Occurrence of Boerhaave's syndrome after diagnostic colonoscopy:what else can emergency physicians do?

Dear editor,Boerhaave’s syndrome is a barogenic tear of the esophagus,typically at the gastroesophageal junction,caused by a sudden increase in intraluminal pressure in the distal esophagus.[1]In recent years,the number of Boerhaave’s syndrome cases has increased,and a growing proportion of clinicians have recognized this rare but life-threatening disease.

Development and validation of a model to determine risk of refractory benign esophageal strictures

BACKGROUND Current research has identified several risk factors for refractory benign esophageal strictures (RBES), but research is scarce on the prediction of RBES in benign esophageal strictures patients. Meanwhile, the long-term outcomes of RBES remain unclear. The aim of this study was to develop and validate a model to determine the progression of RBES in patients with benign esophageal strictures. And we also explored the long-term outcomes and safety in patients with RBES. AIM To develop and validate a model to determine the progression of RBES in patients with benign esophageal strictures, based on the demographic data and endoscopic findings. METHODS A total of 507 benign esophageal stricture patients treated by dilation alone or in combination with stenting were retrospectively enrolled between January 2009 and February 2018. The primary outcome was to establish a risk-scoring model predicting RBES in benign esophageal strictures. The secondary outcome was to explore the clinical effectiveness and adverse events in patients with RBES. RESULTS In the study, age, etiology, and number and length of strictures were the independent risk factors for the refractory performance of benign esophageal strictures. According to risk factors of benign esophageal strictures, a risk-scoring model for predicting RBES in benign esophageal strictures was established: The risk score ranged from 0 to 8 points, and the risk scores were divided into low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-8 points). The proportions of RBES in the corresponding risk categories were 1.0%, 12.2%, and 76.0%, respectively. Among 507 patients, 57 had RBES (39 males;median age, 60 years). The success rate of dilation treatment (51.2%, 21/41) was higher than that of stent placement (37.5%, 6/16). CONCLUSION In this study, 11.3%(57/507) patients had RBES at our hospital. The risk-scoring model predicting RBES in benign esophageal strictures could predict the longterm outcome of patients with strictures ahead.

Gallbladder bleeding along with cholecystocolonic fistula:a case report

Introduction Gallstone disease is a major public-health problem,with a high prevalence ranging from 10%to 15%[1].Acute cholecystitis,chronic cholecystitis,choledocholithiasis,and gallstone pancreatitis are all common complications in clinical practice.However,when gallstones migrate to adjacent viscera or vascular structures,the clinical challenge is far less familiar[2].Gallbladder(GB)bleeding is seldom reported,which mostly manifests as hemobilia.Some cases are caused by cystic artery aneurysm and rupture and others are due to GB rupture[3].Gallstones can erode through the gallbladder wall or bile duct into the adjacent portion,resulting in a cholecystocolonic fistula(CCF),which is a rare complication of gallstones with cholecystitis[4].Here,we share a case of gallbladder bleeding along with cholecystocolonic fistula that has not yet been reported.We hope that,through our unusual case,clinicians gain an enhanced understanding of rare complications caused by gallstones.