy, British society of gastroenterology, Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy guidelines for the management of antithrombotic agents in urgent and elective endoscopic procedures.