Early versus on-demand nasoenteric tube feeding in acute pancreatitis.

Background: Early enteral feeding through a nasoenteric feeding tube is often used in patients with severe acute pancreatitis to prevent gut-derived infections, but evidence to support this strategy is limited. We conducted a multicenter, randomized trial comparing early nasoenteric tube feeding with an oral diet at 72 hours after presentation to the emergency department in patients with acute pancreatitis.

Methods: We enrolled patients with acute pancreatitis who were at high risk for complications on the basis of an Acute Physiology and Chronic Health Evaluation II score of 8 or higher (on a scale of 0 to 71, with higher scores indicating more severe disease), an Imrie or modified Glasgow score of 3 or higher (on a scale of 0 to 8, with higher scores indicating more severe disease), or a serum C-reactive protein level of more than 150 mg per liter.

Training situational awareness to reduce surgical errors in the operating room.

Background: Surgical errors result from faulty decision-making, misperceptions and the application of suboptimal problem-solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim of this review was to assess the validity of methods for improving situational awareness in the surgical theatre.

An individual patient data meta-analysis on factors associated with adverse drug events in surgical and non-surgical inpatients.

Aim: The incidence of adverse drug events (ADEs) in surgical and non-surgical patients may differ. This individual patient data meta-analysis (IPDMA) identifies patient characteristics and types of medication most associated with patients experiencing ADEs and suggests target areas for reducing harm and implementing focused interventions.

Methods: Authors of eligible studies on preventable ADEs (pADEs) were approached for collaboration.

Antioxidants for pain in chronic pancreatitis.

Background: Reduced intake and absorption of antioxidants due to pain and malabsorption are probable causes of the lower levels of antioxidants observed in patients with chronic pancreatitis (CP). Improving the status of antioxidants might be effective in slowing the disease process and reducing pain in CP.

Objectives: To assess the benefits and harms of antioxidants for the treatment of pain in patients with CP.

A systematic review of complicated diverticulitis in post-transplant patients.

Background: Immunosuppression could increase the complication rate in patients with acute diverticulitis. This would justify a low threshold for elective sigmoid resection in these patients after an episode of diverticulitis. Well-documented groups of immunocompromised patients are transplant patients, in which many prospective studies have been conducted.

[Optimal timing of antibiotic prophylaxis: effect on surgical site infection is overrated].

Surgical site infection (SSI) is a common complication of surgery and a major cause of morbidity, mortality and health care costs. Several patient and perioperative care related factors play a role in SSI, which above all is the result of a complex process. Timing of antibiotic prophylaxis (AP) is a process indicator that has been described extensively.

Quality of pharmaceutical care in surgical patients.

Background: Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements.

[Appraising the evidence for new treatments].

For new interventions, the results of sequential randomized or non-randomized trials and meta-analysis can differ significantly. Evaluation of the evidence for the effect of a new treatment is a complex interplay of several factors, including the methodological design, the risk of a coincidental finding and applicability in practice. For proper appraisal of the design of trials, the use of aggregate scores should be avoided and individual study limitations should be mentioned.

Abdominal compartment syndrome in acute pancreatitis: a systematic review.

Abdominal compartment syndrome (ACS) is a lethal complication of acute pancreatitis. We performed a systematic review to assess the treatment and outcome of these patients.A systematic literature search for cohorts of patients with acute pancreatitis and ACS was performed.

Treatment options for chronic pancreatitis.

This Review covers the latest developments in the treatment options for chronic pancreatitis. Pain is the most frequent and dominant symptom in patients with chronic pancreatitis, which ranges from severe disabling continuous pain to mild pain attacks and pain-free periods. Conventional treatment strategies and recent changes in the treatment of pain in patients with chronic pancreatitis are outlined.

Fecal microbiome analysis as a diagnostic test for diverticulitis.

Disease-specific variations in intestinal microbiome composition have been found for a number of intestinal disorders, but little is known about diverticulitis. The purpose of this study was to compare the fecal microbiota of diverticulitis patients with control subjects from a general gastroenterological practice and to investigate the feasibility of predictive diagnostics based on complex microbiota data. Thirty-one patients with computed tomography (CT)-proven left-sided uncomplicated acute diverticulitis were included and compared with 25 control subjects evaluated for a range of gastrointestinal indications.

[Guideline 'Diagnostics in acute abdominal pain in adults'].

The interdisciplinary, evidence-based guideline 'Diagnostics in acute abdominal pain in adults' describes the optimal in-hospital diagnostic work-up of patients with acute abdominal pain. Amongst other recommendations, the guideline advises the use of C-reactive protein and white blood cell count to differentiate urgent from non-urgent causes in an adult with acute abdominal pain presenting at the Emergency Department. If there is clinical suspicion of an urgent condition the guideline advises that additional imaging be performed.

[Plain abdominal x-rays for the sake of the doctor].

Scientific research has demonstrated that the diagnostic accuracy of plain abdominal x-rays is lower than that of other imaging modalities such as CT or ultrasonography in patients with acute abdominal pain. Nevertheless, plain x-rays are continually being used in daily practice. There are several comparable examples in which the implementation of new evidence into clinical practice seems problematic.

A simple clinical decision rule to rule out appendicitis in patients with nondiagnostic ultrasound results.

Objectives: The objective was to identify a set of clinical features that can rule out appendicitis in patients with suspected acute appendicitis and nondiagnostic ultrasound (US) results, allowing safe discharge and next-day reevaluation without initial computed tomography (CT) or magnetic resonance imaging (MRI).

Methods: Data on clinical and US evaluation, including a number of prespecified variables potentially associated with acute appendicitis, were prospectively collected in two diagnostic accuracy studies of imaging. These studies included patients with suspected appendicitis seen in the emergency department (ED).

Evidence based development of bedside clinical drug rules for surgical patients.

Background: Surgical adverse events constitute a considerable problem. More than half of in-hospital adverse events are related to a surgical procedure. Medication related events are frequent and partly preventable.

Treatment options for acute pancreatitis.

This Review covers the latest developments in the treatment of acute pancreatitis. The Atlanta Classification of acute pancreatitis has been revised, proposing several new terms and abandoning some of the old and confusing terminology. The 2012 Revised Atlanta Classification and the determinant-based classification aim to universally define the different local and systemic complications and predict outcome.

Laparoscopy in cholecysto-choledocholithiasis.

Gallstone disease is one of the most common problems in the gastroenterology and is associated with significant morbidity. It may present as stones in the gallbladder (cholecystolithiasis) or in the common bile duct (choledocholithiasis). At the end of the 1980s laparoscopy was introduced and first laparoscopic cholecystectomy was performed in 1985.

Association analysis of genetic variants in the myosin IXB gene in acute pancreatitis.

Introduction: Impairment of the mucosal barrier plays an important role in the pathophysiology of acute pancreatitis. The myosin IXB (MYO9B) gene and the two tight-junction adaptor genes, PARD3 and MAGI2, have been linked to gastrointestinal permeability. Common variants of these genes are associated with celiac disease and inflammatory bowel disease, two other conditions in which intestinal permeability plays a role.

Inter-observer reliability of computed tomographic classifications of diverticulitis.

Aim: The wide use of computed tomography (CT) for diverticulitis has initiated new classifications, but their reliability has not been studied. The aim of the study was to assess the inter-observer agreement of radiologists on the classifications of diverticulitis.

Method: A set of 100 CT examinations of patients with an episode of diverticulitis was used to assess inter-observer agreement.

The role of routine fine-needle aspiration in the diagnosis of infected necrotizing pancreatitis.

Background: Diagnosing infected necrotizing pancreatitis (INP) may be challenging. The aim of this study was to determine the added value of routine fine-needle aspiration (FNA) in addition to clinical and imaging signs of infection in patients who underwent intervention for suspected INP.

Methods: We conducted a post hoc analysis of 208 consecutive patients from a prospective, multicenter database who underwent intervention because of suspected INP.

Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): design and rationale of a randomised controlled multicenter trial [ISRCTN09186711].

Background: Infected necrotising pancreatitis is a potentially lethal disease that nearly always requires intervention. Traditionally, primary open necrosectomy has been the treatment of choice. In recent years, the surgical step-up approach, consisting of percutaneous catheter drainage followed, if necessary, by (minimally invasive) surgical necrosectomy has become the standard of care.