Acute pancreatitis induced by transarterial chemoembolization Irigoin, Robin Rivera; Guadix, Jennifer Hinojosa; García, Manuel Ramos ...
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... et al.,
June 2019, 2019-06-00, 20190601, Letnik:
19
Journal Article
Nutritional parameters (body mass index, albumin, prealbumin, lymphocytes, magnesium, Vitamin D levels) and clinical parameters, including SIBO and EPI, were assessed. The presence of SIBO was ...verified with a glucose hydrogen methane breath test (GHMBT) and EPI with a C13 mixed triglyceride breath test (MTG-BT).
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.
Associations between possible determinants and outcome variables were assessed through binary logistic regression analysis (with sex, etiology, Charlson comorbidity score (including age) and ...recurrent AP included in the model). Independent determinants of increased morbidity and mortality (vs category with lower risk) were: persistent organ failure (POF) vs transient organ failure...
Introduction EUS-guided choledochoduodenostomy offers a less invasive option for the management of biliary obstruction due to pancreatic head tumor after failed ERCP or impossibility to reach the ...papilla. Lumen apposing metal stent (LAMS) deployment using electrocautery-enhanced catheters has decreased procedure times under one minute. Broader availability of this stents has shifted its use from highly specialized therapeutic endoscopists to others with minimal or no therapeutic experience. Although a relatively fast procedure, complications are common and management options are required. Case description We present the case of a 42-year-old patient with a non-resectable stage IV pancreatic head cancer presenting with cholangitis. The papilla was not accessible due to duodenal stricture. EUS-guided choledochoduodenostomy with an 8x8mm LAMS was performed using an electrocautery enhanced delivery cathether. Access was obtained using a free hand technique. Although the catheter appeared to be into the common bile duct (CBD) the distal flange deployed between the CBD and the duodenal wall. A guidewire was inserted and the partially deployed LAMS was removed over the wire through the scope. The stent was re-sheathed and advanced over the wire. The distal flange was deployed again between the CBD and the duodenal wall leading to the notion that the image of the guidewire into the CBD was a ghost image. The partially deployed stent was removed again over the wire and re-sheathed. Given the possibility of a ghost image we removed the guidewire and obtained access through a nearby point performing a successful delivery of the stent and creating the choledochoduodenostomy that drained pus abundantly. A perforation wasn't visible. The patient presented with mild discomfort after the procedure but no signs of perforation. Discussion Although EUS-guided choledochoduodenostomy with LAMS deployment using an electrocautery-enhanced catheter has greatly facilitated the technique broadening its use, possible complications should not be underestimated. This case highlights two practical tips: 1/ a guidewire should always be available and proficiency in over the wire exchanges is recommended; and 2/ a half deployed 6x8mm or 8x8mm LAMS using this delivery system can be safely removed through the scope. In our experience in bench models larger stents are prone to dislodge during removal obstructing the working channel.
Guía Práctica ESPEN: nutrición clínica en las enfermedades del hígado Bischoff, Stephan C; Bernal, William; Dasarathy, Srinivasan ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
04/2022, Letnik:
39, Številka:
2
Journal Article
Odprti dostop
Resumen Introducción: la Guía Práctica se basa en la actual guía científica de la ESPEN sobre nutrición clínica en las enfermedades hepáticas. Métodos: se ha reducido y transformado en diagramas de ...flujo para facilitar su uso en la práctica clínica. La guía está dedicada a todos los profesionales, incluidos médicos, dietistas, Nutriciónistas y enfermeras, que trabajan con pacientes con enfermedad hepática crónica. Resultados: la guía presenta un total de 103 pronunciamientos y recomendaciones con breves comentarios para el manejo Nutricional y metabólico de pacientes con (i) insuficiencia hepática aguda grave, (ii) esteatohepatitis alcohólica, (iii) enfermedad hepática grasa no alcohólica, (iv) cirrosis hepática, y (v) cirugía o trasplante de hígado. Conclusión: las recomendaciones relacionadas con enfermedades están precedidas por recomendaciones generales sobre el diagnóstico del estado Nutricional en los pacientes hepáticos y sobre las complicaciones hepáticas asociadas a la nutrición médica.
ESPEN Practical Guideline: clinical nutrition in liver disease Bischoff, Stephan C; Bernal, William; Dasarathy, Srinivasan ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
2022-Mar-29, Letnik:
39, Številka:
2
Journal Article
Odprti dostop
Background: the Practical Guideline is based on the current scientific ESPEN guide on Clinical Nutrition in Liver Disease. Methods: it has been shortened and transformed into flow charts for easier ...use in clinical practice. The guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with chronic liver disease. Results: a total of 103 statements and recommendations are presented with short commentaries for the nutritional and metabolic management of patients with (i) acute liver failure, (ii) alcoholic steatohepatitis, (iii) non-alcoholic fatty liver disease, (iv) liver cirrhosis, and (v) liver surgery/transplantation. Disease-related recommendations are preceded by general recommendations on the diagnosis of nutritional status in liver patients and on liver complications associated with medical nutrition. Conclusion: this Practical Guideline gives guidance to health care providers involved in the management of liver disease on how to offer optimal nutritional care.
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.
We present the case of a 60-year-old man with a history of left radical nephrectomy due to Fuhrman nuclear grade II renal carcinoma 8 years previously. Abdominal computed tomography was performed due ...to a closed abdominal injury, revealing a solid, 4-cm hypervascular mass in the head of the pancreas. The suspected diagnosis was pancreatic metastasis from renal carcinoma. Cephalic duodenopancreatectomy was performed. The diagnosis was confirmed by histopathological analysis. At 23 months of follow-up, the patient remains disease free.
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