1,720,986 research outputs found
Prevention of post-ERCP complications
No full textEndoscopic retrograde cholangiopancreatography (ERCP) is a common endoscopic procedure which plays a key
role in the management of diseases of the bile ducts and the pancreas. Despite ERCP being performed routinely
since more than 4 decades, it is still related to a considerable rate of complications with post-ERCP pancreatitis
being the most frequent one.
Lately, endoscopic techniques have evolved, and numerous modalities have been developed to prevent or
manage ERCP-related complications, especially PEP, such as the use of intra-rectal non-steroidal anti-
inflammatory drugs (NSAIDs), insertion of prophylactic stents in the pancreatic duct (PD) or intravenous
hyperhydration. Knowledge of the various risk factors and applying validated preventive methods are keys in
providing a safe procedure and optimizing overall patient care
Role of ERCP in Benign Biliary Strictures
No full textBenign biliary strictures (BBS) can be associated with several causes, with postoperative and inflammatory strictures representing the most common ones. Endoscopy represents nowadays the first-line treatment in the management of BBS. Endoscopic balloon dilatation, plastic stents placement, fully covered metal stent placement, and magnetic compression anastomosis are the endoscopic techniques available for the treatment of BBS. The aim of this study is to perform a review of the literature to assess the role of endoscopy in the management of BBS and to evaluate the application of the different procedures in the different clinical setting
Patient-Reported Outcomes for the Assessment of Sexual Health Among Patients Affected by Inflammatory Bowel Disease
No full textPatients affected by inflammatory bowel disease (IBD) frequently report impaired quality of sexual life and complain of sexual dysfunctions. Both disease-specific features and psychological factors can be held responsible for these conditions. However, sexuality and all matters relating to sexual health are often wrongfully considered unrelated to IBD and, therefore, overlooked during medical visits. To overcome these difficulties and to best assess patients' perceptions about their sexual health status, the use of patient-reported outcomes (PROs) could represent a valid strategy. In real-world studies, several non-IBD specific questionnaires, exploring different domains of sexuality, have been applied and validated for the IBD population. This review summarizes the available evidence on sexual health among IBD patients and the data supporting the application of PROs to screen the quality of sexual life, as well as the rate and types of sexual dysfunctions, among IBD patients
Intrapancreatic Fat Deposition: Cause or Consequence of First Acute Pancreatitis Attack?
No full textConsidering the scientific evidence
nowadays available, we suggest that IPFD
should be carefully differentiated between
pancreatic fat accumulation (an overflow of
fat in the pancreas in patients with adipose
excess) and fatty replacement (characterized
by a change in the cellular identity with an
acinar-to-adipocyte transdifferentiation in
patients with pancreatic damage, such as
AP). Different from the conclusions of the
authors of this study, we believe that fatty
replacement is not the “first hit” predisposing
to pancreatic disease, but the “second hit”
driving to pancreatic meta-inflammation
and chronic damage (Figure 1)
Prevention of post-ERCP pancreatitis: current strategies and novel perspectives
Full text linkEndoscopic retrograde cholangiopancreatography (ERCP) is an advanced
endoscopic procedure that might lead to severe adverse events. Post-ERCP pancreatitis (PEP) is the most common post-procedural complication, which is related to significant mortality and increasing healthcare costs. Up to now, the prevalent approach to prevent PEP consisted of employing pharmacological and technical expedients that have been shown to improve
post-ERCP outcomes, such as the administration of rectal nonsteroidal anti-inflammatory drugs, aggressive intravenous hydration, and the placement of a pancreatic stent. However, it has been reported that PEP originates from a more complex interaction of procedural and patient-related factors. Appropriate ERCP training has a pivotal role in PEP prevention strategy, and it is not a chance that a low PEP rate is universally considered one of the most relevant indicators of proficiency in ERCP. Scant data on the acquisition of skills during the
ERCP training are currently available, although some efforts have been recently done to shorten the learning curve by way of simulation-based training and demonstrate competency by meeting technical requirements as well as adopting skill evaluation scales. Besides, the identification of adequate indications for ERCP and accurate pre-procedural risk stratification of patients might help to reduce PEP occurrence regardless of the endoscopist’s technical
abilities, and generally preserve safety in ERCP. This review aims at delineating current preventive strategies and highlighting novel perspectives for a safer ERCP focusing on the prevention of PEP
Endoscopic electroincision of challenging benign biliopancreatic strictures
Full text linkBackground and study aims Endoscopic drainage of benign biliary and pancreatic strictures can be challenging, especially when tightness of the stenosis does not allow passage of mechanical and pneumatic dilation catheters. Electroincision of benign biliopancreatic can be considered in selected cases.Patients and methods Three male patients (mean age 33 years, range 9-60) underwent endoscopic retrograde cholangiopancreatography to drain anastomotic biliary stricture (ABS) following orthotopic liver transplantation (n =2) and pancreatic duct stenosis due to abdominal trauma (n= 1). The biliopancreatic strictures could be passed only with a thin 0.020-inch hydrophilic guidewire. Conventional mechanical and pneumatic dilators failed to pass the strictures due to weakness of the guidewire. Therefore, electrosurgical incision by over-the-wire 6Fr cystotome or needle-knife was attempted using pure cut current.Results The two cases of ABS were approached also by cholangioscopy and the 6Fr cystotome easily passed the strictures, allowing subsequent pneumatic dilatation and insertion of multiple plastic stents. The patient with a pancreatic duct stricture underwent electrosurgical incision using a thin needle knife over-the-wire, resulting in insertion of a 7Fr pancreatic stent. No adverse events occurred; all the patients were discharged within 24 to 48 hours
Magnetic kissing for the endoscopic treatment of a complete iatrogenic stenosis of the hypopharynx
No full textComplete hypopharyngeal stenosis is rare and challenging to treat. A
72-year-old man underwent total laryngectomy with bilateral radical neck dissection, total thyroidectomy, and pectoralis major myocutaneous flap reconstruction to treat laryngeal cancer. Following adjuvant radiotherapy, the patient developed an hypopharyngeal stenosis. This was initially treated with endoscopic dilations. However, after 3 years, stricture recurrence led to complete obstruction of the hypopharyngeal lumen that required placement of a percutaneous endoscopic gastrostomy tube for nutrition. After failure of endoscopic ultrasound-guided recanalization, an endoscopic magnetic compression anastomosis was attempte
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Time is over: Step back to reusable and step forward to recyclable!
No full textWe read with deep interest the position paper from the Italian
Association of Hospital Gastroenterologists and Digestive Endoscopists
(AIGO) reviewing the environmental impact of gastroenterology
and digestive endoscopy. Interestingly the position
paper provides information on the carbon footprint of gastroenterology
and particularly digestive endoscopy. Impressively, gastroenterology
is considered the third largest contributor to waste
production in healthcare.
ERCP accounts only for
the 8% of procedures performed, it accounts for more than 30% of
waste generated. This result can be explained because ERCP is frequently
performed under general anesthesia generating therefore
more waste, and because during ERCP a large number of disposable
devices (guidewires, cannulotomes, balloons, baskets etc.) is used
if compared with other endoscopic procedures
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