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Objectives: Single‐balloon enteroscopy (SBE) is an effective tool for the detection of small intestine lesions. Because it is conventionally performed by two operators, the efficacy of single‐operator SBE method has not yet been elucidated. We aimed to evaluate the diagnostic yield, total enteroscopy rate, procedure time, and complications of single‐operator SBE for small intestinal disease. Methods: This was a single‐center, retrospective study including consecutive patients who underwent single‐operator SBE for suspicious small intestinal disorders or required therapeutic interventions between December 2014 and January 2019. The SBE procedures were performed by four endoscopists. Diagnostic yield, total enteroscopy rate, procedure time, incubation depth, and complications were analyzed, and stratification analysis was performed. Results: Altogether 922 patients with 1422 SBE procedures were included for analysis, among whom 250, 172, and 500 patients underwent SBE via the oral route, the anal route and a combined route, respectively. The overall diagnostic yield was 78.52% (724/922). And 253 patients achieved total enteroscopy, with a total enteroscopy rate of 56.10%. The average procedure time for the oral and anal routes were 69.28 ± 14.72 min and 64.95 ± 13.87 min, respectively. While the incubation depth was 389.95 ± 131.42 cm and 191.81 ± 83.67 cm, respectively. Jejunal perforation was observed in one patient, which was managed by endoclips. Stratification analysis showed that the diagnostic yield and total enteroscopy rate significantly increased with operation experience together with decreased procedure time. Conclusion: Single‐operator SBE is effective and safe for the detection of small intestinal lesions, and is easy to master. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical potential and safety of Moluodan to reverse gastric precancerous lesions. Methods: Patients aged 18–70 years diagnosed with moderate‐to‐severe atrophy and/or moderate‐to‐severe intestinal metaplasia, with or without low‐grade dysplasia, and negative for Helicobacter pylori were recruited in this randomized, double‐blind, parallel‐controlled trial. The primary outcome was the improvement of global histological diagnosis at 1‐year follow‐up endoscopy using the operative link for gastritis assessment, the operative link for gastric intestinal metaplasia assessment, and the disappearance rate of dysplasia. Results: Between November 3, 2017 and January 27, 2021, 166 subjects were randomly assigned to the Moluodan group, 168 to the folic acid group, 84 to the combination group, and 84 to the high‐dose Moluodan group. The improvement in global histological diagnosis was achieved in 60 (39.5%) subjects receiving Moluodan, 59 (37.8%) receiving folic acid, 26 (32.1%) receiving the combined drugs, and 36 (47.4%) receiving high‐dose Moluodan. Moluodan was non‐inferior to folic acid (95% confidence interval: −9.2 to 12.5; P = 0.02). High‐dose Moluodan had a trend for better protective efficacy, though there was no statistical significance. The disappearance rate of dysplasia was 82.8% in the Moluodan group, which was superior to folic acid (53.9%; P = 0.006). No drug‐related serious adverse events were observed. Conclusions: One pack of Moluodan three times daily for 1 year was safe and effective in reversing gastric precancerous lesions, especially dysplasia. Doubling its dose showed a better efficacy trend. [ABSTRACT FROM AUTHOR]

Objective: To investigate the management of Helicobacter pylori (H. pylori) infection by gastroenterologists from secondary and tertiary hospitals in Shandong Province, China, where there is a high prevalence of H. pylori infection. Methods: A questionnaire‐based, stratified sampling survey was conducted from June 1 to August 30, 2021. The ratio of secondary to tertiary hospitals was set at 2:1. An electronic questionnaire was sent to the gastroenterologists via the WeChat platform. Results: A total of 89.09% (1053/1182) gastroenterologists were included. Overall, 34.19% and 60.59% of gastroenterologists recommended screening for and treating H. pylori infection in patients without any competing factors. The most preferred testing method in secondary and tertiary hospitals was the 13C‐urea breath test (53.92% and 80.48%), but the reexamination rate of results close to the cut‐off value was low (55.10% and 59.48%). Gastroenterologists preferred bismuth‐containing quadruple therapy (secondary and tertiary hospitals: 96.67% and 98.53%), but the antibiotic combination prescribed for patients with penicillin allergy was suboptimal in secondary hospitals. The overall post‐treatment follow‐up rate was 64.58%, and gastroenterologists in secondary hospitals were more proactive than those in tertiary hospitals (69.41% vs 60.04%, P = 0.001). Less than 80% of gastroenterologists emphasized the importance of post‐treatment reexamination to their patients. Only a minority of gastroenterologists in secondary and tertiary hospitals (30.79% and 34.36%) achieved acceptable eradication rates (exceeding 80%). Conclusions: Deficiencies exist in gastroenterologists from secondary and tertiary hospitals, and the H. pylori eradication rate is relatively low. Training programs for gastroenterologists are warranted to strengthen their comprehension of guidelines. [ABSTRACT FROM AUTHOR]

A meta-analysis of 1437 patients from 14 RCTs in China showed that prokinetics combined with PPI were more effective in alleviating symptoms than PPI monotherapy; however, no significant intergroup differences were observed in the mucosal healing rate.104 B Statement 16: Endoscopic radiofrequency ablation (RFA) can improve the GERD symptoms b B Overall agreement: A+, 30.0%; A, 60.0% b B Level of evidence: Moderate b Endoscopic treatments for GERD include endoscopic RFA, transoral incisionless fundoplication (TIF) and anti-reflux mucosectomy (ARMS). Gastroesophageal reflux disease (GERD) is common in clinical practice and its prevalence differs significantly in different countries and regions. The results showed that MSA was superior to PPI in reducing reflux symptoms and had fewer complications.122 A meta-analysis of 19 studies in which MSA was used to treat GERD has revealed that MSA and fundoplication are both effective, and there are no significant differences between them with respect to the reduction of PPI use and improvement of patients' QoL, and only 13.2% of patients require PPI after MSA.123 At present, RCTs and long-term follow-up studies of MSA are scarce; therefore, more clinical evidence is required. It was observed that in 308 patients with upper gastrointestinal symptoms the sensitivity and specificity of the reflux disease questionnaire (RDQ) in diagnosing GERD were 62% and 67%, respectively; while those of the gastroesophageal reflux disease questionnaire (GerdQ) were 65% and 71%, respectively.24,25 The diagnostic value of both questionnaires is higher in patients with typical reflux symptoms than in those with atypical symptoms. [Extracted from the article]

Th article reports on the perioperative medications during endoscopic submucosal dissection (ESD) for gastric lesions. Topics discussed include the indications and contraindications of gastric ESD, complications of ESD, and diagnosis of perforation. Also being discussed are the aim and types of perioperative medications.