Objective:To investigate the effects of different types and administration times of defoaming agents on the gastric vision clarity before magnetically controlled capsule endoscopy (MCE) in children.Methods:A retrospective analysis was conducted on children who underwent MCE in Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University from January 2017 to March 2023.Children were divided into three groups based on type of defoaming agents: the simethicone emulsion group (10 mL simethicone emulsion), the dimethicone powder group (5 g dimethicone powder dissolved in 30 mL warm water), and the dimethicone emulsion group (4 mL dimethicone emulsion dissolved in 10 mL water). Each group was further divided into 3 subgroups based on the time of administration before the examination: 30 minutes, 45 minutes, and 60 minutes, resulting in a total of 9 subgroups. The primary outcome measure was the gastric bubble score. Secondary outcomes included gastric cleanliness score, examination time, gastric transit time (GTT), diagnostic efficacy, and safety assessment.Results:A total of 180 children (20 per group) were included in the study. The gastric bubble score (0.89 ± 0.35) and gastric cleanliness score (0.99 ± 0.52) in the 45-minutes subgroup of the dimethicone powder group were significantly lower than those in other groups, indicating better view clarity, with significant differences ( P<0.05). There were no significant differences in examination time, GTT, or the positive detection rate of gastric diseases among the groups ( P>0.05). Conclusion:Administration of defoaming agents before MCE can significantly reduce gastric bubbles and improve the view clarity of the gastric mucosa. The optimal regimen for children is taking 5 g dimethicone powder dissolved in 30 mL warm water 45 minutes before the examination.

Objective:To investigate the effects of different types and administration times of defoaming agents on the gastric vision clarity before magnetically controlled capsule endoscopy (MCE) in children.Methods:A retrospective analysis was conducted on children who underwent MCE in Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University from January 2017 to March 2023.Children were divided into three groups based on type of defoaming agents: the simethicone emulsion group (10 mL simethicone emulsion), the dimethicone powder group (5 g dimethicone powder dissolved in 30 mL warm water), and the dimethicone emulsion group (4 mL dimethicone emulsion dissolved in 10 mL water). Each group was further divided into 3 subgroups based on the time of administration before the examination: 30 minutes, 45 minutes, and 60 minutes, resulting in a total of 9 subgroups. The primary outcome measure was the gastric bubble score. Secondary outcomes included gastric cleanliness score, examination time, gastric transit time (GTT), diagnostic efficacy, and safety assessment.Results:A total of 180 children (20 per group) were included in the study. The gastric bubble score (0.89 ± 0.35) and gastric cleanliness score (0.99 ± 0.52) in the 45-minutes subgroup of the dimethicone powder group were significantly lower than those in other groups, indicating better view clarity, with significant differences ( P<0.05). There were no significant differences in examination time, GTT, or the positive detection rate of gastric diseases among the groups ( P>0.05). Conclusion:Administration of defoaming agents before MCE can significantly reduce gastric bubbles and improve the view clarity of the gastric mucosa. The optimal regimen for children is taking 5 g dimethicone powder dissolved in 30 mL warm water 45 minutes before the examination.

Objective:To establish a decision tree model of pediatric complicated appendicitis (CA) based on Pediatric Appendicitis Score (PAS) combined with inflammatory indicators, and to evaluate its clinical application efficacy in pediatrics.Methods:The clinical data of 544 children diagnosed with appendicitis in Children′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 was retrospectively analyzed. According to postoperative pathology, the children were divided into uncomplicated appendicitis group and CA group. The independent risk factors of CA were screened by univariate and multivariate logistic regression analysis, and these parameters were included to establish the decision tree model. The accuracy of the decision tree model was verified by receiver operating characteristic (ROC) curve.Results:Binary logistic regression analysis indicated that the PAS, C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) were identified as independent risk factors for complicated appendicitis in children (all P<0.05). PAS, CRP and NLR were included as covariables to construct the decision tree model and binary logistic regression model for predicting CA. The decision tree demonstrated an overall accuracy of 79.2% with a sensitivity of 86.7% and specificity of 71.9%, and achieved an area under curve (AUC) of 0.821(95% CI: 0.786-0.857). The binary logistic regression model had a sensitivity of 79.6% and specificity of 69.1%, with an overall accuracy of 75.1% and achieved an AUC of 0.808(95% CI: 0.770-0.845). Conclusions:The decision tree model based on PAS score combined with CRP, NLR is a simple, intuitive and effective tool , which can provide pediatric emergency physicians a reliable basis for diagnosis of pediatric CA.

Objective:To investigate the clinical application value and safety of magnetically controlled capsule gastroscopy (MCCG) in gastric and duodenal examination of children in comparison with conventional gastroscopy.Methods:Data of 160 outpatients or inpatients with abdominal pain accompanied by Helicobacter pylori infection aged 8-16 who underwent either MCCG or conventional gastroscopy in Shanghai Children's Hospital from March 2020 to March 2022 were retrospectively analyzed. Children were divided into the MCCG group ( n=80) and the conventional gastroscopy group ( n=80) according to different examination methods. The detection and examination time of lesions in upper gastrointestinal tract, tolerance and safety between the two groups were analyzed. Results:MCCG was successfully performed in 79 children and conventional gastroscopy was successfully performed in 78 children, respectively. The positive detection rates were 1.3% (1/79) and 1.3% (1/78) in the esophagus ( χ2=0.000, P>0.999), 87.3% (69/79) and 91.0% (71/78) in the stomach ( χ2=0.552, P=0.327) , 15.2% (12/79) and 19.2% (15/78) in duodenum ( χ2=0.450, P=0.533) with no significant difference between the two groups. There was no significant difference in the examination time [72.0 (41.0, 109.5) min VS 6.0 (4.3, 7.0) min, U=24, P<0.001] in the MCCG group and the conventional gastroscopy group. No adverse event occurred in either group. Conclusion:There is no significant difference in the detection rate of gastric and duodenal lesions between the MCCG group and the conventional gastroscopy group. MCCG is safe and stable, and can be used as an diagnostic tool for gastric and duodenal diseases in children.

Objective:To retrospectively analyze the independent risk factors of complicated appendicitis(CA)in children under five years old and establish a clinical prediction model, and to evaluate the clinical application of this model.Methods:A retrospective analysis was performed on children under five years old who underwent appendectomy at Children′s Hospital of Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021.The children were divided into CA group and uncomplicated appendicitis group according to whether there was sign of perforation or gangrene in appendiceal tissue after operation.The differences in clinical features and preoperative laboratory test results between two groups were compared.The independent risk factors of CA were identified and a clinical prediction model was established.The clinical prediction model was verified by receiver operating characteristic curve.Results:A total of 140 children were enrolled in this study, including 84 cases in the CA group and 56 cases in uncomplicated appendicitis group.Univariate and binary Logistic regression analysis showed that the duration of symptoms>23.5 h( OR=6.650, 95% CI 2.469-17.912, P<0.05), abdominal muscle tension( OR=3.082, 95% CI 1.190-7.979, P<0.05) and C-reactive protein>41 mg/L ( OR=3.287, 95% CI 1.274-8.480, P<0.05) were independent risk factors for CA( P<0.05). The clinical prediction model of CA was constructed by the above mentioned three independent risk factors.The area under the receiver operating characteristic curve of the clinical prediction model was 0.881(95% CI 0.825-0.936), the sensitivity was 77.4%, the specificity was 87.5%, the positive predictive value was 91.3% and the negative predictive value was 70.0%. Conclusion:Acute appendicitis in children under five years old is more likely to progress to CA if the duration of symptoms>23.5 h, the level of C-reactive protein is increased, and the abdominal muscle tension is accompanied.The clinical prediction model of CA constructed by common clinical information in pediatric clinics has good prediction efficiency, which provides a simple and feasible reference method for clinicians to distinguish CA from uncomplicated appendicitis.

To investigate the diagnostic value of narrow-band imaging (NBI) endoscopy for esophageal polyps in children. Microscopic morphology of various polyps in 35 children with esophageal polyps in Children's Hospital of Shanghai from January 2016 to June 2020 were observed under both traditional white light endoscopy and NBI endoscopy. The sensitivity and specificity of traditional white light endoscopy and NBI endoscopy were compared with the pathological results as the gold standard. A total of 70 esophageal polypoid lesions were found in 35 children, including 27 single polyps. Pathological results indicated that the majority of polyps were non-neoplastic polyps (52.9%, 37/70).The sensitivity of NBI endoscopy in the diagnosis of esophageal neoplastic polyps was significantly higher than that of white light endoscopy [93.9% (31/33) VS 90.9% (30/33), P < 0.001], and the specificity was also higher [89.2% (33/37) VS 78.4% (29/37), P=0.864]. By observing the microscopic structure of esophageal polyps, NBI endoscopy contributes to the clinical prediction of the pathological properties of polyps. Its sensitivity is superior to the white light endoscopy.

Objective To evaluate value of narrow band imaging(NBI) endoscopy for children with abdominal Henoch?Schonlein purpura ( HSP ) . Methods A total of 46 patients with abdominal HSP were enrolled into the observation group(NBI intervention) from November 2010 to February 2016.Diagnostic rates of white light and NBI endoscopy in abdominal HSP patients, IgA positive rates of targeted biopsies and severe complications were retrospectively analyzed. A total of 25 abdominal HSP patients with no NBI intervention admitted from 2007 to 2009 were randomly enrolled into control group. Data of the control group were compared with those of observation group. Results In observation group, the diagnostic rate under NBI was significantly higher than that under white?light endoscopy[91. 3%(42/46)VS 67. 4%(31/46),χ2=8. 02,P<0. 05]. IgA positive rates of targeted biopsies under NBI was significantly higher than that under white?light endoscopy [ 95. 7%( 88/92 ) VS 69. 6%( 64/92 ) ,χ2 = 21. 79, P<0. 05 ] . Three patients developed such serious complications as digestive hemorrhage as predicted. Compared with control group, abdominal pain and blood stool relief time (10. 96±5. 32 d VS 19. 68±4. 29 d,t=7. 50,P<0. 01), fasting time(10. 37±5. 42 d VS 8. 80± 3. 71 d,t=7. 73,P<0. 01), hospital stay (18. 80±7. 11 d VS 23. 12±4. 36 d, t=3. 16,P<0. 01), time of stool occult blood negative ( 11. 41 ± 6. 30 d VS 19. 12 ± 4. 09 d, t=6. 22, P<0. 01 ) in observation group were significantly shortened. Conclusion NBI endoscopy is valuable for improving the diagnostic accuracy and biopsy accuracy and complication prediction of abdominal Henoch?Schonlein purpura in children.

Objective To investigate the complications and management of nitinol self-expandable metal stent (cSEMS) in treatment of refractory esophageal strictures in children. Methods The clinical data were reviewed for 9 pediatric patients with refractory benign esophageal disorders from May 2009 to December 2016, specially designed cSEMS were applied to them, data about effects and complications were collected during regular follow-ups. Results Successful cSEMS placement was performed in 9 children, the symptom of dysphagia was obviously alleviated after implantation, all patients underwent vomiting and chest pain 1~7 days after operation; 1 case could not put up with the pain, so the stent had to be removed in 36 hours after implantation; 2 cases developed a recurrent stricture within 3 months after stent removal, growth of mild granulation tissue was found in 1 case; In the case with esophageal fistulas, migration and poor adherence to the esophagus was occurred in 3 days after implantation, then a new designed cSEMS with bigger proximal tip was planted in the same place 1 week later, 2 months after stent removed, fistula was healed. Conclusion Placement of cSEMS is safe and effective in treating pediatric patients with refractory esophageal stricture. However, complications associated with stent placement should not be ignored, individually designed stent and timely management of the complications are quite important in order to enhance clinical efficacy.

Objective To evaluate the value of endoscopy with narrow-band imaging(NBI)for tar-geting biopsy of lesions in children with allergic colitis. Methods The colorectal lesions under the model of traditional white light imaging and NBI in children with allergic colitis were observed and recorded. The re-sults of biopsy under white light imaging and NBI were compared with postoperative pathological diagnosis. Results A total of 60 patients completed the study. Under NBI,47(78. 3%)rectal lesions,52(86. 7%) sigmoid colon lesions and 19(31. 7%)descending colon lesions were found. There were 21(35. 0%),25 (41. 7%),and 8(13. 3%)lesions in the transverse colon,ascending colon and iloececus,respectively. For the lesions in transverse colon and ascending colon,the detection rate under NBI was significantly higher than that under white light endoscopy[35. 0% VS 16. 7%(10/ 60),P<0. 05;41. 7% VS 18. 3%(11/ 60),P<0. 05]. No significant difference was found between two methods for the sigmoid and rectal lesion[86. 7% VS 83. 3%(50/ 60),P>0. 05;78. 3% VS 76. 7%(46/ 60),P>0. 05].There was no significant difference in ileo-cecus and descending colon[13. 3% VS 5. 0%(3/ 60),P>0. 05;31. 7% VS 28. 3%(17/ 60),P>0. 05]. The targeted biopsy results by NBI indicated that the ratio of EOS≥6/ HP was significantly higher than the biopsy results by white light imaging. Conclusion NBI is easy to operate and can discern the microcosmic structure which cannot be observed by the traditional endoscopy. It can provide higher diagnostic accuracy of allergic colitis. After suspicious lesions were found under conventional endoscopic check,NBI could be used to guide the targeted biopsy.

Objective To summarize the effectiveness and security of endoscopic removal of foreign bodies of battery in the gastrointestinal tract in children.Methods We analyzed retrospectively the clinical data of 13 patients who swallowed foreign bodies including button cell and cylindrical battery.The 13 patients were treated in our hospital between July 2011 and April 2015,aged 19 months to 12 years.Results A total of 9 cases of foreign bodies in esophagus,including embedded in the first the esophageal stenosis in 4 cases,the second the esophageal stenosis in 3 cases,cardia in 1 case,and 4 cases of foreign body in stomach.We successfully removed 16 foreign bodies of the battery in endoscopy.No serious complications such as perforation,hemorrhaging happened during and after operation.Conclusion It is one relatively safe and effective method of diagnosis and treatment of endoscopic removal of foreign bodies of battery in gastrointestinal tract in children.