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 DETT-associated 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).

Timely treatment of premenstrual syndrome (PMS) is not always available for rural women, because the local medical resources are insufficient. The efficacy of remote intervention by smartphone on PMS has not been confirmed.A retrospective analysis was performed on rural PMS patients between January 2014 and December 2015. After a propensity score matched analysis, 60 patients were enrolled and evenly divided into remote group and outpatient group. Multidisciplinary therapy including cognitive-behavioral therapy (CBT), oral medication, and physical exercise education was used individually, in accordance with their symptoms evaluated by Daily Record of Severity of Problems (DRSP) questionnaire. Patients in remote group utilized WeChat software by smartphone for therapy guidance, while those in outpatient group attended face-to-face interview. Their DRSP scores in 5 new menstrual cycles after therapy were recorded. Then, they were followed up for 1 year.Total DRSP scores of the cases in both groups after initial intervention were less than those before therapy (P < .001), without group difference (P > .05). However, patients in remote group indicated a higher satisfactory rate than the outpatient group (P = .03). On the 1-year follow up, patients in both groups demonstrated similar DRSP scores (P = .07), but the satisfactory rate in remote group was encouragingly higher than that in the outpatient group (P = .02).The efficacy of remote intervention using smartphone on PMS is noninferior to traditional outpatient visits. Nevertheless, high-quality trials are needed.

Which is the optimal treatment for Barrett's esophagus with high grade dysplasia -ablation or complete endoscopic removal?We read with great interest the article by Halsey et al.[1] on the pattern and sites of recurrence of Barrett's esophagus with high grade dysplasia (HGD) following endoscopic liquid nitrogen spray cryotherapy. The authors concluded that ultimately this method achieved a 92 % complete response rate. They also concluded that random 4-quadrant biopsy is not sufficient during surveillance for the detection of recurrent lesions, and that biopsies should be performed routinely in the area immediately below the neosquamocolumnar junction (NSCJ). We think that this article is one of the most important papers to be published in recent years for guiding endoscopists in their choice of treatment for Barrett's HGD and for suggestions of how to follow up the patient. Cryotherapy is one of the multimodal endoscopic intervention ablation management options for Barrett's HGD that have been presented in recent years. Others include argon plasma coagulation, radiofrequency ablation, photodynamic therapy, and multipolar electrocoagulation. Compared with surgical resection, this kind of endoscopic treatment is more effective and is associated with a lower rate of complications. However, in recent literature, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have also emerged as new endoscopic therapeutic interventions for Barrett's HGD [2 -4]. En bloc EMR or ESD achieves almost 100 % complete response rate for HGD diseases, but the procedures carry a high risk of complications, including hemorrhage, perforation, and stricture [5]. In addition, ESD is a time-consuming procedure and requires a long training period, and endoscopic ablation techniques are easy and safe but have high recurrence rates. Hence, we want to know which of the techniques represents the optimal treatment for Barrett's HGDablation or complete endoscopic removal? Barrett's HGD and metaplasia are the strongest risk factors for progression to adenocarcinoma and, as the paper discusses, the risk increases to approximately 30 % in 5 years if HGD is present; conversely, it has been documented anecdotally in the literature that Barrett's esophagus with low grade dysplasia (LGD) has little chance of progression to carcinoma [6]. In our experience, HGD near the opening of the cardia or the gastrocardia has the higher risk of developing into cancer, with approximately 60 % of lesions developing into intramucosal cancer in 2 years. These figures support those of Halsey et al., which showed that the region associated most frequently with the recurrence of HGD and subsequent development into cancer was the area just below the NSCJ. Therefore, only by resecting the lesions completely and in one piece can the disease be prevented from developing into cancer. We think there are three main limitations to the use of endoscopic ablation. First, the depth of the ablation is shallow and uneven and does not reach the submucosa. Second, t...

Background: There is no standardized operation procedure for white light gastroscopy (WLG in China. We aimed to established a standardized procedure of white light gastroscopy for clinic patients screening, to verify its effect and its feasibility in clinical practice.Methods: We applied the standardized procedure for WLG to out-patients at 9 tertiary hospitals in Beijing.All of the clinical information and operation procedure were recorded.Results: We set a standardized operation procedure for WLG. 1051 patients were enrolled in the base-line survey stage between March 2014 and December 2015. 2156 patients were enrolled in the WLG standardized operation stage from January 2016 to June 2017. The median durations of standardized procedure group were signi cantly longer than that of the base-line group (prolonged 60.3 seconds averagely, P=0.003). The taken picture numbers in the standardized procedure group were signi cantly higher than that in the base-line group (17 pictures more averagely, P<0.001). The overall detection rate of gastric mucosal lesions in the standardized procedure group was signi cantly higher than that in the base-line group (52.5% vs. 38.4%, P<0.01). Both the patient and endoscopist satisfaction scores in the standardized procedure group were all signi cantly improved than those in the base-line group.Conclusions: The standardized procedure for WLG can improve the detection rate of gastric lesions signi cantly, and also improve the satisfaction of patients and endoscopists despite prolonged duration.The standardized procedure for white light gastroscopy is effective and feasible in clinical practice with the present endoscopy equipment in China.

Objective To establish a new and easy‐to‐use risk‐scoring predictive model to help identify high‐risk patients with multiple synchronous gastric neoplasms (MSGN), including early gastric cancer (EGC) and gastric dysplasia (GD), before initial endoscopic resection (ER). Methods We retrospectively enrolled 1361 patients with EGC or GD who had undergone ER from November 2006 to September 2019. The patients were randomly divided into the training (n = 681) and validation cohorts (n = 680). In the training phase a prediction score was constructed to assess the independent predictors of MSGN based on multivariate logistic regression analysis. The performance of the prediction model was evaluated using the receiver operating characteristic (ROC) curve and the Hosmer‐Lemeshow test. Results Of the 1361 patients, 122 (9.0%) had MSGN. Three predictors for MSGN were scored and weighted, as follows: elderly male (≥65 y; three points), a family history of gastric cancer (two points) and surface redness (two points). Accordingly, patients were divided into the low (risk score, 0‐3 points) or high‐risk groups (risk score, 4‐7 points). In the validation cohort, the incidence of MSGN in the low‐risk and high‐risk groups were 6.1% and 32.0%, respectively (P < 0.001). Our predictive risk‐scoring model showed good discrimination (the area under the ROC curve [AUROC] 0.719, 95% confidence interval [CI] 0.634‐0.794, P < 0.001) and calibration ability (Hosmer‐Lemeshow test, χ2 = 6.539, P = 0.587) in the validation group. Conclusion This risk‐scoring model has a good performance in predicting MSGN before the initial ER.