Pub Date : 2022-07-31DOI: 10.15279/kpba.2022.27.3.116
J. Chang
Pancreatic cancer can arise in the background of chronic pancreatitis (CP). The relative risks for pancreatic cancer in CP vary considerably according to other contributing factors such as disease duration, excess alcohol consumption, tobacco consumption, eating habits, physical activity, and late-onset diabetes. The incidence of pancreatic cancer is estimated to be about 10 per 105 per year, and the incidence and prevalence of CP are estimated to be 5-12 per 105 and 50 per 105 per year, respectively. The pooled relative risk estimates for pancreatic cancer in CP patients range from 2.7 to 13.3. Subsets of CP subjects with a family history of pancreatic cancer or those with newly developed diabetes over the age of 50 have a higher risk for pancreatic cancer. However, the prevalence of pancreatic cancer is not high enough to justify general screening of the adult CP population. Thus, it is necessary to select subsets of CP cohorts with a significantly high risk of pancreatic cancer. We need a better overall disease model that can define the interaction of multiple risk factors and their cumulative or potential effects on pancreatic cancer.
{"title":"Surveillance for Pancreatic Cancer in Chronic Pancreatitis","authors":"J. Chang","doi":"10.15279/kpba.2022.27.3.116","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.3.116","url":null,"abstract":"Pancreatic cancer can arise in the background of chronic pancreatitis (CP). The relative risks for pancreatic cancer in CP vary considerably according to other contributing factors such as disease duration, excess alcohol consumption, tobacco consumption, eating habits, physical activity, and late-onset diabetes. The incidence of pancreatic cancer is estimated to be about 10 per 105 per year, and the incidence and prevalence of CP are estimated to be 5-12 per 105 and 50 per 105 per year, respectively. The pooled relative risk estimates for pancreatic cancer in CP patients range from 2.7 to 13.3. Subsets of CP subjects with a family history of pancreatic cancer or those with newly developed diabetes over the age of 50 have a higher risk for pancreatic cancer. However, the prevalence of pancreatic cancer is not high enough to justify general screening of the adult CP population. Thus, it is necessary to select subsets of CP cohorts with a significantly high risk of pancreatic cancer. We need a better overall disease model that can define the interaction of multiple risk factors and their cumulative or potential effects on pancreatic cancer.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123595591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-31DOI: 10.15279/kpba.2022.27.3.135
J. Kang, Yang Tae Park, Hyo Jung Kim, Jae Seon Kim
Biliary stent migration is one of the late complications of endoscopic retrograde cholangiopancreatography. Most of the biliary stent migration is asymptomatic and successfully managed by stent removal. A 66-year-old man with unresectable pancreatic cancer, common bile duct obstruction, and duodenal third portion obstruction underwent endoscopic plastic biliary stent placement and duodenal uncovered metallic stent placement in two separate sessions. After 3 weeks from the duodenal stenting, he presented with hematemesis. Urgent esophagogastroduodenoscopy and magnetic resonance imaging showed hemobilia. The patient recovered with conservative managements. Cross-sectional imagings done 2 months later demonstrated the penetration of the biliary stent into portal vein. Here, we present a case of delayed hemobilia caused by penetration of biliary plastic stent into the portal vein.
{"title":"Delayed Hemobilia Caused by Penetration of Biliary Plastic Stent into Portal Vein","authors":"J. Kang, Yang Tae Park, Hyo Jung Kim, Jae Seon Kim","doi":"10.15279/kpba.2022.27.3.135","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.3.135","url":null,"abstract":"Biliary stent migration is one of the late complications of endoscopic retrograde cholangiopancreatography. Most of the biliary stent migration is asymptomatic and successfully managed by stent removal. A 66-year-old man with unresectable pancreatic cancer, common bile duct obstruction, and duodenal third portion obstruction underwent endoscopic plastic biliary stent placement and duodenal uncovered metallic stent placement in two separate sessions. After 3 weeks from the duodenal stenting, he presented with hematemesis. Urgent esophagogastroduodenoscopy and magnetic resonance imaging showed hemobilia. The patient recovered with conservative managements. Cross-sectional imagings done 2 months later demonstrated the penetration of the biliary stent into portal vein. Here, we present a case of delayed hemobilia caused by penetration of biliary plastic stent into the portal vein.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131396984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-31DOI: 10.15279/kpba.2022.27.3.128
Jong Hyun Lee, D. Kim, S. Han, Gwang Ha Kim, H. Seo, S. Hong, Suk Kim, Chang-Won Kim
Percutaneous balloon dilation with or without placement of an external biliary drain is a nonoperative alternative method for treating benign bilioenteric anastomotic strictures. Although this procedure has a high technical success rate, outcomes are less optimal when attempting to dilate refractory tight strictures. For the stricture, cutting balloon can be an option. We present four patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation. To the patients, a peripheral cutting balloon over-the-wire system was inflated, following subsequent conventional non-compliant balloon dilation. After the balloon dilation treatment, an external drainage catheter was placed through the stricture site and maintained for up to 30 days. Technical and end-treatment success was achieved in all four patients. In conclusion, the use of cutting balloon dilation may appear to be a safe and effective alternative method of treatment in patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation.
{"title":"Use of a Cutting Balloon Dilation as a Rescue Therapy in Patients with Benign Bilioenteric Anastomotic Strictures Refractory to Conventional Balloon Dilation","authors":"Jong Hyun Lee, D. Kim, S. Han, Gwang Ha Kim, H. Seo, S. Hong, Suk Kim, Chang-Won Kim","doi":"10.15279/kpba.2022.27.3.128","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.3.128","url":null,"abstract":"Percutaneous balloon dilation with or without placement of an external biliary drain is a nonoperative alternative method for treating benign bilioenteric anastomotic strictures. Although this procedure has a high technical success rate, outcomes are less optimal when attempting to dilate refractory tight strictures. For the stricture, cutting balloon can be an option. We present four patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation. To the patients, a peripheral cutting balloon over-the-wire system was inflated, following subsequent conventional non-compliant balloon dilation. After the balloon dilation treatment, an external drainage catheter was placed through the stricture site and maintained for up to 30 days. Technical and end-treatment success was achieved in all four patients. In conclusion, the use of cutting balloon dilation may appear to be a safe and effective alternative method of treatment in patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131626788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.15279/kpba.2022.27.2.90
Jung Won Jung, S. Woo
The term cholangiocarcinoma (CC) refers to all tumors arising from bile duct epithelium. CCs are characterized by their rarity, difficulty in diagnosis, and overall poor prognosis. This leads to a paucity of data from which to define the natural history and optimal treatment regimens. Currently, surgical resection remains the only potentially curative treatment, but many patients develop recurrence. In addition, a limited number of patients can be candidates for curative resection at diagnosis. Therefore, chemotherapy is inevitable choice for the treatment of advanced CC. Gemcitabine plus cisplatin (GP) is considered a standard option for advanced biliary cancer. A randomized phase III trial (ABC-02 trial) showed the superiority of gemcitabine plus cisplatin over gemcitabine alone. Treatment with nab-paclitaxel plus gemcitabine-cisplatin prolonged median progression-free survival and overall survival vs. those reported for historical controls treated with gemcitabine-cisplatin alone in a phase II study of 60 patients with locally advanced unresectable or metastatic biliary tract cancer. Recent data of the ABC-06 trial has provided slight evidence for the use of second-line chemotherapy after progression on cisplatin plus gemcitabine combination. Other active regimens, that could be considered in patients who include have disease progression while receiving GP and who retain an adequate performance status, includes capecitabine plus cisplatin, liposomal irinotecan plus leucovorin-modulated fluorouracil and a fluoropyrimidine alone. We herein review recent published data regarding the use of palliative chemotherapies in CC patients, with a particular focus on novel cytotoxic agents.
{"title":"Novel Palliative Chemotherapy for Cholangiocarcinoma","authors":"Jung Won Jung, S. Woo","doi":"10.15279/kpba.2022.27.2.90","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.2.90","url":null,"abstract":"The term cholangiocarcinoma (CC) refers to all tumors arising from bile duct epithelium. CCs are characterized by their rarity, difficulty in diagnosis, and overall poor prognosis. This leads to a paucity of data from which to define the natural history and optimal treatment regimens. Currently, surgical resection remains the only potentially curative treatment, but many patients develop recurrence. In addition, a limited number of patients can be candidates for curative resection at diagnosis. Therefore, chemotherapy is inevitable choice for the treatment of advanced CC. Gemcitabine plus cisplatin (GP) is considered a standard option for advanced biliary cancer. A randomized phase III trial (ABC-02 trial) showed the superiority of gemcitabine plus cisplatin over gemcitabine alone. Treatment with nab-paclitaxel plus gemcitabine-cisplatin prolonged median progression-free survival and overall survival vs. those reported for historical controls treated with gemcitabine-cisplatin alone in a phase II study of 60 patients with locally advanced unresectable or metastatic biliary tract cancer. Recent data of the ABC-06 trial has provided slight evidence for the use of second-line chemotherapy after progression on cisplatin plus gemcitabine combination. Other active regimens, that could be considered in patients who include have disease progression while receiving GP and who retain an adequate performance status, includes capecitabine plus cisplatin, liposomal irinotecan plus leucovorin-modulated fluorouracil and a fluoropyrimidine alone. We herein review recent published data regarding the use of palliative chemotherapies in CC patients, with a particular focus on novel cytotoxic agents.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121264984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.15279/kpba.2022.27.2.81
Tae Yoon Lee
Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It can be a life-threatening condition if it is not recognized early. Patients with severe cholangitis may present with hypotension, and mental status changes. The most frequent causes of acute cholangitis are biliary calculi, benign biliary stricture, and malignancy. The most common pathogens isolated are gram-negative bacteria (Escherichia coli, followed by Klebsiella species and Enterobacter species). A diagnosis of acute cholangitis requires evidence of systemic inflammation, cholestasis, and imaging with biliary obstruction. Imaging studies may consist of ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound. The mainstay of treatment consists of fluid resuscitation, antibiotics, and biliary drainage. Penicillin/β-lactamase, third-generation cephalosporin, or carbapenem are all acceptable choices for first-line treatment. In patients with severe cholangitis, biliary drainage should be performed within 24 hours. Patients with severe acute cholangitis require urgent (within 24 hours) biliary decompression. Endoscopic retrograde cholangiopancreatography remains the preferred modality for biliary drainage. In conclusion, acute cholangitis is mostly treatable when recognized and treated early. Recognizing and initiating early treatment leads to markedly decreased patient morbidity and mortality.
{"title":"Diagnosis and Treatment of Acute Cholangitis","authors":"Tae Yoon Lee","doi":"10.15279/kpba.2022.27.2.81","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.2.81","url":null,"abstract":"Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It can be a life-threatening condition if it is not recognized early. Patients with severe cholangitis may present with hypotension, and mental status changes. The most frequent causes of acute cholangitis are biliary calculi, benign biliary stricture, and malignancy. The most common pathogens isolated are gram-negative bacteria (Escherichia coli, followed by Klebsiella species and Enterobacter species). A diagnosis of acute cholangitis requires evidence of systemic inflammation, cholestasis, and imaging with biliary obstruction. Imaging studies may consist of ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound. The mainstay of treatment consists of fluid resuscitation, antibiotics, and biliary drainage. Penicillin/β-lactamase, third-generation cephalosporin, or carbapenem are all acceptable choices for first-line treatment. In patients with severe cholangitis, biliary drainage should be performed within 24 hours. Patients with severe acute cholangitis require urgent (within 24 hours) biliary decompression. Endoscopic retrograde cholangiopancreatography remains the preferred modality for biliary drainage. In conclusion, acute cholangitis is mostly treatable when recognized and treated early. Recognizing and initiating early treatment leads to markedly decreased patient morbidity and mortality.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133907772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.15279/kpba.2022.27.2.109
Jimin Han
{"title":"Perspective on Gender in Endoscopic Retrograde Cholangiopancreatography","authors":"Jimin Han","doi":"10.15279/kpba.2022.27.2.109","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.2.109","url":null,"abstract":"","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133299893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.15279/kpba.2022.27.2.106
J. Choi
비침습적 치료가 강조되는 최근 추세로 인해 내시경 초음파(endoscopic ultrasound, EUS)를 이용한 중재시술의 필요성은 더욱 증가되고 있으며 수년 전부터 고주파열을 이용한 EUS 유도하 국소 췌장 치료법이 개발되어 대동물에서의 전임상실험과 일부 임상 적용 사례가 보고된 바 있다. 본고는 EUS-guided radiofrequency ablation (EUS-RFA)을 소개하고, 현재 연구 개발 진행 상황을 보고하고자 한다. 고주파열치료(radiofrequency ablation, RFA)는 목표하는 병변 위치에 RFA 전극을 삽입한 후 고주파 전류를 가하여 암세포 내의 이온 불안정을 유발하여 세포 손상을 주고 조직 괴사를 일으키는 치료법으로, 바렛 식도와 같은 양성 질환 및 수술이 어려운 간세포암 등에서 최소 침습 치료법으로 이용된다. EUS-RFA는 위 및 십이지장의 경벽을 통해 직접적으로 췌장 및 췌장 주위 종양에 접근하여 RFA를 시행하는 방법이다. 먼저 EUS 하에서 병소를 확인하고 RFA 전극을 병변 내에 위치시킨 후 정해진 설정값에 맞추어 부채꼴 모양으로 방향을 다르게 하며(fanning technique) 종양 전체에 RFA를 시행한다(Fig. 1). 두 가지 RFA 방법이 있는데, EUSRA electrode (Taewoong Medical, Gimpo, Korea)는 국내 기술로 개발된 제품으로 냉각장치와 일체형으로 제작된 EUS용(19G 또는 18G) 미세세침 RFA 장비를 사용하고, 5 mm, 10 mm, 15 mm, 20 mm의 4가지 형태가 있으며, 20-50 W, 10-15초의 설정값으로 RFA를 시행한다(Fig. 2). Habib EUS-RFA (EMcision Ltd, London, UK)는 EUS에 이용되는 19G 또는 22G 미세세침 안으로 1 Fr (0.33 mm) 단전극(monopolar) RFA 기기를 삽입하여 10 W, 120초의 설정값으로 RFA를 시행한다. Habib EUS-RFA의 경우는 미세세침을 이용하기에 EUS로 접근이 어려운 췌장 구상돌기(uncinate process) 등에서 좀 더 쉽게 사용할 수 있으나, 1 Fr 크기의 가느다란 구조이기에 쉽게 파손되어 추가적인 시술이 어려울 수 있다. 그에 반해 EUSRA는 일체형으로 췌장종양 등에 반복적인 RFA 시술이 가능하지만 상대적으로 췌장 구상돌기나 두부의 시술에는 어려움이 있다. Received Dec. 27, 2021 Revised Apr. 10, 2022 Accepted Apr. 11, 2022
{"title":"Endoscopic Ultrasound-Guided Radiofrequency Ablation","authors":"J. Choi","doi":"10.15279/kpba.2022.27.2.106","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.2.106","url":null,"abstract":"비침습적 치료가 강조되는 최근 추세로 인해 내시경 초음파(endoscopic ultrasound, EUS)를 이용한 중재시술의 필요성은 더욱 증가되고 있으며 수년 전부터 고주파열을 이용한 EUS 유도하 국소 췌장 치료법이 개발되어 대동물에서의 전임상실험과 일부 임상 적용 사례가 보고된 바 있다. 본고는 EUS-guided radiofrequency ablation (EUS-RFA)을 소개하고, 현재 연구 개발 진행 상황을 보고하고자 한다. 고주파열치료(radiofrequency ablation, RFA)는 목표하는 병변 위치에 RFA 전극을 삽입한 후 고주파 전류를 가하여 암세포 내의 이온 불안정을 유발하여 세포 손상을 주고 조직 괴사를 일으키는 치료법으로, 바렛 식도와 같은 양성 질환 및 수술이 어려운 간세포암 등에서 최소 침습 치료법으로 이용된다. EUS-RFA는 위 및 십이지장의 경벽을 통해 직접적으로 췌장 및 췌장 주위 종양에 접근하여 RFA를 시행하는 방법이다. 먼저 EUS 하에서 병소를 확인하고 RFA 전극을 병변 내에 위치시킨 후 정해진 설정값에 맞추어 부채꼴 모양으로 방향을 다르게 하며(fanning technique) 종양 전체에 RFA를 시행한다(Fig. 1). 두 가지 RFA 방법이 있는데, EUSRA electrode (Taewoong Medical, Gimpo, Korea)는 국내 기술로 개발된 제품으로 냉각장치와 일체형으로 제작된 EUS용(19G 또는 18G) 미세세침 RFA 장비를 사용하고, 5 mm, 10 mm, 15 mm, 20 mm의 4가지 형태가 있으며, 20-50 W, 10-15초의 설정값으로 RFA를 시행한다(Fig. 2). Habib EUS-RFA (EMcision Ltd, London, UK)는 EUS에 이용되는 19G 또는 22G 미세세침 안으로 1 Fr (0.33 mm) 단전극(monopolar) RFA 기기를 삽입하여 10 W, 120초의 설정값으로 RFA를 시행한다. Habib EUS-RFA의 경우는 미세세침을 이용하기에 EUS로 접근이 어려운 췌장 구상돌기(uncinate process) 등에서 좀 더 쉽게 사용할 수 있으나, 1 Fr 크기의 가느다란 구조이기에 쉽게 파손되어 추가적인 시술이 어려울 수 있다. 그에 반해 EUSRA는 일체형으로 췌장종양 등에 반복적인 RFA 시술이 가능하지만 상대적으로 췌장 구상돌기나 두부의 시술에는 어려움이 있다. Received Dec. 27, 2021 Revised Apr. 10, 2022 Accepted Apr. 11, 2022","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"271 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116187262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.15279/kpba.2022.27.2.97
Tae Il Kim, H. Jeong, Jeong-Eun Song, H. Kim, Jimin Han
Background/Aim: The aim of this study was to compare clinical features of hypertriglyceridemia-induced acute pancreatitis (HTGAP) with those of biliary acute pancreatitis (BAP) and alcoholic acute pancreatitis (AAP), respectively.Methods: Medical records of patients with acute pancreatitis (AP) who were admitted to our institution from January 2014 to December 2018 were retrospectively reviewed. Disease severity and local complications were evaluated according to the 2012 Revised Atlanta Classification. Systemic complications were evaluated according to the Modified Marshall Scoring System.Results: Of the total 610 patients with AP, those with BAP, AAP, and HTGAP were 310 (50.8%), 144 (23.6%), and 17 (2.8%), respectively. Compared with BAP, HTGAP showed higher proportion of moderately severe acute pancreatitis (MSAP) (64.7% vs. 28.1%, p<0.001) and severe acute pancreatitis (SAP) (17.6% vs. 5.5%, p <0.001). And HTGAP showed more local complications (76.5% vs. 26.8%, p<0.001) and higher recurrence rate (52.9% vs. 6.5%, p <0.001), but there was no significant difference in systemic complications (23.5% vs. 11.6%, p =0.140). Contrarily, there was no significant difference between HTGAP and AAP with respect to disease severity (64.7% vs. 63.9% in MSAP and 17.6% vs. 6.9% in SAP, p =0.181), local complications (76.5% vs. 67.4%, p =0.445), recurrence rate (52.9% vs. 32.6%, p =0.096), and systemic complications (23.5% vs. 11.5%, p =0.233).Conclusions: HTGAP showed higher disease severity, more local complications, and higher recurrence rate than BAP. However, there was no significant difference in clinical features between HTGAP and BAP.
背景/目的:本研究的目的是比较高甘油三酯血症引起的急性胰腺炎(HTGAP)与胆源性急性胰腺炎(BAP)和酒精性急性胰腺炎(AAP)的临床特征。方法:回顾性分析我院2014年1月至2018年12月收治的急性胰腺炎(AP)患者的医疗记录。疾病严重程度和局部并发症根据2012年修订的亚特兰大分类进行评估。根据改良马歇尔评分系统评估全身并发症。结果:610例AP患者中，BAP 310例(50.8%)，AAP 144例(23.6%)，HTGAP 17例(2.8%)。与BAP相比，HTGAP显示中重度急性胰腺炎(MSAP)(64.7%比28.1%，p<0.001)和重度急性胰腺炎(SAP)(17.6%比5.5%，p<0.001)的比例更高。HTGAP的局部并发症较多(76.5% vs. 26.8%， p<0.001)，复发率较高(52.9% vs. 6.5%， p<0.001)，但全身并发症无显著性差异(23.5% vs. 11.6%， p =0.140)。相反，HTGAP和AAP在疾病严重程度(MSAP为64.7%比63.9%，SAP为17.6%比6.9%，p =0.181)、局部并发症(76.5%比67.4%，p =0.445)、复发率(52.9%比32.6%，p =0.096)和全身并发症(23.5%比11.5%，p =0.233)方面无显著差异。结论:HTGAP比BAP有更高的疾病严重程度、更多的局部并发症和更高的复发率。然而，HTGAP与BAP的临床特征无显著差异。
{"title":"Differences in Clinical Features between Hypertriglyceridemia-Induced Acute Pancreatitis and Other Etiologies of Acute Pancreatitis","authors":"Tae Il Kim, H. Jeong, Jeong-Eun Song, H. Kim, Jimin Han","doi":"10.15279/kpba.2022.27.2.97","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.2.97","url":null,"abstract":"Background/Aim: The aim of this study was to compare clinical features of hypertriglyceridemia-induced acute pancreatitis (HTGAP) with those of biliary acute pancreatitis (BAP) and alcoholic acute pancreatitis (AAP), respectively.Methods: Medical records of patients with acute pancreatitis (AP) who were admitted to our institution from January 2014 to December 2018 were retrospectively reviewed. Disease severity and local complications were evaluated according to the 2012 Revised Atlanta Classification. Systemic complications were evaluated according to the Modified Marshall Scoring System.Results: Of the total 610 patients with AP, those with BAP, AAP, and HTGAP were 310 (50.8%), 144 (23.6%), and 17 (2.8%), respectively. Compared with BAP, HTGAP showed higher proportion of moderately severe acute pancreatitis (MSAP) (64.7% vs. 28.1%, p<0.001) and severe acute pancreatitis (SAP) (17.6% vs. 5.5%, p <0.001). And HTGAP showed more local complications (76.5% vs. 26.8%, p<0.001) and higher recurrence rate (52.9% vs. 6.5%, p <0.001), but there was no significant difference in systemic complications (23.5% vs. 11.6%, p =0.140). Contrarily, there was no significant difference between HTGAP and AAP with respect to disease severity (64.7% vs. 63.9% in MSAP and 17.6% vs. 6.9% in SAP, p =0.181), local complications (76.5% vs. 67.4%, p =0.445), recurrence rate (52.9% vs. 32.6%, p =0.096), and systemic complications (23.5% vs. 11.5%, p =0.233).Conclusions: HTGAP showed higher disease severity, more local complications, and higher recurrence rate than BAP. However, there was no significant difference in clinical features between HTGAP and BAP.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133792141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-31DOI: 10.15279/kpba.2022.27.1.47
Kook-Hyun Kim
Acute cholecystitis (AC), defined as inflammation of the gallbladder, is mainly caused by gallstones. Over 90% of AC results from obstruction of the cystic duct by stones or sludge, which subsequently increases the intraluminal pressure within the gallbladder and, in conjunction with the presence of bile supersaturated with cholesterol, activates an acute inflammatory cascade. Clinical features play an important role in the diagnosis of AC. The Tokyo Guidelines 2018 for acute cholecystitis designates the presence of local inflammatory signs and systemic inflammatory signs for a suspected diagnosis. It requires confirmation by radiological imaging along with these two factors for a definitive diagnosis. Thanks to less invasiveness, easy availability, ease of use, and cost-effectiveness, ultrasound (US) is usually accepted as the first choice in suspicious AC patients. A meta-analysis comparing methods of diagnosis for AC reported that the US has 81% of sensitivity and 83% of specificity. Abdominal computed tomography is recommended for diagnosing emphysematous or gangrenous cholecystitis. Meanwhile, acute acalculous cholecystitis (AAC) is a life-threatening disease mainly in severely ill patients. It usually affects the patients hospitalized for multiple trauma, burns, cardiopulmonary bypass surgery, long-term total parenteral nutrition or sepsis. The diagnosis of AAC is quite challenging and requires a high index of suspicion. Currently, cholecystectomy is the treatment of choice for AC, although the optimal time for surgery is still controversial. Due to high morbidity and mortality in high surgical risk groups, percutaneous gallbladder drainage can be a safe and feasible alternative to cholecystectomy, particularly for patients unfit for the surgery.
{"title":"The Diagnosis and Treatment of Acute Cholecystitis","authors":"Kook-Hyun Kim","doi":"10.15279/kpba.2022.27.1.47","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.1.47","url":null,"abstract":"Acute cholecystitis (AC), defined as inflammation of the gallbladder, is mainly caused by gallstones. Over 90% of AC results from obstruction of the cystic duct by stones or sludge, which subsequently increases the intraluminal pressure within the gallbladder and, in conjunction with the presence of bile supersaturated with cholesterol, activates an acute inflammatory cascade. Clinical features play an important role in the diagnosis of AC. The Tokyo Guidelines 2018 for acute cholecystitis designates the presence of local inflammatory signs and systemic inflammatory signs for a suspected diagnosis. It requires confirmation by radiological imaging along with these two factors for a definitive diagnosis. Thanks to less invasiveness, easy availability, ease of use, and cost-effectiveness, ultrasound (US) is usually accepted as the first choice in suspicious AC patients. A meta-analysis comparing methods of diagnosis for AC reported that the US has 81% of sensitivity and 83% of specificity. Abdominal computed tomography is recommended for diagnosing emphysematous or gangrenous cholecystitis. Meanwhile, acute acalculous cholecystitis (AAC) is a life-threatening disease mainly in severely ill patients. It usually affects the patients hospitalized for multiple trauma, burns, cardiopulmonary bypass surgery, long-term total parenteral nutrition or sepsis. The diagnosis of AAC is quite challenging and requires a high index of suspicion. Currently, cholecystectomy is the treatment of choice for AC, although the optimal time for surgery is still controversial. Due to high morbidity and mortality in high surgical risk groups, percutaneous gallbladder drainage can be a safe and feasible alternative to cholecystectomy, particularly for patients unfit for the surgery.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"579 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134276210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-31DOI: 10.15279/kpba.2022.27.1.22
E. Kim, Jae Min Lee, T. Lee
Initial and convalescent treatment of acute pancreatitis (AP) is important in order to improve the prognosis and prevent the recurrence in the patients with AP. Initial intensive treatment includes fluid therapy, pain control, antimicrobial therapy, endoscopic retrograde cholangiopancreatography (ERCP), and nutritional support. Goal-directed therapy is recommended for fluid therapy, and the routine use of prophylactic antibiotics is not recommended. In acute gallstone pancreatitis, urgent ERCP should be performed only in patients with cholangitis or persistent cholestasis. Early oral feeding is advisable as tolerated and enteral feeding via nasogastric or nasojejunal tube appear comparable. In convalescent treatment, cholecystectomy during the initial admission is advisable for mild biliary pancreatitis with gallstone as possible, and treatment against alcohol dependence is considerable for recurrent acute alcoholic pancreatitis. In this review, we recommend practice guidelines for initial treatment, nutritional support, and convalescent treatment.
{"title":"Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Initial Treatment, Nutritional Support, Convalescent Treatment","authors":"E. Kim, Jae Min Lee, T. Lee","doi":"10.15279/kpba.2022.27.1.22","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.1.22","url":null,"abstract":"Initial and convalescent treatment of acute pancreatitis (AP) is important in order to improve the prognosis and prevent the recurrence in the patients with AP. Initial intensive treatment includes fluid therapy, pain control, antimicrobial therapy, endoscopic retrograde cholangiopancreatography (ERCP), and nutritional support. Goal-directed therapy is recommended for fluid therapy, and the routine use of prophylactic antibiotics is not recommended. In acute gallstone pancreatitis, urgent ERCP should be performed only in patients with cholangitis or persistent cholestasis. Early oral feeding is advisable as tolerated and enteral feeding via nasogastric or nasojejunal tube appear comparable. In convalescent treatment, cholecystectomy during the initial admission is advisable for mild biliary pancreatitis with gallstone as possible, and treatment against alcohol dependence is considerable for recurrent acute alcoholic pancreatitis. In this review, we recommend practice guidelines for initial treatment, nutritional support, and convalescent treatment.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114350432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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