Objective To evaluate the curative effect of asymptotic full-thickness myotomy type of peroral endoscopic myotomy(POEM) for achalasia.Methods Data of 41 patients who underwent asymptotic POEM at our digestive endoscopy center from December 10th 2010 to January 10th 2014 were retrospectively studied.The postoperative and preoperative symptoms and reflux were compared.Results The postoperative Eckardt scores of symptoms of 41 patients improved significantly(P ＜ 0.001) compared with before.Esophageal dynamic pressure also showed the effectiveness of symptom relief.The incidence of postoperative reflux in symptoms and gastroscopy were 26.83％ and 27.27％,respectively.Conclusion Asymptotic fullthickness myotomy POEM can alleviate the symptoms of achalasia and the effect of inhibiting reflux is generally satisfactory.

Background::To date, there is still a lack of standardized management strategies for gastric low-grade dysplasia (LGD), which is a direct neoplastic precancerous lesion and requires specifically superficial destruction. Radiofrequency ablation (RFA) is expected to be an effective method for gastric LGD, but post-RFA pain may affect patients’ satisfaction and compliance. The current study aimed to evaluate the value of a submucosal injection prior to RFA (SI-RFA) for postoperative pain and treatment outcomes.Methods::Between October 2014 and July 2021, gastric LGDs without risk factors (size >2 cm, unclear boundary, and abnormal microsurface and microvascularity) undergoing regular RFA and SI-RFA were retrospectively analyzed. Postoperative pain scores, wound healing, and clinical efficacy were compared. Propensity score matching, stratified analysis, and multivariable logistic regression were performed to control the confounding variables.Results::One hundred and ninety-seven gastric LGDs in 151 patients received regular RFA. Forty-nine gastric LGDs in 36 patients received SI-RFA. Thirty-six pairs of patients were selected for the assessment of postoperative pain by propensity score matching. Compared to regular RFA, SI-RFA significantly decreased the degree and duration of postoperative pain (OR, 0.32; 95% CI, 0.13-0.84; P = 0.020), improved wound healing rate (80.0% [36/45] vs. 58.9% [89/151], P = 0.012), increased the complete ablation rate (91.8% [45/49] vs. 86.3% [170/197], χ 2 = 1.094, P = 0.295), but correlated with higher rates of local recurrence and progression (25.6% [10/39] vs. 13.2% [18/136], χ 2 = 3.471, P = 0.062; 8.3% [3/36] vs. 0.9% [1/116], P = 0.042). The multivariable logistic regression model confirmed that submucosal injection was associated with local recurrence (OR, 2.93; 95% CI, 1.13-7.58; P = 0.027). Conclusions::Submucosal injections prior to RFA may reduce postoperative pain and scar formation while ensuring complete ablation of gastric LGD. However, local recurrence and progression should be considered seriously.

Objective:To construct a model for predicting early recurrence of hepatocellular carcinoma (HCC) patients after radiofrequency ablation by different machine learning models based on multimodal MRI and clinical indicators, and to evaluate the predictive efficacy of the model.Methods:The data of patients with HCC who underwent radiofrequency ablation in Fourth Medical Center of Chinese PLA General Hospital and the First Medical Center of Chinese PLA General Hospital from January 2015 to December 2021 were retrospectively analyzed. A total of 169 patients with HCC were enrolled, including 152 males and 17 females, aged (57.2±9.2) years. The training set ( n=135) and the test set ( n=34) were randomly divided according to 8∶2. There were 49 cases recurrence in training set and 12 cases recurrence in test set. Based on the training set, the clinical influencing factors of early recurrence in patients with HCC after radiofrequency ablation were screened by univariated and multivariate logistic analysis, and the imaging features were sequentially screened by variance threshold method, select K-best and LASSO regression. Support vector machine (SVM), logistic regression and random forest (RFOREST) were used to construct the prediction models of early postoperative recurrence with simple imagomics alone or combined clinical features, respectively, and the receiver operating characteristic (ROC) curve was used to evaluate the prediction efficiency of the models. Results:Multivariate logistic regression analysis showed that preoperative alpha-fetoprotein >20 μg/L, platelet count >140×10 9 and tumor location were the influential factors for early recurrence of HCC patients after radiofrequency ablation (all P<0.05). Through variance threshold analysis, select K-best and LASSO regression, 16 optimal image omics features were selected. SVM, logistic regression and RFOREST were used to construct a simple imaging omics model for predicting early recurrence of HCC patients after radiofrequency ablation. The areas under ROC curve of the test set were 0.826, 0.830 and 0.826, respectively. And the areas under ROC curve of the constructed imagomics combined clinical model of test set were 0.830, 0.830 and 0.909, respectively. The area under ROC curve of RFOREST in the test set was better than that of SVM and logistic regression ( Z=2.19, 3.98, P=0.008, 0.008). Conclusion:The combined model constructed by SVM, logistic regression and RFOREST based on clinical indicators and image omics features is effective in predicting the early recurrence of patients with HCC after radiofrequency ablation, and the model constructed by RFOREST is the best.

Objective:To evaluate the long-term efficacy and safety of a novel self-help inflatable balloon to prevent esophageal stenosis after extensive endoscopic submucosal dissection (ESD).Methods:Patients with early esophageal cancer or precancerous lesions, undergoing ESD in the First Medical Center of Chinese PLA General Hospital from January 2018 to December 2019 were included in the prospective study, who had post-ESD mucosal defect greater than 5/6 of the esophageal circumference and 30-100 mm in length. The self-help inflatable balloon was used to prevent esophageal stenosis after ESD. Mucosal defect of ESD was divided into grade 1 (≥5/6 and less than the whole circumference) and grade 2 (the whole circumference). The incidence of stricture, the time from ESD to the occurrence of stricture, the total number of endoscopic balloon dilations (EBD) or radial incision and cuttings (RIC), and other adverse events were observed.Results:A total of 27 patients met the including criteria with follow-up time of 14-38 months, including 3 patients of grade 1 and 24 of grade 2. The ulcer longitudinal length was 73.7±18.4 mm. The time of wearing balloons was 92.0±20.0 days. The overall frequency of stricture was 18.5% (5/27), and the stricture incidence of patients of grade 2 resection was only 16.7% (4/27). The median time from balloon removal to stricture was 17 days. To treat the stricture, two patients received 3 EBD sessions, and three other patients received 2, 1 and 2 RIC sessions, respectively. No balloon was removed in advance, and none had a perforation or delayed bleeding.Conclusion:The self-help inflatable balloon shows high efficacy and safety in preventing esophageal stenosis in patients with mucosal defect greater than 5/6 of the esophageal circumference and less than 100 mm in length after extensive esophageal ESD.