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pancreatitis guideline

Salvatore Paiella, Matteo De Pastena, Mirko D'Onofrio, Stefano Francesco Crinò, Teresa Lucia Pan, Riccardo De Robertis, Giovanni Elio, Enrico Martone, Claudio Bassi, Roberto Salvia
Pancreatic cancer (PC) is a solid tumor with still a dismal prognosis. Diagnosis is usually late, when the disease is metastatic or locally advanced (LAPC). Only 20% of PC are amenable to surgery at the time of diagnosis and the vast majority of them, despite radically resected will unavoidably recur. The treatment of LAPC is a challenge. Current guidelines suggest to adopt systemic therapies upfront, based on multi-drugs chemotherapy regimens. However, the vast majority of patients will never experience conversion to surgical exploration and radical resection...
2018: Translational Gastroenterology and Hepatology
Salvatore Amodeo, Antonio Masi, Marcovalerio Melis, Theresa Ryan, Howard S Hochster, Deirdre J Cohen, Anurag Chandra, H Leon Pachter, Elliot Newman
Background: Half of patients with pancreatic adenocarcinoma (PC) present with regionally advanced disease. This includes borderline resectable and locally advanced unresectable tumors as defined by current NCCN guidelines for resectability. Chemoradiation (CH-RT) is used in this setting in attempt to control local disease, and possibly downstage to resectable disease. We report a phase I/II trial of a combination of 5FU/Oxaliplatin with concurrent radiation in patients presenting with borderline resectable and locally advanced unresectable pancreatic cancer...
October 2018: Journal of Gastrointestinal Oncology
Olaya I Brewer Gutierrez, Anne Marie Lennon
Pancreatic cysts are common and are incidentally detected in up to 13.5% of individuals. Intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN) are precursors to pancreatic adenocarcinoma. Most will never develop into pancreatic cancer. Several types of pancreatic cysts have no malignant potential. Solid tumors can present as a pancreatic cysts. Guidelines recommend surveillance. Management includes differentiating IPMNs and MCNs from other types, identifying those at highest risk of harboring pancreatic cancer or high-grade dysplasia, and referral to a multidisciplinary group for evaluation and consideration of surgical resection...
January 2019: Medical Clinics of North America
Thilo Hackert
Pancreatic ductal adenocarcinoma (PDAC) remains to be a therapeutic challenge as only 15%-20% of all patients present with resectable tumor stages by the time of diagnosis. In the remaining patients, either local tumor extension or systemic spread are obstacles for a surgical therapy as the only chance for long-term survival. With regard to local tumor extension, PDAC has been classified as resectable, borderline-resectable (BR) or locally advanced (LA). While there is currently no evidence for neoadjuvant therapy in resectable PDAC, this issue remains controversial in BR-PDAC...
November 2018: Annals of gastroenterological surgery
Yavor Asenov, Melih Akın, Serdar Cantez, Feryal Gün Soysal, Yaman Tekant
BACKGROUND/AIMS: To investigate the safety and long-term results of endoscopic retrograde cholangiopancreatography (ERCP) in children with a literature review. MATERIALS AND METHODS: All patients within the age range of 6-17 years who underwent ERCP between 1994 and 2014 at our institution were retrospectively evaluated. RESULT: Twenty-four patients with a median age of 15 years underwent ERCP. Cannulation of the papilla was achieved in all patients (100%) without the use of needle-knife papillotomy...
November 19, 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
J-P Lammi, M Eskelinen, J Tuimala, J Saarnio, T Rantanen
BACKGROUND: Despite guidelines on blood transfusion (TF) thresholds, there seems to be great variation in transfusion policies between hospitals and surgeons. In order to improve and unify blood transfusion policies, the Finnish Red Cross Blood Service carried out a project concerning the optimal use of blood products (Verivalmisteiden optimaalinen käyttö) between 2002 and 2011. In this study, we determined the blood transfusion trends in major pancreatic surgery in Finland. METHODS: Initially, 1337 patients who underwent major pancreatic resections between 2002 and 2011 were classified into the TF+ or TF- groups...
November 21, 2018: Scandinavian Journal of Surgery: SJS
Richard A Hubner, Antonio Cubillo, Jean-Frédéric Blanc, Davide Melisi, Daniel D Von Hoff, Andrea Wang-Gillam, Li-Tzong Chen, Claus Becker, Khalid Mamlouk, Bruce Belanger, Yoojung Yang, Floris A de Jong, Jens T Siveke
BACKGROUND: The NAPOLI-1 study (NCT01494506) reported that liposomal irinotecan plus 5-fluorouracil and leucovorin (nal-IRI+5-FU/LV) improved overall survival vs 5-FU/LV with manageable toxicity in patients with metastatic pancreatic adenocarcinoma previously treated with gemcitabine-based therapy. Yet, clinicians need treatment strategies that also maintain the patient's health-related quality of life (HRQOL). Here, we report the HRQOL data. METHODS: Patients completed the European Organisation for Research and Treatment of Cancer QOL core questionnaire C30 (EORTC QLQ-C30) at baseline, every 6 weeks, and at 30 days after discontinuation of study treatment...
November 17, 2018: European Journal of Cancer
Elena M Stoffel, Shannon E McKernin, Randall Brand, Marcia Canto, Michael Goggins, Cassadie Moravek, Arun Nagarajan, Gloria M Petersen, Diane M Simeone, Matthew Yurgelun, Alok A Khorana
PURPOSE: An ASCO provisional clinical opinion (PCO) offers timely clinical direction to ASCO's membership and other health care providers. This PCO addresses identification and management of patients and family members with possible predisposition to pancreatic adenocarcinoma. METHODS: ASCO convened an Expert Panel and conducted a systematic review of the literature published from January 1998 to June 2018. Results of the databases searched were supplemented with hand searching of the bibliographies of systematic reviews and selected seminal articles and contributions from Expert Panel members' curated files...
November 20, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Bharat Rao, Aslam Syed, Shailendra Singh, Abhishek Gulati, Ghita Moussiade, Mrinal Garg, Manav Sharma, Suzanne Morrissey, Harry Williams, Donald Atkinson, Suzanne Schiffman, Dulabh Monga, Anthony Lupetin, Alexander Kirichenko, Marcia Mitre, Amy Tang, Manish Dhawan, Abhijit Kulkarni, Shyam Thakkar
OBJECTIVES: Surgery is the curative treatment for pancreatic ductal adenocarcinoma (PDA). Guidelines recommend utilizing a multidisciplinary pancreatic cancer conference (MDPC) in treatment; however, data are limited. The objective of this study was to assess the accuracy of an MDPC. METHODS: Patients with PDA presented at an MDPC were prospectively collected from April 2013 to August 2016. Patients were included if the MDPC predicted them to have resectable PDA and underwent upfront surgery...
November 17, 2018: Pancreas
Nyanza K L M Timmers, Rebecca K Stellato, Cornelis K van der Ent, Roderick H J Houwen, Janna W Woestenenk
Pancreatic-insufficient children with cystic fibrosis (CF) receive age-group-specific vitamin D supplementation according to international CF nutritional guidelines. The potential advantageous immunomodulatory effect of serum 25-hydroxy vitamin D (25(OH)D) on pulmonary function (PF) is yet to be established and is complicated by CF-related vitamin D malabsorption. We aimed to assess whether current recommendations are optimal for preventing deficiencies and whether higher serum 25(OH)D levels have long-term beneficial effects on PF...
November 16, 2018: British Journal of Nutrition
Andrew Khoi Nguyen, Agathon Girgis, Timnit Tekeste, Karen Chang, Mopelola Adeyemo, Armen Eskandari, Emilio Alonso, Priyanka Yaramada, Charles Chaya, Albert Ko, Edmund Burke, Isaiah Roggow, Rebecca Butler, Aniket Kawatkar, Brian S Lim
AIM: To examine the practice pattern in Kaiser Permanente Southern California (KPSC), i.e ., gastroenterology (GI)/surgery referrals and endoscopic ultrasound (EUS), for pancreatic cystic neoplasms (PCNs) after the region-wide dissemination of the PCN management algorithm. METHODS: Retrospective review was performed; patients with PCN diagnosis given between April 2012 and April 2015 (18 mo before and after the publication of the algorithm) in KPSC (integrated health system with 15 hospitals and 202 medical offices in Southern California) were identified...
November 6, 2018: World Journal of Clinical Cases
Michał Wlaźlak, Aleksandra Oleśna, Marian Danilewicz, Janusz Strzelczyk
Introduction Frequency of detection of pancreatic cystic lesions increased recent years. The majorities are pseudocysts, the remaining cysts are mainly neoplasms. Proven risk of malignancy affects intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Material and methods 145 patients operated on at the Department of General and Transplant Surgery in Barlicki Hospital in Lodz, Poland, in 2007-2016 due to pancreatic cystic lesion. The type of surgery, histopathological diagnosis and basic demographic data were analyzed...
June 20, 2018: Polski Przeglad Chirurgiczny
Donevan Westerveld, April Goddard, Nieka Harris, Vikas Khullar, Justin Forde, Peter V Draganov, Chris E Forsmark, Dennis Yang
BACKGROUND AND AIMS: Various gastrointestinal societies have released guidelines on the evaluation of asymptomatic pancreatic cysts (PCs). These guidelines differ on several aspects, which create a conundrum for clinicians. The aim of this study was to evaluate preferences and practice patterns in the management of incidental PCs in light of these societal recommendations. METHODS: An electronic survey distributed to members of the American Society for Gastrointestinal Endoscopy (ASGE)...
November 13, 2018: Digestive Diseases and Sciences
Julio Rosenstock, Vlado Perkovic, Odd Erik Johansen, Mark E Cooper, Steven E Kahn, Nikolaus Marx, John H Alexander, Michael Pencina, Robert D Toto, Christoph Wanner, Bernard Zinman, Hans Juergen Woerle, David Baanstra, Egon Pfarr, Sven Schnaidt, Thomas Meinicke, Jyothis T George, Maximillian von Eynatten, Darren K McGuire
Importance: Type 2 diabetes is associated with increased cardiovascular (CV) risk. Prior trials have demonstrated CV safety of 3 dipeptidyl peptidase 4 (DPP-4) inhibitors but have included limited numbers of patients with high CV risk and chronic kidney disease. Objective: To evaluate the effect of linagliptin, a selective DPP-4 inhibitor, on CV outcomes and kidney outcomes in patients with type 2 diabetes at high risk of CV and kidney events. Design, Setting, and Participants: Randomized, placebo-controlled, multicenter noninferiority trial conducted from August 2013 to August 2016 at 605 clinic sites in 27 countries among adults with type 2 diabetes, hemoglobin A1c of 6...
November 9, 2018: JAMA: the Journal of the American Medical Association
Tze-Yi Low, Brian K P Goh
Background: Recently, there have been several reports on minimally-invasive surgery for extended pancreatectomy (MIEP) in the literature. However, to date, only a limited number of studies reporting on the outcomes of MIEP have been published. In the present study, we report our initial experience with MIEP defined according to the latest the International Study Group for Pancreatic Surgery (ISPGS) guidelines. Methods: Over a 14-month period, a total of 6 consecutive MIEP performed by a single surgeon at a tertiary institution were identified from a prospectively maintained surgical database...
November 9, 2018: Journal of Minimal Access Surgery
Benedikt Kaufmann, Daniel Hartmann, Jan G D'Haese, Pavel Stupakov, Dejan Radenkovic, Beat Gloor, Helmut Friess
One of the main reasons for the dismal prognosis of pancreatic ductal adenocarcinoma (PDAC) is its late diagnosis. At the time of presentation, only approximately 15-20% of all patients with PDAC are considered resectable and around 30% are considered borderline resectable. A surgical approach, which is the only curative option, is limited in borderline resectable patients by local involvement of surrounding structures. In borderline resectable pancreatic cancer (BRPC), neoadjuvant treatment regimens have been introduced with the rationale to downstage and downsize the tumor in order to enable resection and eliminate -microscopic distant metastases...
November 8, 2018: Digestive Surgery
Zhi Cheng, Lauren M Rosati, Linda Chen, Omar Y Mian, Yilin Cao, Marta Villafania, Minoru Nakatsugawa, Joseph A Moore, Scott P Robertson, Juan Jackson, Amy Hacker-Prietz, Jin He, Christopher L Wolfgang, Matthew J Weiss, Joseph M Herman, Amol K Narang, Todd R McNutt
Purpose: For patients with localized pancreatic cancer (PC) with vascular involvement, prediction of resectability is critical to define optimal treatment. However, the current definitions of borderline resectable (BR) and locally advanced (LA) disease leave considerable heterogeneity in outcomes within these classifications. Moreover, factors beyond vascular involvement likely affect the ability to undergo resection. Herein, we share our experience developing a model that incorporates detailed radiologic, patient, and treatment factors to predict surgical resectability in patients with BR and LA PC who undergo stereotactic body radiation therapy (SBRT)...
October 2018: Advances in Radiation Oncology
Bing-Qi Li, Jun Lu, Samuel Seery, Jun-Chao Guo
BACKGROUND/OBJECTIVES: Due to its rarity, epidermoid cyst in intrapancreatic accessory spleen (ECIPAS) is still a diagnostic dilemma during clinical practice. The aim of this review was to summarize the epidemiologic features and management of ECIPAS. METHODS: MEDLINE and EMBASE were searched for English articles reporting on ECIPAS up to April 30th, 2018 following the methodology suggested by the PRISMA guidelines. Categorical variables were reported as frequency and percentage...
October 22, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Bipadabhanjan Mallick, Narendra Dhaka, Vishal Sharma, Sarthak Malik, Saroj K Sinha, Usha Dutta, Pankaj Gupta, Ajay Gulati, Thakur D Yadav, Vikas Gupta, Rakesh Kochhar
BACKGROUND AND OBJECTIVES: Despite improvement in outcomes of acute pancreatitis (AP), some subgroups remain at increased risk. We studied the impact of onset-to-admission interval to a tertiary care centre on outcomes in AP. METHODS: Retrospective analysis of consecutive patients with first episode of AP admitted between 2009 and 2017 on the basis of onset-to-admission interval: ≤7 days, 8-21 days and >21 days was done. Patients were assessed for severity and managed using a step-up approach...
October 17, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Aikaterini Mastoraki, Sotiria Mastoraki, Dimitrios Schizas, Raphael Patras, Nikolaos Krinos, Ioannis S Papanikolaou, Andreas Lazaris, Theodore Liakakos, Nikolaos Arkadopoulos
Venous thromboembolism (VTE) refers to a hypercoagulable state that remains an important and preventable factor in the surgical treatment of malignancies. VTE includes two identical entities with regards to deep vein thrombosis and pulmonary embolism. The incidence of VTE after major abdominal interventions for gastro-intestinal, hepato-biliary and pancreatic neoplastic disorders is as high as 25% without prophylaxis. Prophylactic use of classic or low-molecular-weight heparin, anti-Xa factors, antithrombotic stocking, intermittent pneumatic compression devices and early mobilization have been described...
October 15, 2018: World Journal of Gastrointestinal Oncology
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