Impact of Metastatic Pattern on Survival Following Pancreatectomy for Cancer.

Background And Methods: The incidence of pancreatic cancer is increasing, and up to 55% of patients present with metastatic disease at the time of diagnosis. Many patients also develop metastatic disease following surgical resection. The impact of metastatic patterns on outcomes has not been described.

Impact of myopenia and myosteatosis in patients undergoing abdominal surgery for chronic pancreatitis.

Background: Surgery for chronic pancreatitis is associated with major morbidity and mortality. The aim of this study is to examine the role of preoperative muscle volume and quality on postoperative outcomes in patients with chronic pancreatitis.

Methods: All patients who underwent abdominal surgery for chronic pancreatitis between 2011 and 2018 were identified from an institutional surgical database.

Management of complicated biliary disease in the pediatric population.

Background: Cholesterol stones and biliary dyskinesia have replaced hemolytic disease as the primary indication for pediatric cholecystectomy. This study looks at the cohort of pediatric patients with complicated biliary disease, defined as choledocholithiasis and/or gallstone pancreatitis, to determine the incidence and best treatment options.

Methods: A retrospective review of all cholecystectomies performed over 15 years admitted to the surgical service at a single free-standing children's hospital was performed.

Surgical Diagnoses of Pancreatic Adenocarcinoma Not Found on Previous Endoscopic Ultrasound: A Case Series and Review of the Literature.

Introduction: Pancreatic cancer is a leading cause of death in North America and Western Europe with rising rates in the developing world. Endoscopic ultrasound (EUS) with FNA (fine needle aspiration) is a critical component in the evaluation and diagnosis of pancreatic lesions with a high sensitivity and specificity. In this paper, we report patients at our center who eventually developed pancreatic cancer despite an early negative EUS, and identifying factors that may result in a missed diagnosis.

Adverse outcomes and short-term cost implications of bile duct injury during cholecystectomy.

Background: Bile duct injury (BDI) is an uncommon but major complication of cholecystectomy that has a poorly defined magnitude of effect on hospital costs. This study sought to calculate the healthcare costs, length of stay, and discharge status associated with bile duct injury in patients undergoing cholecystectomy in the United States.

Methods: The Premier Healthcare Database, which comprises hospital-billing records from over 700 hospitals in the United States, was queried for all patients undergoing cholecystectomy between January 2010 and March 2018.

Safety, Efficacy, and Technical Details of Endoscopic Retrograde Cholangiopancreatography After Irreversible Electroporation for Locally Advanced Pancreatic Cancer.

Background: Patients undergoing irreversible electroporation (IRE) for locally advanced pancreatic cancer (LAPC) may experience biliary obstruction owing to inflammation generated by tumor ablation. This study assessed the safety, efficacy, and technical details of endoscopic retrograde cholangiopancreatography (ERCP) for biliary decompression after IRE.

Methods: A single-institution database of patients undergoing IRE for LAPC between 2012 and 2017 was queried for patients requiring post-IRE ERCP.

An unusual presentation of congenital superior mesenteric artery (SMA) syndrome.

A case of a 39-year-old woman diagnosed with superior mesenteric artery syndrome after a 25-year history of nausea, vomiting, and abdominal pain that began as a teenager and the absence of any significant weight loss illustrates the diagnostic complexity of this entity, particularly among teenagers and young adults who present with these symptoms. The patient underwent multiple upper endoscopies and serologic evaluations before a contrasted CT demonstrated an acutely angled SMA and duodenal compression, prompting the diagnosis of SMA syndrome. This case underscores the importance of including congenital SMA syndrome on the differential in young people without an obvious cause of persistent nausea, vomiting, and abdominal pain.

Ductal Cell Reprogramming to Insulin-Producing Beta-Like Cells as a Potential Beta Cell Replacement Source for Chronic Pancreatitis.

Islet cell auto-transplantation is a novel strategy for maintaining blood glucose levels and improving the quality of life in patients with chronic pancreatitis (CP). Despite the many recent advances associated with this therapy, obtaining a good yield of islet infusate still remains a pressing challenge. Reprogramming technology, by making use of the pancreatic exocrine compartment, can open the possibility of generating novel insulin-producing cells.

Safety and efficacy of irreversible electroporation in the treatment of obstructive jaundice in advanced hilar cholangiocarcinoma.

Background: Irreversible electroporation (IRE) has successfully been used for palliation of pancreatic and liver cancers due to its ability to ablate tumors without destroying nearby vital structures. To date, it has not been evaluated in patients with advanced hilar cholangiocarcinoma (AHC). This study presents a single-institution experience with IRE for management of obstructive jaundice in AHC.

Correlation of Biliary Colic in the Absence of Cholelithiasis with Pancreaticobiliary Obstruction.

A small fraction of patients undergoing cholecystectomy for biliary colic are subsequently diagnosed with an obstructive pancreatic head mass. We review our experience with such patients to provide insight into improving evaluation before cholecystectomy. Retrospective chart review of patients undergoing cholecystectomy from 2004 to 2015 identified six patients who underwent laparoscopic cholecystectomy for biliary colic before being diagnosed with a pancreatic head neoplasm within six months after cholecystectomy.

Predictive risk factors associated with cholangitis following ERCP.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is used for the management of many pancreaticobiliary disorders. It is generally safe with a few short-term complications. The risk factors for the development of post-ERCP cholangitis due to stent occlusion have not been previously described.

Assessing the value of endoscopic ultrasound in predicting symptom severity and long-term clinical course in chronic pancreatitis.

Background: To date, no studies have evaluated the correlation between number of endoscopic ultrasound (EUS) criteria met for chronic pancreatitis (CP) and symptom severity over the course of the disease. This study assessed the relationship between number of EUS-based diagnostic criteria for CP and CP severity over time.

Methods: A University of Louisville database was queried for patients undergoing EUS due to concern for chronic pancreatitis between 2005 and 2016.

Comparative Efficacy of Bilateral Thoracoscopic Splanchnicectomy for Intractable Pain Secondary to Pancreatic Cancer vs Chronic Pancreatitis.

Background: Splanchnicectomy has been evaluated for treatment of chronic pain in both pancreatic cancer and chronic pancreatitis patients, although its efficacy has not been compared in these 2 patient populations. This study aimed to compare bilateral thoracoscopic splanchnicectomy in treatment of abdominal pain secondary with pancreatic cancer and chronic pancreatitis.

Study Design: A University of Louisville database was evaluated from July 1998 to March 2016 for patients undergoing bilateral thoracoscopic splanchnicectomy for intractable pain secondary to pancreatic cancer (n = 48) or chronic pancreatitis (n = 75).

Endoscopic management of acute pancreatitis.

Patients presenting with acute pancreatitis can be complex on different levels. Having a multifaceted approach to these patients is often necessary with radiographic, endoscopic, and surgical modalities all working to benefit the patient. Major surgical intervention can often be avoided or augmented by therapeutic and diagnostic endoscopic maneuvers.

Evaluation and treatment of biliary leaks after gastrointestinal surgery.

Introduction: Since the introduction of laparoscopic cholecystectomy more than two decades ago, the incidence of bile duct injury has remained greater than that established during the era of open cholecystectomy.

Discussion: This article reviews the common causes of bile duct injury during laparoscopic cholecystectomy and makes recommendations that should help prevent these serious injuries from occurring.

Conclusions: The incidence of bile duct injury during laparoscopic cholecystectomy, although greater than during open cholecystectomy, can be minimized using specific operative strategies and dissection principles.

Endoscopic retrograde cholangiopancreatography and histopathology correlation for chronic pancreatitis.

Endoscopic retrograde cholangiopancreatography (ERCP) is debated as the gold standard for diagnosing and staging chronic pancreatitis (CP). The Cambridge classification grades CP on ECRP findings from normal (Grade I) to marked (Grade V). Comparison is needed with histopathology, which is considered the true gold standard to set the accuracy of any diagnostic test.

Natural orifice translumenal endoscopic drainage for pancreatic abscesses.

Background: Few series describe endoscopic drainage of pancreatic abscesses. Abscesses are complications of pancreatitis, presenting with sepsis, peritonitis, or both. This report describes the feasibility and efficacy of natural orifice translumenal endoscopic surgery for pancreatic abscesses.

An objective study of pain relief in chronic pancreatitis from bilateral thoracoscopic splanchnicectomy.

Pain from chronic pancreatitis leads to disability, malnutrition, and narcotic dependence. This study demonstrates the efficacy of bilateral thoracoscopic splanchnicectomy in reducing pain associated with chronic pancreatitis. This study reviews results from this procedure between 1998 and 2006.

Endoscopic management of postcholecystectomy bile duct strictures.

Background: Review of 1.6 million cholecystectomies, from 1992 to 1999, demonstrated a 0.5% incidence of bile duct injury, despite increasing experience with laparoscopy.

Long-term follow-up of endoscopic stenting in patients with chronic pancreatitis secondary to pancreas divisum.

Background: Pancreas divisum is the most common anatomic variant of pancreatic development and may lead to pancreatitis. This study evaluated the efficacy of endoscopic stenting in patients with chronic pancreatitis due to pancreas divisum.

Methods: Between 1993 and 2005, 32 patients with chronic pancreatitis due to pancreas divisum were treated with endoscopic stenting.