Best Practice & Research Clinical Gastroenterology最佳实践与研究：临床胃肠病学
Best Practice & Research Clinical Gastroenterology(英文缩写 BEST PRACT RES CL GA),ISSN 1521-6918,eISSN 1532-1916,中文译名:最佳实践与研究：临床胃肠病学 是一本学术期刊。本页汇总该期刊的最新影响因子、分区信息以及最新收录于 PubMed 的文献,帮助您快速了解期刊全貌。
发文量统计区间：2025-09-28 至 2026-09-28，按本站收录文献的发表日期统计。
期刊介绍
历年影响因子趋势
| JCR 数据年份 | 影响因子 | JCR 分区 |
|---|---|---|
| 2021 | 2.695 | Q4 |
| 2022 | 3.200 | Q3 |
| 2023 | 3.200 | Q2 |
| 2024 | 4.000 | Q1 |
| 2025 | 5.200 | Q1 |
Best Practice & Research Clinical Gastroenterology 最新收录文献
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1. Advanced rectal lesions: Best practices for assessment and management.
PMID:日期:2026-06-01Advanced rectal lesions (ARLs), including large laterally spreading lesions (LSLs), villous or high-grade dysplastic adenomas, and early rectal cancers, constitute a critical transitional category between benign adenoma and invasive carcinoma. Historically, radical surgery was liberally employed for these lesions, often resulting in significant morbidity and permanent stoma formation. Contemporary endoscopic and transanal techniques permit curative resection while preserving anorectal function, but careful assessment is mandatory to avoid undertreatment of covert cancers. We reviewed international guidelines and key studies on ARL assessment and management, focusing on endoscopic imaging, staging modalities and therapeutic techniques. Evidence from ESGE, ASGE, NCCN and BSG/ACPGBI guidelines, prospective trials, and observational cohorts was appraised and summarized. Points of divergence between society guidelines are highlighted where relevant to rectal lesion management. The rectum has distinct anatomical and vascular characteristics which strongly influence endoscopic and surgical decision making. Lesions in the rectum have a higher risk of submucosal invasive cancer (SMIC) compared to the remainder of the colon andare more likely to be larger, nodular and villous in nature. Rectal surgery is complex and has a higher risk of stoma formation and adverse events than colon surgery. Appropriately selected organ preserving techniques reduce risk and preserve function for patients. High-definition white-light endoscopy with virtual or dyebased chromoendoscopy permits accurate optical diagnosis of ARLs. Assessment of surface features and morphology allows the endoscopist to predict the risk of covert cancer. Routine biopsy is discouraged to avoid fibrosis. Endoscopic ultrasound and pelvic MRI are used selectively for lesions suspicious for deeper invasion or when planning transanal surgery. Endoscopic resection is appropriate for the majority of lesions in the rectum and a selective strategy ensures that the appropriate technique can be chosen to optimize oncological outcomes. Lesions with features of deep invasive cancer should be carefully appraised and discussed in a multidisciplinary setting. Selected lesions with a low risk of covert cancer may be resected by endoscopic mucosal resection (EMR) with margin ablation. Endoscopic submucosal dissection (ESD) provides superior en-bloc and curative resection rates for higher risk lesions. Emerging data demonstrates that ESD has equivalent or superior outcomes compared to transanal endoscopic microsurgery (TEM), or transanal minimally invasive surgery (TAMIS) for larger rectal lesions. Hybrid techniques (e.g., underwater EMR, tip-in EMR, full-thickness resection devices) may also be utilised in the therapeutic framework. An evidence-based, organ-preserving algorithm for ARLs emphasizes optical risk stratification, individualised technique selection and multidisciplinary input to optimize patient outcomes. Ongoing research will refine hybrid methods, artificial intelligence-aided diagnostics and new organ preserving strategies.
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2. Advances in endoscopic strategies for oesophageal squamous cell carcinoma.
PMID:日期:2026-06-01Endoscopic management of early oesophageal squamous cell carcinoma (ESCC) is progressively moving from a binary curative versus non-curative approach towards a risk-adapted strategy. Accurate optical assessment remains essential, but its limitations support the use of endoscopic resection, particularly endoscopic submucosal dissection (ESD), as both a therapeutic and a staging procedure. Compared with endoscopic mucosal resection, ESD provides higher en-bloc and complete resection rates, better histological assessment and lower local recurrence, although it requires dedicated expertise. Post-resection management should integrate depth of invasion, lymphovascular invasion, differentiation, margin status, comorbidities and patient preferences. Circumferential lesions represent a specific challenge because of the important risk of refractory stenosis. Definitive chemoradiotherapy remains a major organ-preserving option, either after non-curative ESD or as primary treatment, while salvage endoscopic therapy may be considered for selected superficial local failures. Multidisciplinary discussion is therefore central to balance oncological control, treatment morbidity and quality of life.
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3. Developing and operating a high-quality endoscopic resection unit: insights from western institutions.
PMID:日期:2026-06-01The increasing detection of early gastrointestinal neoplasia and large precursor lesions across Western health systems has expanded the role of organ-preserving endoscopic therapies. Endoscopic mucosal resection (EMR). endoscopic submucosal dissection (ESD) and other related endoscopic resection techniques can provide curative-intent treatment with accurate histopathologic staging, but their safe and reproducible delivery depends on robust service design rather than technical expertise alone. This narrative review synthesizes practical insights from Western institutions on the development and operation of a high-quality endoscopic resection unit. Key domains include service model and referral pathways, patient selection and peri-procedural planning, procedural environment, equipment and accessories, multidisciplinary support, complication rescue pathways, workforce training, quality monitoring, and institutional sustainability. Particular emphasis is placed on standardization, multidisciplinary integration, prospective audit, and governance structures that support consistent outcomes and long-term program viability. High-quality resection units should be regarded not simply as procedural services, but as organized clinical platforms that deliver safe, scalable, and organ-preserving treatment, with resilience built within the team framework.
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4. Training in endoscopic submucosal dissection: Current models and future needs.
PMID:日期:2026-06-01Endoscopic submucosal dissection (ESD) has transformed the management of superficial gastrointestinal neoplasia but remains technically demanding, with a steep learning curve posing significant training challenges, particularly in Western countries where case volumes are lower than in East Asia. This review summarizes current ESD training models including ex vivo and live animal models, simulation platforms, and traction devices. We examine learning curve evidence demonstrating that structured supervision reduces the learning curve from approximately 250 to 30-40 cases. Regional differences between Eastern and Western training paradigms are analysed. We propose a five-phase competency-based training pathway and identify priorities for future research including curriculum validation, artificial intelligence-assisted assessment, and scalable mentorship strategies.
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5. Mitigating risk following upper gastrointestinal Endoscopic Submucosal Dissection: preventing bleeding, perforation and stricture formation.
PMID:日期:2026-06-01Endoscopic submucosal dissection (ESD) is an effective organ-sparing technique for superficial neoplasia in the upper gastrointestinal tract, although it remains associated with a non-negligible risk of complications. This narrative review provides an integrated overview of the entire ESD pathway, from pre-procedural risk stratification to intraprocedural management and post-procedural care. Adverse events should be interpreted as the result of the interaction between patient-related factors, lesion characteristics, and procedural complexity. During the procedure, maintaining stable control of the submucosal plane is central; in this context, strategies such as anticipatory vessel coagulation, optimized dissection, traction, and saline immersion contribute to improve visualization and reduce bleeding and perforation risk. Post-procedural risk is largely site-specific, with stricture predominating in the esophagus, delayed bleeding in the stomach, and both bleeding and perforation in the duodenum. A risk-adapted approach is therefore essential to improve safety and optimize outcomes.
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6. Accurate histology prediction before resection of colorectal polyps: Is artificial intelligence shaping the future of optical diagnosis?
PMID:日期:2026-06-01Artificial intelligence (AI) is increasingly entering colonoscopy practice, with computer-aided detection (CADe) systems improving polyp and adenoma detection. However, the next challenge is not only to detect more lesions, but to determine in real time which lesions require resection, histopathological assessment, surveillance adjustment or surgical referral. Computer-aided diagnosis (CADx) systems aim to support this step by predicting colorectal polyp histology before resection and enabling optical diagnosis strategies such as "resect-and-discard" and "diagnose-and-leave". The clinical value of CADx should not be judged by diagnostic accuracy alone. To become clinically meaningful, CADx must safely guide management decisions, meet established ASGE and ESGE thresholds, integrate into real-time workflow and remain valid across endoscopy platforms, imaging modalities, lesion subtypes and operator expertise. Although systems such as CAD EYE, GI Genius, POLAR and endocytoscopy-based algorithms show promising diagnostic performance, recent meta-analyses suggest that CADx has not yet provided clear incremental benefit for "diagnose-and-leave" or "resect-and-discard" strategies when added to endoscopist assessment. This may reflect high baseline confidence among endoscopists, but also current limitations including binary classification schemes, inconsistent handling of sessile serrated lesions, lack of calibrated confidence scores and limited explainability. Beyond diminutive-polyp characterisation, AI is also being explored for invasion-depth prediction in larger or suspicious colorectal lesions, where incorrect predictions may lead to undertreatment or overtreatment. Moreover, AI-assisted colonoscopy remains dependent on high-quality mucosal exposure, adequate bowel preparation, careful inspection and trained endoscopists. Overall, CADx remains promising, but broader implementation requires prospective real-world validation, explainable and interoperable systems, robust human-AI interaction and clinically relevant outcomes before it can safely substitute histopathology in selected settings.
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7. Controversies in technique selection for endoscopic resection of Barrett's neoplasia.
7. 内镜下切除Barrett瘤的技术选择存在争议PMID:日期:2026-06-01Barrett's esophagus-related neoplasia is now predominantly managed with endoscopic eradication therapy. This strategy combines endoscopic resection of visible lesions with ablation of residual Barrett's mucosa, offering excellent safety and long-term disease control. Two endoscopic resection techniques are used in current practice: endoscopic mucosal resection and endoscopic submucosal dissection. Existing guideline recommendations for technique selection vary but are largely based on the suspected depth of invasion and preference for R0 resection. However, the unique biological and clinical features of Barrett's challenge this framework. Neoplasia arises within a field of metaplastic change, and the ultimate goal is not simply complete resection but durable eradication of disease. The traditional oncologic endpoint, R0 resection, may be less meaningful in this context, while more clinically relevant outcomes, such as recurrence, disease-free survival, and patient-centred measures, remain inconsistently defined and reported. Furthermore, technical and procedural considerations, including histopathological accuracy, safety, and resource use, add further complexity to decision-making. This review explores the evolving evidence, highlights ongoing debates in technique selection for Barrett's neoplasia, and proposes considerations to inform patient-centred clinical decision-making and future research priorities.
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9. Colorectal ESD from basics to latest innovations!
PMID:日期:2026-06-01Colorectal endoscopic submucosal dissection (ESD) is gaining adoption in Western practice because it outperforms endoscopic mucosal resection (EMR), with higher en bloc and R0 resection rates, lower local recurrence, and less need for surgery. Its main limitation is technical: colorectal ESD is long, complex, and complication-prone. Multiple recent advances aim to improve reproducibility and safety, including new dissection strategies (pocket-creation, tunneling, underwater ESD), traction systems (clip-band, adaptive and magnetic traction), advanced knives (a novel thin-needle knife with high-pressure waterjet) and closure platforms (reopenable clip with anchor prongs, through-the-scope helix tack-and-suture system and endoscopic hand suturing), stabilizing platforms, and robotic and AI assistance. Safe ESD still depends on fundamental skills: tip control, stable incision and trimming, efficient submucosal dissection, and immediate control of bleeding and perforation. This review aims to summarize current technical solutions, identify persistent limitations, and define priorities for training, case selection, cost-effectiveness, and environmental impact in Western practice.
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10. Endoscopic approach to the large non-pedunculated colorectal polyp: mucosal, submucosal, hot and cold techniques.
PMID:日期:2026-06-01Large non-pedunculated colorectal polyps represent a heterogeneous group of lesions with variable malignant potential and technical complexity. Appropriate management requires careful lesion assessment, estimation of malignant risk and adoption of selective resection strategy with consideration to the patient, the lesion and technical challenges that may be encountered. Advances in endoscopic resection has meant that most colorectal polyps can be safely removed with an expanding role in the management of early colorectal cancer. Inappropriate lesion assessment and premature surgical referral continue to result in avoidable surgery and its associated morbidity. This review summarises the current evidence on techniques for the management of large non-pedunculated colorectal polyps, highlighting areas of uncertainty and priorities for future research.