简介:Necrotizingpancreatitisisanuncommonyetseriouscomplicationofacutepancreatitiswithmortalityratesreportedupto15%thatreach30%incaseofinfection.Traditionallyopensurgicaldebridementwastheonlytoolinourdisposaltomanagethisseriousclinicalentity.Thisapproachishoweverassociatedwithpooroutcomes.Managementhasnowshiftedawayfromopensurgicaldebridementtoamoreconservativemanagementandminimallyinvasiveapproaches.Contemporaryapproachtopatientswithnecrotizingpancreatitisand/orinfectiouspancreatitisissummarizedinthe3Ds:Delay,DrainandDebride.Patientscanbemanagedintheintensivecareunitandanyinterventionshouldbedelayed.Percutaneousdrainagecanbeutilizedfirstandearlyinthecourseofthedisease,followedbyendoscopicdrainageorvideoassistedretroperitoneoscopicdrainageifnecrosectomyisdeemednecessary.Opensurgeryisnowlessfrequentlyperformedandshouldbereservedforcasesrefractorytoanyotherapproach.Themanagementofnecrotizingpancreatitisthereforerequiresamultidisciplinarydynamicmodelofapproachratherthanbeingasurgicaldisease.
简介:TherevisedAtlantaclassificationofacutepancreatitiswasadoptedbyinternationalconsensus,andisbasedonactuallocalandsystemicdeterminantsofdiseaseseverity.Thelocaldeterminantispancreaticnecrosis(sterileorinfected),andthesystemicdeterminantisorganfailure.Localcomplicationsofpancreatitiscanincludeacuteperi-pancreaticfluidcollection,acutenecroticcollection,pseudocystformation,andwalledoffnecrosis.Interventionalendoscopicultrasound(EUS)hasbeenincreasingutilizedinmanagingtheselocalcomplications.AfterperformingaPubMedsearch,theauthorsmanuallyappliedpre-definedinclusioncriteriaorafiltertoidentifypublicationsrelevanttoEUSandpancreaticcollections(PFCs).Theauthorsthenreviewedtheutility,efficacy,andrisksassociatedwithusingtherapeuticEUSandinvolvedEUSdevicesintreatingPFCs.Duetothedevelopmentandregulatoryapprovalofimprovedandnovelendoscopicdevicesspecificallydesignedfortransmuraldrainageoffluidandnecroticdebris(accessandpatencydevices),theauthorspredictcontinuingevolutioninthemanagementofPFCs.WebelievethatEUSwillbecomeanindispensablepartofproceduresusedtodiagnosePFCsandperformimage-guidedinterventions.AfterdrainingaPFC,theamountoftissuenecrosisisthemostimportantpredictorofasuccessfuloutcome.Hence,itseemslogicaltoclassifythesecollectionsbasedontheirpercentageofnecroticcomponentordebrispresentwhenviewedbyimagingmethodsorEUS.Finally,theauthorsproposeanalgorithmformanagingfluidcollectionsbasedontheirsize,location,associatedsymptoms,internalechogenicpatterns,andcontent.
简介:Chronicpancreatitisisanongoingdiseasecharacterizedbypersistentinflammationofpancreatictissues.Withdiseaseprogression,patientswithchronicpancreatitismaydeveloptroublesomecomplicationsinadditiontoexocrineandendocrinepancreaticfunctionalloss.Amongthem,apseudoaneurysm,mainlyinducedbydigestiveenzymeerosionofvesselsinproximitytothepancreas,isarareandlife-threateningcomplicationifbleedingofthepseudoaneurysmoccurs.Atpresent,noprospectiverandomizedtrialshaveinvestigatedthetherapeuticstrategyforthisrarebutcriticalsituation.Theroleofarterialembolization,thetimingofsurgicalinterventionandevensurgicalproceduresarestillcontroversial.Inthisreview,wesuggestthatdynamicabdominalcomputedtomographyandangiographyshouldbeperformedfirsttolocalizethebleedersandtoevaluatetheassociatedcomplicationssuchaspseudocystformation,followedbyarterialembolizationtostopthebleedingandtoachieveearlystabilizationofthepatient’scondition.Withadvancesandimprovementsinendoscopicdevicesandtechniques,therapeuticendoscopyforpancreaticpseudocystsistechnicallyfeasible,safeandeffective.Surgicalinterventionisrecommendedforableedingpseudoaneurysminpatientswithchronicpancreatitiswhoareinanunstablecondition,forthoseinwhomarterialembolizationofthebleedingpseudoaneurysmfails,andwhenendoscopicmanagementofthepseudocystisunsuccessful.Ifableedingpseudoaneurysmislocatedoverthetailofthepancreas,resectionisapreferentialprocedure,whereasifthelesionissituatedovertheheadorbodyofthepancreas,relativelyconservativesurgicalproceduresarerecommended.
简介:TheTenthInternationalGastricCancerCongress(IGCC)washeldinVerona,Italy,fromJune19to22,2013.Themeetingenclosedvariousaspectsofstomachtumormanagement,includingbothtightlyclinicalapproaches,andtopicsmorerelatedtobasicresearch.Moreover,anoverviewongastrointestinalstromaltumorswasprovidedtoo,althoughherenotdiscussed.Herewewilldiscusssometopicsrelatedtomolecularbiologyofgastriccancer(GC),inherenttoprognostic,diagnosticandtherapeutictoolsshownattheconference.Resultsaboutwellknownsubjects,suchasE-cadherinlossofexpression/function,werepresented.Theyrevealedthatothermutationsofthegenewereidentified,showingacontinuousresearchtoimprovediagnosisandprognosisofstomachtumor.Simultaneously,newpossiblemolecularmarkerswithanestablishedroleforotherneoplasms,werediscussed,suchasmesothelin,stomatin-likeprotein2andNotch-1.Hence,awideoverviewincludingbotholdandnewdiagnostic/prognostictoolswasoffered.GreatattentionwasalsodedicatedtopossibledrugstobeusedagainstGC.Theyincludedmonoclonalantibodies,suchasMS57-2.1,drugsusedinotherpathologies,suchasmaraviroc,andnaturalextractsfromplantssuchasbiflorin.WewouldliketocontributetosummarizethemostimpressivestudiespresentedattheIGCC,concerningnovelfindingsaboutmolecularbiologyofgastriccancer.Althoughfurtherinvestigationswillbenecessary,itcanbeinferredthatmoreandmoretoolsweredeveloped,soastobetterfacestomachneoplasms.