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Objective To evaluate the efficacy and safety of modified endoscopic retrograde appendicitis therapy (mERAT) for acute uncomplicated appendicitis in children. Methods From October 2018 to May 2021, clinical data were retrospectively reviewed for 228 hospitalized children of acute uncomplicated appendicitis. They were followed up by telephone and outpatient and inpatient electronic information systems in June 2022.The follow-up time was 19(15, 22) months. Clinical profiles, treatment success rate, recurrence within 1 year of cured and discharged children, operative duration, total hospitalization time, hospitalization time after mERAT, hospitalization expense, success rate of intubation, stent implantation rate, stent self-shedding rate, postoperative stent removal time, number of fecal stones, parasites and food seeds detected in appendix cavity and incidence of adverse events during hospitalization were summarized. Results There were 127 boys and 101 girls. Success rate of intubation was 96.9%(221/228), success rate of treatment 96.9%(221/228) and operative duration 40.0(36.0-45.0) min. Rate of stent placement was 83.3%(184/221) and rate of stent shedding 48.4%(89/184).Total hospitalization time was 3(3, 4) day, hospitalization time after mERAT 2(1, 3) day and total hospitalization expense 12787.0(11770.1, 13585.5) yuan. Seventeen cases were lost to follow-ups and recurrence rate within 1 year was 6.9%(14/204).And the incidence of adverse events during hospitalization was 3.5%(8/228). Conclusion mERAT is both safe and effective for acute uncomplicated appendicitis in children. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical value and safety of enhanced recovery after surgery ( ERAS) plus colonoscopy for colorectal polypi in children. Methods Clinical data were retrospectively reviewed for 200 children undergoing endoscopic resection of colorectal polypi. They were randomized into two groups of ERAS plus colonoscopic polypectomy ( n = 100 ) and conventional perioperative management plus colonoscopic polypectomy ( n = 100) . Perioperative treatment, clinical symptoms, surgical parameters, biochemical indices and postoperative adverse reactions were recorded. Results Operative duration of ERAS and control groups was [ ( 27. 77 ± 8. 76) vs. ( 33. 88 ± 6. 58) min], postoperative defecation time [ ( 1. 50 ± 0. 50) vs. ( 3. 50 ± 1. 00) days] and hospitalization duration [ ( 3. 00 ± 1. 00) vs. ( 6. 00 ± 1. 00) days]. In ERAS children, blood glucose post-operation was significantly higher than that pre-operation[ 5. 75 (5. 15, 6. 08) vs. 5. 10 ( 4. 80, 5. 90), z = - 3. 807, P < 0. 001], blood insulin spiked significantly post-operation[ 16. 30 ( 15. 70, 16. 90) vs. 7. 55(6. 30,9. 05), z = - 8. 682,P < 0. 001], insulin resistance index post-operation was significantly higher than that pre-operation[ 4. 07 (3. 77, 4. 34) vs. 1. 72( 1. 46,2. 02), z = - 8. 682, P < 0. 001], blood glucose post-operation in control group was significantly higher than that in ERAS group [ 9. 60 ( 8. 90, 10. 80) vs. 5. 75(5.15, 6. 08), U =21. 000, P <0. 001], blood insulin was significantly higher in control group than that in ERAS group[22. 80(21. 73, 23. 68) vs. 16. 30( 15. 70, 16. 90), P <0. 001] and insulin resistance index was significantly higher in control group than that in ERAS group[9. 77(8. 89,10. 77) vs. 4. 07(3. 77, 4. 34), P < 0. 001]. Two group are no aspiration during operation and abdominal pain was ( 6 vs. 21), diarrhea ( 4 vs. 5), vomiting ( 5 vs. 24) and dizziness ( 23 vs. 5) . VAS was significantly higher in control group than that in ERAS group[ (6. 00 ± 1. 00) vs. (3.50 ± 1. 00), X² =38. 000,P <0.001]. Conclusion After colonoscopy for colorectal polypi, ERAS can accelerate the rehabilitation and lower postoperative complications in children. It is both safe and feasible in the management of endoscopic smgery. [ABSTRACT FROM AUTHOR]

Digestive endoscopy in children has been developed over the last four decades and its diagnostic and treatment techniques are constantly refined. With a growing popularization of digestive endoscopy in adults, various endoscopic techniques are gradually applied in children. And surgical trend of internal medicine is becoming more and more apparent. Recent studies have successively reported that digestive endoscopy could safely and effectively treat children with benign esophageal stenosis, congenital hypertrophic pyloric stenosis, duodenal diaphragm, acute/chronic appendicitis, giant polyps in gastrointestinal tract and massive gastrointestinal hemorrhage that previously requiring surgical interventions. However, due to small cavity and handling difficulties of digestive tract, wider pediatric applications still require further explorations and improvements. [ABSTRACT FROM AUTHOR]