preface
In recent years, China's digestive endoscopy team has impressed international counterparts with a number of innovations. Digestive endoscopy plays an increasingly important role in the early screening and early treatment of tumors in the digestive system, and the new treatment concept "super minimally invasive surgery" that has been spawned has brought a new development direction to digestive tract diseases: allowing patients to cure diseases while the quality of life can be restored as before.
How can this wish be realized? Please see the interpretation of Professor Ling Hu Enqiang, chairman of the Digestive Endoscopy Branch of the Chinese Medical Association and the Department of Gastroenterology of the First Medical Center of the PLA General Hospital.
01
Innovative diagnosis and treatment mode
· The key to the prevention and treatment of tumors in the digestive system
Gastrointestinal tumors such as esophageal cancer, stomach cancer and colorectal cancer seriously threaten the health of our people. Digestive endoscopy can help us screen early patients, but also treat early and ultra-early tumors, allowing patients to quickly return to normal life and work, so that patients' lives are almost unaffected.
Among the top five tumors in China, digestive system tumors occupy four seats, namely esophageal cancer, stomach cancer, colorectal cancer and liver cancer. Tumors of the digestive system are clearly territorial and hereditary. China's total population accounts for 18% of the world's population, but the number of esophageal cancer and stomach cancer and the number of deaths in China have reached about half of the world. People over 50 years old are the high incidence of digestive system tumors, while the number of elderly people over 60 years old in China has reached 264 million. It can be seen from these data that if the tumors of the digestive system are well controlled, the harm of tumors to the health of the people can be greatly reduced.
Professor Ling Hu introduced that in the past, people were accustomed to treating diseases and going to the hospital with symptoms, but for digestive system tumors, this was too passive. Whether it is esophageal cancer, stomach cancer or colorectal cancer, when the patient has obvious symptoms such as difficulty eating, pus and blood, etc., it usually has reached the middle and advanced stages, and even if active treatment is initiated, the extension of the patient's life can only be calculated in "months".
From another point of view, although some patients with digestive system diseases are clearly a high incidence of tumors, more patients in the clinic are sporadic, and the existing early digestive system tumors are mostly detected by gastroscopy and colonoscopy for other reasons. Therefore, we should not wait for early warning signals to appear in gastrointestinal tumors, but actively screen early in people over 50 years old with the help of digestive endoscopy.
Early digestive system tumors confined to the mucosal and submucosal layers can be endoscopically removed while preserving digestive organs such as the esophagus and stomach. As a result, there is a new model for the treatment of digestive system tumors, that is, with gastrointestinal endoscopic treatment as the mainstay, surgery as a supplement, radiotherapy and chemotherapy as a supplement, and the pathology department has changed from a postoperative "trial" to an intraoperative "adjudication" treatment model. The obvious difference from the previous "surgery-based, endoscopic-supplemented" treatment is that the new model is expected to avoid a series of problems caused by organ removal and anatomical reconstruction. This shift in treatment models has also given birth to a new concept - super minimally invasive surgery.
Create | New | Diagnosis | Therapy | mold | |
02
Innovative ideas
· Provide a platform for surgical development
The main difference between super minimally invasive surgery and traditional surgery is that it pays attention to preserving the patient's original organs while removing the diseased tissue. Therefore, its goal is not only to "cure the disease" of surgery, but also to further "recover as before".
In 2016, Professor Ling Hu Enqiang proposed "super minimally invasive surgery". Taken literally, many would argue that this is just one more "more" word than the well-known minimally invasive procedure, even the president of the World Endoscopy Organization (WEO). After Professor LingHu explained it with a schematic diagram and rich case data, he received the strong support of many international colleagues. In 2021, WEO established the Super Minimally Invasive Committee. Previously, the Digestive Endoscopy Branch of the Chinese Medical Association just established the Super Minimally Invasive Committee in 2019. Nowadays, the new concept has gradually taken root and blossomed among domestic gastrointestinal endoscopists, and many diagnostic and treatment technologies introduced under the guidance of this concept have made China's digestive endoscopy team in the international leading ranks.
For example, according to traditional treatment, even if a tumor patient is in the early stages, some or even all of the organs need to be removed during surgical treatment. Despite the development of various reconstructive surgeries in recent years, the disappearing organs and their functions can still become a nightmare for patients. In the case of cardia cancer, for example, traditional surgery requires removal of the proximal stomach and cardia. After the operation, the strong acid reflux and other sequelae make it difficult for patients to lie flat and fall asleep.
So how to do super minimally invasive surgery? In the case of gastric stromal tumors, for example, doctors will first establish a channel in the loose tissue between the mucosal layer and the muscle layer of the gastric wall, that is, the submucosal layer, by injecting water. With this "tunnel", the endoscope can reach the muscular layer and even the mediastinum and retroperitoneal resection of the tumor. After the removal of the diseased tissue, the structure of the patient's esophagus, stomach, and colorectum has not changed, and the patient's life can be quickly restored as before.
Another more classic is the achalasia surgery, through the above "tunnel", the endoscope can accurately reach the muscle layer of the cardia site and perform incision treatment, after the operation, neither have to worry about the inner wall wound does not heal, nor do you have to worry about complications such as lung abscess. The surgery is less invasive, and skilled doctors can complete the treatment in just over 20 minutes.
"From the perspective of discipline development, the most important significance of the super minimally invasive concept is that it points out the direction for future innovative surgical methods. Innovative surgical and medical devices will have more vitality if they conform to the concept of super minimally invasive. Professor Ling Fox said. This new concept, which draws a clear line with the previous concept of surgery, provides a set of guidelines for the development of future surgery.
Under the guidance of the concept of super minimally invasive, Chinese scholars have developed a series of surgical methods in recent years. For example, retrograde cholangiopancreatography (ERCP), the previous treatment to cut the duodenal papilla, after treatment is prone to bile reflux, infection and other complications. Now insert a guide wire into the nipple area and then send the vitre to remove the gallbladder polyp or crush the stone and remove it. After the end of treatment, the support is lifted and the sphincter returns to normal. There is no gas accumulation in the bile ducts after treatment, and there is no bile reflux.
Similarly, deep pancreatic cysts and tumors can also be punctured through the pancreatic duct or from the stomach wall to complete treatment, biopsy, etc. For advanced gastric stromal tumors, scholars in China have also tried to remove the tumor from endoscopy and preserve the integrity of the stomach.
"Our human understanding of the human body is still very limited, but there is no doubt that after millions of years of evolution, no organ is superfluous, and the function of many organs is not yet clear to us. For example, recent studies have found that the heart can secrete tumor inhibitors, and the gastrointestinal tract directly affects brain waves. Professor Ling Fox said that since people do not know much about the human body, the best way is to protect every organ.
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03
Endoscopic screening of tumors
· The sinking of the center of gravity benefits better
Whether it's dealing with digestive system tumors or promoting the development of the concept of super minimally invasive, endoscopic screening for tumors is an important prerequisite. If the endoscopic screening work sinks to the grass-roots level, it can reduce the pressure of doctors in tertiary hospitals. Having a relatively more abundant examination time at the grassroots level can also improve the tumor detection rate and allow grassroots doctors to have a better sense of professional achievement.
Professor Ling Hu frankly said that one of the important factors restricting the development of China's digestion endoscopy team is the shortage of talents, especially grass-roots endoscopic talents.
In the existing medical education system, the undergraduate education and residency standardized training stages rarely involve gastrointestinal endoscopy knowledge. Therefore, the training of endoscopists often starts from scratch after formal employment and can only be completed after several years of training.
Japan's early cancer detection rate of the digestive system has approached 60%, ranking the world's leading position in this field. Compared with Japan, the number of endoscopic doctors per capita in China is only 1/10 of them.
In order to promote the early screening of tumors in the digestive system in China, Professor Ling Hu suggested that patients be guided to the grass-roots level. "Don't underestimate digestive endoscopy to screen tumors, it tends to take more time than treating tumors, and you also need to have enough patience and careful observation by doctors to avoid missed diagnoses," he said. If the grass-roots endoscopy doctors can be trained well, and the screening patients can be channeled to the grass-roots level through medical insurance payments and other means, so that the existing digestive endoscopy centers in tertiary hospitals can undertake the verification and treatment of suspected cases, we can quickly open the situation and solve the problem of insufficient medical resources. ”
In addition, capsule endoscopic screening is also an option. The Digestive Endoscopy Branch of the Chinese Medical Association has tried to train full-time capsule endoscopic operators and called them "medical practitioners". Usually, those with a high school degree or above can become qualified medical practitioners after 3 months of intensive training. Their main job is to operate the capsule endoscope like a game, photographing the key parts of the digestive tract clearly. Next, the artificial intelligence technology screens out the problematic image data, and finally the professional doctor reads the film for diagnosis. In the future, as this technology matures and becomes popular, it can also alleviate the gap of digestive endoscopists.
Inner | Mirror | Sieve | check | Swelling | tumor
Summary
Professor Ling Hu said that if the detection rate of early esophageal cancer, gastric cancer and colorectal cancer in China can reach 70% after various improvements, the new treatment mode based on endoscopic treatment and supplemented by surgical treatment can become the mainstream, so that the concept of super minimally invasive treatment can have more room to play. Only in this way can the threat of digestive system tumors to the health of our people be minimized. (Written by Zheng Yingpan, a reporter of Health Daily)
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Editor: Zheng Yingpan Hao Run'e