Gastrointestinal Endoscopy

The Department of Digestive Endoscopy of Yueyang Hospital started in the 1980s. After more than 40 years and the efforts of several generations of physicians, upholding the principle of “patient-centered care” and pooling the strength of a multidisciplinary team, it has been built into a modern endoscopic diagnosis and treatment platform integrating preventive screening, diagnosis, treatment and perioperative management. After hardware renovation and talent recruitment in 2024, the Department of Digestive Endoscopy has been comprehensively upgraded; it now covers 1,450 square meters and has 11 rooms, including 2 endoscopic operating rooms and 1 ERCP room. It owns first-class domestic endoscopic equipment, including electronic high-definition and blue laser endoscopy systems, high-frequency electrosurgical knives, argon plasma systems and a C13 Helicobacter pylori detection system. It is equipped with electronic gastroscopes and colonoscopes, ultrafine gastroscopes, duodenoscopes, endoscopic ultrasound, enteroscopes and capsule endoscopes, as well as an independent washing and disinfection room.

The Department of Digestive Endoscopy has a well-structured team with strong technical capabilities, comprising 2 physicians with senior professional titles, 4 PhD holders and 4 master's degree holders, all of whom are experienced endoscopists. It is also staffed with several senior anesthesiologists and nurses, has a post-anesthesia recovery area and is equipped with professional resuscitation equipment to ensure the safety of anesthetized patients.

Discipline features

Screening and minimally invasive treatment of early digestive tract cancer:

Chromoendoscopy + magnifying endoscopy for detailed examination, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD)

“Detect one early cancer, save one life, and make one family happy.”

The 5-year survival rate of advanced gastric cancer is usually 10-20%, while the 5-year survival rate of early gastric cancer can reach over 90%. Therefore, screening for early gastric cancer can greatly improve survival, avoid radical gastrectomy, and significantly improve quality of life.

In the course of diagnosis and treatment, the department follows the guidelines for the diagnosis and treatment of digestive tract tumors, screens patients with high-risk factors, and when suspicious lesions are found, further performs detailed examination with chromoendoscopy and magnifying endoscopy to determine whether the lesion is benign or malignant, and carries out endoscopic minimally invasive resection (EMR/ESD) of early cancer lesions. After the operation, based on pathological results, whole-course management such as long-term follow-up is provided. For difficult, complex or undiagnosed cases, multidisciplinary joint diagnosis and treatment can be carried out together with the departments of gastroenterology, gastrointestinal surgery, pathology, medical imaging, oncology and interventional radiology.

Endoscopic retrograde cholangiopancreatography (ERCP) and related diagnostic and therapeutic techniques, intraductal ultrasonography (IDUS), and peroral cholangioscopy (SpyGlass)

ERCP involves inserting the endoscope through the mouth into the descending part of the duodenum and introducing special instruments through the duodenal papilla into the bile duct or pancreatic duct; it is mainly used for interventional treatment of bile duct stones, biliary tract tumors, biliary pancreatitis and other diseases.

ERCP for the treatment of common bile duct stones has the advantages of being minimally invasive, causing little pain and offering quick recovery, while maintaining the integrity and physiological function of the biliary system; it has now become the first-choice method for treating common bile duct stones.

Intraductal ultrasound (IDUS) is a safe and effective new method developed in recent years for diagnosing common bile duct stones, bile duct tumors and other diseases; it combines endoscopy with high-resolution ultrasonography, requires no contrast agent, provides real-time, high-quality images of the biliary system through high-resolution endoscopic ultrasound, and is not affected by intestinal gas.

SpyGlass, whose full name is the peroral cholangio-pancreatoscopy direct-viewing system, can enter the bile and pancreatic ducts through the biopsy channel of the duodenoscope, removing the last blind spot of the digestive tract. It allows lithotripsy and biopsy under direct vision to differentiate benign and malignant diseases of the bile and pancreatic ducts, as well as radiofrequency and photodynamic therapy for advanced biliary tract tumors.

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Endoscopic ultrasound (EUS) examination and EUS-guided interventional techniques

Endoscopic ultrasound places an ultrasound probe at the front end of the optical endoscope and probes the digestive tract wall and adjacent organs through acoustic imaging technology.

High-frequency mini-probe endoscopic ultrasound can evaluate the origin and nature of submucosal lesions of the gastrointestinal tract, and can also improve the accuracy of diagnosing early gastrointestinal tumors.

Linear-array endoscopic ultrasound can perform detailed scans of abdominal organs, especially lesions of the biliary and pancreatic systems, and can perform fine-needle aspiration biopsy, achieving early diagnosis and characterization of space-occupying lesions in the abdominal cavity, mediastinum and pelvis through the digestive tract. In addition, various interventional techniques have been derived, such as puncture and drainage of pancreatic cysts, puncture and drainage of the bile duct and pancreatic duct, and coil injection for gastric fundal varices.

Endoscopic retrograde appendicitis therapy (ERAT)

The main treatment for acute appendicitis is surgical resection of the appendix. However, in recent years many studies have found that the appendix is not a “useless organ” but an immune organ, so resection is not necessarily the optimal choice. ERAT is an emerging technique that requires neither general anesthesia nor incisions; instruments are merely placed into the appendix through the colonoscope, so that appendicitis can be treated while preserving the appendix.

Capsule endoscopy, enteroscopy examination and treatment

In patients with unexplained gastrointestinal bleeding, examination of the small intestine is often a blind spot of endoscopic examination; with the development of capsule endoscopy and enteroscopy technology, this blind spot has been overcome.

Capsule endoscopy can complete a full examination of the small intestine in a single procedure without pain or trauma; it is easy to operate and highly safe, and is quite suitable for patients who cannot tolerate gastroscopy or colonoscopy, while having a clinical diagnostic rate similar to that of enteroscopy. Therefore, capsule endoscopy has been recommended as the first-choice diagnostic method for small intestine diseases.

Enteroscopy is divided into two routes, oral and anal. At present, oral and anal approaches can be joined to achieve diagnosis and treatment of the entire small intestine. In the past, for some gastrointestinal foreign bodies that had entered the small intestine, routine gastroscopy could not remove them and only surgery could be performed. Now there is an opportunity to remove foreign bodies through enteroscopy, avoiding surgical trauma.

Dilation and stent placement for digestive tract strictures

There are many causes of digestive tract stricture, such as inflammatory strictures, postoperative anastomotic strictures and tumor-related strictures. Benign strictures can be treated with balloon dilation or placement of retrievable stents. Malignant strictures can be treated with permanent metal stents. In patients with acute intestinal obstruction caused by tumors, a metal stent can first be placed to relieve the obstruction, and after preoperative preparation is completed, lesion resection and anastomosis can be performed in the same stage, avoiding the trauma caused by emergency fistula surgery and a second operation.

Percutaneous endoscopic gastrostomy/jejunostomy (PEG/J)

All patients who have difficulty eating by mouth for various reasons and need long-term placement of a gastric tube for nasal feeding nutritional support are candidates for PEG; this technique is particularly suitable for patients with dysphagia caused by various neurological diseases and various other diseases, as well as patients with anorexia nervosa and neurogenic vomiting, and patients who need nutritional support but cannot tolerate surgical fistulation.

This technique involves percutaneous puncture guided by endoscopy to place a fistula tube into the stomach or jejunum for enteral nutrition and palliative gastrointestinal decompression. Compared with indwelling gastric tubes, the advantages of this technique are reducing the probability of reflux and aspiration pneumonia and improving patients' quality of life; compared with surgery, the advantages are minimal trauma, low cost, the possibility of local anesthesia and bedside performance, and simple nursing care.

Endoscopic treatment of esophagogastric varices (EVL, EIS, ESVD, etc.)

Gastroscopy is the gold standard for the diagnosis of esophagogastric varices; it can accurately grade the extent, degree and bleeding risk of varicose veins and perform endoscopic treatment, sealing and ligating the vessels to eliminate varices and reduce bleeding risk. The main methods are endoscopic ligation, sclerosant and tissue adhesive injection, as well as combined and sequential treatment. In addition, in recent years a new treatment has emerged — endoscopic selective varices devascularization (ESVD): by judging the direction of blood flow, the origin of the vessel is accurately determined and tissue adhesive is precisely injected into the origin vein. The advantages of this technique are that it does not require combined treatment of esophageal varices, and compared with traditional ligation combined with tissue adhesive therapy it has the advantages of high efficacy, low bleeding rate and fewer treatment sessions, while also greatly reducing the risk of ectopic embolism and the amount of tissue adhesive used.

Endoscopic sclerotherapy and ligation of internal hemorrhoids

Hemorrhoids are a common anorectal disease; as the saying goes, “nine out of ten men have hemorrhoids” and “ten out of ten women have hemorrhoids”. The most common symptoms are blood in stool, prolapse of hemorrhoids, anal pain and itching. In 2021, the Digestive Endoscopy Branch of the Chinese Medical Association issued the “Chinese Guidelines and Operational Consensus for Endoscopic Diagnosis and Treatment of Internal Hemorrhoids”; patients with grade I-III internal hemorrhoids accompanied by symptoms such as blood in stool and prolapse are suitable for endoscopic minimally invasive treatment. Endoscopic treatment has the advantages of low pain, minimal trauma, few complications, quick recovery and simple postoperative care, and colonoscopy can be performed at the same time to rule out intestinal diseases.

Peroral endoscopic myotomy (POEM) for achalasia

Achalasia is mainly manifested as dysphagia, food regurgitation, retrosternal pain, weight loss and other symptoms.

POEM is one of the important means of treating achalasia. It is an endoscopic minimally invasive surgery that performs myotomy through tunnel endoscopic technique, opening the muscular stenotic ring at the esophagogastric junction to relieve the obstruction. It is a minimally invasive surgery that requires neither thoracotomy nor laparotomy, with minimal surgical trauma and quick postoperative recovery. Its efficacy is reliable and its safety is high.

Endoscopic submucosal tunnel resection of tumors (STER)

Endoscopic submucosal tunnel resection (STER) is an emerging endoscopic technique for treating tumors of the muscularis propria of the digestive tract, derived from POEM. Traditional endoscopic electroresection for submucosal tumors of the digestive tract is prone to perforation during treatment, especially for deep submucosal tumors, which sometimes require full-thickness resection that is difficult to suture, necessitating additional surgical closure and rendering endoscopic surgery meaningless. At sites such as the esophagus, the esophagogastric junction and the gastric antrum, a small opening is first made on the mucosal surface, then the endoscope is advanced into it, a tunnel is established in the submucosa, and the tumor is completely removed under direct vision while the integrity of the mucosa on the surface of the digestive tract is preserved. After the tumor is completely removed, the opening of the mucosal tunnel is closed with metal clips, avoiding perforation of the digestive tract and reducing postoperative complications such as digestive tract leakage.

This method has the advantages of short operation time, minimal trauma, low pain, low cost and quick patient recovery; it can peel off the tumor completely in one session while maintaining the integrity of the digestive tract, has the same therapeutic effect as surgery, and leaves no scar on the body surface after the operation.

Endoscopic treatment of gastroesophageal reflux, such as cardia constriction

Gastroesophageal reflux disease (GERD) is mainly caused by acid reflux leading to esophageal mucosal damage and clinical symptoms such as heartburn. Drug therapy is the most common treatment, but for patients with more severe conditions or those unresponsive to drug therapy, endoscopic treatment may be considered.

Endoscopic placement of nutritional tubes and intestinal obstruction tubes

Various emergency endoscopic procedures, such as for gastrointestinal bleeding and gastrointestinal foreign bodies