Objective To analyze the risk factors of refractory postoperative stenosis after large-scale endoscopic submucosal dissection (ESD) for patients with early esophageal cancer.Methods The data of 35 postoperative stenosis patients previously treated by ESD (dissection ≥3/4 circumferential) for early esophageal cancer from January 2011 to September 2016 in Digestive Endoscopy Center, Changhai Hospital were reviewed.According to the number of endoscopic dilation, 35 patients were divided into two groups: refractory stenosis (≥6 endoscopic dilations, n=21) and non-refractory stenosis (≤5 endoscopic dilations, n=14), comparison between the two groups was performed using t test or Fisher exact probability method.Results Muscle layer damage (P=0.018), longitudinal mucosal defect length (P=0.013), tumor infiltrating depth (P=0.031), and the number of hemostatic clips (P=0.031) were significantly different between the two groups.The history of chemotherapy and radiotherapy, the location of tumor, the macroscopic type, and the postoperative administration of oral prednisolone were not significant differences between the two groups (P>0.05).Conclusion Refractory esophageal stenosis commonly occurs in patients undergoing large-scale ESD with tumor depth >M2, muscle layer damage, longitudinal mucosal defect length ≥50 mm and the number of hemostatic clips ≥6.

OBJECTIVETo probe into the incidence, mechanism and clinical characteristics of chronic subdural hematoma (CSDH) evolving from traumatic subdural effusion (TSE).

METHODSThe clinical materials of 32 patients with CSDH evolving from TSH were analyzed retrospectively and the correlative literature was reviewed.

RESULTS16.7% of the patients with TSH evolved into CSDH. The time of evolution was 22 - 100 days after head injury. All patients were cured with hematoma drainage.

CONCLUSIONSTSE is one of the origins of CSDH. The clinical characteristics of TSE evolving into CSDH include polarization of patient age, and chronic small effusion. The patients are usually injured deceleratedly and accompanied with mild cerebral damage.

Adolescent ; Adult ; Child ; Child, Preschool ; Chronic Disease ; Female ; Hematoma, Subdural ; etiology ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Subdural Effusion ; physiopathology ; Wounds and Injuries ; physiopathology

Objective To investigate the necessity and selection of endoscopic treatment in patients with upper gastrointestinal submucosal tumors ( SMTs) . Methods Clinical data of 306 patients with upper gastrointestinal SMTs at the Digestive Endoscopy Center of Shanghai Changhai Hospital from January 2012 to October 2013 were reviewed, and distribution characteristics, pathology types, endoscopic operation option of SMTs were analyzed. Results Of all 306 cases, 55 lesions ( 18. 0％) were located in esophagus, 244 (79. 7％) in stomach, 7 ( 2. 3％) in duodenum. Pathological results showed that there were 142 cases ( 46. 4％) of leiomyoma, 114 ( 37. 3％) gastrointestinal stromal tumors ( GIST ) , 15 ( 4. 9％) ectopic pancreas,14 ( 4. 6％) lipomas,7 ( 2. 3％) neuroendocrine tumors ( NETs) , and 14 ( 4. 6％) other types. Of esophageal SMTs, leiomyoma accounted for 85. 4％, GIST 5. 4％. Of cardiac SMTs, leiomyoma was 78. 8％, GIST was 12. 1％. Of gastric fundus SMTs, leiomyoma was 28. 7％, GIST was 69. 0％. Of gastric body SMTs, leiomyoma was 38. 6％, GIST was 45. 5％. Of gastric antrum SMTs, leiomyoma was 25. 7％, GIST was 14. 3％. Of duodenal SMTs, leiomyoma was 14. 3％, GIST was 28. 6％. Of all 306 cases, 242 cases( 79. 1％) received ESE, 28 cases( 9. 2％) received STER, 25 cases( 8. 2％) received EFR. Of esophageal operations, ESE was 54. 5％, STER was 40％. Of gastric operations, ESE was 84. 4％, STER was 2. 5％, EFR was 10. 2％. All duodenal patients received ESE. STER was mainly used in esophagus ( 78. 6％) , and EFR was mainly used at gastric fundus ( 72. 0％) and body ( 24. 0％) . Conclusion Regular endoscopic follow-up could be a good option for SMTs located in esophagus, gastric cardiac and antrum, which are mostly benign lesions, especially when no obvious symptoms develop. Endoscopic therapy should be recommended for SMTs located in gastric fundus and body, which are mostly GISTs. STER may be more safe and effective for esophageal SMTs, but not suitable for giant lesions. ESE is the major operation for gastric SMTs, while EFR is more suitable for deep-origin lesions, especially in fundus and body. ESE is the major mode for duodenal SMTs. However, laparoscopic or surgical treatment should be considered when endoscopic treatment is difficult or risky.

Objective To investigate factors affecting ampullary access of endoscopic retrograde cholangiopancreatography (ERCP) in patients undergoing Billroth Ⅱ gastrectomy.Methods A retrospective analysis was performed on data of 261 patients with Billroth Ⅱ gastrectomy who underwent ERCP at Changhai Hospital from January 2008 to December 2017.Multivariate logistic regression analysis was used to analyze the potential factors affecting successful ampullary access,and receiver operating characteristic (ROC) curve was used to assess the predictive ability of potential factors.Results A total of 345 ERCP sessions were collected.The successful ampullary access and cannulation rate were 82.3％ (284/345) and 89.1％ (253/284),respectively.The main reasons for ERCP procedural failure were unable to reach the duodenal blind end and find the papilla (66.3％,61/92) and failure of selective cannulation (33.7％,31/92).The ERCP-related complication rate was 14.2％ (49/345),with post-ERCP pancreatitis rate was 3.2％ (11/345).Multivariate logistic regression analysis indicated that the first ERCP attempt (OR=7.717,95％CI:2.581-23.068.P＜0.001),with Braun anastomosis (OR =8.737,95％CI:2.479-30.797,P =0.001),and no cap-assisted forward-viewing gastroscope (OR =2.774,95％ CI:1.283-5.997,P=0.009) were independent risk factors for failure of ampullary access.According to the B value of each risk factor in logistic regression analysis,that is,no cap-assisted as 1 point,the first ERCP attempt as 2 points,and Braun anastomosis as 2 points,the area under ROC curve was 0.773.When the cut-off point was 2.5,the sensitivity and specificity were 75.0％ and 70.8％,respectively.Conclusion The first ERCP attempt,with Braun anastomosis,and no cap-assisted forward-viewing gastroscope are risk factors for failure of ampullary access of ERCP in Billroth Ⅱ gastrectomy patients.Early identification of high-risk patients may help to improve the success rate of ampullary access.

Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography ( ERCP ) in the treatment of patients with biliary and pancreatic diseases after Billroth Ⅱ gastrectomy. Methods Clinical data of 178 patients with biliary and pancreatic diseases undergoing 237 times of ERCP at the digestive endoscopy center in Changhai Hospital from January 2011 to December 2016 were retrospectively collected. The success rate of procedures and related complications were summed up. Results Among 178 patients undergoing 237 times of ERCP, the successful intubation rate of the endoscope to reach the duodenal papilla was 83. 5％ ( 198/237 ) . The success rate of selective cannulation and completing the expected intervention were 91. 4％ ( 181/198 ) and 98. 9％ ( 179/181 ) , respectively. The total success rate of ERCP was 75. 5％ (179/237), which had an increasing trend with time. The total success rate of ERCP in patients with common bile duct stone was 85. 2％ ( 127/149) , and the stone retrieval rate during the first session was 56. 7％ (72/127). The ERCP-related complication rate was 14. 3％ ( 34/237 ) , with 1. 7％ ( 4/237 ) perforation, 1. 3％ ( 3/237 ) bleeding, 3. 4％ ( 8/237 ) pancreatitis, and 8. 0％ ( 19/237 ) asymptomatic hyperamylasemia. One patient with perforation and 2 patients with severe pancreatitis died of septic shock and multiple organ failure ( 1. 3％, 3/237 ) . Most ERCP-related complications were improved by conservative treatment or second endoscopic intervention ( 91. 2％, 31/34 ) . Conclusion ERCP is effective and safe in the treatment of biliary and pancreatic diseases in patients with prior Billroth Ⅱ gastrectomy. With the development of endoscopic techniques and experience accumulation of endoscopists, the success rate of intubation, selective cannulation and therapeutic intervention can be close to those of patients with normal anatomy, and the incidence of related complications is low.

Objective:To explore the predictive value of HACOR score [heart rate (H), acidosis (A), consciousness (C), oxygenation (O), and respiratory rate (R)] on the clinical outcome of non-invasive positive pressure ventilation in patients with pulmonary encephalopathy due to chronic obstructive pulmonary disease (COPD).Methods:A prospective study was conducted. The patients with COPD combined with pulmonary encephalopathy who were admitted to Henan Provincial People's Hospital from January 1, 2017 to June 1, 2021 and initially received non-invasive positive pressure ventilation were enrolled. Besides non-invasive positive pressure ventilation, standard medical treatments were delivered to these patients according to guidelines. The need for endotracheal intubation was judged as failure of non-invasive ventilation treatment. Early failure was defined as the need for endotracheal intubation within 48 hours of treatment, and late failure was defined as the need for endotracheal intubation 48 hours and later. The HACOR score at different time points after non-invasive ventilation, the length of intensive care unit (ICU) stay, the total length of hospital stay, and the clinical outcome were recorded. The above indexes of patients with non-invasive ventilation were compared between successful and failed groups. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive effect of HACOR score on the failure of non-invasive positive pressure ventilation in the treatment of COPD with pulmonary encephalopathy.Results:A total of 630 patients were evaluated, and 51 patients were enrolled, including 42 males (82.35%) and 9 females (17.65%), with a median age of 70.0 (62.0, 78.0) years old. Among the 51 patients, 36 patients (70.59%) were successfully treated with non-invasive ventilation and discharged from the hospital eventually, and 15 patients (29.41%) failed and switched to invasive ventilation, of which 10 patients (19.61%) were defined early failure, 5 patients (9.80%) were late failure. The length of ICU and the total length of hospital stay of the non-invasive ventilation successful group were significantly longer than those of the non-invasive ventilation failure group [length of ICU stay (days): 13.0 (10.0, 16.0) vs. 5.0 (3.0, 8.0), total length of hospital stay (days): 23.0 (12.0, 28.0) vs. 12.0 (9.0, 15.0), both P < 0.01]. The HACOR score of patients at 1-2 hours in the non-invasive ventilation failure group was significantly higher than that in the successful group [10.47 (6.00, 16.00) vs. 6.00 (3.25, 8.00), P < 0.05]. However, there was no significant difference in HACOR score before non-invasive ventilation and at 3-6 hours between the two groups. The ROC curve showed that the area under the ROC curve (AUC) of 1-2 hour HACOR score after non-invasive ventilation for predicting non-invasive ventilation failure in COPD patients with pulmonary encephalopathy was 0.686, and the 95% confidence interval (95% CI) was 0.504-0.868. When the best cut-off value was 10.50, the sensitivity was 60.03%, the specificity was 86.10%, positive predictive value was 91.23%, and negative predictive value was 47.21%. Conclusions:Non-invasive positive pressure ventilation could prevent 70.59% of COPD patients with pulmonary encephalopathy from intubation. HACOR score was valuable to predict non-invasive positive pressure ventilation failure in pulmonary encephalopathy patients due to COPD.