Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial.

Background: Infected necrotising pancreatitis is a potentially lethal disease and an indication for invasive intervention. The surgical step-up approach is the standard treatment. A promising alternative is the endoscopic step-up approach.

Describing Peripancreatic Collections According to the Revised Atlanta Classification of Acute Pancreatitis: An International Interobserver Agreement Study.

Objectives: Severe acute pancreatitis is associated with peripancreatic morphologic changes as seen on imaging. Uniform communication regarding these morphologic findings is crucial for accurate diagnosis and treatment. For the original 1992 Atlanta classification, interobserver agreement is poor.

Imaging of perihilar cholangiocarcinoma.

Objective: The purpose of this article is to review imaging workup of perihilar cholangiocarcinoma, including MDCT and MRI protocols, imaging findings, differential diagnosis, and staging. A reporting template is included.

Conclusion: Imaging plays a central role in the detection, differential diagnosis, and staging of perihilar cholangiocarcinoma.

Percutaneous treatment of common bile duct stones: results and complications in 110 consecutive patients.

Background/aims: Choledocholithiasis is a common complication of cholecystolithiasis, occurring in 15-20% of patients who have gallbladder stones. Endoscopic retrograde cholangio-pancreatography is the standard treatment. When this is not possible or not feasible, percutaneous transhepatic stone removal is an alternative treatment.

Characterization and treatment of persistent hepatocellular secretory failure.

Background & Aims: Hepatocellular secretory failure induced by drugs, toxins or transient biliary obstruction may sometimes persist for months after removal of the initiating factor and may then be fatal without liver transplantation. We characterized patients with severe persistent hepatocellular secretory failure (PHSF) and treated them with the pregnane X receptor (PXR) agonist, rifampicin. We also studied the effect of rifampicin on PXR-dependent expression of genes involved in biotransformation and secretion in vitro.

Leukemia and brain tumors among children after radiation exposure from CT scans: design and methodological opportunities of the Dutch Pediatric CT Study.

Computed tomography (CT) scans are indispensable in modern medicine; however, the spectacular rise in global use coupled with relatively high doses of ionizing radiation per examination have raised radiation protection concerns. Children are of particular concern because they are more sensitive to radiation-induced cancer compared with adults and have a long lifespan to express harmful effects which may offset clinical benefits of performing a scan. This paper describes the design and methodology of a nationwide study, the Dutch Pediatric CT Study, regarding risk of leukemia and brain tumors in children after radiation exposure from CT scans.

Percutaneous balloon dilatation and long-term drainage as treatment of anastomotic and nonanastomotic benign biliary strictures.

Purpose: This study was designed to determine the effectiveness of percutaneous balloon dilation and long-term drainage of postoperative benign biliary strictures.

Methods: Medical records of patients with postoperative benign biliary strictures, in whom percutaneous transhepatic biliary drainage (PTBD) and balloon dilation was performed between January 1999 and December 2011, were retrospectively reviewed. PTBD and balloon dilation (4-10 mm) were followed by placement of internal-external biliary drainage catheters (8.

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.

Short-term effects of combined hepatic vein embolization and portal vein embolization for the induction of liver regeneration in a rabbit model.

Purpose: Alternative methods to optimize the hypertrophy response after portal vein embolization (PVE) are desired. This study assessed the effect of hepatic vein embolization (HVE) in addition to PVE on liver hypertrophy response in a standardized rabbit model.

Materials And Methods: Thirty rabbits were allocated to groups according to intervention: PVE alone, HVE alone, and a combination of HVE and PVE.

[Improved treatment results in hilar cholangiocarcinoma after transition to more extensive procedure: 20 years experience AMC].

Objective: To determine the result of surgical treatment of patients with hilar cholangiocarcinoma (HCCA) before and after the transition from predominantly local bile duct resections to more extensive resections including partial liver resection in order to achieve complete tumour resection in the Academic Medical Center, Amsterdam (The Netherlands).

Design: Retrospective and descriptive.

Methods: In the period 1988-2003, 117 consecutive patients underwent resection due to suspected HCCA.

Endothelial shear stress: a critical determinant of arterial remodeling and arterial stiffness in humans--a carotid 3.0-T MRI study.

Background: Low endothelial shear stress (ESS) elicits endothelial dysfunction. However, the relationship between ESS and arterial remodeling and arterial stiffness is unknown in humans. We developed a 3.

A step-up approach or open necrosectomy for necrotizing pancreatitis.

Background: Necrotizing pancreatitis with infected necrotic tissue is associated with a high rate of complications and death. Standard treatment is open necrosectomy. The outcome may be improved by a minimally invasive step-up approach.

Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma.

Introduction: Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCCA) requiring major liver resection. The current study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) in patients with resectable HCCA.

Methods: One hundred fifteen consecutive patients were explored for HCCA between 2001 and July 2008 and assigned by initial PBD procedure to either EBD or PTBD.

Comparison of in vivo carotid 3.0-T magnetic resonance to B-mode ultrasound imaging and histology in a porcine model.

Objectives: We compared in vivo 3.0-T magnetic resonance (MR) images of the carotid artery wall in piglets to intima-media thickness measurements of similar carotid segments by B-mode ultrasound (US) and histology to define the corresponding anatomical tissue characteristics and accuracy of carotid MR images.

Background: Carotid MR is increasingly used for the assessment of cardiovascular risk and cardiovascular drug efficacy.

Volumetric and functional recovery of the remnant liver after major liver resection with prior portal vein embolization : recovery after PVE and liver resection.

Introduction: Portal vein embolization is an accepted method to increase the future remnant liver preoperatively. The aim of this study was to assess the effect of preoperative portal vein embolization on liver volume and function 3 months after major liver resection.

Materials And Methods: This is a retrospective case-control study.

Controversies in the use of portal vein embolization.

Background/aims: Portal vein embolization (PVE) has reached worldwide acceptance to increase future remnant liver (FRL) volume before undertaking major liver resection. The aim of this overview is to point out and discuss current controversies in the application of PVE.

Methods: Review of literature pertaining to techniques of PVE, complications, tumor proliferation, timing of resection, and hypertrophy response after PVE.

Describing peripancreatic collections in severe acute pancreatitis using morphologic terms: an international interobserver agreement study.

Background/aims: The current terminology for describing peripancreatic collections in acute pancreatitis (AP) derived from the Atlanta Symposium (e.g. pseudocyst, pancreatic abscess) has shown a very poor interobserver agreement, creating the potential for patient mismanagement.

Percutaneous drainage and stenting for palliation of malignant bile duct obstruction.

Percutaneous biliary drainage and stenting (PTBD) for palliation of malignant obstructive jaundice has evolved to a safe and effective technique. PTBD is equally effective for treatment of distal and proximal bile obstruction. Metal self-expandable stents have proved superior to plastic stents and should therefore be used.

Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons.

Background: Bile duct injury (BDI) after laparoscopic cholecystectomy (LC) has an enormous socioeconomic impact on patients. BDI has been associated with severe morbidity, impaired survival, and poor long-term quality of life. This study was performed to analyze the impact of a multidisciplinary approach in BDI patients on survival.

Results of percutaneous sclerotherapy and surgical treatment in patients with symptomatic simple liver cysts and polycystic liver disease.

Aim: To evaluate the results of the treatment of simple liver cysts (solitary and multiple) and polycystic liver disease (PLD) using percutaneous sclerotherapy and/or surgical procedures in a single tertiary referral centre.

Methods: Retrospective analysis of 54 patients referred for evaluation and possible treatment of simple liver cysts (solitary and multiple) and PLD, from January 1997 to July 2006.

Results: Simple liver cysts were treated in 41 pts (76%) with a mean size of 12.

Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis.

Background: For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct.

Methods: All symptomatic patients with chronic pancreatitis and a distal obstruction of the pancreatic duct but without an inflammatory mass were eligible for the study.

A comparison of primary two- and three-dimensional methods to review CT colonography.

The aim of our study was to compare primary three-dimensional (3D) and primary two-dimensional (2D) review methods for CT colonography with regard to polyp detection and perceptive errors. CT colonography studies of 77 patients were read twice by three reviewers, first with a primary 3D method and then with a primary 2D method. Mean numbers of true and false positives, patient sensitivity and specificity and perceptive errors were calculated with colonoscopy as a reference standard.