BACKGROUND AND STUDY AIMS: Although endoscopic ultrasound (EUS)-guided transmural drainage (EUD) is preferred over conventional transmural drainage (CTD) of pancreatic pseudocysts by endoscopy in many centers, its superiority with respect to technical success and clinical outcome has not yet been demonstrated in a prospective randomized trial. We conducted this prospective ...

BACKGROUND: Oxidative stress (OS) in acute pancreatitis (AP) has been pathologically linked with the systemic inflammatory response and antioxidant supplementation may have a clinical benefit. METHODS: In this prospective, randomised open label, controlled pilot study, patients admitted within 72 hours of onset of pain were randomised to receive either placebo ...

OBJECTIVES: To evaluate the efficacy and safety of ultrasound-guided percutaneous catheter drainage (PCD) treatment for severe acute pancreatitis compared to conservative and conventional surgical treatments. METHODS: Eighty-one patients with severe acute pancreatitis (SAP) were admitted and divided into three groups: forty-nine cases in the conservative therapy group; nineteen cases in ...

We developed the Imaizumi modification of the Beger procedure, a duodenum-preserving pancreatic head resection. The Imaizumi modification allows for removal of more of the subtotal pancreatic head than in the conventional Beger procedure, including the intrapancreatic bile duct, for chronic pancreatitis with common bile duct stenosis. A retrospective study was ...

INTRODUCTION: Total pancreatectomy (TP) is associated with significant metabolic abnormalities leading to considerable morbidity. With the availability of modern pancreatic enzyme formulations and improvements in control of diabetes mellitus, the metabolic drawbacks of TP have diminished. As indications for TP have expanded, we examine our results in patients undergoing TP. ...

The protease inhibitors, nafamostat and gabexate, have been used to prevent pancreatitis related to endoscopic retrograde cholangiopancreatography (ERCP). In vitro, nafamostat inhibits the pancreatic protease activities 10-100 times more potently than gabexate. We evaluated the efficacy of nafamostat for prophylaxis against post-ERCP pancreatitis in comparison with gabexate. Five hundred patients ...

AIM: To assess the efficacy of intramuscular diclofenac and fluid replacement for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. METHODS: A prospective, placebo-controlled study was conducted in 80 patients who underwent ERCP. Patients were randomized to receive parenteral diclofenac at a loading dose of 75 mg followed by the infusion ...

BACKGROUND: Pancreaticoduodenectomy and distal pancreatectomy for lesions of the neck or body of the pancreas sacrifice a large amount of normal pancreatic tissue. Middle pancreatectomy (MP) is a parenchyma sparing technique that reduces the risk of postoperative endocrine and exocrine insufficiency. This study aims to evaluate the perioperative and long-term ...

INTRODUCTION: There is some controversy concerning the choice of best technique for drainage of exocrine secretions in pancreas transplantation. We compared patients with bladder drainage (BD) versus those with enteric drainage (ED). PATIENTS AND METHODS: From March 1995 to September 2008, 118 patients (68 men and 50 women) of overall ...

BACKGROUND: The value of prophylactic gastroenterostomy (usually combined with a biliary bypass) in patients with unresectable cancer of the pancreatic head is controversial. METHODS: A systematic review of retrospective and prospective studies, and a meta-analysis of prospective studies, on the use of prophylactic gastroenterostomy for unresectable pancreatic cancer were performed. ...

BACKGROUND: ERCP can be associated with serious complications. Difficulty in common bile duct (CBD) cannulation is one of the main risk factors for post-ERCP pancreatitis. The double-guidewire technique (DGT) has been considered a promising alternative approach in difficult cannulation situations. OBJECTIVE: To compare the performance of DGT with the standard ...

INTRODUCTION: A central pancreatectomy is a parenchyma-sparing procedure that is performed to reduce long-term endocrine and exocrine insufficiency. METHOD: In this study, we analyzed the perioperative course, the frequency of postoperative onset of diabetes mellitus, and long-term change of body weight in patients undergoing a central pancreatectomy, in comparison to ...

We used a rat model of pancreas cold preservation to assess its effects on islets. Glands were surgically retrieved and stored in University of Wisconsin (UW) solution for 3 hours (Short) or 18 hours (Long) cold ischemia time (CIT). Islet yield was significantly lower in the Long-CIT than the Short-CIT ...

OBJECTIVES: Pancreatic fistula (PF) predicts mortality and morbidity in patients undergoing pancreaticoduodenectomy (PD). This study aimed to assess whether isolated Roux loop pancreaticojejunostomy (IPJ) is superior to conventional pancreaticojejunostomy (CPJ). METHODS: Between September 2003 and July 2007, we performed 108 PDs. All patients underwent classical Kausch-Whipple PD with pancreaticojejunostomy (PJ). ...

To evaluate if percutaneous drainage of sterile fluid collections recurring after initial aspiration in acute pancreatitis yields better results than their conservative management. Fifty-eight patients with fluid collections in acute pancreatitis were followed up prospectively. Forty of them with sterile fluid collections that recurred after initial aspiration were randomly assigned ...

Posterior approach pancreatoduodenectomy (paPD) technique is one of the many modifications of the standard Whipple procedure (sPD). The most important modification of the technique is first approach of the superior mesenteric artery, thus enabling a complete dissection of the right side of this artery and of the portal vein, as ...

BACKGROUND: The present study reports functional and morphological changes noted over long-term follow-up in patients with severe acute pancreatitis. METHODS: Thirty patients who had completed at least 6 months after recovery were included. Fecal fat, urinary D-xylose, blood sugar, C-peptide, pancreatic changes, and recurrences were studied. RESULTS: Etiology was gallstones ...

OBJECTIVE: Acute pancreatitis is the most dreaded complication of ERCP. Two studies have shown a significant effect of glyceryl nitrate (GN) in preventing post-ERCP pancreatitis (PEP). We wanted to evaluate this promising effect in a larger study with a realistically precalculated incidence of PEP. DESIGN/PATIENTS: A randomized, double-blind, placebo-controlled multicenter ...

OBJECTIVES: The aim of this study was to evaluate the efficacy of intrathecal narcotics pump (ITNP) as an alternative treatment for patients with pain from chronic pancreatitis (CP). ITNP offers the advantages of reversibility, lower total narcotic dose, and the pancreas remaining intact. METHODS: Thirteen patients (8 female, 5 male), ...

AIM: To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography (PEP). METHODS: One hundred and seventy patients were enrolled and randomized to two groups: a study group (n = 85) who received 300 mg of oral allopurinol at 15 h and 3 h before ...

OBJECTIVE: To study the effect of low molecular weight heparin (LMWH) in the treatment of severe acute pancreatitis (SAP). METHODS: A total of 265 SAP patients were randomly divided into two groups: firstly, the conventional treatment group (C group, n = 130; and secondly the conventional treatment plus the LMWH ...

BACKGROUND: A gastroenterostomy is the most commonly performed palliative procedure in patients with gastroduodenal outflow obstruction (GOO) caused by unresectable advanced gastric and pancreatic cancer. We developed a new technique--modified Devine exclusion with vertical stomach reconstruction--and evaluated the efficacy of this procedure. METHODS: We retrospectively studied 60 patients who underwent ...

BACKGROUND: The aim of this study was to evaluate the safety of performing a pancreaticojejunostomy with a duct-to-mucosa anastomosis without a stenting tube. METHODS: One hundred twenty-one patients with pancreaticojejunostomy, classified into 2 groups of those with duct-to-mucosa anastomoses with stenting tubes (group A; n = 49) and without stenting ...

BACKGROUND AND AIMS: This study addresses whether antibiotic prophylaxis is beneficial for acute necrotizing pancreatitis. METHODS: This randomized, controlled trial enrolled 276 patients with severe acute pancreatitis. There were 56 patients with 30% or more necrosis proved by contrast-enhanced computerized tomography who were eligible for randomization: 29 in the study ...

Extracorporeal high-intensity focused ultrasound (HIFU) can be used to ablate tissue noninvasively by delivering focused ultrasound energy from an external source. HIFU for clinical treatment of pancreatic cancer has been reported; however, systematic evaluation of the safety and efficacy of pancreatic ablation with HIFU has not been performed. The objectives ...

OBJECTIVES: Some patients with chronic pancreatitis present recurrent flare-ups of pancreatitis and/or unrelenting pain. Current management is mostly limited to analgesics and surgery. We reasoned that anti-inflammatory radiotherapy, which has proven useful to alleviate other painful inflammatory painful disorders, might prove valuable for severely symptomatic patients with chronic pancreatitis. METHODS: ...

When considering surgery for branch duct-intraductal papillary mucinous neoplasms (BD-IPMNs) with suspected malignancy, it should be recognized that these lesions are frequently multifocal and are usually found in elderly patients with potential comorbidities that could affect the outcome of surgery. Clinical trials of chemoprevention have been conducted for a wide ...

BACKGROUND: In duodenoscopy, during endoscopic retrograde cholangiopancreatography (ERCP), a backward-oblique angle duodenoscope (BOAD) is generally used. In Japan, 15 degrees BOAD are mainly used, but in Western countries, 5 degrees BOAD are mostly used. In bile duct cannulation associated with ERCP, a catheter for contrast imaging is used in Japan, ...

AIM: Acute pancreatitis (AP) is fatal when severe and oxidative stress (OS) is postulated to play an important role in its pathophysiology and the development of complications. OS and antioxidant status therefore need to be profiled during early AP. METHODS: Patients presenting to the Gastroenterology wards with early AP i.e. ...

OBJECTIVES: This study examined 85 consecutive patients undergoing total pancreatectomy (+/-islet cell transplant), examining pain relief, insulin requirements, and glycemic control postoperatively. METHODS: A prospective database of all patients undergoing total pancreatectomy for chronic pancreatitis was used to record preoperative and postoperative details from 1996 to 2006. RESULTS: There were ...

OBJECTIVES: Live demonstrations of endoscopic retrograde cholangiopancreatography (ERCP) have a high educational value and contribute significantly to endoscopy development and training. However, the success and safety of live demonstration have been questioned. The aim of this study was to evaluate the success rate and complications of therapeutic ERCP among patients ...

PURPOSE: Frey's procedure for chronic pancreatitis (CP) has been minimized gradually in our institution in recent years. We compared the functional outcome of minimized Frey's procedure with that of modified Frey's procedure to establish how deeply and widely we should cut into the head of the pancreas. METHODS: Between January ...

Hypertriglyceridemia (hyperTG) is a common form of dyslipidemia and is frequently associated with premature coronary disease, and when severe, recurrent events of pancreatitis may occur. The management of hyperTG is generally medical (life style modification, medications). Plasma exchange (PE) has been reported to be useful in emergency situations particularly when ...

OBJECTIVE. To evaluate the efficacy of continuous high-volume hemofiltration for the treatment of severe acute pancreatitis patients and the impact of acute physiology and chronic health evaluation (APACHE) II score on the efficacy of high-volume hemofiltration. MATERIAL AND METHODS. A total of 63 patients diagnosed with severe acute pancreatitis between ...

OBJECTIVE: The aim of this study was to evaluate the negative effects of the Pringle maneuver on pancreatic tissue with respect to the time of performing the maneuver. Moreover, the efficacy of octreotide therapy on pancreatic changes at the time of the Pringle maneuver was assessed. ANIMALS: Fifty male Wistar ...

BACKGROUND: Gallstones represent the most common cause of acute pancreatitis in Sweden. Epidemiological data concerning timing of cholecystectomy and sphincterotomy in patients with first attack of mild acute biliary pancreatitis (MABP) are scarce. Our aim was to analyse readmissions for biliary disease, cholecystectomy within one year, and mortality within 90 ...

BACKGROUND/AIMS: We evaluated the impact of the initial intravenous fluid resuscitation rate within the first 24 h of presentation to the emergency room on important outcomes in severe acute pancreatitis. METHODS: Patients presenting directly with a diagnosis of severe acute pancreatitis were identified retrospectively. Patients were divided into two groups ...

BACKGROUND: Pancreaticojejunal anastomotic leakage remains a major complication after pancreatoduodenectomy, and various means of preventing pancreatic leakage have been studied over the past few decades. The purpose of this study was to determine whether closed suction drainage provided a better option than gravity drainage in pancreaticojejunostomy. METHODS: Between 2004 and ...

BACKGROUND: Early delayed gastric emptying (DGE) is the most common complication after pylorus-preserving pancreatoduodenectomy (PpPD). Recently, a vertical antecolic reconstruction for duodenojejunostomy was recommended to decrease the incidence of early DGE in patients with Billroth II-type reconstruction after PpPD. However, Billroth I-type reconstruction (B-I) after PpPD is still favored in ...

BACKGROUND: Pancreas transplantation (PT) remains the only treatment that can restore insulin independence among insulin-dependent diabetics. An ageing population in developed countries has led to an increasing number of older patients who may be suitable for PT. Some investigators argue that PT in recipients older than 50 years has an ...

BACKGROUND: The unique clinical role of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating biliary tree diseases cannot be completely replaced by other modern imaging modalities such as magnetic resonance cholangiopancreatography. However, post-ERCP pancreatitis is one of the most common and life-threatening complications. Prophylactic medication in the prevention of pancreatitis ...

BACKGROUND: Data on enhanced recovery programmes after pancreatic surgery are sparse. This retrospective cohort study, using historical controls, aimed to evaluate the impact of a fast-track programme after pancreaticoduodenectomy (PD). METHODS: Between 2004 and 2007, 252 patients undergoing PD were treated by a fast-track programme that included earlier postoperative feeding ...

OBJECTIVES: Despite the International Study Group for Pancreatic Fistulae (ISGPF) definition, there exist reports of postoperative collections of uncertain etiology. There is a recent report questioning the ISGPF criteria's ability to accurately predict pancreatic anastomotic failure and outlining new criteria. We decided to validate both proposed criteria based on our ...

INTRODUCTION: Splenectomy is routinely performed in conventional distal pancreatectomies. Spleen removal with its possible sequelae of infections and haematological complications has prompted the development of spleen-preserving techniques. This study aimed to evaluate the safety and clinical outcomes of distal pancreatectomy with preservation of the spleen. METHODS: A retrospective review of ...

INTRODUCTION: Various surgical techniques are used to manage problematic drooling. These include: (1) re-routing of the submandibular ducts/excision of the sublingual glands (group 1), (2) excision of the submandibular glands/parotid duct ligation (group 2), and (3) ligation of the parotid and submandibular ducts (group 3). PURPOSE: To compare the long-term ...

HYPOTHESIS: Postoperative pancreatic fistula (POPF) is one of the most severe surgical complications of pancreatoduodenectomy (PD) with pancreaticojejunostomy (PJ) reconstruction. Recently, POPF has been classified as grade A, B, or C. Relaparotomy is mandatory for POPF associated with sepsis or hemorrhage (grade C). Peripancreatic drainage and completion pancreatectomy are the ...

AIM: To review our cases of congenital cystic adenomatoid malformation (CCAM) with special emphasis on the management of prenatally diagnosed asymptomatic CCAM (PDA-CCAM). METHODS: A total of 42 consecutive CCAM patients treated between 1990 and 2008 at our institution and affiliated hospitals were divided into four groups, according to whether ...

OBJECTIVE: The aim of this study was to summary the experiences and lessons from periduodenal perforations related to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). METHODS: A retrospective review from 2004 to 2007 identified 9 patients (0.37%) of periduodenal perforation related to ERCP/EST. Charts were reviewed for the following ...

INTRODUCTION/AIM: Periampullary diverticula (PAD) discovered incidentally during endoscopic retrograde cholangiopancreatography are usually asymptomatic, but can be a source of significant morbidity. The size of the diverticula and position of the papilla in relation to the diverticula are variable. The twofold aim of this study was to determine the prevalence of ...

BACKGROUND: Preoperative endoscopic pancreatic sphincterotomy (EPS) has been proposed to prevent postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) or enucleation (EN). The use of EPS as a curative treatment for POPF has been scarcely reported. We reported 10 consecutive patients who were successfully treated by EPS for a prolonged ...