Gastroenterology

I. Overview of the Department of Gastroenterology

The Department of Gastroenterology of the Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital) was established as an independent department in July 2005. After more than 20 years of unremitting effort and in-depth development, it has formed distinctive subspecialty features in the diagnosis and treatment of digestive system diseases; its clinical standards hold a leading position in the city and are also at an advanced level within the province. In 2017 the department successfully passed the GCP inspection and certification of the China Food and Drug Administration and currently holds the qualification to conduct clinical trials of drugs and medical devices; in the same year it was rated a Dongguan municipal clinical key specialty. In 2019 it was named a Dongguan municipal "Youth Civilization Unit" (qingnian wenminghao) and, in the same year, was designated a China Esophageal and Gastric Varices Treatment Base. In 2024 it received such honors as the Chen Guiquan Medical Leading Talent specialty team, the National Colorectal Polyp Management Project Collaborative Center, and a Guangdong Provincial Inflammatory Bowel Disease Alliance member unit. It has been built into a distinguished department integrating clinical care, scientific research, teaching and high-quality nursing services. Particularly in recent years, the department has achieved rapid progress in the field of endoscopic diagnosis and treatment and has gained a certain degree of influence within the province and even nationwide.

The department serves as the chair unit of the Digestive Endoscopy Branch of the Dongguan Medical Association, the chair unit of the Digestive Nursing Professional Committee of the Dongguan Nursing Association, and the leading unit of the Digestive Endoscopy Nursing Group of the Dongguan Nursing Association; in the diagnosis and treatment of digestive system diseases and in digestive endoscopy it holds a regional leading position. It is a solid backing for town and subdistrict hospitals: the department actively establishes liaison channels with town and subdistrict hospitals and with community health service centers, building a sound pattern of two-way diagnosis and treatment with mutual benefit. By means of technical outreach and teleconsultation it promotes the development of primary-level services; the quality of outpatient and endoscopic diagnosis and treatment continues to improve, and more and more local residents benefit.

(1) Workforce development: The department has a medical and nursing team with specialized expertise and rich experience. It currently has 47 physicians, among them 25 with senior professional titles and 18 with intermediate professional titles, 3 holding doctoral degrees and 22 holding master's degrees. It has medical leading talents, outstanding young talents and master's degree supervisors, forming an echelon of inheritance that combines senior, middle-aged and young staff. Relying on its advantages in talent and technology as well as advanced equipment, the Department of Gastroenterology has achieved staged breakthroughs and leapfrog development in recent years.

(2) Clinical capabilities: The system of minimally invasive digestive endoscopic diagnosis and treatment techniques is increasingly mature. The department routinely performs endoscopic treatment of various early digestive tract tumors, implantation of various digestive tract stents, endoscopic treatment of various types of gastrointestinal bleeding, fecal microbiota transplantation, and such digestive endoscopic procedures as EMR, ESD, ERCP, EUS, STER, ESE, EFTR, ERAT, POEM and G-POEM, forming a technical profile characterized by "super-minimally invasive" treatment; the number of cases and the success rate rank among the top in the city. The volume of gastroscopy and colonoscopy examinations is about 70,000 per year, ERCP about 500 procedures per year, and EUS about 850 cases per year, all the highest in the Dongguan area.

Both the Honglou campus and the Puji campus of the hospital have expert-staffed gastroenterology specialist outpatient clinics, endoscopy centers and inpatient wards, better meeting the public's needs for medical care. The Honglou campus has 56 open beds and the Puji campus has 33 open beds.

After more than 20 years of development, a number of diagnostic and therapeutic techniques rank at the forefront of the province, including massive gastrointestinal bleeding, liver cirrhosis, refractory ascites, inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn's disease, severe acute pancreatitis, liver failure, severe jaundice, obstructive suppurative cholangitis, refractory peptic ulcer, chronic diarrhea, and screening for early digestive tract tumors — especially screening with chromoendoscopy and magnifying endoscopy, minimally invasive endoscopic management of early cancers and a range of other advanced endoscopic diagnostic techniques and minimally invasive endoscopic therapeutic techniques — as well as interventional procedures, all of which are at an advanced level within the province.

(3) Subspecialty development: The department actively advances subspecialty development and, around the goals of "disease-specific care by dedicated teams, technology leadership and research drive," builds a clinical research-oriented discipline system to raise the level of diagnosis and treatment and the influence of the discipline. At present the department has six subspecialties/specialty groups: inflammatory bowel disease (IBD), screening for early digestive tract cancer, gastrointestinal bleeding, endoscopic ultrasound diagnosis and treatment, hepatology, and hepatobiliary and pancreatic diagnosis and treatment. Each specialty group is headed by a core specialist holding a full senior or associate senior professional title, and each subspecialty is equipped with a dedicated talent echelon, achieving disease-specific care by dedicated teams, markedly raising the department's standards of diagnosis and treatment, and realizing refined management and specialized development.

(4) Scientific research achievements: Over the past five years the department has actively carried out a number of research projects at provincial and municipal levels and published multiple papers in medical journals at various levels. In total it has undertaken 8 research projects approved at municipal level or above, including 3 municipal key projects, 1 municipal science and technology commissioner project and 3 municipal general projects; it has carried out 1 provincial-level project under the Guangdong–Dongguan Joint Fund (regional cultivation). It has published more than 38 medical papers, among them 15 SCI papers, 6 papers in Chinese core journals and 14 papers in science and technology core journals; it holds 9 invention patents, has participated in the writing of 5 monographs and guidelines, and has introduced 7 new techniques. It participates in a number of domestic multicenter clinical studies; more than 10 GCP projects have been carried out cumulatively, and the annual funding of the projects exceeds one million yuan.

(5) Teaching: As one of the first batch of national standardized residency training bases, the Department of Gastroenterology has trained more than 150 residents in standardized training over the past 3 years and undertakes clinical internship teaching for a number of medical colleges and universities across the country, including Southern Medical University, Sun Yat-sen University, Guangdong Medical University and Guangzhou Medical University. Its teaching work has been at a leading level within the hospital for many years, and it has been rated an advanced department in clinical teaching and an outstanding teaching and research section.

(6) Nursing team: The nursing team of the Department of Gastroenterology, as the chair unit of the Digestive Nursing Professional Committee of the Dongguan Nursing Association, has long provided nursing care for common, frequently occurring and difficult digestive system diseases. The team actively cooperates with the medical departments in developing a number of new techniques and new services and has accumulated rich clinical nursing experience. The nursing team consistently upholds the "patient-centered" nursing philosophy and, with love, patience, attentiveness and a sense of responsibility, carefully nurses every patient, providing patients with comprehensive, professional and high-quality nursing services.

II. Specialized Endoscopic Techniques

(1) Painless gastroscopy and colonoscopy Painless gastroscopy and colonoscopy allow patients to complete the entire examination and treatment process in a painless state, with notable advantages such as high comfort, short duration and a low rate of missed diagnoses. The department has introduced digestive endoscopy equipment that is advanced in the field; the equipment not only has better flexibility and maneuverability, but its insertion tube is also thinner, and it is equipped with an HD high-definition lens and a narrow band imaging (NBI) system, so that chromoendoscopy and magnifying examination can be performed on suspicious lesions; when polyps are found, forceps biopsy can be taken promptly or the polyps can be resected, thereby achieving more precise diagnosis and treatment.

At present, the department performs about 70,000 gastroscopy and colonoscopy examinations each year, of which 80% are painless, safeguarding the gastrointestinal health of the people of Dongguan.

(2) Endoscopic ultrasonography (EUS) Endoscopic ultrasonography (EUS) is a digestive tract examination technique that combines endoscopy with ultrasound. While the endoscope directly visualizes the luminal morphology, real-time ultrasound scanning is also performed, thereby obtaining the histological characteristics of the individual layers of the duct wall and ultrasound images of adjacent organs, providing the digestive endoscopist with a "third eye".

After precise examination and diagnosis, physicians can use the various minimally invasive therapeutic techniques described above to treat mucosal and submucosal lesions, and can also perform procedures such as puncture and drainage, biopsy or stent implantation under the guidance of endoscopic ultrasound. The department introduced this technique in 2017 and currently completes more than 600 cases per year; the technique is performed in a mature manner.

(3) Endoscopic submucosal dissection (ESD) Endoscopic submucosal dissection (ESD) is one of the most revolutionary minimally invasive therapeutic techniques in the endoscopic field over the past two decades. It emphasizes step-by-step dissection of the lesion under endoscopy, effectively avoiding the problems of conventional open surgery, such as large trauma, destruction of normal anatomical structures and a relatively high incidence of complications.

Compared with other similar techniques, ESD has the advantages of a wider range of indications and a higher en bloc resection rate for large, complex lesions in a single session (reaching more than 96%).

Combined with histopathology, ESD can also provide precise histological staging of the tumor, clarifying the depth of invasion and the differentiation status of the tumor, which helps physicians judge accurately the extent and depth of the tumor.

ESD is technically demanding, but has a high success rate, complete resection and a low tumor recurrence rate.

The department has performed this technique for more than 10 years, with about 450 cases per year, resolving the diagnosis and treatment of various early digestive tract cancers for a large number of patients and significantly saving medical resources.

(4) Endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFR) Most submucosal tumors are benign lesions, but they gradually enlarge and some carry a risk of malignant transformation, such as gastrointestinal stromal tumors and neuroendocrine tumors (carcinoid).

With the development of minimally invasive endoscopic therapeutic techniques, most digestive tract submucosal tumors can now be resected under endoscopy; combined with endoscopic ultrasound, the growth layer, size and approximate pathological type of the tumor can be accurately determined, after which the appropriate endoscopic submucosal excavation (ESE) or endoscopic full-thickness resection (EFR) can be selected for treatment.

ESE is suitable for submucosal tumors that are mainly benign or of low-grade malignancy and grow predominantly within the lumen of the digestive tract; for larger submucosal tumors with exophytic growth, EFR can be used for complete resection.

Thanks to superb endoscopic suturing technique, the formerly difficult problem of intraoperative gastrointestinal perforation has now been reliably resolved.

The department has performed the above techniques for 6 years and currently performs more than 40 such treatments each year; the techniques are mature and achieve a more minimally invasive therapeutic effect.

(5) Endoscopic retrograde cholangiopancreatography (ERCP) Endoscopic retrograde cholangiopancreatography (ERCP) is currently one of the main means of minimally invasive treatment for biliary and pancreatic diseases. In this technique an endoscope is passed through the mouth into the descending part of the duodenum, and dedicated instruments are introduced through the duodenal papilla into the bile duct or the pancreatic duct; after injection of a contrast medium, X-ray films are taken to display the structure of the pancreatic and biliary ducts.

Because ERCP requires no open incision, it involves minimal trauma, a short procedure time, fewer complications than surgery and a substantially shortened hospital stay.

Placement of a biliary stent after ERCP to treat malignant biliary strictures caused by bile duct tumors or pancreatic tumors produces good results.

On this basis, a series of further procedures can also be performed, including duodenal papillary incision (sphincterotomy), balloon dilation, stone extraction, stent implantation in the common bile duct or the pancreatic duct, and nasobiliary tube placement.

The department has performed this technique for 16 years and currently performs more than 400 procedures per year, ranking at a leading level in the province.

The application of this technique means that some biliary and pancreatic operations that previously involved greater trauma can now be performed as minimally invasive treatments with less trauma, with notable advantages such as short procedure time, rapid recovery and fewer complications.

(7) Submucosal tunneling endoscopic resection (STER) Submucosal tunneling endoscopic resection (STER) is an emerging endoscopic therapeutic technique for submucosal tumors of the esophagus and stomach. The procedure is performed through the body's natural orifices; using the latest minimally invasive resection instruments and technical route, an opening is made in the surface layer (mucosa) of the esophagus and a submucosal "tunnel" is created along the esophageal dissection plane (submucosa), the submucosal lesion is resected under direct endoscopic vision, and the mucosal incision is then closed with metal clips.

This technique can both completely resect the tumor and preserve the integrity of the digestive tract, with treatment advantages of safety, minimal invasiveness, rapid recovery and few complications. The department has performed this technique for 6 years and currently performs more than 30 cases per year.

(8) Peroral endoscopic myotomy (POEM) Peroral endoscopic myotomy (POEM) mainly targets refractory achalasia. Patients present with spasm of the lower esophageal sphincter, so that food cannot pass smoothly into the stomach, leading to difficulty eating, frequent vomiting and continuous weight loss.

At present, peroral endoscopic myotomy (POEM) has become the first-choice treatment for achalasia. This technique requires neither thoracotomy nor laparotomy; the entire procedure is performed painlessly through a gastroscope, and it has the advantages of short procedure time, minimal trauma and rapid recovery, and patients can generally eat on the second day after the procedure.

The department has performed this technique for 7 years, performing more than 20 cases per year; as stated by the department, all cases have been successful, and its technical level ranks at the leading level in the province.

(9) Endoscopic retrograde appendicitis therapy (ERAT) Endoscopic retrograde appendicitis therapy (ERAT) is a new technique for treating appendicitis that has been developed in recent years along with the development of minimally invasive endoscopic diagnostic and therapeutic techniques.

Through an endoscope and using retrograde contrast imaging, the technique places a stent into the appendiceal lumen to fully drain the pus within the appendiceal lumen and reduce the pressure inside it, thereby achieving the goal of treating acute appendicitis.

ERAT has the advantages of minimal trauma, no scarring, a rapid therapeutic effect and quick recovery.

(10) Endoscopic esophageal and gastric variceal sclerotherapy (EVS) Endoscopic esophageal and gastric variceal sclerotherapy (EVS) precisely identifies and selects the source vessels and outflow vessels of the gastroesophageal varices and performs precise occlusion, so as to achieve timely hemostasis and prevent rebleeding.

The department states that this technique can achieve one-time eradication of gastroesophageal varices, thereby enabling patients with liver cirrhosis to live safely and healthily over the long term.

(11) Esophageal variceal rupture bleeding ligation (EVL) Esophageal variceal rupture bleeding ligation (EVL) is a safe and effective treatment for hemostasis and for the prevention of bleeding from ruptured esophageal varices. Through a gastroscope, the varicose veins of the esophagus are ligated with rubber bands, providing timely hemostasis and saving the patient's life.

(12) Double-balloon enteroscopy Double-balloon enteroscopy is one of the more advanced small-bowel endoscopic techniques currently available. By inflating and deflating the two balloons to advance the endoscope, it can reach the deep part of the small intestine, overcoming the blind spots in the diagnosis and treatment of small-bowel diseases and enabling diagnosis and simultaneous treatment of small-bowel diseases.

This procedure is time-consuming, carries risks such as bleeding and perforation, and places extremely high demands on the operator's skill.

As the Department of Gastroenterology of a public grade-A tertiary hospital leading in scale in Dongguan, the department now routinely performs double-balloon enteroscopy.

The technique is overall mature and reliable; the overall complication rate is below 1% and the success rate of the examination is relatively high. It allows direct visualization of the small-bowel mucosa and clear identification of lesions, effectively resolving various difficult problems in the diagnosis and treatment of small-bowel diseases.

Since the department began performing this technique in 2023, it has successfully completed 18 double-balloon enteroscopy examinations, with cases covering obscure small-bowel bleeding, suspected Crohn's disease, small-bowel polyps, small-bowel tumors and obscure small-bowel obstruction.

No severe complications occurred in any of the cases.

Postoperative follow-up results were good, indicating high safety and clinical diagnostic and therapeutic value.

Since the technique was promoted, it has gained a good reputation in the Dongguan region and attracted patients from other areas to come for examination.