Objective To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis and treatment of pancreas divisum(PD) associated with recurrent acute pancreatitis(RAP) in children and teenagers. Methods Data of patients with symptomatic PD associated with RAP under 18 years old who were diagnosed and treated with ERCP from January 2011 to January 2015 were retrospectively analyzed. Patients with complete pancreas divisum underwent endoscopic minor sphincterotomy combined with dorsal duct stenting ( ESCS ) , and those with incomplete pancreas divisum underwent bi?papilla endoscopic sphincterotomy combined with dorsal duct stenting ( Bi?ESCS ) . ERCP?related data, complications were recorded. Long?term follow?up was conducted for procedure related complications. Results Nine patients with symptomatic PD associated with RAP were firstly diagnosed. A total of 18 ERCP procedures were performed in these patients, with success rate of 100. 0% ( 18/18) in the minor papilla cannulation, and mild ERCP?related complication rate of 11. 1% ( 2/18) . One was acute mild pancreatitis and the other was hyperamylasemia. During follow?up from 3 to 60 months, all patients had pain relief, among whom 7 were asymptomatic, with no onset of acute pancreatitis. Dorsal ducts of all patients were not obviously dilated in MRCP or CT scan. All patients gained weight and presented normal physical and intelligence development. Conclusion Symptomatic PD associated with RAP can be completely diagnosed with ERCP . ESCS and Bi?ESCS are safe and effective endoscopic treatment techniques for pediatric cases.

Objective:To study the risk factors for duodenal injury caused by malposition of plastic bile duct stent for the treatment of biliary stricture.Methods:Data of 1 408 patients with biliary stricture (2 607 procedures of plastic stent placement) who received plastic stent placement in Hangzhou First People's Hospital from January 2017 to December 2021 were retrospectively analyzed and duodenal injury caused by bile duct stent malposition after placement was recorded. The patients were divided into two groups: the malposition injury group ( n=23 procedures) and the non-malposition injury group ( n=2 584 procedures). The differences in the baseline data and procedure-related condition between the malposition injury group and the non-malposition injury group were compared, and the independent risk factors for duodenal injury caused by bile duct plastic stent malposition were studied by using logistic regression analysis. Results:A total of 2 607 procedures of plastic stent placement were performed in 1 408 patients with biliary stricture, and 23 cases of duodenal injury were caused by stent malposition. Logistic regression analysis revealed that a history of gastrointestinal surgery ( OR=4.278, 95% CI: 1.332-13.737, P=0.015), a history of endoscopic sphincterotomy (EST) ( OR=8.128, 95% CI: 2.382-27.738, P=0.001), and high-level bile duct stenosis ( OR=4.457, 95% CI: 1.722-11.539, P=0.002), plastic stents with a length≥ 7 cm ( OR=4.701, 95% CI: 1.708-12.938, P=0.003) and Christmas tree-shaped stent ( OR=6.890, 95% CI: 1.540-30.830, P=0.012) were independent risk factors for duodenal injury caused by bile duct plastic stent malposition. Conclusion:High-level bile duct stenosis, the use of plastic stents with a length≥ 7 cm and Christmas tree-shaped stent, a history of gastrointestinal surgery, and a history of EST could increase the risk of duodenal injury caused by bile duct plastic stent malposition in patients with bile duct stenosis.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.