BACKGROUND: This study was designed to evaluate the surgical outcomes of an alternative method of pancreaticojejunostomy and pancreaticogastrostomy according to the size of the remnant pancreatic duct following pancreaticoduodenectomy. METHODS: Eighty-four patients who underwent pancreaticoduodenectomy by the same surgeon were retrospectively reviewed from February 1997 to December 2004. Pancreaticojejunostomy for ...

This article reviews the current rate of intraoperative and postanesthesia complications in an acute care hospital and Level II Trauma center. One thousand patients were assessed for intraoperative and postoperative complications and compared with a previous study from 1991 in a different institution. The overall rate of complications in this ...

OBJECTIVE: To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acute cholecystitis. METHODS: A cross-sectional study was conducted in Faghihi and Namazee Hospitals between September 1999 to August 2004. All files of patients with definite diagnosis of gallstone induced acute cholecystitis were reviewed for ...

BACKGROUND AND STUDY AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is an important gastrointestinal endoscopic procedure in the study and treatment of pancreaticobiliary diseases. The critical step of the procedure is cannulation of the common bile duct (CBD) and/or the pancreatic duct. Cannulation can be a technical challenge at times. Fat is ...

BACKGROUND: Therapeutic ERCP has an established role in the treatment of pancreatobiliary diseases, but little information is available on the outcomes of this procedure in patients 90 years of age and older. OBJECTIVE: To evaluate the efficacy and the safety of therapeutic ERCP in an extremely elderly cohort. DESIGN: Retrospective ...

OBJECTIVES: Involvement of the pancreas in systemic lupus erythematosus is rare. The purpose of this article is to provide a detailed review of lupus-associated pancreatitis. METHODS: We describe 3 patients with lupus-associated pancreatitis and review the English literature of the last 30 years, including the demographic, clinical, therapeutic, and prognostic ...

OBJECTIVE: The aim of this study was to compare long-term recurrence and death rates after a first episode of acute pancreatitis in patients with and without gallstones. Additionally, it was of interest to find out if there were factors predictive of readmission or death. MATERIAL AND METHODS: Over a period ...

BACKGROUND: The management of acute pancreatitis (AP) is still based on speculative and unproven paradigms in many centers. Therefore, we performed an evidence-based analysis to assess the best available treatment. METHODS: A comprehensive Medline and Cochrane Library search was performed evaluating the indication and timing of interventional and surgical approaches, ...

OBJECTIVE: To compare the efficacy of endoscopic retrograde cholangiopancreatography +/- endoscopic sphincterotomy (ERCP +/- ES) versus traditional conservative management in early gallstone pancreatitis with persistent ampullary obstruction (GSP + AO). SUMMARY BACKGROUND DATA: The effectiveness of early ERCP +/- ES in this setting is controversial. METHODS: Sixty-one consecutive patients with ...

OBJECTIVE: To carry out a meta-analysis of published studies in order to evaluate the clinical efficacy of prophylactic antibiotics in severe acute pancreatitis (SAP). MATERIAL AND METHODS: MEDLINE, China Biological Medicine, Embase and Cochrane Data Base for Systematic Reviews were searched for randomized controlled trials on the efficacy of prophylactic ...

OBJECTIVE: To evaluate the efficacy of octreotide in the treatment of chemoradiotherapy (CRT)-induced diarrhea (CRTID) refractory to conventional loperamide treatment in this pilot study. METHODS: Forty-two rectal carcinoma (T(3-4)N(0-2)M(0)) patients with grade 2 or 3 diarrhea refractory to loperamide were enrolled to receive octreotide. Eligible patients were treated with pelvic ...

BACKGROUND AND OBJECTIVE: The use of antibiotics in acute pancreatitis despite recent clinical trials remains controversial. The aim of this study is to review the latest clinical trials and guidelines about antibiotics in acute pancreatitis and determine its proper use. METHODS: Through a Medline search, we selected and analyzed pertinent ...

BACKGROUND/PURPOSE: The Achilles' heel of operative pancreatectomies is the pancreaticoenterostomy for proximal resections and the pancreatic parenchymal closure for distal resections. Inhibition of pancreatic exocrine secretions by somatostatin analogues has been suggested to decrease pancreas-specific complications, but this topic remains controversial. METHODS: We performed a randomized, prospective, placebo-controlled, multicenter trial ...

PURPOSE: Pancreatitis has been reported long after total choledochal cyst excision. The aim of this study was to determine if the disease process of postoperative pancreatitis differs between a primary and secondary cyst excision in a long-term follow-up. METHODS: Among 53 postoperative patients who underwent a total cyst excision and ...

CONTEXT: Pancreaticoduodenectomy continues to have a high morbidity (40-50%). Major complications of pancreaticoduodenectomy include leaks from the pancreaticojejunostomy and an intra-abdominal bleed from the gastroduodenal artery stump. The omentum has been used for the prevention of anastomotic leaks. OBJECTIVES: The use of omental flaps to prevent a pancreaticojejunostomy leak and ...

OBJECTIVE: We investigated the long-term outcome of autoimmune pancreatitis (AIP) including morphological changes in the pancreas, pancreatic duct, biliary tract, pancreatic function, and changes in the clinical manifestations after oral prednisolone (PSL) therapy. PATIENTS AND METHODS: We prospectively followed 12 patients for a period of over 12 months (median follow-up ...

Solid pseudopapillary neoplasm of pancreas (SPN) is a rare entity; therefore proper diagnosis, evaluation and formulation of treatment protocols is difficult. A total of 14 cases were diagnosed and treated at our institute over a 10-year period (1992-2002). A retrospective study of all these cases was performed with respect to ...

AIM OF THE STUDY: Cystic dystrophy in heterotopic pancreas (CDHP) is rare. The aim of this study was to evaluate the diagnosis, management, and follow-up of the CDHP. PATIENTS AND METHODS: Between August 1990 and March 2004, 12 patients with CDHP underwent a duodenopancreatectomy. The patients were retrospectively reviewed. RESULTS: ...

BACKGROUND: Neoadjuvant chemoradiotherapy (neo-CRT) is being used with increasing frequency for periampullary tumors, but how it alters the complication rate of pancreaticoduodenectomy (PD) is unclear. METHODS: A retrospective analysis was conducted of 79 patients with periampullary malignancies who received 5-fluorouracil-based neo-CRT followed by PD. RESULTS: There was no difference in ...

This study was performed to analyze the efficacy of the prophylactic use of octreotide (Novartis, Stein, Switzerland) for pancreatic fistula following a pancreaticoduodenectomy. The medical records of 190 patients who underwent a pancreaticoduodenectomy at the Samsung Medical Center in Seoul, Korea between January 2000 and December 2002 were reviewed. Patients ...

BACKGROUND/AIMS: Severe acute pancreatitis is associated with microcirculatory impairment, increased gut permeability and metabolic changes. The aim of the present study was to evaluate initial fluid resuscitation and nutritional support versus outcome in patients with severe acute pancreatitis. METHODS: All cases of acute pancreatitis admitted 1994-2003 were analyzed retrospectively. The ...

OBJECTIVE: To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospective and randomized setting. SUMMARY BACKGROUND DATA: While several techniques have been proposed for reconstructing pancreatico-digestive continuity, only a limited number of randomized studies have been carried out. METHODS: A total of 151 patients undergoing pancreaticoduodenectomy with ...

OBJECTIVE: To evaluate the capacity of enteral nutrition, in comparison with the total parenteral nutrition (TPN) plus antibiotic therapy, for avoiding pancreatic necrosis infection in the severe acute pancreatitis. METHODS: In the period between October 1998 and September 2003, 87 patients met the inclusion criteria and took part in this ...

BACKGROUND: Nowadays, there is a remarkable rise in resectability rate of periampullary adenocarcinoma and the mortality and morbidity of the pancreaticoduodenectomy procedure have been reduced remarkably, while the 5 year survival rates of patients with carcinoma of the head of the pancreas are still below 25%. We conducted this retrospective ...

BACKGROUND AND PURPOSE: Some patients with chronic pancreatitis may require surgery, mainly because of disabling medically intractable pain, suspicion of malignancy or complications related to chronic pancreatitis. This study analyzed the efficacy of pancreaticoduodenectomy (PD) for patients with chronic pancreatitis in terms of pain relief, control of local complications and ...

INTRODUCTION: As the population ages, the incidence of biliary tract pathologies also increases, leading to an increase in the demand for endoscopic retrograde cholangiopancreatography (ERCP) interventions. Our aims are to assess the outcomes, safety and complications associated with ERCP performed in an elderly population. METHODS: Patients aged 80 years or ...

OBJECTIVE: In this study we aimed to compare the utility and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly and younger groups of people. METHODS: The study involved 299 patients who underwent ERCP for the first time between March 2002 and January 2003. Group A consisted of 202 patients who ...

The incidence of acute pancreatitis varies considerably between regions and is estimated at 5-80 per 100,000 population. The mortality rate of acute edematous-interstitial pancreatitis is below 1%, whereas 10-24% of patients with severe acute pancreatitis die. The early prognostic factors that can be used to determine whether the clinical course ...

The patient was an 83-year-old woman who was admitted to our hospital for evaluation and treatment of chronic hypoglycemia that was first identified 3 years earlier. Serum insulin and C-peptide levels were both elevated during hypoglycemia. Contrast abdominal computed tomography revealed a tumor in the body of the pancreas with ...

The aim of the present study was to evaluate the influence of low-dose perioperative octreotide on the prevention of complications (pancreatic fistula and general complications) in patients undergoing pancreatic surgery followed by pancreaticojejunostomy. A total of 105 patients were randomized to receive either octreotide 0.1 mg subcutaneously 3 times/day for ...

OBJECTIVE: Unlike patients with alcoholic hepatitis, patients with acute alcoholic pancreatitis seldom come into the hospital in an intoxicated state. Long-term history of heavy drinking induces increases in the serum pancreatic enzymes and pancreatitis-associated protein profiles during the withdrawal period. The aim of this study was to investigate the role ...

BACKGROUND: The aim of the current study was to clarify the actual clinicopathologic status of extremely rare pancreatic carcinoids. To date, statistical evaluation of such carcinoids has been hampered because an insufficient number of cases has prevented any reliable statistical analyses. METHODS: The Niigata Registry for Gut-Pancreatic Endocrinomas contains a ...

BACKGROUND: Pancreaticoduodenectomy has undergone numerous technical modifications since the original reported series in 1935, but little focus has been directed to the dissection and ligation of the mesenteric blood supply to the first portion of the jejunum. METHODS: Sixty-four patients in whom the device was used were compared to a ...

BACKGROUND AND AIM: In acute pancreatitis (AP), oral refeeding may stimulate pancreatic secretion, increasing the inflammation of the glandular tissue causing relapse of abdominal pain or even exacerbation of the disease. This study aimed to assess the prevalence and risk factors of abdominal pain relapse over oral refeeding in patients ...

BACKGROUND: Tumors that arise in the region of the major duodenal papilla account for 5% of GI neoplasms and 36% of resectable pancreaticoduodenal tumors. There is limited published literature that addresses the safety of endoscopic excision of the papilla. Although there is consensus about prophylactic pancreatic-duct stent placement, there is ...

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used technique for the diagnosis and treatment of biliary and pancreatic diseases. OBJECTIVE: To know the complication rate of ERCP in the elderly. PATIENTS AND METHODS: Patient files who underwent ERCP were reviewed and were divided into two groups: aged 65 and ...

BACKGROUND: Acute pancreatitis is one of the complications after Endoscopic retrograde cholangio pancreatography (ERCP) and it could be fatal. Several drugs were used to prevent or decrease this complication. Corticosteroid is one of the medications which may have such potential. It is affordable and available everywhere. OBJECTIVES: To compare the ...

BACKGROUND AND AIMS: Pancreatic cancer is characterized by a constant deterioration in quality of life, excruciating pain and progressive cachexia. The aim of this study was to compare the effectiveness of two invasive methods of pain treatment in these patients: neurolytic coeliac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) to ...

BACKGROUND: The aim of the study was to evaluate the influence of low dose perioperative Octreotide on the prevention of complications (pancreatic fistula and general complications) in patients undergoing pancreatic surgery followed by pancreatico-jejunostomy. MATERIAL AND METHODS: 105 patients were randomized to receive either Octreotide 0.1 mg subcutaneously 3 times/day ...

BACKGROUND: The aim of this study was to evaluate pancreatic exocrine and endocrine function after pancreaticoduodenectomy. STUDY DESIGN: Pancreatic exocrine function was evaluated by a questionnaire and medical examination of stools after discontinuing pancreatic enzyme supplements for at least 10 days. Severe steatorrhea was defined as frequent, nauseating, yellow, and ...

BACKGROUND: Nesidioblastosis is often resistant to medical therapy and requires near-total pancreatectomy. There is little information on the postoperative imaging findings of these patients. Objective: To demonstrate by US the late imaging findings in these patients. MATERIALS AND METHODS: Children diagnosed with nesidioblastosis and who had undergone 90-95% pancreatectomy received ...

BACKGROUND: The General Practice Research Database (GPRD) is widely used to study incidence rates. This study examines whether incidence rates are overestimated during the first year after registration, how long one needs to wait to obtain accurate incidence rates, and whether the time period of overestimation differs among disease types. ...

Intra-abdominal and retroperitoneal lymphangiomas are a rare, congenital malformations of the lymphatics, which are found predominantly in children. The aim of this study is to evaluate the clinical features of this tumor, highlighting the differences in adults and pediatric patients. We also evaluate the preoperative diagnosis, radiological features, surgical treatment, ...

BACKGROUND: Surgical treatment of necrotizing pancreatitis (NP) has undergone considerable changes during the past 2 decades. In this study, we report our experience of necrosectomy and continuous closed lavage over the past 19 years in an attempt to define changes in patient characteristics and outcome at an academic referral center. ...

OBJECTIVES: Early assessment of the severity and the etiology is crucial in the management of acute pancreatitis. To determine the value of procalcitonin (PCT) as a prognostic marker and as an indicator of biliary etiology in the early phase of acute pancreatitis. METHODS: In a prospective study, 75 consecutive patients ...

BACKGROUND: Potentially resectable periampullary tumours may not be treated appropriately due to lack of local expertise in both assessment of resectability and resection in referring centres. Tata Memorial Hospital is a major referral centre for oncology and these patients are finally referred to this institution. In carefully selected patients, resection ...

BACKGROUND: Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis. HYPOTHESIS: Acute diverticulitis initially treated nonoperatively does not require elective colectomy. DESIGN: Retrospective cohort study. SETTING: Twelve Kaiser Permanente hospitals in Southern California. PATIENTS: Three thousand one hundred sixty-five patients with acute diverticulitis. INTERVENTIONS: ...

BACKGROUND: There is controversy about the optimal method to detect common bile duct (CBD) stones in patients with mild resolving gallstone pancreatitis. The aim of this study was to evaluate magnetic resonance cholangiopancreatography (MRCP) in detecting choledocholithiasis in this group of patients. STUDY DESIGN: A prospective randomized trial was conducted. ...

BACKGROUND: Percutaneous cholecystostomy (PC) has been used in managing acute cholecystitis in the setting of a patient with severe comorbidities where emergency cholecystectomy would carry significant mortality. The present study aims to assess the role, efficacy and complications of PC in acute cholecystitis. METHODS: Retrospective review of case notes of ...

BACKGROUND: Only 2 large (more than 100 patients) prospective trials comparing pancreatogastrostomy (PG) with pancreatojejunostomy (PJ) after pancreatoduodenectomy (PD) have been reported until now. One nonrandomized study showed that there were less pancreatic and digestive tract fistula with PG, whereas the other, a randomized trial from a single high-volume center, ...