Humans ; Tertiary Care Centers ; Singapore ; Endoscopy, Gastrointestinal ; Intestinal Diseases/diagnostic imaging*

Endoscopy is a common tool for the diagnosis and treatment of gastrointestinal disorders in children. The presence of bubbles in the gastrointestinal tract is one of the important factors affecting the clarity of endoscopic visual field, and the application of defoamers can significantly reduce bubbles in the gastrointestinal tract, improve the quality of gastrointestinal preparation, and further increase disease detection rate. Various studies have been conducted on gastrointestinal preparation before endoscopy in children, but there still lacks a uniform protocol for the application of defoamers. This article summarizes the use of defoamers in children before digestive endoscopy and related research advances and points out that existing studies on defoamers have a small sample size and that there are still controversies over the selection and timing of administration, so as to provide a reference for in-depth research on defoamers in the future.
Humans ; Child ; Endoscopy, Gastrointestinal ; Gastrointestinal Diseases/diagnosis*

OBJECTIVES: Gastrointestinal endoscopy plays an important role in the diagnosis and treatment of gastrointestinal diseases. The satisfaction degree of gastrointestinal endoscopy can directly affect the patient's compliance and further impact the treating effect. At present, there is no scale to evaluate the satisfaction degree of gastrointestinal endoscopy in China. This study aims to develop a satisfaction scale of gastrointestinal endoscopy suitable for national conditions and to evaluate its reliability and validity, which provides a tool for clinic to evaluate patients' satisfaction with gastrointestinal endoscopy. METHODS: The original gastrointestinal endoscopy satisfaction scale was compiled by literature review, consulting senior endoscopists and experts. Through the first round of survey about 120 patients, the original scale was analyzed and modified according to the results to get the gastrointestinal endoscopy satisfaction scale (formal scale). The formal scale was used to conduct the second round of survey about 200 patients. The reliability and validity of the scale were analyzed and evaluated according to the survey results. RESULTS: The reliability of the original scale was good but the validity was poor. The formal scale had 2 dimensions and 10 items, the Cronbach's alpha and split-half reliability were 0.889 and 0.823. The structure validity index χ²/df was 2.513, root mean square error of approximation (RMSEA) was 0.094, goodness of fit index (GFI) was 0.914, adjusted goodness of fit index (AGFI) was 0.861, comparative fit index (CFI) was 0.946, normed fit index (NFI) was 0.915. The aggregate validity was general, the discriminative validity was good, and the direct score of patients was strongly correlated with the total score of the scale. CONCLUSIONS The gastrointestinal endoscopy satisfaction scale has good reliability and validity, which can be used as a tool to evaluate patients' satisfaction with gastrointestinal endoscopy in China.
Humans ; Reproducibility of Results ; China ; Endoscopy, Gastrointestinal ; Patient Compliance ; Personal Satisfaction

Endoscopy, Gastrointestinal ; Anesthesia ; Surveys and Questionnaires ; Anesthesiology ; Hospitals, Public ; China ; Endoscopy

OBJECTIVE: To discuss the development of a multifunctional and multipoint fixed support drainage device for the digestive tract, as well as the effect of its application on animal experimental models and patients. METHODS: The digestive tract multifunctional and multipoint fixed support drainage device is designed according to the requirements of the various gastrointestinal surgery and interventional procedures. It has metal flaps and airbags to achieve multi point fixation. The cuffs and shears are used to achieve endoscopic removal. And through different tube diameters and lengths, surgeons can achieve different surgical purposes. RESULTS: A multifunctional and multipoint fixed support drainage device for the digestive tract was successfully designed and developed. The application experiment of the winged pancreatico-intestinal supporting drainage tube on animal models and patients, showed lower drainage fluid amylase level, faster amylase recovery speed, and better perioperative safety. CONCLUSIONS The support drainage device has the characteristics of simple operation, firm fixation, and good controllability of removal. It is an ideal choice among support drainage tubes in gastrointestinal surgery and interventional operations.
Drainage ; Gastrointestinal Tract ; Endoscopy

Objective: By investigating the correlation between quantitative parameters of contrast enhanced ultrasound (CEUS) and commonly used activity assessment indicators of Crohn's disease (CD), and comparing the predictive power of laboratory inflammatory indicators with CEUS on Crohn's disease (CD), the significance of CEUS was evaluated. Methods: A case-control study. From October 2019 to December 2021, the clinical data of 67 patients with CD who were diagnosed by endoscopy and underwent contrast-enhanced ultrasonography were retrospectively analyzed in the First Affiliated Hospital with Nanjing Medical University, and their routine ultrasound and CEUS parameters, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin (FC), Crohn's disease activity index (CDAI) and simplified endoscopic score for Crohn's disease (SES-CD) were collected. Using SES-CD as the standard, the patients were divided into a remission group and an active group, and the correlation of laboratory inflammatory indexes and contrast-enhanced ultrasound parameters with CDAI and SES-CD were evaluated. Besides, the ROC curve was used to analyze the predictive efficacy of each index on CD endoscopic activity. Results: A total of 67 patients were included in this study. According to the SES-CD score, there were 17 patients in the remission group and 50 patients in the active group. Except for the coefficient of the enhancement wash in slope and time to peak (TTP), the peak intensity (PI), area under the angiography curve, and laboratory inflammatory indexes were significantly different between the two groups (P<0.05), which also showed a moderate positive correlation with CDAI and SES-CD (P<0.05). ROC analysis showed that among the non-invasive indicators, PI and area under the angiography curve had the highest AUCs for predicting CD endoscopic activity, which were 0.912 and 0.891, respectively; with SES-CD taking >3 as the cut-off value, the corresponding sensitivities were 78.0% and 72.0%, with specificities of 100.0% and 94.1%, respectively. Conclusion: CEUS can objectively and repeatedly evaluate the disease activity of CD patients, and has great clinical application value, which can be used as a reliable imaging method for diagnosis and follow-up of patients with Crohn's disease.
Humans ; Crohn Disease/diagnosis* ; Case-Control Studies ; Retrospective Studies ; Endoscopy, Gastrointestinal ; C-Reactive Protein/analysis* ; Severity of Illness Index

BACKGROUND: Worldwide, the volume and availability of digestive endoscopy have undergone dramatic development in recent years, with increasing attention on quality assurance. We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions. METHODS: We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually. The questionnaires included the personnel, annual volume, and quality indicators of endoscopy. An endoscopy quality index (EQI) was developed based on recorded quality indicators using principal component analysis to determine the relative weight. RESULTS: From 2015 to 2019, 806, 1412, 2644, 2468, and 2541 hospitals were respectively enrolled in this study. The average annual volume of endoscopy increased from 12,445 to 16,206 (1.30-fold) and from 2938 to 4255 (1.45-fold) in tertiary and secondary hospitals, respectively. The most obvious growth was observed in diagnostic colonoscopy (1.44-fold for all hospitals after standardization). The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3% (55,210/448,861) to 17.7% (85,429/482,647) and from 11.4% (69,411/608,866) to 16.9% (107,192/634,235), respectively. The adenoma detection rate of diagnostic colonoscopy increased from 14.9% (2,118,123/14,215,592) to 19.3% (3,943,203/20,431,104). The EQI model included 12 quality indicators, incorporating 64.9% (7.792/12) of the total variance into one comprehensive index. According to the EQI measurements, the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals. CONCLUSIONS Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality. The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.
Humans ; Colonoscopy/methods* ; Endoscopy, Gastrointestinal ; Endoscopy, Digestive System/methods* ; Surveys and Questionnaires ; Adenoma ; China

INTRODUCTION: In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. METHODS: The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process. RESULTS: The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists. CONCLUSION These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.
Conscious Sedation ; Endoscopy, Gastrointestinal ; Hospitals ; Humans ; Hypnotics and Sedatives ; Singapore

After nearly 40 years of development, digestive endoscopy in children has been widely applied, and it has helped to expand the spectrum of pediatric digestive system diseases and greatly improve the diagnosis and treatment of pediatric digestive system diseases. Pediatric digestive endoscopy has become a subject. However, there are some problems such as the unbalanced development of pediatric digestive endoscopy across China, the lack of homogeneity in diagnosis and treatment system, the tendency of adult-oriented diagnosis and treatment techniques, and the localization of training quality, which affect the standardized and healthy development of pediatric digestive endoscopy. The diagnosis and treatment with digestive endoscopy in children should adhere to both pediatric characteristics and technological innovation to propose the concept of comfort, emphasize the importance of standardization (including the space and process for endoscopic diagnosis and treatment, perioperative evaluation, training mode, and access qualification), standardize the minimally invasive techniques, and develop artificial intelligence. It is of great importance to formulate related consensus statements and guidelines on the basis of medical safety and the features of the growth and development of children, so as to achieve the high-quality development of pediatric digestive endoscopy, effectively improve the diagnosis and treatment levels of pediatric digestive endoscopy, and bring benefits to more pediatric patients.
Artificial Intelligence ; Child ; China ; Consensus ; Digestive System Diseases/diagnosis* ; Endoscopy, Gastrointestinal ; Humans

OBJECTIVES: To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children. METHODS: A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital, China Medical University, from January 2011 to May 2021. According to the cause of the disease, they were divided into primary ulcer group (primary group; n=148) and secondary ulcer group (secondary group; n=25). The clinical data were compared between the two groups. RESULTS: A total of 173 children with upper gastrointestinal ulcer were enrolled, with a male/female ratio of 3.9:1. Compared with girls, boys had significantly higher proportions of duodenal ulcer and primary ulcer (P<0.05). Compared with the children aged below 6 years, the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers. Of the 148 children in the primary group, 95 (64.2%) had Helicobacter pylori infection. Abdominal pain was the most common clinical symptom and was observed in 101 children (68.2%). Duodenal ulcer was common and was observed in 115 children (77.7%), followed by gastric ulcer in 25 children (16.9%) and esophageal ulcer in 7 children (4.7%). Multiple ulcers were observed in 32 children (21.6%). Seventy children (47.3%) experienced complications, among which bleeding was the most common complication and was observed in 63 children (43.6%). Of the 25 children in the secondary group, abdominal pain was the most common clinical symptom and was observed in 9 children (36.0%), with a significantly lower incidence rate than the primary group (P<0.05); foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children (68%), followed by abdominal Henoch-Schönlein purpura in 5 children (20.0%) and Crohn's disease in 3 children (12.0%). The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group (P<0.05). CONCLUSIONS Upper gastrointestinal ulcer is more common in boys than girls, and duodenal ulcer and primary ulcer are more common in boys. Children aged 6-14 years often have duodenal ulcer and primary ulcer, and giant ulcer and multiple ulcers are relatively uncommon. Primary ulcer in children has a variety of clinical manifestations, mainly abdominal pain, and duodenal ulcer is relatively common, with bleeding as the main complication. The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes, and it is more likely to induce huge ulcers and multiple ulcers.
Abdominal Pain ; Child ; Duodenal Ulcer/epidemiology* ; Endoscopy, Gastrointestinal/adverse effects* ; Female ; Helicobacter Infections/diagnosis* ; Helicobacter pylori ; Humans ; Male ; Retrospective Studies ; Ulcer