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Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necroti...
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Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. Contrary to earlier data from uncontrolled studies, a large multicenter randomized trial comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet after 72 h, did not show that early nasoenteric tube feeding was superior in reducing the rate of infection or death in patients with AP at high risk for complications. Although early ERCP does not have a role in the treatment of predicted mild pancreatitis, except in the case of concomitant cholangitis, it may ameliorate the disease course in patients with predicted severe pancreatitis. Currently, a large-scale randomized study is underway and results are expected in 2017. (C) 2016 S. Karger AG, Basel
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Background:Biliary pancreatitis (BP) is common in adults and children. Current standard of care is to perform a cholecystectomy (CCE) to decrease the recurrence risk of pancreatitis. Controversy exists as to the timing of surgery,...
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Background:Biliary pancreatitis (BP) is common in adults and children. Current standard of care is to perform a cholecystectomy (CCE) to decrease the recurrence risk of pancreatitis. Controversy exists as to the timing of surgery, early versus delayed surgical intervention. Adult literature suggests a greater benefit of early CCE. Comparatively, there is limited pediatric literature as to the optimal timing of a CCE in children. We report a retrospective case series of children with BP who underwent early versus late CCE.Methods:A retrospective chart review was performed of children with BP for a period of 45 months. Reviewed information included patient demographics, timing of CCE, and the occurrence of adverse events preceding or following surgical intervention. Early CCE was defined as surgery during the index admission; late CCE was defined as surgery during a subsequent admission.Results:Nineteen children and adolescents (17 girls) were identified to have had BP with a subsequent CCE. Cholecystectomy was performed early in 9 patients with no adverse events. Ten patients had delayed surgery with 4 occurrences of adverse clinical events (recurrence of pancreatitis or biliary colic abdominal pain) while awaiting their CCE.Conclusions:Adverse biliary-related events occur at a higher rate in children with mild BP who undergo a delayed CCE when compared to early CCE performance. Early CCE is safe to perform in children with mild BP.
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BACKGROUND Biliary microlithiasis/sludge is detected in approximately 30% of patients with idiopathic acute pancreatitis (IAP). As recurrent biliary pancreatitis can be prevented, the underlying aetiology of IAP should be establis...
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BACKGROUND Biliary microlithiasis/sludge is detected in approximately 30% of patients with idiopathic acute pancreatitis (IAP). As recurrent biliary pancreatitis can be prevented, the underlying aetiology of IAP should be established. AIM To develop a machine learning (ML) based decision tool for the use of endosonography (EUS) in pancreatitis patients to detect sludge and microlithiasis. METHODS We retrospectively used routinely recorded clinical and laboratory parameters of 218 consecutive patients with confirmed AP admitted to our tertiary care hospital between 2015 and 2020. Patients who did not receive EUS as part of the diagnostic work-up and whose pancreatitis episode could be adequately explained by other causes than biliary sludge and microlithiasis were excluded. We trained supervised ML classifiers using H 2 O.ai automatically selecting the best suitable predictor model to predict microlithiasis/sludge. The predictor model was further validated in two independent retrospective cohorts from two tertiary care centers (117 patients). RESULTS Twenty-eight categorized patients’ variables recorded at admission were identified to compute the predictor model with an accuracy of 0.84 [95% confidence interval (CI): 0.791-0.9185], positive predictive value of 0.84, and negative predictive value of 0.80 in the identification cohort (218 patients). In the validation cohort, the robustness of the prediction model was confirmed with an accuracy of 0.76 (95%CI: 0.673-0.8347), positive predictive value of 0.76, and negative predictive value of 0.78 (117 patients). CONCLUSION We present a robust and validated ML-based predictor model consisting of routinely recorded parameters at admission that can predict biliary sludge and microlithiasis as the cause of AP.
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Background: In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out. Aim: To report the results of a follow-up on a large series of patients hospitalised for pancreatitis. Methods: ...
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Background: In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out. Aim: To report the results of a follow-up on a large series of patients hospitalised for pancreatitis. Methods: Data of 631 patients admitted to 35 Italian hospitals were retrospectively evaluated 51.7 ± 8.4 months after discharge. Results: The average recovery time after mild or severe pancreatitis was 28.2 and 53.4 days respectively. Fourteen sequelae were not resolved and 9 cases required late surgical intervention. Eighty patients (12.7%) had a second hospital admission. Of the patients with mild biliary pancreatitis, 67.9% underwent a cholecystectomy. The overall incidence of relapse was 12.7%. Mortality was 9.8% and no death was related to pancreatitis. Three patients died from carcinoma of the pancreas. Conclusion: Reported recovery time after an attack of pancreatitis was longer than expected in the mild forms. The treatment of sequelae was delayed beyond one year after discharge. The incidence of relapse of biliary pancreatitis in patients not undergoing a cholecystectomy was low, due to endoscopic treatment. Mortality from pancreatic-related causes is low, but there is an association with malignant pancreatic or ampullary tumours not diagnosed during the acute phase of the illness.
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Abstract Background and aims There are limited data about the benign biliary strictures (BBS) which can develop during the clinical course of acute biliary pancreatitis (ABP) due to compression of the common bile duct (CBD) by ede...
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Abstract Background and aims There are limited data about the benign biliary strictures (BBS) which can develop during the clinical course of acute biliary pancreatitis (ABP) due to compression of the common bile duct (CBD) by edematous and inflamed pancreatic tissue. We aimed to determine the incidence of BBS due to ABP and its clinical course after endoscopic management.Methods The study was retrospectively conducted among patients with ABP who were admitted to a single tertiary reference center during 3?years. BBS-ABP was defined as distal narrowing of the CBD with proximal dilatation and delayed drainage of the contrast into the duodenum. Endoscopic treatment was performed by inserting a single 7F or 10F plastic stent which was exchanged every 3?months until stricture resolution. Patients were followed for 1?year after stricture resolution.Results Seven hundred and twenty-one patients had ABP during the study period. Among them, 257 (35.6%) patients underwent ERCP and 26 patients (3.6%) had CBD stricture due to ABP. A 7 Fr plastic stent was inserted in 18 patients and 10 Fr in 8 patients. The stricture was completely resolved at 3?months in 66.7%, at 6?months 23.8% and at 9?months (9.5%) of the patients. There was no procedure-related complications other than asymptomatic stent migration in 4 (19%) patients. None of the patients had recurrent biliary stricture during the 1?year stent-free follow-up period.Conclusion BBS-ABP is a frequently seen clinical entity. In most patients, the stricture improves within 3?months and temporary endoscopic stenting prevents the patients from the consequences of the obstruction during this period.
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Background/objectives: Gallstones are the leading cause of acute pancreatitis in developed countries. National and international guidelines recommend that a cholecystectomy should be performed during the index hospitalization for ...
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Background/objectives: Gallstones are the leading cause of acute pancreatitis in developed countries. National and international guidelines recommend that a cholecystectomy should be performed during the index hospitalization for acute gallstone pancreatitis. We aimed to delineate the national trends for same-admission cholecystectomy and ERCP for acute gallstone pancreatitis over the last ten years.
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Trotz zunehmender Aufklärung der Pathophysiologie der akuten Pankreatitis ist eine pankreasspezifische Therapie, z. B. eine Hemmung der Proteasen, nicht erfolgreich. Wahrscheinlich greift dieser therapeutische Ansatz zu spät in ...
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Trotz zunehmender Aufklärung der Pathophysiologie der akuten Pankreatitis ist eine pankreasspezifische Therapie, z. B. eine Hemmung der Proteasen, nicht erfolgreich. Wahrscheinlich greift dieser therapeutische Ansatz zu spät in den pathophysiologischen Ablauf ein. Entscheidend ist die Beurteilung des Schweregrades der Erkrankung und ein interdisziplinäres therapeutisches Vorgehen: Schmerztherapie, enterale Ernährung via Ernährungssonde, Behandlung der extrapankreatischen Komplikationen wie Verbrauchskoagulopathie, Ateminsuffizienz und Nierenversagen. Eine Schlüsselstellung liegt in der Bilanzierung der ausgedehnten Flüssigkeitsverluste. Die prophylaktische Antibiotikaapplikation bei Nekrotisierung zur Verhinderung einer Infektion kann erwogen werden. Bei bereits infizierten Nekrosen besteht Operationsindikation. Bei biliärer Pankreatitis erfolgt bei Nachweis von Gallengangssteinen die endoskopische retrograde Cholangiopankreatographie mit Papillotomie und im Intervall die elektive Cholezystektomie.Despite our increasing knowledge in the pathophysiology of acute pancreatitis therapeutic strategies based on this knowledge, such as inhibition of proteases, are not convincing. It is most likely that these strategies are initiated to late after the onset of pancreatitis. It is of utmost importance to clarify the severity of the disease for planning interdisciplinary approaches: therapy of pain, enteral nutrition via a jejunal tube, as well as treatment of extrapancreatic complications, such as respiratory insufficiency, coagulopathy, and renal insufficiency. A key role plays the exact balance of potential high fluid losses. Prophylactic application of antibiotics such as imipenem in cases of necrotizing pancreatitis to prevent infection is widely used. Infected necroses are an indication for surgery. In biliary pancreatitis one has to remove impacted bile duct stones via ERCP and papillotomy followed by elective cholecystectomy.Schlüsselwörter Akute Pankreatits - Nekrotisierende Pankreatitis - Biliäre Pankreatitis - ERCP - KomplikationenKeywords Acute pancreatitis - Necrotizing pancreatitis - Biliary pancreatitis - ERCP - ComplicationsDie Literatur zu diesem Beitrag finden Sie auf den Seiten XX–XX im Beitrag Mössner J, Keim V: Therapie der chronischen Pankreatitis.
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Biliary intraepithelial neoplasia (BilIN) and intraductal papillary neoplasm of the biliary tract (IPN-B) were suggested the premalignant conditions of cholangiocarcinoma. BilIN microscopically manifests as flat, pseudopapillary o...
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Biliary intraepithelial neoplasia (BilIN) and intraductal papillary neoplasm of the biliary tract (IPN-B) were suggested the premalignant conditions of cholangiocarcinoma. BilIN microscopically manifests as flat, pseudopapillary or micropapillary lesions. In contrast, IPN-B is grossly visible, and is characterized by prominent papillary proliferation with distinct fibrovascular cores. A 65 years old woman was diagnosed the recurrent acute pancreatitis of uncertain etiology, 4 times, during the past 5 years. At the last admission, abdominal computed tomography revealed a tiny stone in the distal common bile duct. We performed an endoscopic retrograde cholangiopancreatography, and studies revealed a filling defect on distal CBD without evidence of CBD stone and a suspicious of soft tissue mass in the ampulla. We obtained biopsy specimens at the ampulla and distal CBD by biopsy forceps under the fluoroscopic guidance. The pathological report demonstrated BilIN. Therefore, we report a case of BilIN presented with recurrent acute pancreatitis with brief review.
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The rate of choledocholithiasis at the time of elective surgery after mild acute biliary pancreatitis is still unclear because it decreases rapidly after the onset. The aims of this study are as follows: (1) To investigate whether...
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The rate of choledocholithiasis at the time of elective surgery after mild acute biliary pancreatitis is still unclear because it decreases rapidly after the onset. The aims of this study are as follows: (1) To investigate whether the incidence of choledocholithiasis in mild biliary pancreatitis is higher than in patients with symptomatic cholelithiasis. (2) To evaluate the usefulness of intraoperative cholangiography in the diagnosis of unsuspected choledocholithiasis in mild pancreatitis. Prospective study including 130 patients undergoing laparoscopic surgery and classified into two groups: mild biliary pancreatitis (n = 44) and symptomatic cholelithiasis (n = 86). Choledocholithiasis was evaluated by endoscopic cholangiopancreatography, magnetic resonance, and intraoperative cholangiography. Preoperatively, choledocholithiasis was identified in five patients with symptomatic cholelithiasis and two with biliary pancreatitis (5.81 vs 4.54%; p = 0.472). In 117 cases (90%), intraoperative cholangiography was successfully performed, identifying unsuspected choledocholithiasis in five patients of the colelithiasis group and in three in the group of pancreatitis (5.81 vs 6.81%; p = 0.492). The total number of patients with choledocholithiasis in the whole series was 15 (11.5%); 11.6% in colelithiasis group vs 11.4% in biliary pancreatitis group; p = 0.605. The rate of choledocholithiasis was not significantly different between the groups of patients with mild acute biliary pancreatitis and symptomatic cholelithiasis. Intraoperative cholangiography identified unsuspected choledocholithiasis in 6.81% of patients with mild acute biliary pancreatitis.
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