A study of 50 cases in different modalities of treatment of chronic pancreatitis
|
|
- Robyn Hardy
- 6 years ago
- Views:
Transcription
1 Different modalities of treatment of chronic pancreatitis Original Research Article ISSN: (P) A study of 50 cases in different modalities of treatment of chronic pancreatitis Jayesh Gohil, Pallav Patel 2,Jaydeep Gadhavi 2, Hiren Parmar * A Associate Professor, 2 Assistant Professor General Surgery Department, GMERS Medical College, Gandhinagar, Gujarat, India *Corresponding author drhirenparmar@gmail.com How to cite this article: Jayesh Gohil, Pallav Patel, Jaydeep Gadhavi, Hiren Parmar. A study of 50 cases in different modalities of treatment of chronic pancreatitis. IAIM, 205; 2(4): Available online at Received on: Accepted on: Abstract Background: Chronic pancreatitis was defined by features consistent with irreversible pancreatic inflammation, i.e., clinical, structural or functional abnormality of the pancreas. The presence of pancreatic calculi or ductal irregularity/parenchymal atrophy was determined at imaging using ultrasonography, CT scan, MRI, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS). Material and methods: The profile of 50 patients with chronic pancreatitis seen in the General Surgery, Gastro surgery Department of Civil Hospital, Ahmedabad, from May 2007 to September 2009 were included. The diagnosis of chronic pancreatitis was based on clinical, biochemical (serum amylase, serum criteria and anti-diabetic treatment requirement) and imaging. Various treatment modalities like conservative, endotherapy and surgical were evaluated. Results: Out of 50 patients, 33 underwent surgery, underwent endotherapy, 6 underwent external drainage via pigtail catheterization and 4 were kept on medical therapy that later on underwent surgery due to partial or no relief of abdominal pain. The indication for surgery was in these 33 patients and the surgical procedures were performed. 5 (0%) patients had postoperative complications; major among these being wound dehiscence (n=2), pancreatic fistula (n=), gastrointestinal bleed (n=) and intra abdominal bleed (n=). There were four postoperative death (3 post whipple s and post triple bypass). Conclusion: Idiopathic pancreatitis is the most common form of chronic pancreatitis seen at our hospital, and in general, the majority of these subjects showed a good responsee to endotherapy and surgery of chronic pancreatitis. Pancreatic endotherapy is effective as short-term intervention, can be used at an early stage and has limited indications. Key words Chronic pancreatitis, Different treatment strategies, Results, Complications. Page 64
2 Introduction (64%), alcoholic in 7 (34%) and hyperlipidemia in 2%. Pain (n=; 22%), lump (n=9; 38%), weight loss (n=24; 32%), nausea/vomiting (n=5, 30%), gastrointestinal (GI) bleed (n=; 0.5%) were usual symptoms with eighteen (36%) 7 (4%) had clinical Chronic pancreatitis (CP) was defined by features consistent with irreversible pancreatic inflammation, i.e., clinical, structural or functional abnormality of the pancreas []. The presence of pancreatic calculi or ductal irregularity/parenchymal atrophy was determined at imaging using ultrasonography, CT scan [2], MRI, magnetic resonance cholangiopancreatography (MRCP) [3], endoscopic retrograde cholangiopancreatography (ERCP) [4] or endoscopic ultrasound (EUS) [5]. Ultrasound and CT were the usual initial investigations. Other imaging modalities were carried out when indicated. Diabetes mellitus was diagnosed if the fasting plasma glucose value was equal to, or greater than, 26 mg/dl confirmed on two occasions and/or a plasma glucose value equal to, or greater than, 200 mg/dl after a two-hour glucose load confirmed on two occasions, and/or requirements for nsulin or oral hypoglycemic drugs. Alcohol intake was considered significant in chronic pancreatitis patients who had been taking the equivalent of 80 g or more ethanol/day for at least five years. Material and methods The profile of 50 patients with chronic pancreatitis seen in the General Surgery, Gastro surgery Department of Civil Hospital, Ahmedabad, from May 2007 to September 2009 were included. The diagnosis of chronic pancreatitis was based on clinical, biochemical (serum amylase, serum criteria and anti-diabetic treatment requirement) and imaging. Various treatment modalities like conservative, endotherapy and surgical were evaluated. Results The median age of our patients was 42 (0-62) years. There were 38 men and 2 women. The etiology of CP was idiopathic pancreatitis in, 32 patients had diabetes and steatorrhea. Patients were evaluated with X-ray abdomen, ultrasonography (USG), contrast enhanced computed tomography (CECT), ERCP and MRCP depending upon the presentation and associated complications. On evaluation, biliary obstruction was diagnosed in (22%), pseudocyst was present in 23 (46%) and pancreatic cancer in association with CP was diagnosed in (22%) patients with dilated main pancreatic duct (MPD) in 5 (30%) and pancreatic calcifications in 7 (4%). Treatment modalities Out of 50 patients, 33 underwent surgery, underwent endotherapy, 6 underwent external drainage via pigtail catheterization and 4 were kept on medical therapy that later on underwent surgery due to partial or no relief of abdominal pain. Medical therapy 4patients were treated with pancreatic enzyme supplements for abdominal pain and followed for a minimum period of 6 months. None had complete relief of pain, 6 (42.85%) had partial relief and 8 (57.4%) did not respond to therapy. Endotherapy out of 50 patients (22%) underwent endotherapy for relief of abdominal pain. Eight (72.72%) had complete response and 3 (27.27%) had partial response as per Table and Table 2. Surgery 33 out of 50 patients (66%) underwent surgery for abdominal pain. The operated patients were Page 65
3 followed for to 5 years. About 26 (78.78%) had alcoholic patients. Majority of patients (95.%) complete relief of pain and 7 (2.2%) had had pain [7]; however this could reflect selection partial response. The indicationn for surgery was bias as most patients with persistent pain were in these 33 patients and the surgical procedures referred to our hospital. were performed. 5 (0%) patients had postoperative complications; major among Diabetes mellitus was significantly more these being wound dehiscence (n=2), pancreatic common in calcific pancreatitis group as fistula (n=), GI bleed (n=) and intra abdominal compared to the non-calcificc group [8]. This may bleed (n=). There were four postoperative reflect that calcification develops in late stages death (3 post whipple s and post triple of chronic pancreatitis associated with advanced bypass). On follow up, all patients with jaundice, endocrine deficiency. Patients with alcoholic cholangitis and bleeding had relief of their pancreatitis had significantly shorter duration of symptoms. Patients underwent a prospective symptoms as compared to idiopathic study to assess the effect of ductal pancreatitis. decompression on pancreaticc exocrine and endocrine function. Pancreatic endocrine Surgery was the mainstay of therapy in most function was evaluated by improvement in patients (n=33) [9]. Patients (n=4) were diabetic status. Patients underwent the initiated with medical therapy but due to evaluation preoperatively and on follow up at partial/no response were later on treated with least after six months of surgery. In this study, surgery. Failure of conservative management in there was some improvement in the status of this study may due to presentation of patients in beta cell function (in some patients, dose of advance stages of the disease (huge cyst insulin was reduced or patients on insulin were compressing surrounding structures, pancreatic shifted on oral hypoglycemic drugs) on follow up mass, common bile duct (CBD) strictures due to of 6-2 months. (Table 3, Table 4 and Table pancreatitis, MPD calculi with dilatation) [0]. 5) Endoscopic retrograde pancreatography Discussion followed by pancreatic endotherapy was done in 6 patients. Endotherapy was done via It is often difficult to differentiate recurrent transpapillary route in all these patients with acute pancreatitis from exacerbations of chronic either a pancreatic stent or nasopancreatic pancreatitis. Even today, in certain situations, drain. Extra corporeal shock wave lithotripsy the correct diagnosis can often be achieved only fragmentation of pancreatic duct calculi in on follow up of the patient. In all our patients, conjunction with endoscopic clearance of the the diagnosis of chronic pancreatitis was main pancreatic duct is associated with confirmed by imaging studies. In contrast to maximum pain relief and least complication western countries idiopathic pancreatitis is the []. Pancreatic stone lithotripsy was done in 3 leading etiology (4.8%), followed by alcoholism of our patients. Endoscopic (34.9%) in this study [6]. Alcohol intake is quite cystogastrostomy/cystoduodenostomy was uncommon in females, so all cases of done in 5 patients with complete/partial relief in pancreatitis due to alcohol were seen in men. all patients. Timing of endotherapy is best However 37.2% of idiopathic pancreatitis delayed approximately 4 weeks to allow the occurred in females. Calcification was present in pseudocyst to mature. Earlier intervention may 5.% of the idiopathic group and 38.8% of be necessitated by complications such as Page 66
4 infection, hemorrhage, enteric or billary has limited indications. The failure of ductal obstruction [2]. decompression to relieve pain in short term is consistent with the multifactorial etiology of Transmural drainage throughh the stomach pain in chronic pancreatitis. Surgical (cystogastrostomy) is preferred for psedocyst in decompression provides immediate pain relief in the body and tail of the pancreas while those in 70-90% of patients. However surgery remains the head are drained into the duodenum the mainstay of treatmentt of majority of our (cystoduodenostomy). An important concern in patients and had shown comparatively better transmural drainage is potential bleeding (n=) results of endotherapy and conservative from blood vessels interposed between the management. pseudocyst and gastroduodenal wall. Endoscopic ultrasound (EUS) or EUS-guided References puncture of the pseudocyst eliminates this risk.. Mayerle J, Hoffmeister A, Werner J, Witt When the cyst contains clear fluid, 0 Fr double H, Lerch MM, Mössner J. Chronic pigtail stent will adequately drain the cyst. In the pancreatitis - Definition, etiology, presence of necrotic debris, placement of a investigation and treatment. Dtsch naso-cystic catheter for irrigation in addition of Arztebl Int, 203; 0: the tract using a controlled radial expansion 2. Grözinger G, Grözinger A, Horger M. The (CRE) balloon followed by removal of necrotic role of volume perfusion CT in the material with a dormia basket prevents diagnosis of pathologies of the pancreas. subsequent clogging of the stent. Rofo, 204; 86: Transpapillary cyst drainage is cyst-duct communication is complication rates are lower with transpapillary access (6%) than after the transmural approach (39%). Stents may be placed into the pseudocyst; when technically not feasible, the stents should be advanced to the site of ductal commumication as close as possible to the pseudocyst. In the presence of associated ductal disruptions, stents may either bridge the disruptions or be placed into the pseudocyst [4, 5, 6, 7]. Conclusion preferred when evident [3]; Idiopathic pancreatitis is the most common form of chronic pancreatitis seen at our hospital, and in general, the majority of these subjects showed a good response to endotherapy and surgery of chronic pancreatitis. Pancreatic endotherapy is effective as short-term intervention, can be used at an early stage and 3. Liu K, Xie P, Peng W, Zhou Z. Magnetic resonance cholangiopancreatography: Comparison of two- and three- for the dimensional sequences assessment of pancreatic cystic lesions. Oncol Lett, 205; 9: Pericleous S, Smith LI, Karim MA, Middleton N, Musbahi A, Ali A. Endoscopic retrograde cholangiopancreatography in Ayrshire, Scotland: A comparison of two age cohorts. Scott Med J, 205. Mar 6. pii: Rana SS, Vilmann P. Endoscopic ultrasound features of chronic pancreatitis: A pictorial review. Endosc Ultrasound, 205; 4: Muniraj T, Aslanian HR, Farrell J, Jamidar PA. Chronic pancreatitis, a comprehensive review and update. Part I: Epidemiology, etiology, risk factors, genetics, pathophysiology, and clinical features. Dis Mon, 204; 60: Page 67
5 7. Olesen SS, Juel J, Nielsen AK, Frøkjær JB, 3. Ergun M, Aouattah T, Gillain C, Gigot JF, Wilder-Smith OH, Drewes AM. Pain Hubert C, Deprez PH. Endoscopic severity reduces life quality in chronic ultrasound-guided transluminal drainage pancreatitis: Implications for design of of pancreatic duct obstruction: Long- future outcome trials. Pancreatology, 20; 43: term outcome. Endoscopy, 204; 4: Davison LJ. Diabetes mellitus and 4. Matsubayashi H, Kakushima N, Takizawa pancreatitis--cause or effect? J Small K, Tanaka M, Imai K, Hotta K, Ono H. Anim Pract, 205; 56: Diagnosis of autoimmune pancreatitis. 9. Niedergethmann M, Nephuth O, World J Gastroenterol, 204; 20: Hasenberg T. Chronic pancreatitis. 69. Operation indications and procedures. 5. Tandan M, Nageshwar Reddy D. Chirurg., 204; 85(2): Endotherapy in chronic pancreatitis. 0. Kwek AB, Ang TL, Maydeo A. Current World J Gastroenterol, 203; 9: 656- status of endotherapy for chronic 64. pancreatitis. Singapore Med J., 204; 6. Muniraj T, Aslanian HR, Farrell J, Jamidar 55(2): PA. Chronic pancreatitis, a. Ahmed Ali U, Pahlplatz JM, Nealon WH, comprehensive review and update. Part van Goor H, Gooszen HG, Boermeester II: Diagnosis, complications, and MA. Endoscopic or surgical intervention management. Dis Mon, 205; 6: for painful obstructive chronic 7. Ni Q, Yun L, Roy M, Shang D. Advances pancreatitis. Cochrane Database Syst in surgical treatment of chronic Rev, 205; 3: CD pancreatitis. World J Surg Oncol, 205; 2. Bouwense SA, de Vries M, Schreuder LT, 3: 430. Olesen SS, Frøkjær JB, Drewes AM, van Goor H, Wilder-Smith OH. Systematic mechanism-orientated approach to chronic pancreatitis pain. World J Gastroenterol, 205; 2: Source of support: Nil Conflict of interest: None declared. Table : Endotherapy. Type Sphincterotomy + stenting ESWL + Stenting 3 Sphincterotomy + Stone removal + Stenting Endoscopic CD/CG 5 No. 2 Percentage Complication 4 6 Acute pancreatitis 2 0 Gastrointestinal bleed Page 68
6 Different modalities of treatment of chronic pancreatitis Table 2: Results of endotherapy. ISSN: (P) Results Complete pain relief Partial pain relief Shincterotomy + ESWL + stenting Stenting 2 None 2 Sphinterotomy + Stone Endoscopic CD/CG removal + Stenting 4 Table 3: Complications of surgery. Complication Wound dehiscence Pancreatic fistula G.I. bleed Biliary leakage No Percentagee Table 4: Surgical procedures. Surgery Whipples LPJ (Partington, Rochelle) Frey s Distal Pancreatectomy Triple bypass Cystogastrostomy/Roux-en-y cystojejunostomy Spleenectomy Biliary procedures No Percentage Table 5: Results of surgery. Result LPJ Pain relief 9 Morbidity Mortality Endo insufficiency status Whipples Frey s CG/RCJ DP TBP 4 Page 69
PANCREATIC PSEUDOCYST DRAINAGE: ENDOSCOPIC APPROACHES & THE NURSING ROLE. PRESENTED BY: Susan DePasquale, CGRN, MSN
PANCREATIC PSEUDOCYST DRAINAGE: ENDOSCOPIC APPROACHES & THE NURSING ROLE PRESENTED BY: Susan DePasquale, CGRN, MSN Pancreatic Fluid Collection (PFC) A result of pancreatic duct (PD) and side branch disruption,
More informationThe role of ERCP in chronic pancreatitis
The role of ERCP in chronic pancreatitis Marianna Arvanitakis Erasme University Hospital, ULB, Brussels, Belgium 10 th Nottingham Endoscopy Masterclass SPEAKER DECLARATIONS This presenter has the following
More informationSurgical Management of Chronic Pancreatitis VERENA LIU, MD KINGS COUNTY HOSPITAL CENTER SURGERY GRAND ROUNDS 4/1/2013
Surgical Management of Chronic Pancreatitis VERENA LIU, MD KINGS COUNTY HOSPITAL CENTER SURGERY GRAND ROUNDS 4/1/2013 Case Report 42F with h/o chronic pancreatitis due to alcohol use with chronic upper
More informationTreatment of chronic calcific pancreatitis endoscopy versus surgery
Treatment of chronic calcific pancreatitis endoscopy versus surgery 35 - year old ladypresented to LPC Mumbai with intermittent abdominal pain. Pain was intermittent, colicky, more in epigastrium and periumbilical
More informationPANCREATIC PSEUDOCYSTS. Madhuri Rao MD PGY-5 Kings County Hospital Center
PANCREATIC PSEUDOCYSTS Madhuri Rao MD PGY-5 Kings County Hospital Center 34 yo M Case Presentation PMH: Chronic pancreatitis (ETOH related) PSH: Nil Meds: Nil NKDA www.downstatesurgery.org Symptoms o Chronic
More informationChronic Pancreatitis: When to Scope? Gregory A. Cote, MD, MS Assistant Professor of Medicine Indiana University School of Medicine
Chronic Pancreatitis: When to Scope? Gregory A. Cote, MD, MS Assistant Professor of Medicine Indiana University School of Medicine Endoscopy & Chronic Pancreatitis Diagnosis EUS ERCP Exocrine Function
More informationManagement of Pancreatic Fistulae
Management of Pancreatic Fistulae Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre Fistula definition A Fistula is a permanent abnormal passageway between two organs (epithelial
More informationOverview. Doumit S. BouHaidar, MD ACG/VGS/ODSGNA Regional Postgraduate Course Copyright American College of Gastroenterology 1
Doumit S. BouHaidar, MD Associate Professor of Medicine Director, Advanced Therapeutic Endoscopy Virginia Commonwealth University Overview Copyright American College of Gastroenterology 1 Incidence: 4
More informationOutcome of pancreatic ascites in patients with tropical calcific pancreatitis managed using a uniform treatment protocol
Indian J Gastroenterol 2009(May June):28(3):102 106 CASE SERIES Outcome of pancreatic ascites in patients with tropical calcific pancreatitis managed using a uniform treatment protocol Prakash Kurumboor
More informationVirtual MR Pancreatoscopy in the Evaluation of the Pancreatic Duct in Chronic Pancreatitis
MULTIMEDIA ARTICLE - Videoclips Virtual MR Pancreatoscopy in the Evaluation of the Pancreatic Duct in Chronic Pancreatitis Rakesh Kalapala 1, Lingareddy Sunitha 2, Reddy D Nageshwar 1, Guduru V Rao 1,
More informationPatient characteristics Intervention Comparison Length of follow-up. Endoscopic treatment. Endoscopic transampullary drainage of the pancreatic duct
1) In patients with alcohol-related, what is the safety and efficacy of a) coeliac access block vs medical management b) thoracoscopic splanchnicectomy vs medical management c) coeliac access block vs
More informationPancreatic Benign April 27, 2016
Department of Surgery Pancreatic Benign April 27, 2016 James Choi Dr. Hernandez Objectives Medical Expert: 1. Anatomy and congenital anomalies of the pancreas and pancreatic duct (divisum, annular pancreas
More informationChronic Pancreatitis. Ara Sahakian, M.D. Assistant Professor of Medicine USC core lecture
Chronic Pancreatitis Ara Sahakian, M.D. Assistant Professor of Medicine USC core lecture What is Chronic Pancreatitis Progressive inflammatory disease Pancreatic parenchyma replaced w/fibrous tissue Destruction
More informationChronic pancreatitis is a fibroinflammatory disease of the
Session 2C: Pancreaticobiliary Disease CHRONIC PANCREATITIS: WHEN TO SCOPE? Gregory A. Coté, MD, MS Chronic pancreatitis is a fibroinflammatory disease of the pancreas that presents with several distinct
More informationChronic Pancreatitis
Gastro Foundation Fellows Weekend 2017 Chronic Pancreatitis Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre Aetiology in SA Alcohol (up to 80%) Idiopathic Tropical Obstruction Autoimmune
More informationESPEN Congress Brussels 2005
ESPEN Congress Brussels 2005 Therapeutic endoscopy of pancreatic diseases. How endoscopy may improve nutrition? Myriam Delhaye Therapeutic endoscopy of pancreatic diseases. How endoscopy may improve nutrition?
More informationPANCREATIC PSEUDOCYSTS: Optimal therapeutic strategies. Jacques DEVIERE, MD, PhD Erasme University Hospital Brussels
PANCREATIC PSEUDOCYSTS: Optimal therapeutic strategies Jacques DEVIERE, MD, PhD Erasme University Hospital Brussels 1. Diagnosis. 2. Multidisciplinary approach. 3. Therapeutic planning. 4. How? 5. Follow-up
More information16 April 2010 Resident Teaching Conference. Pancreatitis. W. H. Nealon, M.D., F.A.C.S. J.J. Smith, M.D., D.W.D.
16 April 2010 Resident Teaching Conference Pancreatitis W. H. Nealon, M.D., F.A.C.S. J.J. Smith, M.D., D.W.D. Santorini Wirsung anatomy.med.umich.edu/.../ duodenum_ans.html Bud and ductology Ventral pancreatic
More informationDoes it matter what we drain?
Endoscopic Management of Pancreatic Fluid Collections Shyam Varadarajulu, MD Medical Director Center for Interventional Endoscopy Florida Hospital, Orlando Does it matter what we drain? Makes all the difference!
More informationThe Pancreas. Basic Anatomy. Endocrine pancreas. Exocrine pancreas. Pancreas vasculature. Islets of Langerhans. Acinar cells Ductal System
SGNA: Back to Basics Rogelio G. Silva, MD Assistant Clinical Professor of Medicine University of Illinois at Chicago Department of Medicine Division of Gastroenterology Advocate Christ Medical Center GI
More informationEndoscopic Ultrasound-Guided Treatment of Pancreaticocutaneous Fistulas
ACG CASE REPORTS JOURNAL CASE REPORT ENDOSCOPY Endoscopic Ultrasound-Guided Treatment of Pancreaticocutaneous Fistulas Abdul Haseeb, MD, Barham K. Abu Dayyeh, MD, Michael J. Levy, MD, Larissa L. Fujii,
More informationMaking ERCP Easy: Tips From A Master
Making ERCP Easy: Tips From A Master Raj J. Shah, M.D., FASGE Associate Professor of Medicine University of Colorado School of Medicine Co-Director, Endoscopy Director, Pancreaticobiliary Endoscopy Services
More informationStudy of post cholecystectomy biliary leakage and its management
Original Research Article Study of post cholecystectomy biliary leakage and its management P. Krishna Kishore 1*, B. Manju Sruthi 2, G. Obulesu 3 1 Assistant Professor, Departmentment of General Surgery,
More informationDisclosures. Extra-hepatic Biliary Disease and the Pancreas. Objectives. Pancreatitis 10/3/2018. No relevant financial disclosures to report
Extra-hepatic Biliary Disease and the Pancreas Disclosures No relevant financial disclosures to report Jeffrey Coughenour MD FACS Clinical Associate Professor of Surgery and Emergency Medicine Division
More informationJOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES
JOHN M UECKER, MD, FACS COMPLEX PANCREATICODUODENAL INJURIES THE PROBLEM DUODENAL / PANCREATIC INJURIES Difficult to diagnose Not very common Anatomic and physiologic challenges 90% rate of associated
More informationBiliary tree dilation - and now what?
Biliary tree dilation - and now what? Poster No.: C-1767 Congress: ECR 2012 Type: Educational Exhibit Authors: I. Ferreira, A. B. Ramos, S. Magalhães, M. Certo; Porto/PT Keywords: Pathology, Diagnostic
More informationCHRONIC PANCREATITIS CONSERVATIVE TREATMENT, ENDOSCOPY OR SURGERY?
Endoscopy 2006 Update and Live Demonstration Berlin, 04. 05. Mai 2006 CHRONIC PANCREATITIS CONSERVATIVE TREATMENT, ENDOSCOPY OR SURGERY? J. F. Riemann A. Rosenbaum Medizinische Klinik C, Klinikum Ludwigshafen
More informationThe Influence of Pancreatic Ductal Anatomy on the Complications of Pancreatitis. William H. Nealon M.D.
The Influence of Pancreatic Ductal Anatomy on the Complications of Pancreatitis William H. Nealon M.D. Students and Trainees: Guide to Creativity, Productivity and Innovation in a Clinical Career Choose
More informationArticle Efficacy of Pancreatic Endotherapy in Pancreatic Ascites and Pleural Effusion
Article Efficacy of Pancreatic Endotherapy in Pancreatic Ascites and Pleural Effusion Sudhir Gupta, Nitin Gaikwad *, Amol Samarth, Niraj Sawalakhe and Tushar Sankalecha Department of Gastroenterology,
More informationEndoscopic Management of Acute Pancreatitis. Theo Doukides, MD Gastroenterology and Therapeutic Endoscopy February 13, 2018
Endoscopic Management of Acute Pancreatitis Theo Doukides, MD Gastroenterology and Therapeutic Endoscopy February 13, 2018 Objectives Assessment of acute pancreatitis Early management Who needs an ERCP
More informationChronic Pancreatitis
Supportive module 2: Basics of diagnosis, treatment and prevention of major gastroenterological diseases Chronic Pancreatitis LECTURE IN INTERNAL MEDICINE FOR IV COURSE STUDENTS M. Yabluchansky, L. Bogun,
More informationTitle. region. Author(s) Citation Surgery, 145(3), pp ; Issue Date
NAOSITE: Nagasaki University's Ac Title Author(s) Huge pancreatic pseudocyst migratin region. Tajima, Yoshitsugu; Mishima, Takehi Taiichiro; Adachi, Tomohiko; Tsuneo Citation Surgery, 145(3), pp.341-342;
More informationComparative evaluation of structural and functional changes in pancreas after endoscopic and surgical management of pancreatic necrosis
ORIGINAL ARTICLE Annals of Gastroenterology (2014) 27, 162-166 Comparative evaluation of structural and functional changes in pancreas after endoscopic and surgical management of pancreatic necrosis Surinder
More informationChronic pancreatitis mimicking intraductal papillary mucinous neoplasm of the pancreas; Report of tow cases
Jichi Medical University Journal Chronic pancreatitis mimicking intraductal papillary mucinous neoplasm of the pancreas; Report of tow cases Noritoshi Mizuta, Hiroshi Noda, Nao Kakizawa, Nobuyuki Toyama,
More informationDiagnosis of chronic Pancreatitis. Christoph Beglinger, University Hospital Basel, Switzerland
Diagnosis of chronic Pancreatitis Christoph Beglinger, University Hospital Basel, Switzerland Pancreatitis Pancreas Pancreas - an organ that makes bicarbonate to neutralize gastric acid, enzymes to digest
More informationCholangiocarcinoma (Bile Duct Cancer)
Cholangiocarcinoma (Bile Duct Cancer) The Bile Duct System (Biliary Tract) A network of bile ducts (tubes) connects the liver and the gallbladder to the small intestine. This network begins in the liver
More informationSevere necrotizing pancreatitis. ICU Fellowship Training Radboudumc
Severe necrotizing pancreatitis ICU Fellowship Training Radboudumc Acute pancreatitis Patients with acute pancreatitis van Dijk SM. Gut 2017;66:2024-2032 Diagnosis Revised Atlanta classification Abdominal
More informationManagement of the Mucin Filled Bile Duct. A Complication of Intraductal Papillary Mucinous Tumor of the Pancreas
CASE REPORT Management of the Mucin Filled Bile Duct. A Complication of Intraductal Papillary Mucinous Tumor of the Pancreas Anand Patel, Louis Lambiase, Antonio Decarli, Ali Fazel Division of Gastroenterology
More informationProf. (DR.) MD. ISMAIL PATWARY. MBBS, FCPS, MD, FACP, FRCP(Glasgow, Edin) Professor, Dept. of Medicine, Sylhet women s Medical College, Sylhet
Prof. (DR.) MD. ISMAIL PATWARY MBBS, FCPS, MD, FACP, FRCP(Glasgow, Edin) Professor, Dept. of Medicine, Sylhet women s Medical College, Sylhet CHRONIC PANCREATITIS Defined as a progressive inflammatory
More informationPancreatoscopy-Directed Electrohydraulic Lithotripsy for Pancreatic Ductal Stones in Painful
Pancreatoscopy-Directed Electrohydraulic Lithotripsy for Pancreatic Ductal Stones in Painful Chronic Pancreatitis Using SpyGlass Short title: EHL for Pancreatic Ductal Stones Noor LH Bekkali 1, MD, PhD;
More informationMagnetic resonance cholangiopancreatography (MRCP) is an imaging. technique that is able to non-invasively assess bile and pancreatic ducts,
SECRETIN AUGMENTED MRCP Riccardo MANFREDI, MD, MBA, FESGAR Magnetic resonance cholangiopancreatography (MRCP) is an imaging technique that is able to non-invasively assess bile and pancreatic ducts, in
More informationSOD (Sphincter of Oddi Dysfunction)
SOD (Sphincter of Oddi Dysfunction) SOD refers to the mechanical malfunctioning of the Sphincter of Oddi, which is the valve muscle that regulates the flow of bile and pancreatic juice into the duodenum.
More informationPancreatico-Duodenal Trauma: Drain, Debride, Divert, Despair BACKGROUND EPIDEMIOLOGY 9/11/2018
Pancreatico-Duodenal Trauma: Drain, Debride, Divert, Despair Rochelle A. Dicker, M.D. Professor of Surgery and Anesthesia UCLA BACKGROUND Lancet 1827: Travers, B Rupture of the Pancreas British Journal
More informationA LEADER IN ADVANCED ENDOSCOPY AND HEPATOBILIARY SURGERY
A LEADER IN ADVANCED ENDOSCOPY AND HEPATOBILIARY SURGERY St. Peter s Hospital Advanced Endoscopy & Hepatobiliary Center Welcome The St. Peter s Hospital Advanced Endoscopy & Hepatobiliary Center is a leader
More informationNew developments in diagnosis and non-surgical treatment of chronic pancreatitis
bs_bs_banner doi:10.1111/jgh.12250 NUTRITIONAL FACTORS IN PANCREATOBILIARY DISORDERS New developments in diagnosis and non-surgical treatment of chronic pancreatitis Kazuo Inui, Junji Yoshino, Hironao
More informationACG Clinical Guideline: Management of Acute Pancreatitis
ACG Clinical Guideline: Management of Acute Pancreatitis Scott Tenner, MD, MPH, FACG 1, John Baillie, MB, ChB, FRCP, FACG 2, John DeWitt, MD, FACG 3 and Santhi Swaroop Vege, MD, FACG 4 1 State University
More informationPictorial review of Benign Biliary tract abnormality on MRCP/MRI Liver with Endoscopic (including splyglass) and Endoscopic Ultrasound correlation
Pictorial review of Benign Biliary tract abnormality on MRCP/MRI Liver with Endoscopic (including splyglass) and Endoscopic Ultrasound correlation Poster No.: C-2617 Congress: ECR 2015 Type: Educational
More informationAnatomical and Functional MRI of the Pancreas
Anatomical and Functional MRI of the Pancreas MA Bali, MD, T Metens, PhD Erasme Hospital Free University of Brussels Belgium mbali@ulb.ac.be Introduction The use of MRI to investigate the pancreas has
More informationEndoscopic treatment for chronic pancreatitis: indications, technique, results
J Hepatobiliary Pancreat Sci (2010) 17:770 775 DOI 10.1007/s00534-009-0182-7 TOPICS Chronic pancreatitis: current treatment strategies Endoscopic treatment for chronic pancreatitis: indications, technique,
More informationCPT COD1NG UPDATES Gastroenterology CPT Advisors
2014 CPT COD1NG UPDATES Gastroenterology CPT Advisors Joel V. Brill, MD, AGA CPT Advisor Daniel C. DeMarco, MD, ACG CPT Advisor Glenn D. Littenberg, MD, ASGE CPT Advisor The American College of Gastroenterology
More informationComplex pancreatico- duodenal injuries. Elmin Steyn Head, Division of Surgery Faculty of Health Sciences Stellenbosch University
Complex pancreatico- duodenal injuries Elmin Steyn Head, Division of Surgery Faculty of Health Sciences Stellenbosch University Pancreatic and duodenal trauma: daunting or simply confusing? 2-4% of abdominal
More informationFigure 2: Post-cholecystectomy biliary-like pain
Figure 2: Post-cholecystectomy biliary-like pain 1 patient with recurrent episodes of pain (not daily), in the epigastrium/right upper quadrant, lasting >30 mins, building to a steady level, interrupting
More informationWhat Is Pancreatitis?
What Is Pancreatitis? Pancreatitis is inflammation (swelling) of the pancreas that is most often caused by gallstones or alcohol abuse. There are other causes that your gastroenterologist will look for,
More informationEndoscopic Management of the Iatrogenic CBD Injury
The Liver Week 2014, Jeju, Korea Endoscopic Management of the Iatrogenic CBD Injury Jong Ho Moon, MD, PhD Department of Internal Medicine Soon Chun Hyang University School of Medicine Bucheon/Seoul, KOREA
More informationERCP and EUS: What s New and What Should We Do?
ERCP and EUS: What s New and What Should We Do? Rajesh N. Keswani, MD Associate Professor of Medicine Division of Gastroenterology Northwestern University Feinberg School of Medicine EUS/ERCP in 2015 THE
More informationGroove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology
Groove Pancreatitis: Endoscopic Treatment via the Papilla and Duct of Santorini Morphology The Harvard community has made this article openly available. Please share how this access benefits you. Your
More information6 th August 2018 Day 1 - Gallbladder & Bile duct Topic
Venue: Sterling Hospital Auditorium, Sterling Hospitals, Gurukul Road Ahmedabad, Gujarat 6 th August 2018 Day 1 - Gallbladder & Bile duct Registration(8:00am-8:15am) Inauguration(8:15am-8:30am) Welcome
More informationShort- and Long-term Results of Modified Frey s Procedure in Patients with Chronic Pancreatitis: A Retrospective Japanese Single-Center Study
Kobe J. Med. Sci., Vol. 60, No. 2, pp. E30-E36, 2014 Short- and Long-term Results of Modified Frey s Procedure in Patients with Chronic Pancreatitis: A Retrospective Japanese Single-Center Study MASAKI
More informationThe Use of Pancreatoscopy in the Diagnosis of Intraductal Papillary Mucinous Tumor Lesions of the Pancreas
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:S53 S57 The Use of Pancreatoscopy in the Diagnosis of Intraductal Papillary Mucinous Tumor Lesions of the Pancreas KENJIRO YASUDA, MUNEHIRO SAKATA, MOOSE
More informationACUTE CHOLANGITIS AS a result of an occluded
Digestive Endoscopy 2017; 29 (Suppl. 2): 88 93 doi: 10.1111/den.12836 Current status of biliary drainage strategy for acute cholangitis Endoscopic treatment for acute cholangitis with common bile duct
More informationCase Scenario 1. Discharge Summary
Case Scenario 1 Discharge Summary A 69-year-old woman was on vacation and noted that she was becoming jaundiced. Two months prior to leaving on that trip, she had had a workup that included an abdominal
More informationChronic pancreatitis an increasing Indian Problem
Chronic pancreatitis an increasing Indian Problem Dr Ramesh Ardhanari M.S; MCh.(SGE); FRCS (Hon)(G) Medical Director, Sr. Consultant & Head Dept. of Surgical Gastroenterology Meenakshi Mission Hospital,Madurai
More informationM. Ellrichmann; C. Jürgensen; A. Arlt; A. Fritscher-Ravens
Randomized multicenter study on pancreatic duct stenting in disrupted or obstructed ducts in context with endoscopic treatment of pancreatic pseudocysts. M. Ellrichmann; C. Jürgensen; A. Arlt; A. Fritscher-Ravens
More informationTHE CRITICAL COMPLCATIONS AND MANAGEMENTS AFTER PANCREATIC SURGERY 2013/12/21
THE CRITICAL COMPLCATIONS AND MANAGEMENTS AFTER PANCREATIC SURGERY Tsann-Long Hwang, MD, FACS Department of Surgery Chang Gung Memorial Hospital Chang Gung University Taipei, TAIWAN 2013/12/21 THE DIFFICULTY
More information5/17/2013. Pancreatic Cancer. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Case presentation. Differential diagnosis
Overview Case presentation Postgraduate Course in General Surgery Differential diagnosis Diagnosis and therapy Eric K. Nakakura Koloa, HI March 26, 2013 Outcomes CASE 1: CASE 1: A 78-year-old man developed
More informationHepatobiliary investigations
Hepatobiliary investigations Hepatobiliary Services Information for patients Liver i Stomach Pancreas Gall bladder Introduction You have been referred to the Hepatobiliary Unit. We specialise in procedures
More informationA Guide for Patients Living with a Biliary Metal Stent
A Guide for Patients Living with a Biliary Metal Stent What is a biliary metal stent? A biliary metal stent (also known as a bile duct stent ) is a flexible metallic tube specially designed to hold your
More informationOriginal Policy Date 12:2013
MP 6.01.30 Magnetic Resonance Cholangiopancreatography Medical Policy Section Radiology Is12:2013sue 3:2005 Original Policy Date 12:2013 Last Review Status/Date 12:2013 Return to Medical Policy Index Disclaimer
More informationClinical Spectrum of Presentation of Obstructive Jaundice in Inflammation, Stone Disease, and Malignancy
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/326 Clinical Spectrum of Presentation of Obstructive Jaundice in Inflammation, Stone Disease, and Malignancy R Selvasekaran
More informationRole of Therapeutic Endoscopy in Hepatic Hydatid Disease after Surgical Intervention: Case Report
ISPUB.COM The Internet Journal of Gastroenterology Volume 10 Number 2 Role of Therapeutic Endoscopy in Hepatic Hydatid Disease after Surgical Intervention: Case Report H Ono, M Okabe, T Kimura, M Kawakami,
More informationOriginal Article INTRODUCTION
Original Article A retrospective study evaluating endoscopic ultrasound guided drainage of pancreatic fluid collections using a novel lumen apposing metal stent on an electrocautery enhanced delivery system
More informationPancreatic Cancer. What is pancreatic cancer?
Scan for mobile link. Pancreatic Cancer Pancreatic cancer is a tumor of the pancreas, an organ that is located behind the stomach in the abdomen. Pancreatic cancer does not always cause symptoms until
More informationEndoscopic Management of Biliary Strictures. Sammy Ho, MD Director of Pancreaticobiliary Services and Endoscopic Ultrasound Montefiore Medical Center
Endoscopic Management of Biliary Strictures Sammy Ho, MD Director of Pancreaticobiliary Services and Endoscopic Ultrasound Montefiore Medical Center Malignant Biliary Strictures Etiologies: Pancreatic
More informationMild. Moderate. Severe
2012 Revised Atlanta Classification Acute pancreatitis Classified based on absence or presence of local and/or systemic complications Mild Acute Pancreatits Moderate Severe P. A. Banks, T. L. Bollen, C.
More informationand Transmural Drainage
HPB Surgery, 2000, Vol. 11, pp. 333-338 Reprints available directly from the publisher Photocopying permitted by license only (C) 2000 OPA (Overseas Publishers Association) N.V. Published by license under
More informationSurgical Management of CBD Injury Jin Seok Heo
Surgical Management of CBD Injury Jin Seok Heo Department of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Bile duct injury (BDI) Introduction Incidence
More informationTogether, putting patients first
The Role of a Gastroenterologist in the Diagnosis and Management of Pancreatic Cancer Sarah Jowett, Consultant Gastroenterologist Bradford Teaching Hospitals Trust Leeds Regional Study Day, 12 September
More informationThis page explains some of the medical words that you may hear when you are finding out about pancreatic cancer and how it is treated.
A-Z of medical words This page explains some of the medical words that you may hear when you are finding out about pancreatic cancer and how it is treated. Absorption: once your food has been broken down,
More informationSurgical management of pancreatic ascites
International Surgery Journal Gunturi SRV et al. Int Surg J. 2017 Feb;4(2):564-570 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20170088
More informationClinical Profile of Idiopathic Chronic Pancreatitis in North India
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:594 599 Clinical Profile of Idiopathic Chronic Pancreatitis in North India DEEPAK K. BHASIN,* GURSEWAK SINGH,* SURINDER S. RANA,* SHOKET M. CHOWDRY,* NUSRAT
More informationSpyGlass DS-guided lithotripsy for pancreatic duct stones in symptomatic treatment-refractory chronic calcifying pancreatitis
SpyGlass DS-guided lithotripsy for pancreatic duct stones in symptomatic treatment-refractory chronic calcifying pancreatitis Authors Christian Gerges *, 1, David Pullmann *, 1,FarzanBahin 1,MarkusSchneider
More informationEUS Guided Pancreatic Duct Drainage: When? How?
PBS-IV Beyond the Horizon of Interventional EUS EUS Guided Pancreatic Duct Drainage: When? How? Uzma D. Siddiqui, M.D. Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine,
More informationDiagnosis of tumor extension in biliary carcinoma has. Differential Diagnosis and Treatment of Biliary Strictures
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:S79 S83 Differential Diagnosis and Treatment of Biliary Strictures KAZUO INUI, JUNJI YOSHINO, and HIRONAO MIYOSHI Department of Internal Medicine, Second
More informationERCP in altered anatomy. Lars Aabakken Oslo University Hospital - Rikshospitalet Oslo, Norway
ERCP in altered anatomy Lars Aabakken Oslo University Hospital - Rikshospitalet Oslo, Norway CO2 as insufflation gas Reduces post-procedure pain Reduces in-procedure bowel distension Improves the intubation
More informationEndoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline Updated August 2018
Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Updated August 2018 Authors Jean-Marc Dumonceau 1, Myriam Delhaye 2, Andrea Tringali 3, 4, Marianna Arvanitakis
More informationEUS-Guided Transduodenal Biliary Drainage in Unresectable Pancreatic Cancer with Obstructive Jaundice
CASE REPORT EUS-Guided Transduodenal Biliary Drainage in Unresectable Pancreatic Cancer with Obstructive Jaundice Tiing Leong Ang, Eng Kiong Teo, Kwong Ming Fock Division of Gastroenterology, Department
More informationOriginal Article. Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome
Tropical Gastroenterology 2015;36(1):31 35 Original Article Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome Surinder S Rana 1, Vishal Sharma 1, Deepak
More informationUse of Nasopancreatic Drainage for Severe Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Case Series
doi: 10.2169/internalmedicine.0549-17 Intern Med 57: 2657-2662, 2018 http://internmed.jp CASE REPORT Use of Nasopancreatic Drainage for Severe Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis:
More informationCorrespondence should be addressed to Justin Cochrane;
Case Reports in Gastrointestinal Medicine Volume 2015, Article ID 794282, 4 pages http://dx.doi.org/10.1155/2015/794282 Case Report Acute on Chronic Pancreatitis Causing a Highway to the Colon with Subsequent
More informationA CASE REPORT OF SPONTANEOUS BILOMA - AN ENIGMATIC SURGICAL PROBLEM
A CASE REPORT OF SPONTANEOUS BILOMA - AN ENIGMATIC SURGICAL PROBLEM *Sumanta Kumar Ghosh and Biswajit Mukherjee ESIC Medical College, Joka, Kolkata, India *Author for Correspondence ABSTRACT Occurrence
More information3/28/2012. Periampullary Tumors. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Eric K. Nakakura Ko Olina, HI
Overview Postgraduate Course in General Surgery Case presentation Differential diagnosis Diagnosis and therapy Outcomes Principles of palliative care Eric K. Nakakura Ko Olina, HI March 27, 2012 CASE 1:
More informationTitle: The endoscopic ultrasound-assisted Rendez-Vous technique for treatment of recurrent pancreatitis due to pancreas divisum and ansa pancreatica
Title: The endoscopic ultrasound-assisted Rendez-Vous technique for treatment of recurrent pancreatitis due to pancreas divisum and ansa pancreatica Authors: Sergio López-Durán, Celia Zaera, Juan Ángel
More informationCase Report (1) Sphincter of Oddi Dysfunction. Case Report (3) Case Report (2) Case Report (4) Case Report (5)
Dr David Westaby Imperial NHS Trust Imperial College Medical School London Case Report (1)! TD 33yr old male! Feb May 2010: Recurrent episodes of abdominal pain! June 2010 Episode severe abdominal pain
More informationPancreatic Lesions. Valerie Jefford Pediatric Surgery Rounds June 6, 2003
Pancreatic Lesions Valerie Jefford Pediatric Surgery Rounds June 6, 2003 Embryology 4 th week 2 buds of endodermal origin from caudal foregut Dorsal and ventral bud Ventral migrates dorsally with CBD (below/behind
More informationEndoscopic Retrograde Pancreatography and Laparoscopic Cholecystectomy. TEAM 1 Janix M. De Guzman, MD Presentor
Endoscopic Retrograde Pancreatography and Laparoscopic Cholecystectomy TEAM 1 Janix M. De Guzman, MD Presentor Premise 40F Jaundice Abdominal pain US finding of gallstones with apparently normal common
More informationMultidetector CT evaluation of acute pancreatitis and its complications and its correlation with clinical outcome
INTERNATIONAL JOURNAL OF CURRENT RESEARCH IN BIOLOGY AND MEDICINE ISSN: 2455-944X www.darshanpublishers.com DOI:10.22192/ijcrbm Volume 3, Issue 1-2018 Original Research Article Multidetector CT evaluation
More informationCLASSIFICATION OF CHRONIC PANCREATITIS
CLASSIFICATION OF CHRONIC PANCREATITIS EAGE, Podstgraduate Course, Prague, April 2010. Tomica Milosavljević School of Medicine, University of Belgrade Clinical Center of Serbia,Belgrade The phrase chronic
More informationSurgical management of chronic pancreatitis: Our institutional experience
Quest Journals Journal of Medical and Dental Science Research Volume 3~ Issue 1 (2016) pp:01-09 ISSN(Online) : 2394-076X ISSN (Print):2394-0751 www.questjournals.org Research Paper Surgical management
More informationSex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria
ORIGINAL ARTICLE Annals of Gastroenterology (2018) 31, 1-6 Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria Ankit Chhoda
More information