OBJECTIVE:To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery.
BACKGROUND:EPI is a common complication after pancreatic ...surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients.
METHODS:Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement.
RESULTS:These guidelines analyze the definition of EPI after pancreatic surgery, (one question), its frequency after specific techniques and underlying disease (four questions), its clinical consequences (one question), diagnosis (one question), when and how to treat postsurgical EPI (two questions) and its impact on the quality of life (one question). Eleven statements answering those 10 questions were providedone (9.1%) was rated as a strong recommendation according to GRADE, three (27.3%) as moderate and seven (63.6%) as weak. All statements had strong agreement.
CONCLUSIONS:EPI is a frequent but under-recognized complication of pancreatic surgery. These guidelines provide evidence-based recommendations for the definition, diagnosis, and management of EPI after pancreatic surgery.
Splanchnic vein thrombosis (SVT) is a well-recognised though little-studied complication in acute pancreatitis (AP). SVT risk factors, its clinical consequences and the role of anticoagulation (AC) ...therapy is scarce.
To evaluate the incidence and natural history of SVT in AP.
Post hoc analysis of a prospective multicentre cohort study involving 23 hospitals in Spain. AP complications were identified by computer tomography, and patients with SVT were re-evaluated after two years.
A total of 1655 patients with AP were included. The overall incidence of SVT was 3.6%. SVT was significantly associated with male gender, younger age and alcoholic aetiology. Every local complication increased SVT incidence, and this risk rose gradually with larger extension and infection of necrosis. These patients had a longer hospital stay and underwent a greater number of invasive treatments, regardless of AP severity. Forty-six patients with SVT were followed up. SVT resolution rate was 54.5% in the AC group and 30.8% in the non-AC group with lower thrombotic complications in the SVT resolution group (83.3% vs 22.7%; p<0.001). No AC-related adverse events occurred.
This study identifies the risk factors and negative clinical impact of SVT in AP. Our results justify future trials to demonstrate the role of AC in this clinical scenario.
The incidence of pancreatic cancer (PC) in Spain has progressively increased over the past 6 decades. Pancreatic ductal adenocarcinoma represents over 80 % of all pancreatic neoplasms. The study by ...Enrique Gili-Ortiz on pancreatic cancer-related mortality trends in Spain revealed a significant increase in death rates in our country, which may be partly attributed to population ageing and increased smoking, obesity, and diabetes rates. Other known factors, including chronic pancreatitis, seem to play a less significant role from a quantitative perspective.
Multicenter study on the safety of bariatric endoscopy Espinet Coll, Eduardo; Nebreda Durán, Javier; López-Nava Breviere, Gontrand ...
Revista española de enfermedades digestivas,
05/2017, Letnik:
109, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Bariatric endoscopy includes a series of specific techniques focused on the management of obese patients. As a quality criterion, safety as expressed by a minimal incidence of serious complications ...is required in addition to efficacy.
A descriptive, retrospective, multicenter review of the experience recorded at seven hospitals included in the Grupo Español de Endoscopia Bariátrica (GETTEMO) in order to document the incidence, cause, and resolution (including legal consequences) of serious complications reported for each bariatric technique, and according to endoscopist expertise.
In all, 6,771 bariatric endoscopic procedures were collected, wherein 57 serious complications (0.84%) were identified. Balloons: Orbera®-Medsil®, 5/5,589; Spatz2® (older model): 44/225; Heliosphere®: 1/70; Obalon®: 0/107. Sutures: POSE®, 5/679; sleeve gastroplasty with Apollo® system: 0/55. Prostheses: Endobarrier®: 2/46. All complications were resolved with medical/endoscopic management except for five cases (0.07%) that required surgery. A single lawsuit occurred (esophageal perforation with Spatz2® balloon), which had a favorable outcome. There was no mortality, and apparently no differences were found according to endoscopist expertise level.
In our multicenter experience, bariatric endoscopy may be considered as a safe procedure (0.84% of serious complications in all). However, some devices may induce a higher proportion of complications, such as 19.55% for Spatz2® balloons (already replaced) or 4.34% for Endobarrier® sleeves (at the upper limit of accepted safety), although our experience with the latter is limited. All complications were resolved with conservative medical management, and only exceptionally required surgery (0.07%). No technique-related mortality was seen, and only one lawsuit occurred. Further evolutionary studies are required on the novel endoscopic techniques presently emerging to authenticate our results.
A Rare Cause of Biliary Colics Fernandez-Urien, Ignacio; Marra-López, Carlos; Jiménez, Javier
Gastroenterology (New York, N.Y. 1943),
10/2014, Letnik:
147, Številka:
4
Journal Article
Spanish Consensus Document on Bariatric Endoscopy. Part 1. General considerations Espinet Coll, Eduardo; López-Nava Breviere, Gontrand; Nebreda Durán, Javier ...
Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva,
06/2018, Letnik:
110, Številka:
6
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
Obesity is a chronic multifactorial, incurable, recurrent, and progressive disease associated with significant physical and psychological complications, and considerable morbidity and mortality. For ...this reason, the assessment, management, and follow-up of obese patients should take place in the setting of a multidisciplinary unit equipped with adequate human and structural resources. Medical treatment using hygienic-dietary measures, while indispensable, may be insufficient, and surgery, which is reserved for severe or morbid obesity, is not exempt from complications neither is to the liking of many patients. In this context three situations may be considered where endoscopic treatment, used as a supplementary strategy with few complications, contributes to benefit obese patients: first, in a subgroup of patients with grade-II overweight or non-morbid obesity where medical therapy alone failed or needs supplementation. Second, in patients with morbid obesity when surgery is rejected, is contraindicated, or entails excessive risk. Finally, in patients with superobesity who need to lose weight before bariatric surgery in order to reduce surgery-related morbidity and mortality. In this regard, the Spanish Task Force on Bariatric Endoscopy (Grupo Español de Trabajo para el Tratamiento Endoscópico del Metabolismo y la Obesidad, GETTEMO) have developed this Consensus Document to serve as practical guidance for all professionals involved in the endoscopic management of obesity, and to facilitate establishing a minimum set of requirements for the proper functioning of a bariatric endoscopy unit.
ABSTRACT
Astrophysical surveys rely heavily on the classification of sources as stars, galaxies, or quasars from multiband photometry. Surveys in narrow-band filters allow for greater discriminatory ...power, but the variety of different types and redshifts of the objects present a challenge to standard template-based methods. In this work, which is part of a larger effort that aims at building a catalogue of quasars from the miniJPAS survey, we present a machine learning-based method that employs convolutional neural networks (CNNs) to classify point-like sources including the information in the measurement errors. We validate our methods using data from the miniJPAS survey, a proof-of-concept project of the Javalambre Physics of the Accelerating Universe Astrophysical Survey (J-PAS) collaboration covering ∼1 deg2 of the northern sky using the 56 narrow-band filters of the J-PAS survey. Due to the scarcity of real data, we trained our algorithms using mocks that were purpose-built to reproduce the distributions of different types of objects that we expect to find in the miniJPAS survey, as well as the properties of the real observations in terms of signal and noise. We compare the performance of the CNNs with other well-established machine learning classification methods based on decision trees, finding that the CNNs improve the classification when the measurement errors are provided as inputs. The predicted distribution of objects in miniJPAS is consistent with the putative luminosity functions of stars, quasars, and unresolved galaxies. Our results are a proof of concept for the idea that the J-PAS survey will be able to detect unprecedented numbers of quasars with high confidence.
OBJECTIVE:The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated ...with worse outcomes.
SUMMARY OF BACKGROUND DATA:AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease.
METHODS:A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity.
RESULTS:A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality.
CONCLUSION:The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.
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