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https://www.readbyqxmd.com/read/29019583/management-of-infected-pancreatic-necrosis-state-of-the-art
#1
Roberto Rasslan, Fernando da Costa Ferreira Novo, Alberto Bitran, Edivaldo Massazo Utiyama, Samir Rasslan
Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively...
September 2017: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/28971378/endoscopic-ultrasound-guided-transmural-drainage-of-walled-off-pancreatic-necrosis-in-patients-with-portal-hypertension-and-intra-abdominal-collaterals
#2
Surinder S Rana, Ravi Sharma, Sobur Uddin Ahmed, Rajesh Gupta
BACKGROUND: Acute necrotizing pancreatitis (ANP) is complicated with segmental portal hypertension (PHT) and formation of venous collaterals. Presence of collaterals in vicinity of endoscopic transmural tract can lead to potentially catastrophic situation. Here, we report safety and outcome of EUS-guided transmural drainage of walled-off pancreatic necrosis (WOPN) in patients with PHT and intra-abdominal collaterals. METHODS: Retrospective analysis of collected database of patients (n=18; age 40...
October 2, 2017: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
https://www.readbyqxmd.com/read/28948113/one-of-the-largest-pancreatic-pseudocysts-in-the-literature-a-case-report
#3
Sulaiman Alhassan, Shifa Umar, Mark Lega
The pancreatic pseudocyst is a pancreatic fluid collection which classically develops due to acute or chronic pancreatitis. A 68-year-old male with the remote history of alcohol abuse presented with abdominal pain secondary to acute pancreatitis. The first computed tomography (CT) of the abdomen showed acute necrotizing pancreatitis. He was initially treated conservatively. Repeat CT of the abdomen after two weeks revealed a peripancreatic fluid collection of 20x12x10 cm. One month later, he became septic following biliary stent placement...
July 20, 2017: Curēus
https://www.readbyqxmd.com/read/28924589/can-we-now-recommend-hydrogen-peroxide-for-pancreatic-necrosectomy-time-for-controlled-data
#4
EDITORIAL
Patrick Yachimski
No abstract text is available yet for this article.
September 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28924588/endoscopic-pancreatic-necrosectomy-why-scuff-when-you-can-flush-the-muck-make-it-an-easy-row-to-hoe
#5
Rinkesh Kumar Bansal, Rajesh Puri, Narendra S Choudhary, Sumit Bhatia, Nisharg Patel, Saurabh K Patle, Gaurav K Patil, Amit Agarwal, Chandra Prabha, Randhir Sud
BACKGROUND AND AIMS:  Endoscopic ultrasound (EUS) guided drainage of symptomatic pancreatic walled-off necrosis (WON) followed by fully covered self-expanding metal stent (FCSEMS) placement offers several advantages such as higher technical success rate and the option of necrosectomy. The aim of this study was to evaluate the safety and efficacy of EUS guided drainage of patients with WON by using FCSEMS and intracavitary lavage with a solution containing hydrogen peroxide and adopting a step-up approach...
September 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28918807/endoscopic-ultrasonography-guided-drainage-of-pancreatic-collections-including-the-role-of-necrosectomy
#6
REVIEW
Ryan Law, Todd H Baron
In recent years, the management of symptoms of pancreatic fluid collections has shifted from surgical and percutaneous interventions to endoscopic techniques. Available data show that endoscopic drainage can be achieved with minimal morbidity and procedural-related mortality, a high degree of technical and clinical success, and acceptable risk of adverse events. Although endoscopic management of walled-off necrosis provides a durable, minimally invasive treatment option, it is still generally performed only in tertiary care medical centers because of the overall complexity of this clinical scenario...
October 2017: Gastrointestinal Endoscopy Clinics of North America
https://www.readbyqxmd.com/read/28858947/is-transcutaneous-endoscopic-necrosectomy-appropriate-method-in-managing-all-patients-with-walled-off-pancreatic-necrosis-that-extend-into-the-paracolic-gutter
#7
Enver Zerem, Predrag Jovanović, Mirza Omerović, Dženan Jahić, Dina Zerem, Omar Zerem
No abstract text is available yet for this article.
August 30, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28803859/interventions-for-walled-off-necrosis-using-an-algorithm-based-endoscopic-step-up-approach-outcomes-in-a-large-cohort-of-patients
#8
Yukako Nemoto, Rajeev Attam, Mustafa A Arain, Guru Trikudanathan, Shawn Mallery, Gregory J Beilman, Martin L Freeman
OBJECTIVES: The minimally invasive step-up approach for treatment of walled off necrosis (WON) involves drainage followed by later necrosectomy as needed, and is superior to primary surgical necrosectomy. Reported series of endoscopic transluminal necrosectomy include highly selected patients. We report outcomes of a large series of patients with WON managed by an algorithm based on an endoscopically centered step-up approach. METHODS: Consecutive patients with necrotizing pancreatitis from 2009 to 2014, with intervention only for infected or persistently symptomatic WON...
September 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/28798041/minimal-access-necrosectomy-the-newest-advance-of-many-in-the-treatment-of-necrotising-pancreatitis
#9
EDITORIAL
Michael G Sarr
No abstract text is available yet for this article.
August 10, 2017: Gut
https://www.readbyqxmd.com/read/28796142/successful-open-and-endoscopic-transgastric-necrosectomy-for-huge-infected-walled-off-pancreatic-necrosis-a-case-report
#10
Yuko Okishio, Satoshi Yokoyama, Yasuhiro Higashide, Kohei Ueno, Mitsuru Masuda, Shinichi Hosokawa, Ryo Kamimura, Daisuke Ito, Masato Ichimiya, Shiro Uyama
No abstract text is available yet for this article.
September 2017: Pancreas
https://www.readbyqxmd.com/read/28796138/predictive-value-of-computed-tomography-scans-and-clinical-findings-for-the-need-of-endoscopic-necrosectomy-in-walled-off-necrosis-from-pancreatitis
#11
Fabian Finkelmeier, Christian Sturm, Mireen Friedrich-Rust, Jörg Bojunga, Christoph Sarrazin, Andrea Tal, Johannes Hausmann, Stefan Zeuzem, Stephan Zangos, Jörg Albert, Harald Farnik
OBJECTIVES: Choosing the best treatment option at the optimal point of time for patients with walled-off necrosis (WON) is crucial. We aimed to identify imaging parameters and clinical findings predicting the need of necrosectomy in patients with WON. METHODS: All patients with endoscopically diagnosed WON and pseudocyst were retrospectively identified. Post hoc analysis of pre-interventional contrast-enhanced computed tomography was performed for factors predicting the need of necrosectomy...
September 2017: Pancreas
https://www.readbyqxmd.com/read/28791329/clinical-impact-of-eus-treatment-of-walled-off-pancreatic-necrosis-with-dedicated-devices
#12
Ilaria Tarantino, Dario Ligresti, Fabio Tuzzolino, Luca Barresi, Gabriele Curcio, Antonino Granata, Mario Traina
BACKGROUND AND STUDY AIMS:  Walled-off pancreatic necrosis (WOPN) represents the major risk factor for sepsis-related multiple organ failure. Surgical debridement is an invasive approach associated with high rates of adverse events (AEs) and death. As an alternative, endoscopic ultrasound-guided cysto-gastro-anastomosis has emerged as an effective treatment for WOPNs. Recently a new dedicated-lumen apposing metal stent (LAMS) has been used with satisfactory results in treating peri-pancreatic fluid collections, including WOPNs...
August 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28782748/ileostomy-site-approach-for-adhesiolysis-and-laparoscopic-cholecystectomy-in-a-hostile-abdomen-a-novel-technique
#13
Deeplaxmi Purushottam Borle, Nikhil Agrawal, Asit Arora, Senthil Kumar, Tushar Kanti Chattopadhyay
INTRODUCTION: Gallstones are an etiological factor in 23%-54% of patients with acute pancreatitis. A small proportion of these patients will also have intestinal complications requiring necrosectomy with diverting loop ileostomy. Later, these patients require cholecystectomy and ileostomy reversal. Laparoscopic cholecystectomy is fraught with difficulty in these patients due to dense intra-abdominal adhesions, and many surgeons resort to an open approach. We describe a technique which takes advantage of the ileostomy site for initial access...
August 1, 2017: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/28774886/minimally-invasive-and-endoscopic-versus-open-necrosectomy-for-necrotising-pancreatitis-a-pooled-analysis-of-individual-data-for-1980-patients
#14
Sandra van Brunschot, Robbert A Hollemans, Olaf J Bakker, Marc G Besselink, Todd H Baron, Hans G Beger, Marja A Boermeester, Thomas L Bollen, Marco J Bruno, Ross Carter, Jeremy J French, Djalma Coelho, Björn Dahl, Marcel G Dijkgraaf, Nilesh Doctor, Peter J Fagenholz, Gyula Farkas, Carlos Fernandez Del Castillo, Paul Fockens, Martin L Freeman, Timothy B Gardner, Harry van Goor, Hein G Gooszen, Gerjon Hannink, Rajiv Lochan, Colin J McKay, John P Neoptolemos, Atilla Oláh, Rowan W Parks, Miroslav P Peev, Michael Raraty, Bettina Rau, Thomas Rösch, Maroeska Rovers, Hans Seifert, Ajith K Siriwardena, Karen D Horvath, Hjalmar C van Santvoort
OBJECTIVE: Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. DESIGN: We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy...
August 3, 2017: Gut
https://www.readbyqxmd.com/read/28713067/eus-guided-drainage-of-peripancreatic-fluid-collections-with-lumen-apposing-metal-stents-and-plastic-double-pigtail-stents-comparison-of-efficacy-and-adverse-event-rates
#15
Gabriel D Lang, Cassandra Fritz, Trisha Bhat, Koushik K Das, Faris M Murad, Dayna S Early, Steven A Edmundowicz, Vladimir M Kushnir, Daniel K Mullady
BACKGROUND AND AIMS: Transmural drainage with double-pigtail plastic stents (DPPSs) was the mainstay of endoscopic therapy for symptomatic peripancreatic fluid collections (PPFCs) until the introduction of lumen-apposing covered self-expanding metal stents (LAMSs). Currently, there are limited data regarding the efficacy and adverse event rate of LAMSs compared with DPPSs. METHODS: A retrospective analysis of EUS-guided PPFC drainage at a single tertiary care center between 2008 and 2015 was performed...
July 14, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28702167/clostridium-perfringens-s-necrotizing-acute-pancreatitis-a-case-of-success
#16
Rita Castro, Joana Mendes, Luís Amaral, Rui Quintanilha, Tiago Rama, António Melo
The authors report a case of a 62-year-old man with upper abdominal pain with few hours of onset and vomits. The initial serum amylase was 2306 U/L. The first CT showed signs of a non-complicated acute pancreatitis. He suffered clinical deterioration and for this reason he was admitted on the intensive care unit where he progressed to multiple organ failure in <24 h. A new CT scan was performed that showed pneumoperitoneum and pneumoretroperitoneum. He underwent an exploratory laparotomy and pancreatic necrosectomy and vacuum pack laparostomy were performed...
June 2017: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/28697152/transcutaneous-endoscopic-necrosectomy-for-walled-off-pancreatic-necrosis-in-the-paracolic-gutter
#17
Monica Saumoy, Nikhil A Kumta, Amy Tyberg, Elizabeth Brown, Micheal D Lieberman, Soumitra R Eachempati, Ronald S Winokur, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh
BACKGROUND: Walled-off pancreatic necrosis (WON) is a sequelae of acute pancreatitis that requires debridement, once infected. Recently, endoscopic necrosectomy has become the mainstay for management. However, peripancreatic collections that extend to the paracolic gutter or lesser sac, are more challenging to treat endoscopically. We report an endoscopic method for management of necrotic collections that extend into the paracolic gutter. METHODS: Consecutive patients, with symptomatic WON extending into the retroperitoneum, were included in a prospective registry...
July 10, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28516758/necrotizing-pancreatitis-current-management-and-therapies
#18
REVIEW
Christine Boumitri, Elizabeth Brown, Michel Kahaleh
Acute necrotizing pancreatitis accounts for 10% of acute pancreatitis (AP) cases and is associated with a higher mortality and morbidity. Necrosis within the first 4 weeks of disease onset is defined as an acute necrotic collection (ANC), while walled off pancreatic necrosis (WOPN) develops after 4 weeks of disease onset. An infected or symptomatic WOPN requires drainage. The management of pancreatic necrosis has shifted away from open necrosectomy, as it is associated with a high morbidity, to less invasive techniques...
July 2017: Clinical Endoscopy
https://www.readbyqxmd.com/read/28494574/endoscopic-management-of-peri-pancreatic-fluid-collections
#19
REVIEW
Hon Chi Yip, Anthony Yuen Bun Teoh
In the past decade, there has been a progressive paradigm shift in the management of peri-pancreatic fluid collections after acute pancreatitis. Refinements in the definitions of fluid collections from the updated Atlanta classification have enabled better communication amongst physicians in an effort to formulate optimal treatments. Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has emerged as the procedure of choice over surgical cystogastrostomy. The approach provides similar success rates with low complications and better quality of life compared with surgery...
September 15, 2017: Gut and Liver
https://www.readbyqxmd.com/read/28487603/endoscopic-management-of-pancreatic-fluid-collections-revisited
#20
REVIEW
Zaheer Nabi, Jahangeer Basha, D Nageshwar Reddy
The development of pancreatic fluid collections (PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has become easier...
April 21, 2017: World Journal of Gastroenterology: WJG
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