Pub Date : 2023-09-01Epub Date: 2023-07-17DOI: 10.1097/MOG.0000000000000957
Jean-Francois Rey
Purpose of review: With the incessant advances in information technology and its implications in all domains of our life, artificial intelligence (AI) started to emerge as a need for better machine performance. How it can help endoscopists and what are the areas of interest in improving both diagnostic and therapeutic endoscopy in each part of the gastrointestinal (GI) tract. What are the recent benefits and clinical usefulness of this new technology in daily endoscopic practice.
Recent findings: The two main AI systems categories are computer-assisted detection 'CADe' for lesion detection and computer-assisted diagnosis 'CADx' for optical biopsy and lesion characterization. Multiple softwares are now implemented in endoscopy practice. Other AI systems offer therapeutic assistance such as lesion delineation for complete endoscopic resection or prediction of possible lymphanode after endoscopic treatment. Quality assurance is the coming step with complete monitoring of high-quality colonoscopy. In all cases it is a computer-aid endoscopy as the overall result rely on the physician. Video capsule endoscopy is the unique example were the computer conduct the device, store multiple images, and perform accurate diagnosis.
Summary: AI is a breakthrough in digestive endoscopy. Screening gastric and colonic cancer detection should be improved especially outside of expert's centers. Prospective and multicenter trials are mandatory before introducing new software in clinical practice.
{"title":"Artificial intelligence in digestive endoscopy: recent advances.","authors":"Jean-Francois Rey","doi":"10.1097/MOG.0000000000000957","DOIUrl":"10.1097/MOG.0000000000000957","url":null,"abstract":"<p><strong>Purpose of review: </strong>With the incessant advances in information technology and its implications in all domains of our life, artificial intelligence (AI) started to emerge as a need for better machine performance. How it can help endoscopists and what are the areas of interest in improving both diagnostic and therapeutic endoscopy in each part of the gastrointestinal (GI) tract. What are the recent benefits and clinical usefulness of this new technology in daily endoscopic practice.</p><p><strong>Recent findings: </strong>The two main AI systems categories are computer-assisted detection 'CADe' for lesion detection and computer-assisted diagnosis 'CADx' for optical biopsy and lesion characterization. Multiple softwares are now implemented in endoscopy practice. Other AI systems offer therapeutic assistance such as lesion delineation for complete endoscopic resection or prediction of possible lymphanode after endoscopic treatment. Quality assurance is the coming step with complete monitoring of high-quality colonoscopy. In all cases it is a computer-aid endoscopy as the overall result rely on the physician. Video capsule endoscopy is the unique example were the computer conduct the device, store multiple images, and perform accurate diagnosis.</p><p><strong>Summary: </strong>AI is a breakthrough in digestive endoscopy. Screening gastric and colonic cancer detection should be improved especially outside of expert's centers. Prospective and multicenter trials are mandatory before introducing new software in clinical practice.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-05-11DOI: 10.1097/MOG.0000000000000950
Ishaan Vohra, Harishankar Gopakumar, Douglas G Adler
Purpose of review: Gastroparesis is a chronic debilitating condition with rising incidence and healthcare burden. As abdominal surgeries, diabetes, viral infections and autoimmune diseases become more prevalent, gastroparesis will continue to upsurge. Conservative treatment options for gastroparesis are limited by their side effects and short-term efficacy. Gastric endoscopic pyloromyotomy (G-POEM) is a novel incisionless endosurgical technique with excellent long-term outcomes. This review is in time, as the demand for G-POEM will continue to escalate.
Recent findings: This review encompasses the conservative and nonconservative treatment options for gastroparesis. G-POEM is a nonconservative treatment option, and the aim of this review is to discuss the variations in technique of G-POEM, short-term and long-term clinical efficacy of G-POEM and adverse events associated with it.
Summary: G-POEM has high technical and clinical success with minimal adverse events. G-POEM outcomes are similar or superior when compared with other treatment options for refractory gastroparesis. G-POEM is being widely adopted and will become the preferred treatment choice in patients with refractory gastroparesis.
{"title":"G-POEM for gastroparesis: past, present and future.","authors":"Ishaan Vohra, Harishankar Gopakumar, Douglas G Adler","doi":"10.1097/MOG.0000000000000950","DOIUrl":"10.1097/MOG.0000000000000950","url":null,"abstract":"<p><strong>Purpose of review: </strong>Gastroparesis is a chronic debilitating condition with rising incidence and healthcare burden. As abdominal surgeries, diabetes, viral infections and autoimmune diseases become more prevalent, gastroparesis will continue to upsurge. Conservative treatment options for gastroparesis are limited by their side effects and short-term efficacy. Gastric endoscopic pyloromyotomy (G-POEM) is a novel incisionless endosurgical technique with excellent long-term outcomes. This review is in time, as the demand for G-POEM will continue to escalate.</p><p><strong>Recent findings: </strong>This review encompasses the conservative and nonconservative treatment options for gastroparesis. G-POEM is a nonconservative treatment option, and the aim of this review is to discuss the variations in technique of G-POEM, short-term and long-term clinical efficacy of G-POEM and adverse events associated with it.</p><p><strong>Summary: </strong>G-POEM has high technical and clinical success with minimal adverse events. G-POEM outcomes are similar or superior when compared with other treatment options for refractory gastroparesis. G-POEM is being widely adopted and will become the preferred treatment choice in patients with refractory gastroparesis.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9931051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-07-17DOI: 10.1097/MOG.0000000000000955
Nicholas Norris, David M Troendle
Purpose of review: Some children with acute recurrent and chronic pancreatitis stand to benefit from therapeutic endoscopic interventions. The purpose of this review is to summarize specific endoscopic therapies used for these conditions and highlight areas of future research.
Recent findings: Multicenter collaboration and consortium efforts have provided more data now than ever on the technical outcomes and safety of therapeutic endoscopic procedures for pancreatitis in children. Indications are growing but more research is needed to help guide patient selection.
Summary: Advanced endoscopic procedures including endoscopic retrograde cholangiopancreatography, endoscopic-ultrasound guided therapies, and single-operator pancreatoscopy may be used in patients with acute recurrent or chronic pancreatitis to manage pancreatic duct obstruction or local complications including pseudocysts and walled-off necrosis. Patient and procedural factors differ between adults and children. Access to these procedures for younger children is growing, and technical outcomes and adverse event rates appear similar between adults and children.
{"title":"Endotherapy in pediatric pancreatitis.","authors":"Nicholas Norris, David M Troendle","doi":"10.1097/MOG.0000000000000955","DOIUrl":"10.1097/MOG.0000000000000955","url":null,"abstract":"<p><strong>Purpose of review: </strong>Some children with acute recurrent and chronic pancreatitis stand to benefit from therapeutic endoscopic interventions. The purpose of this review is to summarize specific endoscopic therapies used for these conditions and highlight areas of future research.</p><p><strong>Recent findings: </strong>Multicenter collaboration and consortium efforts have provided more data now than ever on the technical outcomes and safety of therapeutic endoscopic procedures for pancreatitis in children. Indications are growing but more research is needed to help guide patient selection.</p><p><strong>Summary: </strong>Advanced endoscopic procedures including endoscopic retrograde cholangiopancreatography, endoscopic-ultrasound guided therapies, and single-operator pancreatoscopy may be used in patients with acute recurrent or chronic pancreatitis to manage pancreatic duct obstruction or local complications including pseudocysts and walled-off necrosis. Patient and procedural factors differ between adults and children. Access to these procedures for younger children is growing, and technical outcomes and adverse event rates appear similar between adults and children.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9931880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-07-18DOI: 10.1097/MOG.0000000000000966
Lanhong Yao, Zheyuan Zhang, Elif Keles, Cemal Yazici, Temel Tirkes, Ulas Bagci
Purpose of review: Early and accurate diagnosis of pancreatic cancer is crucial for improving patient outcomes, and artificial intelligence (AI) algorithms have the potential to play a vital role in computer-aided diagnosis of pancreatic cancer. In this review, we aim to provide the latest and relevant advances in AI, specifically deep learning (DL) and radiomics approaches, for pancreatic cancer diagnosis using cross-sectional imaging examinations such as computed tomography (CT) and magnetic resonance imaging (MRI).
Recent findings: This review highlights the recent developments in DL techniques applied to medical imaging, including convolutional neural networks (CNNs), transformer-based models, and novel deep learning architectures that focus on multitype pancreatic lesions, multiorgan and multitumor segmentation, as well as incorporating auxiliary information. We also discuss advancements in radiomics, such as improved imaging feature extraction, optimized machine learning classifiers and integration with clinical data. Furthermore, we explore implementing AI-based clinical decision support systems for pancreatic cancer diagnosis using medical imaging in practical settings.
Summary: Deep learning and radiomics with medical imaging have demonstrated strong potential to improve diagnostic accuracy of pancreatic cancer, facilitate personalized treatment planning, and identify prognostic and predictive biomarkers. However, challenges remain in translating research findings into clinical practice. More studies are required focusing on refining these methods, addressing significant limitations, and developing integrative approaches for data analysis to further advance the field of pancreatic cancer diagnosis.
{"title":"A review of deep learning and radiomics approaches for pancreatic cancer diagnosis from medical imaging.","authors":"Lanhong Yao, Zheyuan Zhang, Elif Keles, Cemal Yazici, Temel Tirkes, Ulas Bagci","doi":"10.1097/MOG.0000000000000966","DOIUrl":"10.1097/MOG.0000000000000966","url":null,"abstract":"<p><strong>Purpose of review: </strong>Early and accurate diagnosis of pancreatic cancer is crucial for improving patient outcomes, and artificial intelligence (AI) algorithms have the potential to play a vital role in computer-aided diagnosis of pancreatic cancer. In this review, we aim to provide the latest and relevant advances in AI, specifically deep learning (DL) and radiomics approaches, for pancreatic cancer diagnosis using cross-sectional imaging examinations such as computed tomography (CT) and magnetic resonance imaging (MRI).</p><p><strong>Recent findings: </strong>This review highlights the recent developments in DL techniques applied to medical imaging, including convolutional neural networks (CNNs), transformer-based models, and novel deep learning architectures that focus on multitype pancreatic lesions, multiorgan and multitumor segmentation, as well as incorporating auxiliary information. We also discuss advancements in radiomics, such as improved imaging feature extraction, optimized machine learning classifiers and integration with clinical data. Furthermore, we explore implementing AI-based clinical decision support systems for pancreatic cancer diagnosis using medical imaging in practical settings.</p><p><strong>Summary: </strong>Deep learning and radiomics with medical imaging have demonstrated strong potential to improve diagnostic accuracy of pancreatic cancer, facilitate personalized treatment planning, and identify prognostic and predictive biomarkers. However, challenges remain in translating research findings into clinical practice. More studies are required focusing on refining these methods, addressing significant limitations, and developing integrative approaches for data analysis to further advance the field of pancreatic cancer diagnosis.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9945537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-05-11DOI: 10.1097/MOG.0000000000000951
Mitchell L Ramsey, Phil A Hart, Christopher E Forsmark
Purpose of review: The diagnosis and management of exocrine pancreatic dysfunction (EPD) can be challenging. EPD classically results from conditions that cause loss of pancreatic acinar cell function and decreased digestive enzyme production. However, several conditions may contribute to signs or symptoms of EPD with otherwise normal pancreatic exocrine function. A thoughtful approach to considering these conditions, along with their specific therapies, can guide a tailored management approach.
Recent findings: An EPD severity classification schema has been proposed, which emphasizes a shift towards a more restrictive prescription of pancreas enzyme replacement therapy (PERT) for patients with milder EPD. In contrast, PERT use has been associated with a measurable survival benefit among individuals with EPD and pancreatic cancer, so the prescription of PERT may be more liberal in this population. Recent publications in the cystic fibrosis population offer pearls guiding the titration and optimization of PERT.
Summary: Among individuals with severe EPD, PERT is an effective therapy. Among individuals with milder EPD, although PERT is effective, there may be opportunities to provide additional and potentially more effective therapies.
{"title":"Evaluation and management of exocrine pancreatic insufficiency: pearls and pitfalls.","authors":"Mitchell L Ramsey, Phil A Hart, Christopher E Forsmark","doi":"10.1097/MOG.0000000000000951","DOIUrl":"10.1097/MOG.0000000000000951","url":null,"abstract":"<p><strong>Purpose of review: </strong>The diagnosis and management of exocrine pancreatic dysfunction (EPD) can be challenging. EPD classically results from conditions that cause loss of pancreatic acinar cell function and decreased digestive enzyme production. However, several conditions may contribute to signs or symptoms of EPD with otherwise normal pancreatic exocrine function. A thoughtful approach to considering these conditions, along with their specific therapies, can guide a tailored management approach.</p><p><strong>Recent findings: </strong>An EPD severity classification schema has been proposed, which emphasizes a shift towards a more restrictive prescription of pancreas enzyme replacement therapy (PERT) for patients with milder EPD. In contrast, PERT use has been associated with a measurable survival benefit among individuals with EPD and pancreatic cancer, so the prescription of PERT may be more liberal in this population. Recent publications in the cystic fibrosis population offer pearls guiding the titration and optimization of PERT.</p><p><strong>Summary: </strong>Among individuals with severe EPD, PERT is an effective therapy. Among individuals with milder EPD, although PERT is effective, there may be opportunities to provide additional and potentially more effective therapies.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9945543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-07-13DOI: 10.1097/MOG.0000000000000967
Nader Bakheet, Dilhana Badurdeen, Adrian Sartoretto, Vivek Kumbhari
Purpose of review: The aim of this review is to present the current state of the field, highlight recent developments, and describe the clinical outcomes of these endoluminal bariatric and metabolic procedures.
Recent findings: The landscape of endoluminal devices and techniques for treating obesity has expanded significantly, with FDA-approved therapies currently available to patients with a body mass index values as high as 50 kg/m 2 . Although notable advancements have been made in this area, there is a need for further emphasis to be placed on the metabolic improvements resulting from these therapies, in addition to the conventional focus on weight loss outcomes. Some of these procedures are now FDA approved for the treatment of metabolic disease as opposed to weight loss. To achieve the most favorable results, it is imperative that all endoluminal interventions are combined with a moderately intensive diet and lifestyle program lasting at least 12 months.
Summary: Endoluminal metabolic and bariatric therapy represents a bridge between lifestyle counseling, pharmaceutical interventions, and the most efficacious treatment for obesity, bariatric surgery. By virtue of its minimally invasive approach, this therapy may be an appealing option for patients who are ineligible for, or averse to, bariatric surgery and who have experienced suboptimal outcomes or unable to afford medical treatments. Furthermore, these interventions may be particularly beneficial in the early stages of obesity.
综述的目的:本综述旨在介绍该领域的现状、最新进展,并描述这些腔内减肥和代谢手术的临床效果:用于治疗肥胖症的腔内设备和技术的范围已大大扩展,目前经 FDA 批准的疗法适用于体重指数值高达 50 kg/m 2 的患者。虽然这一领域已经取得了显著的进步,但除了传统的关注减肥效果外,还需要进一步强调这些疗法对新陈代谢的改善作用。目前,美国食品及药物管理局(FDA)已批准其中一些程序用于治疗代谢疾病,而非减肥。摘要:腔内代谢和减肥疗法是生活方式咨询、药物干预和最有效的肥胖症治疗方法--减肥手术之间的桥梁。这种疗法采用微创方式,对于不符合减肥手术条件或不愿意接受减肥手术的患者,以及疗效不理想或无力负担医疗费用的患者来说,可能是一种颇具吸引力的选择。此外,这些干预措施可能对肥胖症的早期阶段特别有益。
{"title":"Endoluminal bariatric and metabolic therapies: state-of-the-art.","authors":"Nader Bakheet, Dilhana Badurdeen, Adrian Sartoretto, Vivek Kumbhari","doi":"10.1097/MOG.0000000000000967","DOIUrl":"10.1097/MOG.0000000000000967","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this review is to present the current state of the field, highlight recent developments, and describe the clinical outcomes of these endoluminal bariatric and metabolic procedures.</p><p><strong>Recent findings: </strong>The landscape of endoluminal devices and techniques for treating obesity has expanded significantly, with FDA-approved therapies currently available to patients with a body mass index values as high as 50 kg/m 2 . Although notable advancements have been made in this area, there is a need for further emphasis to be placed on the metabolic improvements resulting from these therapies, in addition to the conventional focus on weight loss outcomes. Some of these procedures are now FDA approved for the treatment of metabolic disease as opposed to weight loss. To achieve the most favorable results, it is imperative that all endoluminal interventions are combined with a moderately intensive diet and lifestyle program lasting at least 12 months.</p><p><strong>Summary: </strong>Endoluminal metabolic and bariatric therapy represents a bridge between lifestyle counseling, pharmaceutical interventions, and the most efficacious treatment for obesity, bariatric surgery. By virtue of its minimally invasive approach, this therapy may be an appealing option for patients who are ineligible for, or averse to, bariatric surgery and who have experienced suboptimal outcomes or unable to afford medical treatments. Furthermore, these interventions may be particularly beneficial in the early stages of obesity.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-07-20DOI: 10.1097/MOG.0000000000000968
Muhammad Haseeb, Christopher C Thompson
Purpose of review: Gastroesophageal reflux disease (GERD) is the most common chronic condition with increasing prevalence in the Western world. Despite medical therapy, a considerable proportion of patients continue to experience symptoms, thus fueling the demand for minimally invasive GERD treatment options. This review will assess the currently available endoscopic approaches by analyzing their outcomes data, indication for use and limitations.
Recent findings: With increasing evidence of the safety and efficacy of endoscopic therapies, recent guidelines and consensus society documents have updated their recommendations for the endoscopic treatment of GERD. In this review, we have comprehensively assessed the current landscape of endoscopic approaches for the treatment of GERD and provided insight into future directions.
Summary: Endoscopic therapies for GERD show promise as new treatments emerge and existing therapies evolve into safer and more reproducible options. They are well positioned to cater to a large subset of the population suffering from chronic condition of GERD.
{"title":"Endoscopic therapy for gastroesophageal reflux disease: where are we, where are we going?","authors":"Muhammad Haseeb, Christopher C Thompson","doi":"10.1097/MOG.0000000000000968","DOIUrl":"10.1097/MOG.0000000000000968","url":null,"abstract":"<p><strong>Purpose of review: </strong>Gastroesophageal reflux disease (GERD) is the most common chronic condition with increasing prevalence in the Western world. Despite medical therapy, a considerable proportion of patients continue to experience symptoms, thus fueling the demand for minimally invasive GERD treatment options. This review will assess the currently available endoscopic approaches by analyzing their outcomes data, indication for use and limitations.</p><p><strong>Recent findings: </strong>With increasing evidence of the safety and efficacy of endoscopic therapies, recent guidelines and consensus society documents have updated their recommendations for the endoscopic treatment of GERD. In this review, we have comprehensively assessed the current landscape of endoscopic approaches for the treatment of GERD and provided insight into future directions.</p><p><strong>Summary: </strong>Endoscopic therapies for GERD show promise as new treatments emerge and existing therapies evolve into safer and more reproducible options. They are well positioned to cater to a large subset of the population suffering from chronic condition of GERD.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-07-05DOI: 10.1097/MOG.0000000000000959
Allison L Yang, Santhi Swaroop Vege
Purpose of review: The purpose of the review is to critically evaluate the evidence from the literature to establish the current perspective on fluid resuscitation (FR) in acute pancreatitis (AP). We will review the rationale, type of fluid, rate of administration, total volume, duration, monitoring, ideal outcomes to be studied in clinical trials and recommendations for future studies.
Recent findings: FR remains the key component of supportive therapy in AP. The paradigm has shifted from administration of aggressive fluid resuscitation towards more moderate FR strategies. Lactated Ringer's remains the preferred fluid for resuscitation. There remain critical gaps in knowledge regarding the end point(s) to indicate adequate resuscitation, and accurate assessments of fluid sequestration and intravascular volume deficit in AP.
Summary: There is insufficient evidence to state that goal-directed therapy, using any of the parameters to guide fluid administration, reduces the risk of persistent organ failure, infected pancreatic necrosis, or mortality in AP, as well as the most appropriate method for the same.
综述目的:综述的目的是对文献中的证据进行批判性评估,以确立当前对急性胰腺炎(AP)液体复苏(FR)的看法。我们将回顾液体复苏的原理、液体类型、给药速度、总量、持续时间、监测、临床试验中需要研究的理想结果以及对未来研究的建议:最近的研究结果:FR 仍是 AP 支持疗法的关键组成部分。目前的治疗模式已从积极的液体复苏转变为更为温和的急性肾衰竭治疗策略。乳酸林格氏液仍是首选的复苏液体。小结:目前还没有足够的证据表明,使用任何参数指导液体输注的目标导向疗法可降低 AP 患者持续器官衰竭、感染性胰腺坏死或死亡的风险,也没有足够的证据表明最合适的方法是什么。
{"title":"Fluid resuscitation in acute pancreatitis.","authors":"Allison L Yang, Santhi Swaroop Vege","doi":"10.1097/MOG.0000000000000959","DOIUrl":"10.1097/MOG.0000000000000959","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of the review is to critically evaluate the evidence from the literature to establish the current perspective on fluid resuscitation (FR) in acute pancreatitis (AP). We will review the rationale, type of fluid, rate of administration, total volume, duration, monitoring, ideal outcomes to be studied in clinical trials and recommendations for future studies.</p><p><strong>Recent findings: </strong>FR remains the key component of supportive therapy in AP. The paradigm has shifted from administration of aggressive fluid resuscitation towards more moderate FR strategies. Lactated Ringer's remains the preferred fluid for resuscitation. There remain critical gaps in knowledge regarding the end point(s) to indicate adequate resuscitation, and accurate assessments of fluid sequestration and intravascular volume deficit in AP.</p><p><strong>Summary: </strong>There is insufficient evidence to state that goal-directed therapy, using any of the parameters to guide fluid administration, reduces the risk of persistent organ failure, infected pancreatic necrosis, or mortality in AP, as well as the most appropriate method for the same.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9931630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-07-05DOI: 10.1097/MOG.0000000000000956
Nikola Gligorijevic, Maja Stefanovic-Racic, Erin E Kershaw
Purpose of review: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) should be considered in all cases of acute pancreatitis and triglyceride levels measured early, so that appropriate early and long-term treatment can be initiated.
Recent findings: In most cases of HTG-AP, conservative management (nothing by mouth, intravenous fluid resuscitation and analgesia) is sufficient to achieve triglyceride levels less than 500 mg/dl. Intravenous insulin and plasmapheresis are sometimes used, although prospective studies showing clinical benefits are lacking. Pharmacological management of hypertriglyceridemia (HTG) should start early and target triglyceride levels of less than 500 mg/dl to reduce the risk or recurrent acute pancreatitis. In addition to currently used fenofibrate and omega-3 fatty acids, several novel agents are being studied for long-term treatment of HTG. These emerging therapies focus mainly on modifying the action of lipoprotein lipase (LPL) through inhibition of apolipoprotein CIII and angiopoietin-like protein 3. Dietary modifications and avoidance of secondary factors that worsen triglyceride levels should also be pursued. In some cases of HTG-AP, genetic testing may help personalize management and improve outcomes.
Summary: Patients with HTG-AP require acute and long-term management of HTG with the goal of reducing and maintaining triglyceride levels to less than 500 mg/dl.
{"title":"Medical management of hypertriglyceridemia in pancreatitis.","authors":"Nikola Gligorijevic, Maja Stefanovic-Racic, Erin E Kershaw","doi":"10.1097/MOG.0000000000000956","DOIUrl":"10.1097/MOG.0000000000000956","url":null,"abstract":"<p><strong>Purpose of review: </strong>Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) should be considered in all cases of acute pancreatitis and triglyceride levels measured early, so that appropriate early and long-term treatment can be initiated.</p><p><strong>Recent findings: </strong>In most cases of HTG-AP, conservative management (nothing by mouth, intravenous fluid resuscitation and analgesia) is sufficient to achieve triglyceride levels less than 500 mg/dl. Intravenous insulin and plasmapheresis are sometimes used, although prospective studies showing clinical benefits are lacking. Pharmacological management of hypertriglyceridemia (HTG) should start early and target triglyceride levels of less than 500 mg/dl to reduce the risk or recurrent acute pancreatitis. In addition to currently used fenofibrate and omega-3 fatty acids, several novel agents are being studied for long-term treatment of HTG. These emerging therapies focus mainly on modifying the action of lipoprotein lipase (LPL) through inhibition of apolipoprotein CIII and angiopoietin-like protein 3. Dietary modifications and avoidance of secondary factors that worsen triglyceride levels should also be pursued. In some cases of HTG-AP, genetic testing may help personalize management and improve outcomes.</p><p><strong>Summary: </strong>Patients with HTG-AP require acute and long-term management of HTG with the goal of reducing and maintaining triglyceride levels to less than 500 mg/dl.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9985602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}