Korean J Intern Med
Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Published: March 2022
Background/aims: Different modalities have been employed to reduce the risk and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, there has been a paucity of studies comparing the efficacy of various prophylactic modalities for preventing PEP. This network meta-analysis (NMA) aimed to determine the relative efficacy of pancreatic duct stents and pharmacological modalities for preventing PEP.
Methods: We performed a systematic and comprehensive search to identify and analyze all randomized controlled studies published until June 2020 that examined the effectiveness of pancreatic duct stents, rectal non-steroidal anti-inflammatory drugs (NSAIDs) based regimens, hydration, and their combinations for the prevention of PEP. The primary outcome was the frequency of PEP. An NMA was performed to combine direct and indirect comparisons of different prophylactic modalities.
Results: The NMA included 46 studies evaluating 18 regimens in 16,241 patients. Based on integral analysis of predictive interval plots, and expected mean ranking and surface under the cumulative ranking curve values, combination prophylaxis with indomethacin + lactated Ringer's solution (LR), followed by diclofenac + nitrate and indomethacin + normal saline, was found to be the most efficacious modality for the overall prevention of PEP. Indomethacin + LR, followed by diclofenac and pancreatic duct stents, was the most efficacious modality for high-risk groups.
Conclusion: Rectal NSAIDs-based combination regimens with aggressive hydration or nitrate are superior to single modalities for the prevention of PEP.
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http://dx.doi.org/10.3904/kjim.2021.410 | DOI Listing |
J Clin Med
December 2024
Department of Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea.
/: The aim of this study is to evaluate the impact of modified Blumgart anastomosis methods during pancreaticojejunostomy (PJ) on the incidence of clinically relevant postoperative pancreatic fistula (POPF) after laparoscopic pancreaticoduodenectomy (LPD). : This is a retrospective cohort study analyzing data of patients who underwent LPD from 2018 to 2022. The primary endpoint was the incidence of grade B and C POPF based on the International Study Group on Pancreatic Fistula criteria and PJ anastomosis time.
View Article and Find Full Text PDFDiagn Pathol
January 2025
Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, P.R. China.
Background: Fasciolopsis buski is a large fluke that parasitises the human small intestine, with its infection in the biliary tract being even rarer. Given its relatively rare occurrence in recent years, the clinical diagnosis of F. buski infections can pose certain challenges.
View Article and Find Full Text PDFBackground: There is controversy regarding which is the best reconstruction technique after the pancreatoduodenectomy. Currently, there are no studies comparing the three most frequent reconstruction techniques: Whipple + Roux-en-Y gastrojejunostomy (WRYGJ), pyloric-preserving + Billroth II (PPBII), and Whipple + BII (WBII).
Methods: Between 2012 and March 2023, 246 patients underwent pancreaticoduodenectomy with the following type of reconstruction techniques: (1) WRYGJ: 40 patients; (2) PPBII: 118 patients; and (3) WBII: 88 patients.
Diabetes
January 2025
Institute of Biotechnology, National Tsing Hua University, Hsinchu, Taiwan.
Pancreatic cystic changes in adults are increasingly identified through advanced cross-sectional imaging. However, the impact of initial/intra-lobular epithelial remodeling on the local β-cell population remains unclear. In this study, we examined 10 human cadaveric donor pancreases (tail and body regions) via integration of stereomicroscopy, clinical H&E histology, and 3D immunohistochemistry, identifying 36 microcysts (size: 1.
View Article and Find Full Text PDFRev Esp Enferm Dig
January 2025
Digestive Medicine, Hospital Clinico Universitario de Valencia .
We report the case of a 24-year-old man from Brazil presenting with jaundice and epigastric pain. Abdominal CT and endoscopic ultrasound (EUS) revealed a mass in the pancreatic-duodenal groove, intrahepatic duct dilation, and lymphadenopathy, initially suggestive of lymphoproliferative syndrome. However, cytopathological analysis of EUS-guided fine needle aspiration (EUS-FNA) of the lymph nodes confirmed paracoccidioidomycosis.
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