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Cirak Z, Tanoglu A, Yeniceri M, Tanoglu EG, Kaplan M, Sade AG. Certolizumab Has Favorable Efficacy on Preventing Pancreas and Target Organs Damage in Acute Pancreatitis. Pancreas 2024; 53:e588-e594. [PMID: 38986079 DOI: 10.1097/mpa.0000000000002343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVE It was targeted to assess the efficacy of certolizumab on pancreas and target organs via biochemical parameters and histopathologic scores in experimental acute pancreatitis (AP). MATERIALS AND METHODS Forty male Sprague Dawley rats were divided into the following 5 equal groups: group 1 (sham group), group 2 (AP group), group 3 (AP + low-dose certolizumab group), group 4 (AP + high-dose certolizumab group), and group 5 (placebo group). Rats in all groups were sacrificed 24 hours after the last injection and amylase, tumor necrosis factor α, transforming growth factor β, interleukin 1β, malondialdehyde, superoxide dismutase, and glutathione peroxidase levels were studied in blood samples. Histopathological investigation of both the pancreas and target organs (lungs, liver, heart, kidneys) was performed by a pathologist blind to the groups. In silico analysis were also accomplished. RESULTS The biochemical results in the certolizumab treatment groups were identified to be significantly favorable compared to the AP group (P < 0.001). The difference between the high-dose group (group 4) and low-dose treatment group (group 3) was found to be significant in terms of biochemical parameters and histopathological scores (P < 0.001). In terms of the effect of certolizumab treatment on the target organs (especially on lung tissue), the differences between the low-dose treatment group (group 3) and high-dose treatment group (group 4) with the AP group (group 2) were significant. CONCLUSIONS Certolizumab has favorable protective effects on pancreas and target organs in AP. It may be a beneficial agent for AP treatment and may prevent target organ damage.
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Affiliation(s)
- Zafer Cirak
- From the Department of Internal Medicine, Honaz State Hospital
| | - Alpaslan Tanoglu
- Department of Internal Medicine, Division of Gastroenterology, Bahçeşehir University, Faculty of Medicine
| | - Murat Yeniceri
- University of Health Sciences, Institution of Hamidiye Health Sciences, Department of Molecular Biology and Genetics
| | - Esra Guzel Tanoglu
- Department of Internal Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Hospital
| | - Mustafa Kaplan
- Department of Internal Medicine, University of Health Sciences, Sultan Abdülhamid Han Hospital
| | - Ayşe Gökcen Sade
- Department of Pathology, University of Health Sciences, Sultan Abdülhamid Han Hospital, Istanbul, Turkey
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Küstner S, Gallardo M, Higuera F, Claria RS, Mazza O, Ardiles V, Pekolj J, de Santibañes M. Early laparoscopic cholecystectomy in acute mild gallstone pancreatitis. Is there a role for routine admission contrast-enhanced CT Scan? Langenbecks Arch Surg 2024; 409:219. [PMID: 39023574 DOI: 10.1007/s00423-024-03394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This study aims to evaluate the efficacy of admission contrast-enhanced CT scans in formulating strategies for performing early laparoscopic cholecystectomy in cases of acute gallstone pancreatitis. METHODS Patients diagnosed with acute gallstone pancreatitis underwent a CT scan upon admission (after at least 24 h from symptom onset) to confirm diagnosis and assess peripancreatic fluid, collections, gallstones, and common bile duct stones. Patients with mild acute gallstone pancreatitis, following the Atlanta classification and Baltazar score A or B, were identified as candidates for early cholecystectomy (within 72 h of admission). RESULTS Within the analyzed period, 272 patients were diagnosed with mild acute gallstone pancreatitis according to the Atlanta Guidelines. A total of 33 patients (12.1%) were excluded: 17 (6.25%) due to SIRS, 10 (3.6%) due to local complications identified in CT (Balthazar D/E), and 6 (2.2%) due to severe comorbidities. Enhanced CT scans accurately detected gallstones, common bile duct stones, pancreatic enlargement, inflammation, pancreatic collections, and peripancreatic fluid. Among the cohort, 239 patients were selected for early laparoscopic cholecystectomy. Routine intraoperative cholangiogram was conducted in all cases, and where choledocholithiasis was present, successful treatment occurred through common bile duct exploration. Only one case required conversion from laparoscopic to open surgery. There were no observed severe complications or mortality. CONCLUSION Admission CT scans are instrumental in identifying clinically stable patients with local tomographic complications that contraindicate early surgery. Patients meeting the criteria for mild acute gallstone pancreatitis, as per Atlanta guidelines, without SIRS or local complications (Baltazar D/E), can safely undergo early cholecystectomy within the initial 72 h of admission.
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Affiliation(s)
- Stefan Küstner
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Martin Gallardo
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Felipe Higuera
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Oscar Mazza
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Pekolj
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martín de Santibañes
- General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Lin C, Li J, Liu B, Hong X, Luo T, Ye J, Yu Y, Peng X, Gou S, Tang H, Yuan T, Luo J, Yang M, Feng B, Zhao Z, Ning C, Sun Z, Zhu S, Chen L, Shen D, Huang G. Metagenomic next-generation sequencing, instead of procalcitonin, could guide antibiotic usage in patients with febrile acute necrotizing pancreatitis: a multicenter, prospective cohort study. Int J Surg 2024; 110:2721-2729. [PMID: 38348834 PMCID: PMC11093443 DOI: 10.1097/js9.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/26/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUNDS The effectiveness of procalcitonin-based algorithms in guiding antibiotic usage for febrile acute necrotizing pancreatitis (ANP) remains controversial. Metagenomic next-generation sequencing (mNGS) has been applied to diagnose infectious diseases. The authors aimed to evaluate the effectiveness of blood mNGS in guiding antibiotic stewardship for febrile ANP. MATERIALS AND METHODS The prospective multicenter clinical trial was conducted at seven hospitals in China. Blood samples were collected during fever (T ≥38.5°C) from ANP patients. The effectiveness of blood mNGS, procalcitonin, and blood culture in diagnosing pancreatic infection was evaluated and compared. Additionally, the real-world utilization of antibiotics and the potential mNGS-guided antimicrobial strategy in febrile ANP were also analyzed. RESULTS From May 2023 to October 2023, a total of 78 patients with febrile ANP were enrolled and 30 patients (38.5%) were confirmed infected pancreatic necrosis (IPN). Compared with procalcitonin and blood culture, mNGS showed a significantly higher sensitivity rate (86.7% vs. 56.7% vs. 26.7%, P <0.001). Moreover, mNGS outperformed procalcitonin (89.5 vs. 61.4%, P <0.01) and blood culture (89.5 vs. 69.0%, P <0.01) in terms of negative predictive value. Blood mNGS exhibited the highest accuracy (85.7%) in diagnosing IPN and sterile pancreatic necrosis, significantly superior to both procalcitonin (65.7%) and blood culture (61.4%). In the multivariate analysis, positive blood mNGS (OR=60.2, P <0.001) and lower fibrinogen level (OR=2.0, P <0.05) were identified as independent predictors associated with IPN, whereas procalcitonin was not associated with IPN, but with increased mortality (Odds ratio=11.7, P =0.006). Overall, the rate of correct use of antibiotics in the cohort was only 18.6% (13/70) and would be improved to 81.4% (57/70) if adjusted according to the mNGS results. CONCLUSION Blood mNGS represents important progress in the early diagnosis of IPN, with particular importance in guiding antibiotic usage for patients with febrile ANP.
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Affiliation(s)
- Chiayen Lin
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
| | - Jiarong Li
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
| | - Baiqi Liu
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
| | - Xiaoyue Hong
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
| | - Tao Luo
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, Changde
| | - Jinsong Ye
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, Changde
| | - Yi Yu
- Department of Hepatobiliary Surgery, General Surgery, The First People’s Hospital of Chenzhou City, Chenzhou
| | - Xinran Peng
- Department of Hepatobiliary Surgery, General Surgery, The First People’s Hospital of Chenzhou City, Chenzhou
| | - Shanmiao Gou
- Department of Pancreatic Surgery, General Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Huayong Tang
- Department of General Surgery, The First Affiliated Hospital of Hunan Traditional Chinese Medical College
| | - Tongli Yuan
- Department of General Surgery, The First Affiliated Hospital of Hunan Traditional Chinese Medical College
| | - Jianguan Luo
- Department of Hepatobiliary Surgery, General Surgery, Liuyang People’s Hospital, Changsha
| | - Ming Yang
- Department of Hepatobiliary Surgery, General Surgery, Liuyang People’s Hospital, Changsha
| | - Bin Feng
- Center of Hepatobiliary and Pancreatic Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan Province, People’s Republic of China
| | - Zhijian Zhao
- Center of Hepatobiliary and Pancreatic Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan Province, People’s Republic of China
| | - Caihong Ning
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
| | - Zefang Sun
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
| | - Shuai Zhu
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
| | - Lu Chen
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
| | - Dingcheng Shen
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
| | - Gengwen Huang
- Department of Pancreatic Surgery, General Surgery
- Department of Hernia and Abdominal Wall Surgery
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha
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Sivakumar SG, Sekaran M, Muthukrishnan S, Natesan AV, Nalankilli VP, Senthilnathan P, Palanivelu C. Laparoscopic necrosectomy for acute necrotising pancreatitis: Retrospective analysis of a decade-long experience from a tertiary centre. J Minim Access Surg 2024; 20:127-135. [PMID: 38557646 PMCID: PMC11095801 DOI: 10.4103/jmas.jmas_215_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION The objective of this study is to evaluate the role of minimally invasive surgery for the management of necrotising pancreatitis in acute settings and to propose tailor-made approaches to deal with various locations of pancreatic necrosis. PATIENTS AND METHODS Three hundred and thirteen patients underwent laparoscopic management of necrotising pancreatitis in this study period from January 2010 to June 2021, out of which 122 patients underwent minimally invasive necrosectomy for acute necrotising pancreatitis. The remaining 191 patients underwent laparoscopic internal drainage in the form of cystogastrostomy/cystojejunostomy for walled-off pancreatic necrosis. RESULTS Mean body mass index was 26.45 ± 3.78 kg/sqm. Mean operating time was 56.40 ± 20.48 min and mean blood loss was 120 ± 31.45 mL. Ten patients required reoperation (6 underwent open procedure and 4 underwent laparoscopic redo necrosectomy). Six patients died of multi-organ failure. The mean duration of return of bowel function was 5 ± 1.8 days. The mean length of hospital stay after surgery was 10.19 ± 7.09 days. There were no major wound-related complications. CONCLUSION A minimally invasive approach to pancreatic necrosectomy is safe and feasible with good outcomes in centres with advanced laparoscopic expertise. It requires not only careful case selection but also proper timing and the ideal route of access to achieve optimal outcomes.
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Affiliation(s)
| | - Monika Sekaran
- Department of HPB, Minimal Access Surgery and Liver Transplant, Gem Hospital, Chennai, Tamil Nadu, India
| | - Srinivasan Muthukrishnan
- Department of HPB, Minimal Access Surgery and Liver Transplant, Gem Hospital, Chennai, Tamil Nadu, India
| | - Anand Vijai Natesan
- Department of HPB, Minimal Access Surgery and Liver Transplant, Gem Hospital, Chennai, Tamil Nadu, India
| | - V. P. Nalankilli
- Department of HPB, Minimal Access Surgery and Liver Transplant, Gem Hospital, Chennai, Tamil Nadu, India
| | - Palanisamy Senthilnathan
- Department of HPB, Minimal Access Surgery and Liver Transplant, Gem Hospital, Chennai, Tamil Nadu, India
| | - Chinnusamy Palanivelu
- Department of HPB, Minimal Access Surgery and Liver Transplant, Gem Hospital, Chennai, Tamil Nadu, India
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Liu Y, Dai S, Qin S, Zhou J, Wang Z, Yin G. The pathogenic mutations of APOA5 in Chinese patients with hyperlipidemic acute pancreatitis. Lipids Health Dis 2024; 23:44. [PMID: 38331899 PMCID: PMC10851583 DOI: 10.1186/s12944-024-02011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND AIMS To study the role of gene mutations in the development of severe hypertriglyceridemia (HTG) in patients with hyperlipidemic acute pancreatitis (HLAP), especially different apolipoprotein A5 (APOA5) mutations. METHODS Whole-exome sequencing was performed on 163 patients with HLAP and 30 patients with biliary acute pancreatitis (BAP). The pathogenicity of mutations was then assessed by combining clinical information, predictions of bioinformatics programs, information from multiple gene databases, and residue location and conservation. The pathogenic mutations of APOA5 were visualized using the software. RESULTS 1. Compared with BAP patients, pathogenic mutations of APOA5 were frequent in HLAP patients; among them, the heterozygous mutation of p.G185C was the most common. 2. All six pathogenic mutations of APOA5 identified in this study (p.S35N, p.D167V, p.G185C, p.K188I, p.R223C, and p.H182fs) were positively correlated with severe HTG; they were all in the important domains of apolipoprotein A-V (apoA-V). Residue 223 is strictly conserved in multiple mammals and is located in the lipoprotein lipase (LPL)-binding domain (Pro215-Phe261). When Arg 223 is mutated to Cys 223, the positive charge of this residue is reduced, which is potentially destructive to the binding function of apoA-V to LPL. 3. Four new APOA5 mutations were identified, namely c.563A > T, c.667C > T, c.788G > A, and c.544_545 insGGTGC. CONCLUSIONS The pathogenic mutations of APOA5 were specific to the patients with HLAP and severe HTG in China, and identifying such mutations had clinical significance in elucidating the etiology and subsequent treatment.
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Affiliation(s)
- Yuxin Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China
| | - Si Dai
- Department of Gastroenterology, Songtao Miao Autonomous County People's Hospital, Tongren, 554199, Guizhou Province, China
| | - Shuqi Qin
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China
| | - Jing Zhou
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China
| | - Zhendan Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China
| | - Guojian Yin
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, District, No.1055, San-Xiang Road, Gu-Su, Suzhou, 215000, Jiangsu Province, China.
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6
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Wen Y, Xu L, Zhang D, Sun W, Che Z, Zhao B, Chen Y, Yang Z, Chen E, Ni T, Mao E. Effect of early antibiotic treatment strategy on prognosis of acute pancreatitis. BMC Gastroenterol 2023; 23:431. [PMID: 38066411 PMCID: PMC10709887 DOI: 10.1186/s12876-023-03070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Antibiotic use in the early stages of acute pancreatitis is controversial. The purpose of this study was to investigate the effect of early antibiotic application on the prognosis of acute pancreatitis (AP). MATERIALS AND METHODS Clinical data of patients with primary AP admitted to our emergency ward within 72 hours of onset were retrospectively collected from January 2016 to December 2020. We classified patients with acute pancreatitis according to etiology and disease severity, and compared the differences in hospital stay, laparotomy rate, and in-hospital mortality among AP patients who received different antibiotic treatment strategies within 72 hours of onset. RESULTS A total of 1134 cases were included, with 681 (60.1%) receiving early antibiotic treatment and 453 (39.9%) not receiving it. There were no significant differences in baseline values and outcomes between the two groups. In subgroup analysis, patients with biliary severe acute pancreatitis (SAP) who received early antibiotics had lower rates of laparotomy and invasive mechanical ventilation, as well as shorter hospital stays compared to those who did not receive antibiotics. In logistic regression analysis, the early administration of carbapenem antibiotics in biliary SAP patients was associated with a lower in-hospital mortality rate. Early antibiotic use in biliary moderate-severe acute pancreatitis (MSAP) reduced hospital stays and in-hospital mortality. Quinolone combined with metronidazole treatment in biliary mild acute pancreatitis (MAP) shortened hospital stays. Early antibiotic use does not benefit patients with non-biliary AP. CONCLUSION Strategies for antibiotic use in the early stages of AP need to be stratified according to cause and disease severity.
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Affiliation(s)
- Yi Wen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Xu
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dayi Zhang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenwu Sun
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zaiqian Che
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Zhao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhitao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tongtian Ni
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Enqiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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7
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Bruno MJ. Endoscopy in Gallstone Pancreatitis. Gastrointest Endosc Clin N Am 2023; 33:701-707. [PMID: 37709405 DOI: 10.1016/j.giec.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The root cause for biliary pancreatitis is a transient impediment of the outflow of secretion from the pancreatic duct due to gallstones and sludge obstructing the ampulla of Vater. Based on meta-analyses and recent studies, clear recommendations can be formulated when and when not to perform an ERC in patients with biliary pancreatitis. ERC is indicated urgently in patients with biliary pancreatitis and concomitant cholangitis. Urgent ERC is not indicated in patients with predicted mild or severe biliary pancreatitis without cholangitis, even when stones or sludge are proven on EUS imaging.
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Affiliation(s)
- Marco J Bruno
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam 3015 GD, the Netherlands.
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8
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Blundell JD, Gandy RC, Close JCT, Harvey LA. Time to interval cholecystectomy and associated outcomes in a population aged 50 and above with mild gallstone pancreatitis. Langenbecks Arch Surg 2023; 408:380. [PMID: 37770612 PMCID: PMC10539187 DOI: 10.1007/s00423-023-03098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Cholecystectomy on index admission for mild gallstone pancreatitis (GSP) is recommended, although not always feasible. This study examined rates and outcomes of people aged ≥ 50 years who underwent interval (delayed) cholecystectomy at increasing time points. METHODS Hospitalisation and death data were linked for individuals aged ≥ 50 years admitted to hospital in New South Wales, Australia with mild GSP between 2008-2018. Primary outcome was interval cholecystectomy timing. Secondary outcomes included mortality, emergency readmission for gallstone-related disease (GSRD) (28 and 180-day), and length of stay (LOS) (index admission and total six-month GSRD). RESULTS 3,003 patients underwent interval cholecystectomy: 861 (28.6%) at 1-30, 1,221 (40.7%) at 31-90 and 921 (30.7%) at 91-365 days from index admission. There was no difference in 365-day mortality between groups. Longer delay to cholecystectomy was associated with increased 180-day emergency GSRD readmission (17.5% vs 15.8% vs 19.9%, p < 0.001) and total six-month LOS (5.9 vs 8.4 vs 8.3, p < 0.001). Endoscopic retrograde cholangiopancreatography (ERCP) was increasingly required with cholecystectomy delay (14.5% vs 16.9% vs 20.4%, p < 0.001), as were open cholecystectomy procedures (4.8% vs 7.6% vs 11.3%, p < 0.001). Extended delay was associated with patients of lower socioeconomic status, regional/rural backgrounds or who presented to a low volume or non-tertiary hospital (p < 0.001). CONCLUSION Delay to interval cholecystectomy results in increased rates of emergency readmission, overall LOS, risks of conversion to open surgery and need for ERCP. Index admission cholecystectomy is still recommended, however when not possible, interval cholecystectomy should be performed within 30 days to minimise patient risk and healthcare burden.
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Affiliation(s)
- Jian D Blundell
- Prince of Wales Hospital, Sydney, NSW, Australia.
- Neuroscience Research Australia, Sydney, NSW, Australia.
- University of NSW, Sydney, NSW, Australia.
| | - Robert C Gandy
- Prince of Wales Hospital, Sydney, NSW, Australia
- University of NSW, Sydney, NSW, Australia
| | - Jacqueline C T Close
- Prince of Wales Hospital, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- University of NSW, Sydney, NSW, Australia
| | - Lara A Harvey
- Neuroscience Research Australia, Sydney, NSW, Australia
- University of NSW, Sydney, NSW, Australia
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9
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Podda M, Pellino G, Di Saverio S, Coccolini F, Pacella D, Cioffi SPB, Virdis F, Balla A, Ielpo B, Pata F, Poillucci G, Ortenzi M, Damaskos D, De Simone B, Sartelli M, Leppaniemi A, Jayant K, Catena F, Giuliani A, Di Martino M, Pisanu A. Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study. Updates Surg 2023; 75:493-522. [PMID: 36899292 PMCID: PMC10005914 DOI: 10.1007/s13304-023-01488-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990).
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Affiliation(s)
- Mauro Podda
- Emergency Surgery Unit, Department of Surgical Science, Policlinico Universitario "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, SS 554, Km 4,500, Monserrato, 09042, Cagliari, Italy.
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Salomone Di Saverio
- Department of Surgery, "Madonna del Soccorso" Hospital, San Benedetto del Tronto, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Unit, Pisa University Hospital, Pisa, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Francesco Virdis
- Trauma and Acute Care Surgery Unit, "Niguarda Ca Granda" Hospital, Milan, Italy
| | - Andrea Balla
- General and Minimally-Invasive Surgery Unit, "San Paolo" Hospital, Civitavecchia, Rome, Italy
| | | | - Francesco Pata
- General Surgery Unit, "Nicola Giannettasio" Hospital, Corigliano-Rossano, Italy
| | - Gaetano Poillucci
- Department of General Surgery, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Marche Polytechnic University, Ancona, Italy
| | - Dimitrios Damaskos
- Department of Upper G.I. Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Belinda De Simone
- Department of Emergency and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy/Saint Germain en Laye, Poissy Cedex, France
| | | | - Ari Leppaniemi
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kumar Jayant
- Department of Surgery & Cancer, Imperial College London, Du Cane Road, London, UK
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, "Bufalini" Hospital, Cesena, Italy
| | - Antonio Giuliani
- General and Emergency Surgery Unit, San Carlo Hospital, Potenza, Italy
| | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, "A.O.R.N. Cardarelli", Naples, Italy
| | - Adolfo Pisanu
- Emergency Surgery Unit, Department of Surgical Science, Policlinico Universitario "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, SS 554, Km 4,500, Monserrato, 09042, Cagliari, Italy
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10
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Diagnosis and Management of Acute Pancreatitis in Pregnancy. Clin Obstet Gynecol 2023; 66:237-249. [PMID: 36044625 DOI: 10.1097/grf.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Acute pancreatitis is rare in pregnancy; however, the associated morbidity and mortality make prompt diagnosis and appropriate management essential. 1,2 Although most cases are mild and improve with limited interventions, severe cases require a multidisciplinary approach in a critical care setting. The main principles of management include identification of an etiology to guide therapy, fluid resuscitation, electrolyte repletion, early nutritional support, and pain management. Antibiotics are not indicated for prophylaxis and should be reserved for cases with a suspected infectious process. Surgical management is indicated in select cases. Management in pregnant patients has few differences which are outlined below.
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11
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Yang Y, Zhang Y, Wen S, Cui Y. The optimal timing and intervention to reduce mortality for necrotizing pancreatitis: a systematic review and network meta-analysis. World J Emerg Surg 2023; 18:9. [PMID: 36707836 PMCID: PMC9883927 DOI: 10.1186/s13017-023-00479-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A series of randomized controlled trials have investigated the efficacy and safety of different timings of interventions and methods of intervention. However, the optimal treatment strategy is not yet clear. METHODS We searched PubMed, EMBASE, ClinicalTrials.gov and the Cochrane Library until November 30, 2022. A systematic review and Bayesian network meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Trials comparing different treatment strategies for necrotizing pancreatitis were included. This study was registered in the Prospective Register of Systematic Reviews (CRD42022364409) to ensure transparency. RESULTS We analyzed a total of 10 studies involving 570 patients and 8 treatment strategies. Although no statistically significant differences were identified comparing odds ratios, trends were confirmed by the surface under the cumulative ranking (SUCRA) scores. The interventions with a low rate of mortality were delayed surgery (DS), delayed surgical step-up approach (DSU) and delayed endoscopic step-up approach (DEU), while the interventions with a low rate of major complications were DSU, DEU and DS. According to the clustered ranking plot, DSU performed the best overall in reducing mortality and major complications, while DD performed the worst. Analysis of the secondary endpoints confirmed the superiority of DEU and DSU in terms of individual components of major complications (organ failure, pancreatic fistula, bleeding, and visceral organ or enterocutaneous fistula), exocrine insufficiency, endocrine insufficiency and length of stay. Overall, DSU was superior to other interventions. CONCLUSION DSU was the optimal treatment strategy for necrotizing pancreatitis. Drainage alone should be avoided in clinical practice. Any interventions should be postponed for at least 4 weeks if possible. The step-up approach was preferred.
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Affiliation(s)
- Yang Yang
- grid.265021.20000 0000 9792 1228Department of Surgery, Tianjin Medical University, Tianjin, 300070 China ,grid.417036.7Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, 122 Sanwei Road, Nankai District, Tianjin, 300110 China
| | - Yu Zhang
- grid.265021.20000 0000 9792 1228Department of Surgery, Tianjin Medical University, Tianjin, 300070 China ,grid.417036.7Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, 122 Sanwei Road, Nankai District, Tianjin, 300110 China
| | - Shuaiyong Wen
- grid.265021.20000 0000 9792 1228Department of Surgery, Tianjin Medical University, Tianjin, 300070 China ,grid.417036.7Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, 122 Sanwei Road, Nankai District, Tianjin, 300110 China
| | - Yunfeng Cui
- Department of Surgery, Tianjin Medical University, Tianjin, 300070, China. .,Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, 122 Sanwei Road, Nankai District, Tianjin, 300110, China.
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12
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Etheridge JC, Castillo-Angeles M, Sinyard RD, Jarman MP, Havens JM. Impact of hospital characteristics on best-practice adherence for gallstone pancreatitis: a nationwide analysis. Surg Endosc 2023; 37:127-133. [PMID: 35854127 DOI: 10.1007/s00464-022-09444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Current guidelines recommend cholecystectomy during the index admission for gallstone pancreatitis, and a growing body of evidence indicates that patients benefit from cholecystectomy within the first 48 h of admission. We examined the impact of hospital characteristics on adherence to these data-driven practices. METHODS We queried the National Inpatient Sample for patients admitted for gallstone pancreatitis between October 2015 and December 2018. Patients who underwent same-admission cholecystectomy were identified by procedure codes. Cholecystectomies within the first two days were classified as early cholecystectomies. Multivariable logistic regression was used to determine the association between hospital characteristics and adherence to these practices. RESULTS Of 163,390 admissions for gallstone pancreatitis, only 90,790 (55.6%) underwent cholecystectomy before discharge. Mean time from admission to cholecystectomy was 2.9 days; 27.0% of patients (44,005) underwent early cholecystectomy. Odds of same-admission cholecystectomy were highest in large hospitals (OR 1.21, 95% CI 1.13-1.28), urban teaching centers (OR 1.33, 95% CI 1.21-1.46), and the South (OR 1.70, 95% CI 1.57-1.83). Odds of early cholecystectomy did not vary with hospital size, urban-rural status, or teaching status but were highest in the West (OR 1.98, 95% CI 1.80-2.18). CONCLUSION Best-practice adherence for cholecystectomy in gallstone pancreatitis remains low despite an abundance of evidence and clinical practice guidelines. Active interventions are needed to improve delivery of surgical care for this patient population. Implementation efforts should focus on small hospitals, rural areas, and health systems in the Northeast region.
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Affiliation(s)
- James C Etheridge
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Manuel Castillo-Angeles
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert D Sinyard
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Joaquim M Havens
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
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13
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Lin C, Bonsu AAFK, Li J, Ning C, Chen L, Zhu S, Zhong Q, Shen D, Huang G. Application of metagenomic next-generation sequencing for suspected infected pancreatic necrosis. Pancreatology 2022; 22:864-870. [PMID: 35864066 DOI: 10.1016/j.pan.2022.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS) is increasingly used for the clinical diagnosis of infectious diseases, but there is a paucity of data regarding the application of mNGS in the early diagnosis of infected pancreatic necrosis (IPN). OBJECTIVE To investigate the clinical application value of mNGS in the pathogenic diagnosis of IPN. METHODS Forty-two patients with suspected IPN were prospectively and consecutively enrolled from August 2019 to August 2021. Blood samples were collected for mNGS and microbial culture simultaneously during fever (T ≥ 38.5 °C). For patients who had indications of surgical interventions, peri-pancreatic specimens were collected for mNGS and microbial culture simultaneously during the first surgical intervention to confirm IPN. The clinical performance of mNGS and microbial culture were compared. RESULTS A total of 21 patients (50.0%) were confirmed to have IPN during hospitalization. The sensitivity of blood mNGS was significantly higher than blood culture (95.2% vs. 23.8%, P < 0.001) in diagnosing IPN. The negative predictive value of blood mNGS was 90.0%. The turnaround time of mNGS was significantly shorter than that of microbial culture [(37.70 ± 1.44) vs. (115.23 ± 8.79) h, P < 0.01] and the average costs of mNGS accounted for 1.7% of the average total cost of hospitalization. The survival analysis demonstrates that the positive blood mNGS result was not associated with increased mortality (P = 0.119). CONCLUSIONS With more valuable diagnostic performance and shorter turnaround time, clinical mNGS represents a potential step forward in the early diagnosis of IPN.
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Affiliation(s)
- Chiayen Lin
- Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
| | - Abdul Aziz F K Bonsu
- Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
| | - Jiarong Li
- Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
| | - Caihong Ning
- Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
| | - Lu Chen
- Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
| | - Shuai Zhu
- Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
| | - Qiaoqing Zhong
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
| | - Dingcheng Shen
- Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China.
| | - Gengwen Huang
- Department of Pancreatic Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China.
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14
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Blundell JD, Gandy RC, Close J, Harvey L. Cholecystectomy for people aged 50 years or more with mild gallstone pancreatitis: predictors and outcomes of index and interval procedures. Med J Aust 2022; 217:246-252. [PMID: 35452133 PMCID: PMC9545298 DOI: 10.5694/mja2.51492] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/25/2022] [Indexed: 12/13/2022]
Abstract
Objectives To estimate the proportions of people aged 50 years or more with mild gallstone pancreatitis who undergo index cholecystectomy (during their initial hospital admission) or interval cholecystectomy (during a subsequent admission); to compare outcomes following index and interval cholecystectomy; and to identify factors associated with undergoing interval cholecystectomy. Design, setting, participants Analysis of linked hospitalisation and deaths data for all people aged 50 years or more with mild gallstone pancreatitis who underwent cholecystectomy in New South Wales within twelve months of their index admission, 1 July 2008 ‒ 30 June 2018. Main outcome measures Cholecystectomy classification (index or interval). Secondary outcomes: all‐cause mortality (30‒365 days), emergency re‐admissions with gallstone‐related disease (within 28 or 180 days of discharge); hospital lengths of stay (index admission, and all admissions with gallstone‐related disease over six months). Results A total of 1836 patients underwent index cholecystectomy (37.9%) and 3003 interval cholecystectomy (62.1%). Mortality to twelve months was similar in the two groups. Larger proportions of people who underwent interval cholecystectomy were re‐admitted within 28 days (246, 8.2% v 23, 1.3%) or 180 days (527, 17.6% v 59, 3.2%), or required open cholecystectomy (238, 7.9% v 69, 3.8%). Mean index admission length of stay was longer for index than interval cholecystectomy (7.7 [SD, 4.7] days v 5.3 [SD, 3.9] days), but six‐month total length of stay was similar (8.2 [SD, 5.6] days v 7.9 [SD, 5.8] days). Interval cholecystectomy was more likely for patients with three or more comorbid conditions (adjusted odds ratio [aOR], 1.29; 95% CI, 1.08‒1.55) or private health insurance (aOR, 1.31; 95% CI, 1.13‒1.51), and for those admitted to low surgical volume hospitals (aOR, 1.84; 95% CI, 1.03‒3.31). Conclusions Most NSW people over 50 with mild gallstone pancreatitis did not undergo index cholecystectomy, despite recommendations in international guidelines. Delayed cholecystectomy was associated with more frequent open cholecystectomy procedures and gallstone disease‐related emergency re‐admissions, as well as with low or medium hospital surgical volume, comorbidity, and having private insurance.
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Affiliation(s)
- Jian D Blundell
- Prince of Wales Hospital and Community Health Services Sydney NSW
- Falls, Balance and Injury Research Centre Neuroscience Research Australia Sydney NSW
| | - Robert C Gandy
- Prince of Wales Hospital and Community Health Services Sydney NSW
- Prince of Wales Clinical School University of New South Wales Sydney NSW
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre Neuroscience Research Australia Sydney NSW
- Prince of Wales Clinical School University of New South Wales Sydney NSW
| | - Lara Harvey
- Falls, Balance and Injury Research Centre Neuroscience Research Australia Sydney NSW
- University of New South Wales Sydney NSW
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15
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Diagnosis and Treatment of Acute Pancreatitis. Diagnostics (Basel) 2022; 12:diagnostics12081974. [PMID: 36010324 PMCID: PMC9406704 DOI: 10.3390/diagnostics12081974] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
The pancreas is a glandular organ that is responsible for the proper functioning of the digestive and endocrine systems, and therefore, it affects the condition of the entire body. Consequently, it is important to effectively diagnose and treat diseases of this organ. According to clinicians, pancreatitis—a common disease affecting the pancreas—is one of the most complicated and demanding diseases of the abdomen. The classification of pancreatitis is based on clinical, morphologic, and histologic criteria. Medical doctors distinguish, inter alia, acute pancreatitis (AP), the most common causes of which are gallstone migration and alcohol abuse. Effective diagnostic methods and the correct assessment of the severity of acute pancreatitis determine the selection of an appropriate treatment strategy and the prediction of the clinical course of the disease, thus preventing life-threatening complications and organ dysfunction or failure. This review collects and organizes recommendations and guidelines for the management of patients suffering from acute pancreatitis.
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16
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Chelpuri Y, Pabbathi S, Alla GR, Yadala RK, Kamishetti M, Banothu AK, Boinepally R, Bharani KK, Khurana A. Tropolone derivative hinokitiol ameliorates cerulein-induced acute pancreatitis in mice. Int Immunopharmacol 2022; 109:108915. [PMID: 35679663 DOI: 10.1016/j.intimp.2022.108915] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/17/2022]
Abstract
Hinokitiol is a natural bio-active tropolone derivative with promising antioxidant and anti-inflammatory properties. This study was conducted to evaluate the ameliorative effects of hinokitiol against acute pancreatitis induced by cerulein. Mice were pre-treated with hinokitiol intraperitoneally for 7 days (50 and 100 mg/kg), and on the final day of study, cerulein (6 × 50 μg/kg) was injected every hour for six times. Six hours after the last dose of cerulein, blood was collected from the mice through retro-orbital plexus for biochemical analysis. After blood collection, mice were euthanized and the pancreas was harvested for studying effects on oxidative stress, pro-inflammatory cytokines, immunohistochemistry and histopathology of tissue sections. Hinokitiol treatment significantly reduced edema of the pancreas and reduced the plasma levels of lipase and amylase in mice with cerulein-induced acute pancreatitis. It also attenuated the oxidative and nitrosative stress related damage as evident from the reduced malondialdehyde (MDA) and nitrite levels, which were significantly increased in the mice with acute pancreatitis. Furthermore, hinokitiol administration significantly reduced the pancreatitis-evoked decrease in the activity of catalase, glutathione (GSH) and superoxide dismutase (SOD) in the pancreatic tissue. Pre-treatment with hinokitiol significantly reduced the elevated levels of pro-inflammatory cytokines like interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α) as well as increased the levels of anti-inflammatory cytokine interleukin-10 (IL-10) in the pancreatic tissue of mice with acute pancreatitis. The immunohistochemical expression of nuclear factor kappa light chain enhancer of activated B cells (NF-κB), cyclooxygenase (COX-2) and TNF-α were significantly decreased by hinokitiol in mice with cerulein-induced acute pancreatitis. In conclusion, the results of the present study demonstrate that hinokitiol has significant potential to prevent cerulein-induced acute pancreatitis.
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Affiliation(s)
- Yamini Chelpuri
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science (CVSc), Rajendranagar, Hyderabad 500030, PVNRTVU, Telangana, India
| | - Shivakumar Pabbathi
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science (CVSc), Rajendranagar, Hyderabad 500030, PVNRTVU, Telangana, India
| | - Gopala Reddy Alla
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science (CVSc), Rajendranagar, Hyderabad 500030, PVNRTVU, Telangana, India
| | - Ravi Kumar Yadala
- Department of Veterinary Pathology, College of Veterinary Science (CVSc), Rajendranagar, Hyderabad 500030, PVNRTVU, Telangana, India
| | - Mounika Kamishetti
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science (CVSc), Rajendranagar, Hyderabad 500030, PVNRTVU, Telangana, India
| | - Anil Kumar Banothu
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science (CVSc), Rajendranagar, Hyderabad 500030, PVNRTVU, Telangana, India.
| | - Ramya Boinepally
- Department of Veterinary Pathology, Veterinary Clinical Complex, College of Veterinary Science (CVSc), Warangal 506166, PVNRTVU, Telangana, India
| | - Kala Kumar Bharani
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science (CVSc), Warangal 506166, PVNRTVU, Telangana, India
| | - Amit Khurana
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science (CVSc), Rajendranagar, Hyderabad 500030, PVNRTVU, Telangana, India; Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science (CVSc), Warangal 506166, PVNRTVU, Telangana, India; Centre for Biomedical Engineering (CBME), Indian Institute of Technology (IIT) Delhi, Hauz Khas, New Delhi 110016, India.
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17
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Etheridge JC, Cooke RM, Castillo-Angeles M, Jarman MP, Havens JM. Disparities in uptake of cholecystectomy for idiopathic pancreatitis: A nationwide retrospective cohort study. Surgery 2022; 172:612-616. [PMID: 35568585 DOI: 10.1016/j.surg.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The majority of cases of idiopathic acute pancreatitis (IAP) are thought to result from occult biliary disease. A growing body of evidence suggests that cholecystectomy for IAP reduces the risk of recurrence by up to two thirds. This study examined nationwide uptake and disparities in adoption of cholecystectomy for IAP. METHODS The National Inpatient Sample was queried to identify admissions for IAP between October 2015 and December 2018. Patients who underwent cholecystectomy before discharge and those that did not were compared using Wald χ2 tests for categorical variables and Student's t test for continuous variables. Patient- and hospital-level predictors of cholecystectomy were identified using weighted multivariable logistic regression. RESULTS Of 62,305 estimated admissions for IAP, only 665 (1.1%) underwent cholecystectomy before discharge. Female sex, initiation of total parenteral nutrition (TPN), insurance status, and hospital type were associated with cholecystectomy on univariable analysis. On multivariable analysis, Hispanic patients (odds ration [OR] 1.60, 95% confidence interval [CI] 1.01-2.56), patients on TPN (OR 2.70, 95% CI 1.17-6.24), and those with private insurance (OR 2.18, 95% CI 1.48-3.21 versus Medicare/Medicaid) were more likely to receive operations. Small hospitals and hospitals in rural areas were least likely to perform empiric cholecystectomies. CONCLUSION Despite increasing evidence supporting cholecystectomy after IAP, the practice remains rare in the United States. Educational efforts and active implementation efforts are needed to promote adoption. Particular attention should be focused on small, rural centers and those that disproportionately care for uninsured patients and patients with public insurance.
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Affiliation(s)
- James C Etheridge
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Ryan M Cooke
- Department of Biological Sciences, University of Alabama, Tuscaloosa, AL
| | - Manuel Castillo-Angeles
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Joaquim M Havens
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
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18
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Lu B, Yin J, Wang J, Cai Y, Xu X. Management of pancreatic walled-off necrosis using an ultrasonic pneumatic lithotripsy system and double-catheter aspirated lavage performed through drainage tract: a case report. J Int Med Res 2022; 50:3000605221090098. [PMID: 35352586 PMCID: PMC8973053 DOI: 10.1177/03000605221090098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with pancreatic walled-off necrosis (WON) treated by minimally invasive approaches often require repeated necrosectomy instead of conventional open necrosectomy. A 55-year-old woman with lateral infected pancreatic WON was successfully treated by an infrequently used technique involving an ultrasonic pneumatic lithotripsy system (UPLS) and double-catheter aspirated lavage through a percutaneous drainage tract. No perioperative complications occurred. The mean operating time of the repeated procedures was 35 minutes (range, 25–48 minutes). The total hospitalization stay was 46 days, and no recurrence of the fluid collection was observed during the 15-month follow-up period. UPLS-assisted necrosectomy and double-catheter aspirated lavage is an alternative technique for lateral WON that fails to improve by percutaneous drainage. It efficiently combines disintegration and aspiration procedures and can be safely repeated under total intravenous anesthesia through sinus tracts.
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Affiliation(s)
- Bei Lu
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China
| | - Junjie Yin
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China
| | - Jingrui Wang
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China
| | - Yang Cai
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China
| | - Xiao Xu
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China
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19
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Park SY, Kim MJ, Park I, Kim HY, Lee M, Park YS, Chung SP. Predisposing Factors and Neurologic Outcomes of Patients with Elevated Serum Amylase and/or Lipase after Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11051426. [PMID: 35268517 PMCID: PMC8910840 DOI: 10.3390/jcm11051426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/19/2022] Open
Abstract
This study investigated the patient outcomes, incidence, and predisposing factors of elevated pancreatic enzyme levels after OHCA. We conducted a retrospective cohort study of patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Elevation of pancreatic enzyme levels was defined as serum amylase or lipase levels that were at least three times the upper limit of normal. The factors associated with elevated pancreatic enzyme levels and their association with neurologic outcomes and mortality 28 days after OHCA were analyzed. Among the 355 patients, 166 (46.8%) patients developed elevated pancreatic enzyme levels. In the multivariable analysis (odds ratio, 95% confidence interval), initial shockable rhythm (0.62, 0.39−0.98, p = 0.04), time from collapse to return of spontaneous circulation (1.02, 1.01−1.04, p < 0.001), and history of coronary artery disease (1.7, 1.01−2.87, p = 0.046) were associated with elevated pancreatic enzyme levels. After adjusting for confounding factors, elevated pancreatic enzyme levels were associated with neurologic outcomes (5.44, 3.35−8.83, p < 0.001) and mortality (3.74, 2.39−5.86, p < 0.001). Increased pancreatic enzyme levels are common in patients treated with TTM after OHCA and are associated with unfavorable neurologic outcomes and mortality at 28 days after OHCA.
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Affiliation(s)
- Shin Young Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.Y.K.); (M.L.)
| | - Myeongjee Lee
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.Y.K.); (M.L.)
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
- Correspondence: ; Tel.: +82-2-2228-2460; Fax: +82-2-2227-7908
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (S.Y.P.); (M.J.K.); (I.P.); (S.P.C.)
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20
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Rios-Diaz AJ, Lamm R, Metcalfe D, Devin CL, Pucci MJ, Palazzo F. National recurrence of pancreatitis and readmissions after biliary pancreatitis. Surg Endosc 2022; 36:7399-7408. [PMID: 35233658 DOI: 10.1007/s00464-022-09153-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND National and international guidelines support early cholecystectomy after mild gallstone pancreatitis but a recent nationwide study suggested these recommendations are not universally followed. Our study sought to quantify the national utilization of same hospitalization cholecystectomy versus non-operative management (NOM) and its association with pancreatitis recurrence, readmissions, and costs after mild gallstone pancreatitis (GP). METHODS Adult patients admitted with mild GP were identified from the Nationwide Readmission Database 2010-2015. Primary outcomes included the rate of cholecystectomy during the index admission as well as pancreatitis recurrence and readmission at 30 and 180 days (30d, 180d) comparing NOM to same hospitalization cholecystectomy. Mortality upon readmission, total length of stay (LOS), and total costs (combined index-readmission hospital costs) were also explored. Cox proportional hazards regression and generalized linear models controlled for patient/hospital confounders. RESULTS Among the 65,067 patients identified, 30% underwent cholecystectomy. The NOM cohort was older (58 vs. 50 years), had more comorbidities (Charlson index > 2, 23.5% vs. 11.5%), fewer female patients (56.7% vs. 67%) and less discharge-to-home (84.9% vs. 94.4%) (all p < 0.001). NOM was associated with increase in recurrence and unplanned readmissions at 30d [Hazard Ratio 3.53 (95% CI 2.92-4.27), 2.41 (2.11-2.74), respectively], and 180d [4.27 (3.65-4.98), 2.78 (2.54-3.04), respectively], as well as increased mortality during 180d readmission 1.88 (1.06-3.35). This approach was also associated with significant increase in LOS [predicted mean difference 2.79 days (95% CI 2.46-3.12)] and total costs [$2507.89 ($1714.4-$3301.4)]. CONCLUSIONS In the USA, most patients presenting with mild GP do not undergo same hospitalization cholecystectomy. This strategy results in higher recurrent pancreatitis, mortality during readmission, and an additional $4.85 M/year in hospital costs nationwide. These data support same hospitalization cholecystectomy as the gold standard for mild GP.
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Affiliation(s)
- Arturo J Rios-Diaz
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Ryan Lamm
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| | - David Metcalfe
- Rheumatology and Musculoskeletal Sciences (NDORMS), Nuffield Department of Orthopedics, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Courtney L Devin
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| | - Michael J Pucci
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, 1015 Walnut Street, Philadelphia, PA, 19107, USA
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Ruiz Rebollo ML. Recurrent acute biliary pancreatitis - A frequent and preventable condition potentially associated with morbidity and mortality. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:67-69. [PMID: 35073721 DOI: 10.17235/reed.2022.8563/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recurrent acute biliary pancreatitis (RABP) is a common condition associated with an increase in hospital admissions, morbidity, mortality, and healthcare costs. This editorial will attempt to discuss the issue's current status as well as actions for its prevention.
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22
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Hydrogen peroxide assisted endoscopic necrosectomy for walled-off pancreatic necrosis: A systematic review and meta-analysis. Pancreatology 2021; 21:1540-1547. [PMID: 34565668 DOI: 10.1016/j.pan.2021.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/04/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic necrosectomy (EN) is the preferred approach for management of symptomatic or infected walled-off pancreatic necrosis (WOPN). Hydrogen peroxide (H2O2) has been reported to be a good adjunctive therapy for EN. We performed a systematic review and meta-analysis to evaluate effectiveness and safety of H2O2 assisted EN for WOPN. METHODS A comprehensive search of multiple databases (through December 2020) was performed to identify studies that reported outcomes of H2O2 assisted EN for WOPN. Outcomes assessed included clinical success, technical success, and adverse events. RESULTS A total of 454 patients with mean age (47.3 ± 7.9 years) and WOPN size (12.4 ± 3.1 cm) were included from 15 studies. The median H2O2 concentration was 3% (range 0.1-3%), with dilution and volume ranging from 1:1 to 10:1 and 20 ml to 1 L, respectively. The rates of technical success, clinical success and adverse events was 97.3% (95% confidence interval [CI]: 94.8-98.6, I2 = 0), 89.8% (95% CI: 86.3-92.5, I2 = 0) and 17.9% (95% CI: 12.6-24.7, I2 = 38), respectively. The most common adverse event was bleeding (7.1%) followed by stent migration (5.3%). On meta-regression, WOPN size, patient age, use of metal stent, number of necrosectomies and transgastric access were not significant predictor for technical success, clinical success or adverse events. CONCLUSION H2O2 assisted EN is effective and safe for management of WOPN. Its use may be encouraged, and future randomized controlled studies are needed to study the optimal technique, concentration and best predictors of success.
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Fratantoni ME, Giuffrida P, Di Menno J, Ardiles V, de Santibañes M, Clariá RS, Palavecino M, de Santibañes E, Pekolj J, Mazza O. Prevalence of Persistent Common Bile Duct Stones in Acute Biliary Pancreatitis Remains Stable Within the First Week of Symptoms. J Gastrointest Surg 2021; 25:3178-3187. [PMID: 34159556 DOI: 10.1007/s11605-021-05068-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute biliary pancreatitis (ABP) is often associated with persistent common bile duct (CBD) stones. The best strategy in terms of timing of surgery is still controversial. The aim of the current study is to describe the prevalence of persistent common bile duct (CBD) stones in ABP during the first week of symptoms at a high-volume referral center. STUDY DESIGN Single-institution retrospective analysis of a prospectively collected database. Patients with diagnosis of ABP who underwent laparoscopic cholecystectomy (LC) between January 2009 and December 2019 were extracted. RESULTS Two hundred thirty-one patients were included. Cholecystectomy was performed laparoscopically in 230 (99.57%) patients. Intraoperative cholangiogram was performed in all patients. Two hundred nine (90%) patients had surgery within the first 7 days. Global prevalence of persistent CBD stones during IOC was 19.91% (95% CI 14.96-25.65). No significant association between timing to surgery and presence of CBD stones was found for the first week since the initial attack (p=0.28). Prevalence of CBD stones was significantly higher after day 7 (p=0.007 and 0.005). Positive findings in preoperative MRCP are significantly related to intraoperative CBD stones (p=0.0001). Mild postoperative complications (CD I/II) were present in 21 patients (9.09%). No difference was found in morbidity between CBD stones group and non-CBD stones group (p=0.48). We observed no severe complications nor mortality. CONCLUSIONS In patients with mild acute biliary pancreatitis, the prevalence of persistent CBD stones does not change within the first 7 days since the onset of symptoms. This fact may have major clinical relevance when deciding the optimal therapeutic strategy in this population.
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Affiliation(s)
- Maria Eugenia Fratantoni
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - Pablo Giuffrida
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Juliana Di Menno
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Victoria Ardiles
- HPB Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Martín de Santibañes
- HPB Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Rodrigo Sanchez Clariá
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Martin Palavecino
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- HPB Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Juan Pekolj
- HPB Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Oscar Mazza
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
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Oxid Comparative Analysis of the Significance of Bisap and Mews Score for an Early Assessment of Illness Severity and Treatment Outcome of Acute Pancreatitis. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2019-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study was to determine the significance of the use of the BISAP score, which is specific for patients with AP, in relation to the application of the MEWS score that is important for assessing the condition of critically ill patients in intensive care units, but is not specific for patients with AP. The research was conducted as a cohort prospective study and included patients of both sexes, older than 18 and diagnosed with AP. BISAP and MEWS score were monitored at least at four time points: on admission to the hospital (zero), 48 hours, 72 hours and 7 days after admission to the hospital.
High levels of discrimination between patients with fatal outcome and cured patients are determined in both cases, with discrimination at MEWS being somewhat higher than BISAP score. The BISAP0 had the best discrimination for BISAP score, AUROC (0.807) and also MEWS0 for MEWS score, AUROC (0.899). In our research, the highest sensitivity was shown by BISAP7d (92.1%) and MEWS48 (88.1%), and a high specificity of 87.5% had BISAP score, 48h, 72h and MEWS score at all four points of measurement.
BISAP score has a better prognostic value in relation to the form of pancreatitis, the development of complications and the outcome. However, the calculation of the MEWS score is based on monitoring the basic vital parameters so that its application is much simpler and does not require additional costs.
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25
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Acharya A, Mohan N, Ardhanari R. Surgical Considerations in Acute Pancreatitis. Indian J Surg 2021. [DOI: 10.1007/s12262-019-02062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Direct Endoscopic Necrosectomy With and Without Hydrogen Peroxide for Walled-off Pancreatic Necrosis: A Multicenter Comparative Study. Am J Gastroenterol 2021; 116:700-709. [PMID: 33982939 DOI: 10.14309/ajg.0000000000000987] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Endoscopic necrosectomy has emerged as the preferred treatment modality for walled-off pancreatic necrosis. This study was designed to evaluate the safety and efficacy of direct endoscopic necrosectomy with and without hydrogen peroxide (H2O2) lavage. METHODS Retrospective chart reviews were performed for all patients undergoing endoscopic transmural management of walled-off pancreatic necrosis at 9 major medical centers from November 2011 to August 2018. Clinical success was defined as the resolution of the collection by imaging within 6 months, without requiring non-endoscopic procedures or surgery. RESULTS Of 293 patients, 204 met the inclusion criteria. Technical and clinical success rates were 100% (204/204) and 81% (166/189), respectively. For patients, 122 (59.8%) patients had at least one H2O2 necrosectomy (H2O2 group) and 82 (40.2%) patients had standard endoscopic necrosectomy. Clinical success was higher in the H2O2 group: 106/113 (93.8%) vs 60/76 (78.9%), P = 0.002. On a multivariate analysis, the use of H2O2 was associated with higher clinical success rate (odds ratio 3.30, P = 0.033) and earlier resolution (odds ratio 2.27, P < 0.001). During a mean follow-up of 274 days, 27 complications occurred. Comparing procedures performed with and without H2O2 (n = 250 vs 183), there was no difference in post-procedure bleeding (7 vs 9, P = 0.25), perforation (2 vs 3, P = 0.66), infection (1 vs 2, P = 0.58), or overall complication rate (n = 13 [5.2%] vs 14 [7.7%], P = 0.30). DISCUSSION H2O2-assisted endoscopic necrosectomy had a higher clinical success rate and a shorter time to resolution with equivalent complication rates relative to standard necrosectomy.See the visual abstract at http://links.lww.com/AJG/B714.(Equation is included in full-text article.).
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Junare PR, Debnath P, Nair S, Chandnani S, Udgirkar S, Thange R, Jain S, Deshmukh R, Debnath P, Rathi P, Contractor Q, Deshpande A. Complete hemogram: simple and cost-effective in staging and predicting outcome in acute pancreatitis. Wien Klin Wochenschr 2021; 133:661-668. [PMID: 33620577 DOI: 10.1007/s00508-021-01821-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND An important goal in management of acute pancreatitis (AP) is early prediction and recognition of disease severity. Various predictive scoring systems are in clinical use with their own limitations and there is always a quest for simple, practical, quantifiable, dynamic and readily available markers for predicting disease severity and outcome. Complete hemogram is routinely ordered in all patients with AP. In recent years red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and platelet lymphocyte ratio (PLR) have been found to be independent predictors of prognosis in various benign and malignant conditions. This prospective study evaluated complete hemogram based markers in AP. MATERIAL AND METHODS Complete hemogram analysis was done and NLR, LMR, PLR values were calculated. Development of organ failure, the need for intensive care unit (ICU) admission and interventions, development of complications (local/systemic) and 100-day mortality were assessed. RESULTS In this study 160 subjects of AP were included. Complete hemogram analysis was performed within 24 h after admission. C‑reactive protein, RDW, NLR, PLR and bedside index of severity in acute pancreatitis (BISAP) values were higher in severe AP than moderate AP group than mild AP group, while LMR values were decreased in the corresponding severe, moderate and mild AP groups (p < 0.001). The NLR performed best for prediction of ICU admission, organ failure, interventions and mortality with area under receiver operating curve (AUROC) were 0.943, 0.940, 0.902 and 0.910, respectively. CONCLUSION Hemogram based markers are simple, objective, dynamic and readily available. They can be considered in addition to conventional multifactorial scoring systems for prediction of outcome and prognosis of AP.
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Affiliation(s)
- Parmeshwar Ramesh Junare
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India.
| | - Prasanta Debnath
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Sujit Nair
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Suhas Udgirkar
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Ravi Thange
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Rahul Deshmukh
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Partha Debnath
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Qais Contractor
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Akshay Deshpande
- Department of Surgery, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
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Evaluation of socioeconomic and healthcare disparities on same admission cholecystectomy after endoscopic retrograde cholangiopancreatography among patients with acute gallstone pancreatitis. Surg Endosc 2021; 36:274-281. [PMID: 33481109 DOI: 10.1007/s00464-020-08272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite literature and guidelines recommending same admission cholecystectomy (CCY) after endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute gallstone pancreatitis, clinical practice remains variable. The aim of this study was to investigate the role of clinical and socio-demographic factors in the management of acute gallstone pancreatitis. METHODS Patients with acute gallstone pancreatitis who underwent ERCP during hospitalization were reviewed from the U.S. Nationwide Inpatient Sample database between 2008 and 2014. Patients were classified by treatment strategy: ERCP + same admission CCY (ERCP + CCY) versus ERCP alone. Measured variables including age, race/ethnicity, Charlson Comorbidity Index (CCI), hospital type/region, insurance payer, household income, length of hospital stay (LOS), hospitalization cost, and in-hospital mortality were compared between cohorts using χ2 and ANOVA. Multivariable logistic regression was performed to identify specific predictors of same admission CCY. RESULTS A total of 205,012 patients (ERCP + CCY: n = 118,318 versus ERCP alone: n = 86,694) were analyzed. A majority (53.4%) of patients that did not receive same admission CCY were at urban-teaching hospitals. LOS was longer with higher associated costs for patients with same admission CCY [(6.8 ± 5.6 versus 6.4 ± 6.5 days; P < 0.001) and ($69,135 ± 65,913 versus $52,739 ± 66,681; P < 0.001)]. Mortality was decreased significantly for patients who underwent ERCP + CCY versus ERCP alone (0.4% vs 1.1%; P < 0.001). Multivariable regression demonstrated female gender, Black race, higher CCI, Medicare payer status, urban-teaching hospital location, and household income decreased the odds of undergoing same admission CCY + ERCP (all P < 0.001). CONCLUSION Based upon this analysis, multiple socioeconomic and healthcare-related disparities influenced the surgical management of acute gallstone pancreatitis. Further studies to investigate these disparities are indicated.
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Easler JJ. The role of endoscopic therapy in the minimally invasive management of pancreatic necrosis. Korean J Intern Med 2021; 36:32-44. [PMID: 33472284 PMCID: PMC7820657 DOI: 10.3904/kjim.2020.542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
Pancreatic necrosis is among the most frequently encountered local complications of acute pancreatitis and associates with severe disease. Infected pancreatic necrosis further enhances the risk for morbidity and mortality. Pancreatic fluid collections that result from pancreatic necrosis evolve from acute necrotic collections to walled off necrosis and are defined by their distinct characteristics on cross sectional imaging. A variety of interventions spanning multiple disciplines are available for the drainage and debridement of pancreatic necrosis. Prospective, randomized trials have identified management strategies that incorporate minimally invasive interventions as having the best outcomes for patients with symptomatic pancreatic necrosis. The scientific literature has confidently positioned endoscopic drainage and necrosectomy among the most effective interventions for patients with symptomatic walled off necrosis. Innovations such as the use of metallic stents, chemical debridement and multiple modalities for drainage of pancreatic necrosis show promise in improving outcomes for patients managed with endoscopic interventions.
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Affiliation(s)
- Jeffrey James Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
- Correspondence to Jeffrey James Easler, M.D. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 N. University Blvd, Suite 1634, Indianapolis, IN 46202, USA Tel: +1-3179484978 Fax: +1-3179681265 E-mail:
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Abstract
Despite the increased global recognition of pediatric pancreatic diseases, there are limited data on the utility of sophisticated endoscopic procedures such as endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in their management. Promising results of recent studies have highlighted the emerging therapeutic utility of EUS and ERCP in children. With these latest developments in mind, this article reviews the current literature regarding diagnostic and therapeutic uses, benefits, limitations, and clinical outcomes of EUS and ERCP in pediatric pancreatology.
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Liao WC, Tu TC, Lee KC, Tseng JH, Chen MJ, Sun CK, Wang SY, Chang WK, Chang PY, Wu MS, Lin TJ, Lee HL, Chen JH, Yuan KC, Liu NJ, Wu HC, Liang PC, Wang HP, Hwang TL, Lee CL. Taiwanese consensus recommendations for acute pancreatitis. J Formos Med Assoc 2020; 119:1343-1352. [PMID: 31395463 DOI: 10.1016/j.jfma.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/11/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022] Open
Abstract
The incidence of acute pancreatitis and related health care utilization are increasing. Acute pancreatitis may result in organ failure and various local complications with risks of morbidity and even mortality. Recent advances in research have provided novel insights into the assessment and management for acute pancreatitis. This consensus is developed by Taiwan Pancreas Society to provide an updated, evidence-based framework for managing acute pancreatitis.
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Affiliation(s)
- Wei-Chih Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tien-Chien Tu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Kuei-Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jseng-Hwei Tseng
- Department of Imaging & Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheuk-Kay Sun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shang-Yu Wang
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, Taiwan
| | - Pi-Yi Chang
- Department of Radiology, Taichung Veterans General Hospital, Taiwan
| | - Ming-Shun Wu
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Jung Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
| | - Hsiang-Lin Lee
- Department of Surgery, Chung Shan Medical University Hospital, Institute of Medicine4, Chung Shan Medical University, Taichung, Taiwan
| | - Jiann-Hwa Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Taipei, Taiwan
| | - Kuo-Ching Yuan
- Division of Acute Care Surgery and Trauma, Department of Surgery, Taipei Medical University Hospital, Taiwan
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsing-Chien Wu
- Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsann-Long Hwang
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Lin-Kou, Taiwan
| | - Chia-Long Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan.
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Fusco R, Cordaro M, Siracusa R, D’Amico R, Genovese T, Gugliandolo E, Peritore AF, Crupi R, Impellizzeri D, Cuzzocrea S, Di Paola R. Biochemical Evaluation of the Antioxidant Effects of Hydroxytyrosol on Pancreatitis-Associated Gut Injury. Antioxidants (Basel) 2020; 9:antiox9090781. [PMID: 32842687 PMCID: PMC7555523 DOI: 10.3390/antiox9090781] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis is a severe abdominal pathology often associated with several complications including gut dysfunction. Oxidative stress is one of the most important pathways involved in this pathology. Hydroxytyrosol (HT), a phenolic compound obtained from olive oil, has shown anti-inflammatory and antioxidant properties. We evaluated the effects of HT administration on pancreatic and intestinal injury induced by caerulein administration. CD1 female mice were administered caerulein (50 μg/kg) for 10 h. HT treatment (5 mg/kg) was performed 30 min after the first caerulein injection and for two consecutive hours afterwards. One hour after the last caerulein injection, mice were sacrificed and serum, colon and pancreatic tissue samples were collected. HT was able to reduce the serum hallmarks of pancreatitis (amylase and lipase), histological damage score in both pancreas and colon tissue, inflammatory cells recruitment (mast cells) in both injured tissues, intrapancreatic trypsin activity and overexpression of the adhesion molecules (Intercellular Adhesion Molecule-1 (ICAM-1) and P-selectin) in colon. Additionally, HT reduced cytokine (interleukin 1 beta (IL- 1β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α)) levels in serum, pancreas and colon tissue and chemokine release (monocyte chemotactic protein-1 (MCP1/CCL2)) in pancreas and colon tissue. HT decreased lipid peroxidation and oxidative stress (superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR) and glutathione S-transferase (GST) activity) by enhancing the nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase 1 (HO-1) in both injured tissues. Moreover, HT preserved intestinal barrier integrity, as shown by the diamine oxidase (DAO) serum levels and tight junction (zonula occludens (ZO) and occludin) expression in pancreas and colon. Our findings demonstrated that HT would be an important therapeutic tool against pancreatitis-induced injuries in the pancreas and gut.
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Affiliation(s)
- Roberta Fusco
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.F.); (R.S.); (R.A.); (T.G.); (E.G.); (A.F.P.); (R.D.P.)
| | - Marika Cordaro
- Department of Biomedical, Dental and Morphological and Functional Imaging University of Messina, Via Consolare Valeria, 98125 Messina, Italy;
| | - Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.F.); (R.S.); (R.A.); (T.G.); (E.G.); (A.F.P.); (R.D.P.)
| | - Ramona D’Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.F.); (R.S.); (R.A.); (T.G.); (E.G.); (A.F.P.); (R.D.P.)
| | - Tiziana Genovese
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.F.); (R.S.); (R.A.); (T.G.); (E.G.); (A.F.P.); (R.D.P.)
| | - Enrico Gugliandolo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.F.); (R.S.); (R.A.); (T.G.); (E.G.); (A.F.P.); (R.D.P.)
| | - Alessio Filippo Peritore
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.F.); (R.S.); (R.A.); (T.G.); (E.G.); (A.F.P.); (R.D.P.)
| | - Rosalia Crupi
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy;
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.F.); (R.S.); (R.A.); (T.G.); (E.G.); (A.F.P.); (R.D.P.)
- Correspondence: (D.I.); (S.C.); Tel.: +39-090-676-5208 (D.I. & S.C.)
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.F.); (R.S.); (R.A.); (T.G.); (E.G.); (A.F.P.); (R.D.P.)
- Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, Saint Louis, MO 63104, USA
- Correspondence: (D.I.); (S.C.); Tel.: +39-090-676-5208 (D.I. & S.C.)
| | - Rosanna Di Paola
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (R.F.); (R.S.); (R.A.); (T.G.); (E.G.); (A.F.P.); (R.D.P.)
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Jiang X, Shi JY, Wang XY, Hu Y, Cui YF. The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study. Mil Med Res 2020; 7:38. [PMID: 32799919 PMCID: PMC7429726 DOI: 10.1186/s40779-020-00265-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis (AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis (NP). METHODS We conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n = 148), pancreatic infection group(n = 65), extrapancreatic infection group(n = 22) and combined infection group(n = 50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed. RESULTS In terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91 ± 4.65, 9.46 ± 5.05, respectively) and organ failure rate (40.9 and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group (P < 0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased (P < 0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays (68.28 ± 51.80 vs 55.58 ± 36.24, P < 0.05) and higher mortality (24.0% vs 9.2%, P < 0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization (59.1%) and mortality rates (18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant (MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection (24.7% vs 3.6%, P = 0.001). CONCLUSION Clinicians should be aware that extrapancreatic infection (EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.
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Affiliation(s)
- Xun Jiang
- Tianjin Medical University, Tianjin, 300041 China
| | - Ji-Yu Shi
- Tianjin Medical University, Tianjin, 300041 China
| | - Xia-Yu Wang
- Tianjin Medical University, Tianjin, 300041 China
| | - Yong Hu
- Tianjin Medical University, Tianjin, 300041 China
| | - Yun-Feng Cui
- Tianjin Medical University, Tianjin, 300041 China
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, 122 Sanwei Road, Nankai district, Tianjin, 300110 China
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Dai W, Zhao Y, Du GL, Zhang RP. Comparison of early and delayed cholecystectomy for biliary pancreatitis: A meta-analysis. Surgeon 2020; 19:257-262. [PMID: 32768360 DOI: 10.1016/j.surge.2020.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Biliary stones are the most common etiology of acute pancreatitis Cholecystectomy has been accepted as a popular treatment for acute biliary pancreatitis (ABP) to reduce the risk of recurrent complications. However, the precise time of intervention still remains controversial. OBJECTIVE The aim of this meta-analysis was to compare early and delayed cholecystectomy and determine the most precise timing of cholecystectomy following gallstone pancreatitis. METHOD Search the publications on comparison the efficacy of early cholecystectomy comparison with delayed cholecystectomy in treatment outcomes of ABP to October, 2018. After rigorous reviewing on quality, the data was extracted from eligible trials. All trials analyzed the summary hazard ratios (HRs) of the endpoints of interest, including survival data and individual postoperative complications. RESULTS A total of 9 trials were met our inclusion criteria. The pooled results indicate that postoperative complications、readmission rate、conversion to an open procedure and cholecystectomy-related morbidity/mortality did not have statistical significance (P > 0.05) between the early and delayed cholecystectomy. While, the length of hospital stay was shorter for the early cholecystectomy group than the delayed group in all included studies. CONCLUSIONS Although the efficacy of delayed intervention in terms of inflammation reduction is definite, their adverse events are often major limitations. In the present study, an early cholecystectomy may result in a significantly shortened hospital stays without increased complications or mortality.
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Affiliation(s)
- Wei Dai
- Department of Emergency Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yan Zhao
- Department of Nephrology, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Gong-Liang Du
- Department of Emergency Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Rui-Peng Zhang
- Department of Vascular Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
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The Role of Laparoscopic Cholecystectomy After Severe and/or Necrotic Pancreatitis in the Setting of Modern Minimally Invasive Management of Pancreatic Necrosis. Pancreas 2020; 49:935-940. [PMID: 32658078 DOI: 10.1097/mpa.0000000000001601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The trend toward minimally invasive procedures (MIP) in necrotizing pancreatitis is increasing. The optimal timing and technique of cholecystectomy in severe/necrotizing pancreatitis is unclear. This study aims to determine the role of laparoscopic cholecystectomy after severe/necrotizing pancreatitis in the context of MIP. METHODS Retrospective analysis of a prospective database was performed for consecutive patients after cholecystectomy for gallstone pancreatitis between January 2011 and January 2018 at Monash Health, Melbourne, Australia. RESULTS Three hundred fifty-five patients with gallstone pancreatitis underwent laparoscopic cholecystectomy with 2 conversions. Patients with severe pancreatitis were older (P = 0.002), with a more even sex distribution when compared with mild pancreatitis. Females predominated in the mild pancreatitis group.Patients with moderate/severe pancreatitis (P = 0.002) and necrosis (P > 0.001) were more likely to have delayed cholecystectomy compared with mild pancreatitis. There was no increase in biliary presentations while awaiting cholecystectomy. Length of stay for patients with severe/necrotizing pancreatitis (P = 0.001) was increased, surgical complications appeared similar. CONCLUSIONS Laparoscopic cholecystectomy can be performed safely and effectively for pancreatitis, irrespective of severity. The paradigm shift in the management of severe necrotizing pancreatitis away from open necrosectomy toward MIP can be extended to encompass laparoscopic cholecystectomy.
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Niu DG, Li WQ, Huang Q, Yang F, Tian WL, Li C, Ding LA, Fang HC, Zhao YZ. Open necrosectomy combined with continuous positive drainage and prophylactic diverting loop ileostomy for late infected pancreatic necrosis: a retrospective cohort study. BMC Gastroenterol 2020; 20:212. [PMID: 32640995 PMCID: PMC7341608 DOI: 10.1186/s12876-020-01343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate an innovative open necrosectomy strategy with continuous positive drainage and prophylactic diverting loop ileostomy for the management of late infected pancreatic necrosis (LIPN). Methods Consecutive patients were divided into open necrosectomy (ON) group (n = 23), open necrosectomy with colonic segment resection (ON+CSR) group (n = 8) and open necrosectomy with prophylactic diverting loop ileostomy (ON+PDLI) group (n = 11). Continuous positive drainage (CPD) via double-lumen irrigation–suction tube (DLIST) was performed in ON+PDLI group. The primary endpoints were duration of organ failure after surgery, postoperative complication, the rate of re-surgery and mortality. The secondary endpoints were duration of hospitalization, cost, time interval between open surgery and total enteral nutrition (TEN). Results The recovery time of organ function in ON+PDLI group was shorter than that in other two groups. Colonic complications occurred in 13 patients (56.5%) in the ON group and 3 patients (27.3%) in the ON+PDLI group (p = 0.11). The length of stay in the ON+PDLI group was shorter than the ON group (p = 0.001). The hospitalization cost in the ON+PDLI group was less than the ON group (p = 0.0052). Conclusion ON+PDLI can avoid the intestinal dysfunction, re-ileostomy, the resection of innocent colon and reduce the intraoperative trauma. Despite being of colonic complications before or during operation, CPD + PDLI may show superior effectiveness, safety, and convenience in LIPN.
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Affiliation(s)
- Dong-Guang Niu
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Wei-Qin Li
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Qian Huang
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Fan Yang
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Wei-Liang Tian
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Chen Li
- Oncology Department, Xintai people's Hospital, Tai'an, 271200, Shandong, China
| | - Lian-An Ding
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Hong-Chun Fang
- Gastrointestinal Surgery Department, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Yun-Zhao Zhao
- Department of General Surgery, Jinling clinical college of Nanjing Medical University, Nanjing, 210002, Jiangsu, China. .,Department of General Surgery, Jinling clinical college of Nanjing Medical University, 305 East Zhongshan Road, Nanjing, 210000, Jiangsu, China.
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Radulova-Mauersberger O, Belyaev O, Birgin E, Bösch F, Brunner M, Müller-Debus CF, Wellner UF, Grützmann R, Keck T, Werner J, Uhl W, Witzigmann H. [Indications for Surgical and Interventional Therapy of Acute Pancreatitis]. Zentralbl Chir 2020; 145:374-382. [PMID: 32557429 DOI: 10.1055/a-1164-7099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND 15 to 20% of patients with acute pancreatitis develop necrosis of the pancreatic parenchyma or extrapancreatic tissue. The disease is associated with a mortality rate of up to 20%. The mainstays of treatment consist of intensive medical care and surgical and interventional therapy. METHODS A systematic literature search focused on indications for surgical and interventional therapy of necrotising pancreatitis. 85 articles were analysed for this review. By using the Delphi method, the results were presented to the quality committee for pancreas diseases of the German Society for General and Visceral Surgery and to expert pancreatologists in an interactive conference using plenary voting during the visceral medicine congress 2019 in Wiesbaden. For the finalised recommendations, an agreement of 84% of participants was achieved. RESULTS Documented or clinical suspicion of infected, necrotising pancreatitis are indications for surgical and interventional therapy (recommendation grade: strong; evidence grade; low). Sterile necrosis is a less common indication for intervention due to late complications or persistent severe pancreatitis. Invasive interventions should be delayed when possible until four weeks after onset of pancreatitis. Optimal treatment strategy consists of a "step-up approach" (evidence grade: high; recommendation grade: strong). The first step is catheter drainage, followed, if necessary, by minimally invasive surgical or interventional necrosectomy. If minimally invasive techniques do not result in clinical improvement, open necrosectomy is necessary. 35 to 50% of patients are successfully treated with drainage alone. Indications for emergency intervention are bowel perforation, bowel ischemia and bleeding. Surgical decompression of abdominal compartment syndrome is indicated if the patient is refractory to medical treatment and percutaneous drainage. Abscesses and symptomatic pseudocysts are indications for interventional drainage. Early cholecystectomy during index admission is recommended for patients with mild biliary pancreatitis. Cholecystectomy should be delayed after severe, biliary pancreatitis. CONCLUSION The recommendations for surgical an interventional therapy of necrotising pancreatitis address the basis of current indications in literature. They should serve in daily practice as a reference standard for decision making in multidisciplinary teams.
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Affiliation(s)
- Olga Radulova-Mauersberger
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Orlin Belyaev
- Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum, Sankt Josef-Hospital, Deutschland
| | - Emrullah Birgin
- Chirurgische Klinik, Universitätsklinikum Mannheim, Deutschland
| | - Florian Bösch
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum der Universität München, Deutschland
| | | | | | | | | | - Tobias Keck
- Chirurgische Klinik, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Deutschland
| | - Jens Werner
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum der Universität München, Deutschland
| | - Waldemar Uhl
- Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum, Sankt Josef-Hospital, Deutschland
| | - Helmut Witzigmann
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Deutschland
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Martinez M, Cole J, Dove J, Blansfield J, Shabahang M, Wild J, Widom K, Torres D, Factor M. Outcomes of Endoscopic and Surgical Pancreatic Necrosectomy: A Single Institution Experience. Am Surg 2020. [DOI: 10.1177/000313481908500946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pancreatic necrosis can be managed conservatively; however, infection of pancreatic necrosis usually dictates more aggressive management. Our study aimed to assess the outcomes of open pancreatic necrosectomy (OPN) and endoscopic pancreatic necrosectomy (EPN) in a single center. Data from patients undergoing pancreatic necrosectomy at the Geisinger Medical Center from January 1, 2007, to April 25, 2016, were collected and retrospectively analyzed. Cohorts were composed of EPN (n = 22) and OPN (n = 34) groups. The prevalence of preoperative respiratory failure, septic shock, and multiorgan dysfunction syndrome was higher in the OPN group. The OPN group presented with a higher Bedside Index Severity in Acute Pancreatitis score. Postoperative abscess, persistent kidney dysfunction, and death were more frequent in the OPN group. The EPN group had a higher read-mission rate. The results of the univariate analysis for complication and mortality demonstrated that higher mortality and persistent kidney dysfunction were associated with the procedure type, specifically OPN and with a higher Bedside Index Severity in Acute Pancreatitis score. Patients who presented with higher severity of disease underwent an OPN, whereas EPN often was performed successfully in a more benign clinical setting. However, patients with infected necrosis are served best in a tertiary medical facility where multiple treatment modalities are available.
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Affiliation(s)
- Manuel Martinez
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Joshua Cole
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - James Dove
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Joseph Blansfield
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Mohsen Shabahang
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey Wild
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Kenneth Widom
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Denise Torres
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Matthew Factor
- From the Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Lariño-Noia J, de la Iglesia-García D, González-Lopez J, Díaz-Lopez J, Macías-García F, Mejuto R, Quiroga A, Mauriz V, Jardí A, Iglesias-García J, Domínguez-Muñoz JE. Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis. Surg Endosc 2020; 35:644-651. [PMID: 32076856 DOI: 10.1007/s00464-020-07428-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Current treatment of infected pancreatic necrosis (IPN) follows a step-up approach. Our group designed a step-up protocol that associates endoscopic drainage with local infusion of antibiotics through transmural nasocystic catheter. Aim of our study was to evaluate our step-up protocol for IPN in terms of proportion of patients avoiding necrosectomy. METHODS Retrospective analysis of patients admitted with acute pancreatitis (AP) between January 2015 and December 2018. The number of patients who responded to each therapeutic step were analysed: step 1, systemic antibiotics; step 2, endoscopic transmural drainage and local infusion of antibiotics; step 3, endoscopic necrosectomy. RESULTS 1158 patients with AP were included. 110 patients (8.4%) suffered from necrotising pancreatitis; 48 of them had IPN (42.6% of necrotising pancreatitis) and were treated with systemic antibiotics. Nineteen patients (39.6% of IPN) responded and did not required any invasive therapy. Six patients with IPN on systemic antibiotics died within the first 4 weeks of disease before step 2 could be applied. Urgent surgical necrosectomy in the first 4 weeks was performed in three additional patients. Endoscopic drainage and local antibiotic therapy was performed in the remaining 20 patients; 9 (45% of them) did well and 9 patients underwent necrosectomy (18.7% of IPN). Two patients died on drainage. Overall mortality of the total cohort of AP was 2.53% CONCLUSIONS: Addition of local infusion of antibiotics to endoscopic drainage avoids the need of necrosectomy in half of patients with IPN not responding to systemic antibiotics.
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Affiliation(s)
- Jose Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
| | - Daniel de la Iglesia-García
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Jaime González-Lopez
- Department of Pharmacy, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Javier Díaz-Lopez
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Fernando Macías-García
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Rafael Mejuto
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Adriano Quiroga
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Violeta Mauriz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Andrea Jardí
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain
| | - Julio Iglesias-García
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain
| | - J Enrique Domínguez-Muñoz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain
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Davoodabadi A, Beigmohammadi E, Gilasi H, Arj A, Taheri Nassaj H. Optimizing cholecystectomy time in moderate acute biliary pancreatitis: A randomized clinical trial study. Heliyon 2020; 6:e03388. [PMID: 32099920 PMCID: PMC7031006 DOI: 10.1016/j.heliyon.2020.e03388] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/16/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background In mild to moderate gallstone pancreatitis, cholecystectomy is the most appropriate treatment for prevention of further biliary attacks. However, the timing of cholecystectomy is not precisely determined. The present study was conducted to compare outcomes of very early (within 48 h) versus delayed (more than 1 week) laparoscopic cholecystectomy in patients with acute biliary pancreatitis (ABP). Methods This randomized clinical trial study was conducted in Shahid Beheshti Hospital of Kashan University of Medical Sciences from September 2016 to Mar 2019. Two hundred and eight cases with mild to moderate ABP were randomly assigned to 2 groups, with 104 patients in group 1 (operation within 48 h) and 104 in group 2 (operation after one week). Age, sex, biochemical parameters, clinical manifestation at the time of admission, operation time, recurrent biliary problems, relapse, peri-operative complications, conversion rate, and hospital length of stay in the two groups were recorded and compared. In addition, Ranson's score and Revised Atlanta criteria, the American Society of Anaesthesiologists Physical Status ASA-PS, Charlson Co-Morbidity Index (CCI), complexity of surgery and Clavien-Dindo score were also determined. Results There were no differences in demographics, peri-operative complications 4 (4%) vs. 4 (4%), P = 1), conversion rate (10.6% vs. 11.5%; P = 0.825) and procedure time (83 vs. 81 minutes, P = 0.110) between the two groups. There were no deaths in either group; however, the length of hospital stay was shorter in the early group compared to the delayed one, (3.66 ± 1.12 vs. 10.35 ± 1.76, P < 0.001). Conclusion Cholecystectomy within 48 h decreases significantly the length of hospital stay, without any difference in conversion rate, procedure time, or complication rate.
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Affiliation(s)
| | - Esmail Beigmohammadi
- Departments of surgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamidreza Gilasi
- Departments of Epidemiology& Biostatistics, Kashan University of Medical Sciences, Kashan, Iran
| | - Abbas Arj
- Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Taheri Nassaj
- Departments of surgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Departments of surgery, Kashan University of Medical Sciences, Kashan, Iran
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Giuffrida P, Biagiola D, Cristiano A, Ardiles V, de Santibañes M, Sanchez Clariá R, Pekolj J, de Santibañes E, Mazza O. Laparoscopic cholecystectomy in acute mild gallstone pancreatitis: how early is safe? Updates Surg 2020; 72:129-135. [PMID: 32009229 DOI: 10.1007/s13304-020-00714-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
The surgical strategy to resolve the underlying biliary pathology in patients with acute gallstone pancreatitis (AGP) remains controversial. The aim of this study was to evaluate the safety and effectiveness of early laparoscopic cholecystectomy (ELC) in patients with mild AGP. A retrospective cohort of consecutive patients diagnosed with mild AGP according to the Atlanta Guidelines from January 2009 to July 2019 was selected. Patients were assigned to surgery on the first available surgical shift, 48 h after the symptoms onset. Univariate analysis was performed to determine the association between AGP and grades of Balthazar (A, B and C) with time to surgery, days of hospitalization and postoperative complications. From 239 patients evaluated, 238 (99.58%) were operated by laparoscopic approach. Intraoperative cholangiogram was performed routinely. Choledocholithiasis, if present, was successfully treated by laparoscopic common bile duct exploration in all cases. A significant association was found between Balthazar grades and time to surgery (median of 3 days, p = 0.003), with length hospitalization and from surgery to discharge, with median of 4 days (p = 0.0001) and 2 days (p = 0.003), respectively. Mild postoperative complications (CD I/II) were observed in 22/239 patients (9.2%). This represents 2% of patients with grade A of Balthazar, 9% of grade B and 14% of grade C (p = 0.016). We observed no severe complications or mortality. ELC with routine intraoperative cholangiogram, performed on the first available surgical shift 48 h after the symptoms of pancreatitis onset, is a viable, effective and safe strategy for the resolution of mild AGP and its underlying biliary pathology in a single procedure.
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Affiliation(s)
- Pablo Giuffrida
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - David Biagiola
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Agustín Cristiano
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Victoria Ardiles
- HPB Surgery Section and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Martín de Santibañes
- HPB Surgery Section and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Rodrigo Sanchez Clariá
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Juan Pekolj
- HPB Surgery Section and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- HPB Surgery Section and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina
| | - Oscar Mazza
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABD, Buenos Aires, Argentina.
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Berger S, Taborda Vidarte CA, Woolard S, Morse B, Chawla S. Same-Admission Cholecystectomy Compared with Delayed Cholecystectomy in Acute Gallstone Pancreatitis: Outcomes and Predictors in a Safety Net Hospital Cohort. South Med J 2020; 113:87-92. [DOI: 10.14423/smj.0000000000001067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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44
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Gambitta P, Maffioli A, Spiropoulos J, Armellino A, Vertemati M, Aseni P. Endoscopic ultrasound-guided drainage of pancreatic fluid collections: The impact of evolving experience and new technologies in diagnosis and treatment over the last two decades. Hepatobiliary Pancreat Dis Int 2020; 19:68-73. [PMID: 31610989 DOI: 10.1016/j.hbpd.2019.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided drainage is the preferred approach for drainage of pancreatic fluid collections (PFCs) due to the better experience and significant progress using newer stents and access devices during last decade. This study aimed to evaluate the role of the evolving experience and possible influence of new technological devices on the outcome of patients evaluated for PFCs and submitted to EUS-guided drainage during two different periods: the early period at the beginning of experience when a standardized technique was used and the late period when the increased experience of the operator, combined with different stents quality were introduced in the management of PFCs. METHODS We retrospectively analyzed the clinical data of a cohort of 91 consecutive patients, who underwent EUS-guided drainage of symptomatic PFCs from October 2001 to September 2017. Demographic, therapeutic results, complications, and outcomes were compared between early years' group (2001-2008) and late years' group (2009-2017). RESULTS Endoscopic treatment was successfully achieved in 55.6% (20/36) of patients in the early years' group, and in 96.4% (53/55) in the late years' group. Eighteen patients (12 in early years' and 6 in the late year's group) required additional open surgery. Procedural complications were observed in 5 patients, 4 in early years' and 1 in late years' group. Mortality was registered in two patients (2.2%), one for each group. CONCLUSIONS During our long-term survey using EUS-guided endoscopic drainage of PFCs, significantly better outcomes in term of improved success rate and decrease complications rate were observed during the late period.
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Affiliation(s)
- Pietro Gambitta
- Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Endoscopy Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Maffioli
- Chirurgia Generale 1, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Antonio Armellino
- Endoscopy Division, Ospedale San Leopoldo Mandic di Merate, ASST Lecco, Lecco, Italy
| | - Maurizio Vertemati
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Paolo Aseni
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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45
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Infected walled-off pancreatic necrosis managed with percutaneous-endoscopic transabdominal drainage: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [DOI: 10.1016/j.rgmxen.2019.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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46
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Pan X, Fang X, Wang F, Li H, Niu W, Liang W, Wu C, Li J, Tu X, Pan L, Sun J. Butyrate ameliorates caerulein-induced acute pancreatitis and associated intestinal injury by tissue-specific mechanisms. Br J Pharmacol 2019; 176:4446-4461. [PMID: 31347703 PMCID: PMC6932943 DOI: 10.1111/bph.14806] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Acute pancreatitis (AP) is a common acute abdominal condition, frequently associated with intestinal barrier dysfunction, which aggravates AP retroactively. Butyrate exhibits anti-inflammatory effects in a variety of inflammatory diseases. However, its potential beneficial effect on AP and the underlying mechanisms have not been investigated. EXPERIMENTAL APPROACH Experimental AP was induced by caerulein hyperstimulation in wild-type and GPR109A-/- mice. Sodium butyrate was administered intragastrically for 7 days prior to caerulein hyperstimulation. Anti-inflammatory mechanisms of butyrate were further investigated in peritoneal macrophages. KEY RESULTS Butyrate prophylaxis attenuated AP as shown by reduced serum amylase and lipase levels, pancreatic oedema, myeloperoxidase activity, and improved pancreatic morphology. Amelioration of pancreatic damage by butyrate was associated with reduced levels of TNF-α, IL-6, and CCL2 and suppressed activation of the NLRP3 inflammasome in both pancreas and colon. Further, butyrate ameliorated pancreatic inflammation by suppressing interactions between histone deacetylase 1 (HDAC1) and AP1 and STAT1 with increased histone acetylation at H3K9, H3K14, H3K18, and H3K27 loci, resulting in suppression of NLRP3 inflammasome activation and modulation of immune cell infiltration in pancreas. Additionally, butyrate mediated STAT1/AP1-NLRP3 inflammasome suppression via HDAC1 inhibition was demonstrated in peritoneal macrophage. In colon, butyrate inhibited NLRP3 inflammasome activation via GPR109A. Accordingly, the modulatory effects of butyrate on AP, AP-associated gut dysfunction, and NLRP3 inflammasome activation were diminished in GPR109A-/- mice. CONCLUSION AND IMPLICATIONS Our study dissected tissue-specific anti-inflammatory mechanisms of butyrate during AP, suggesting that increased colonic levels of butyrate may be a strategy to protect against AP.
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MESH Headings
- Acute Disease
- Administration, Oral
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/analysis
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Butyrates/administration & dosage
- Butyrates/analysis
- Butyrates/pharmacology
- Ceruletide
- Female
- Intestinal Diseases/chemically induced
- Intestinal Diseases/drug therapy
- Intestinal Diseases/metabolism
- Intestine, Small/drug effects
- Intestine, Small/metabolism
- Intestine, Small/pathology
- Macrophages/drug effects
- Macrophages/metabolism
- Macrophages/pathology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Knockout
- Pancreas/drug effects
- Pancreas/metabolism
- Pancreatitis/chemically induced
- Pancreatitis/drug therapy
- Pancreatitis/metabolism
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Affiliation(s)
- Xiaohua Pan
- State Key Laboratory of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of Food Science and TechnologyJiangnan UniversityWuxiChina
| | - Xin Fang
- State Key Laboratory of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of MedicineJiangnan UniversityWuxiChina
| | - Fei Wang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji HospitalTongji University School of MedicineShanghaiChina
| | - Hongli Li
- State Key Laboratory of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of Food Science and TechnologyJiangnan UniversityWuxiChina
| | - Wenying Niu
- State Key Laboratory of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of MedicineJiangnan UniversityWuxiChina
| | - Wenjie Liang
- State Key Laboratory of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of MedicineJiangnan UniversityWuxiChina
| | - Chengfei Wu
- State Key Laboratory of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of Food Science and TechnologyJiangnan UniversityWuxiChina
| | - Jiahong Li
- State Key Laboratory of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of Food Science and TechnologyJiangnan UniversityWuxiChina
| | - Xing Tu
- State Key Laboratory of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of Food Science and TechnologyJiangnan UniversityWuxiChina
| | - Li‐Long Pan
- School of MedicineJiangnan UniversityWuxiChina
| | - Jia Sun
- State Key Laboratory of Food Science and TechnologyJiangnan UniversityWuxiChina
- School of Food Science and TechnologyJiangnan UniversityWuxiChina
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Safety and efficacy of early image-guided percutaneous interventions in acute severe necrotizing pancreatitis: A single-center retrospective study. Indian J Gastroenterol 2019; 38:480-487. [PMID: 32002829 DOI: 10.1007/s12664-019-00969-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 06/24/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acute necrotizing pancreatitis is managed conservatively in early phase of the disease. Even minimally invasive procedure is preferred after 21 days of onset and there is a paucity of data on decision and outcomes of early radiological interventions. This study aimed to evaluate efficacy and safety of early image-guided percutaneous interventions in management of acute severe necrotizing pancreatitis. METHODS A single-center retrospective study was performed after obtaining Institutional review board approval for analyzing hospital records of patients with acute necrotizing pancreatitis from January 2012 to July 2017. Seventy-eight consecutive patients with necrotizing pancreatitis and acute necrotic collections (ANC) were managed with percutaneous catheter drainage (PCD) and catheter-directed necrosectomy, in early phase of the disease (< 21 days). Clinical data and laboratory parameters of the included patients were evaluated until discharge from hospital, or mortality. RESULTS Overall survival rate was 73.1%. Forty-two (53.8%) patients survived with PCD alone, while the remaining 15 (19.2%) survivors needed additional necrosectomy. The timing of intervention from the start of the hospitalization to drainage was 14.3 ± 2.4 days. Significant risk factors for mortality were the presence of organ system failure, need for mechanical ventilation, renal replacement therapy, and the acute physiology and chronic health evaluation II (APACHE II) score. An APACHE II score cutoff value of 15 was a significant discriminant for predicting survival with catheter-directed necrosectomy. CONCLUSION An early PCD of ANC in clinically deteriorating patients with acute necrotizing pancreatitis, along with aggressive catheter-directed necrosectomy can avoid surgical interventions, and improve outcome in a significant proportion of patients with acute necrotizing pancreatitis.
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Munir F, Jamshed MB, Shahid N, Muhammad SA, Ghanem NB, Qiyu Z. Current status of diagnosis and Mesenchymal stem cells therapy for acute pancreatitis. Physiol Rep 2019; 7:e14170. [PMID: 31691545 PMCID: PMC6832003 DOI: 10.14814/phy2.14170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis (AP) is an acute gastrointestinal disorder that is the most common and requiring emergency hospitalization. Its incidence is increasing worldwide, thus increasing the burden of medical services. Approximately 20% of the patients develop moderate to severe necrotizing pancreatitis associated with pancreatic or peri-pancreatic tissue necrosis and multiple organ failure. There are many reports about the anti-inflammatory effect of mesenchymal stem cells (MSCs) on pancreatitis and the repair of tissue damage. MSCs cells come from a wide range of sources, autologous MSCs come from bone marrow and allogeneic MSCs such as umbilical cord blood MSCs, placenta-derived MSCs, etc. The wide source is not only an advantage of MSCs but also a disadvantage of MSCs. Because of different cell sources and different methods of collection and preparation, it is impossible to establish a unified standard method for evaluation of efficacy. The biggest advantage of iMSCs is that it can be prepared by a standardized process, and can be prepared on a large scale, which makes it easier to commercialize. This paper reviews the present status of diagnosis and progress of MSCs therapy for AP.
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Affiliation(s)
- Fahad Munir
- Department of Hepatobiliary SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouPeople’s Republic of China
| | - Muhammad B. Jamshed
- Department of Hepatobiliary SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouPeople’s Republic of China
| | - Numan Shahid
- Department of General SurgeryThe School of International Studies of Wenzhou Medical UniversityWenzhouPeople’s Republic of China
| | - Syed A. Muhammad
- Institute of Molecular Biology and BiotechnologyBahaudin Zakariya UniversityMultan, PunjabPakistan
| | - Noor B. Ghanem
- The School of International Studies of Wenzhou Medical UniversityWenzhouPeople’s Republic of China
| | - Zhang Qiyu
- Department of Hepatobiliary SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouPeople’s Republic of China
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Zhang K, Zhu X, Hou C, Shi C, Miao Y, Li Q. Minimally invasive drainage versus open surgical debridement in SAP/SMAP - a network meta-analysis. BMC Gastroenterol 2019; 19:168. [PMID: 31638914 PMCID: PMC6802312 DOI: 10.1186/s12876-019-1078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background The efficacy of some therapeutic methods (open surgical debridement (OSD), conservative treatment (CST) and minimally invasive drainage (MID)) for severe acute pancreatitis (SAP) and moderately severe acute pancreatitis (MSAP) has been widely evaluated. However, the results remained controversial. We performed this study to illuminate whether any difference in incidence exists on patients with SAP/MSAP treated with OSD and MID. Methods Eligible articles were collected base of a comprehensive review of PUBMED, EMBASE, COCHRANE, CKNI and WANGFANG for published randomized controlled trials. Two steps of meta-analysis were performed, routine pair-wise meta-analysis and network meta-analysis. Results Thirteen studies were included in this study. Participants were classed as 5 groups, CST, early MID (EMID), late MID (LMID), early OSD (EOSD) and late OSD (LOSD). And MID contains endoscopic drainage (ESD), percutaneous catheter drainage (PCD) and minimally invasive surgery (MIS). Compared with CST, MID could decrease both mortality and multiple organ dysfunction syndrome (MODS) rate but OSD couldn’t. Both EMID and MID can significantly decrease the mortality and MODS rate compared to CST. PCD might be most likely to have a benefit compared to CST. Conclusion Existing evidence for the use of MID in SAP/MSAP is reliable and it can be used as early treatment. OSD, if necessary, should be avoided or delayed as long as possible. Electronic supplementary material The online version of this article (10.1186/s12876-019-1078-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kai Zhang
- Pancreatic Center & Department of General Surgery, The First Affliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,Pancreas Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Xiaole Zhu
- Pancreatic Center & Department of General Surgery, The First Affliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,Pancreas Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Chaoqun Hou
- Pancreatic Center & Department of General Surgery, The First Affliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,Pancreas Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Chenyuan Shi
- Pancreatic Center & Department of General Surgery, The First Affliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,Pancreas Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yi Miao
- Pancreatic Center & Department of General Surgery, The First Affliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China. .,Pancreas Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
| | - Qiang Li
- Pancreatic Center & Department of General Surgery, The First Affliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China. .,Pancreas Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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50
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Lavage through percutaneous catheter drains in severe acute pancreatitis: Does it help?A randomized control trial. Pancreatology 2019; 19:929-934. [PMID: 31521496 DOI: 10.1016/j.pan.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/19/2019] [Accepted: 09/07/2019] [Indexed: 02/07/2023]
Abstract
AIMS There is no study comparing large volume lavage through image guided percutaneously placed drains in severe acute pancreatitis. METHODS Of the 114 randomized patients, 60 eligible candidates were randomly allocated to - Lavage Treatment (LT) group (28 patients) and Dependent Drainage (DD) group (32 patients). Primary end point was reversal of pre-existing organ failure, development of new onset organ failure, need for surgery, mortality and hospital stay. RESULTS Both the groups were comparable in terms of demographic data, onset and severity of pancreatitis. LT group had higher infected pancreatic necrosis (75% vs 50%,p = 0.047). On intention to treat analysis, lavage treatment group showed a significant reversal of persistent organ failure (84% vs 50%, p = 0.23), reduction in APACHEII scores (3.5 ± 3.405 vs 1.16 ± 3.811 p = 0.012), as measured at the time of placement of PCD to cessation of intervention. There was no difference in development of new onset organ failure in the two groups (25% vs37.5% p=.290). 75% in LT group and 69% in DD group improved with PCD alone. There was no difference in the catheter related complications and number of catheters used. The need for surgical intervention was comparable in two groups (18.8% vs 14.3% p=.737). There was a trend toward decreased mortality in group A (18.8% vs 28.8% p=.370). CONCLUSION Large volume lavage trough PCD improves organ failure and this translates into trend towards reduced mortality.
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