Pub Date : 2023-04-11DOI: 10.3389/fgstr.2023.1129715
M. Q. Chaudhry, S. Abid, N. Kayani
This is a case of a young gentleman, who presented with complaints of hematochezia, weight loss and fluctuating fever for the past five months. The patient was a known case of Hirschsprung disease and Ulcerative colitis (IUC) and underwent a rectal Duhamel procedure in the past. On examination there was a fistula with an external opening at the anal verge. The clinical suspicion at this point was enterocutaneous fistula, abscess, and incontinence secondary to Hirschsprung disease. Investigations including MRI and sigmoidoscopy were carried out. A tissue from the anorectal junction was taken for histopathology review. Histopathological analysis suggested granulomatous inflammation with collection of epithelioid histiocytes along with caseating necrosis. This was consistent with the diagnosis of anal tuberculosis. The patient was started on a quadruple regimen of anti-tuberculous drugs (ATT). The patient six months into treatment has shown significant clinical improvement.
{"title":"Case report: Anal tuberculosis presenting as an anal fistula","authors":"M. Q. Chaudhry, S. Abid, N. Kayani","doi":"10.3389/fgstr.2023.1129715","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1129715","url":null,"abstract":"This is a case of a young gentleman, who presented with complaints of hematochezia, weight loss and fluctuating fever for the past five months. The patient was a known case of Hirschsprung disease and Ulcerative colitis (IUC) and underwent a rectal Duhamel procedure in the past. On examination there was a fistula with an external opening at the anal verge. The clinical suspicion at this point was enterocutaneous fistula, abscess, and incontinence secondary to Hirschsprung disease. Investigations including MRI and sigmoidoscopy were carried out. A tissue from the anorectal junction was taken for histopathology review. Histopathological analysis suggested granulomatous inflammation with collection of epithelioid histiocytes along with caseating necrosis. This was consistent with the diagnosis of anal tuberculosis. The patient was started on a quadruple regimen of anti-tuberculous drugs (ATT). The patient six months into treatment has shown significant clinical improvement.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49243384","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 : 2023-03-23DOI: 10.3389/fgstr.2023.1161610
Arndt Steube, J. Stallhofer, A. Stallmach
Ulcerative colitis (UC) is one of the main forms of chronic inflammatory bowel disease; however, despite intensive efforts, its etiology remains unclear. It is generally accepted that disturbances in the gastrointestinal microbiota (“dysbiosis”) contribute to the manifestation and perpetuation of UC. To date, treatment has focused on anti-inflammatory strategies; however, their widespread application is limited by side effects and primary/secondary loss of response. Following the resounding success of fecal microbiota transfer (FMT) to treat Clostridioides difficile infection (CDI), numerous studies have shown that FMT is also effective and safe in UC patients. In this review, we discuss the various modifications (e.g., antibiotic preconditioning, multi-donor concept, extension/intensification of application, long-term therapy, and dietary donor conditioning) that increase the efficacy of FMT. We then describe how the continuous need for healthy donors and the associated medicolegal requirements, limit the large-scale application of FMT. We conclude that FMT will likely be viewed as a transitional technology, which will be superceded by recombinantly produced bioproducts once the therapeutically active substances have been identified.
{"title":"Fecal microbiota transfer to treat ulcerative colitis: Medical and legal challenges","authors":"Arndt Steube, J. Stallhofer, A. Stallmach","doi":"10.3389/fgstr.2023.1161610","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1161610","url":null,"abstract":"Ulcerative colitis (UC) is one of the main forms of chronic inflammatory bowel disease; however, despite intensive efforts, its etiology remains unclear. It is generally accepted that disturbances in the gastrointestinal microbiota (“dysbiosis”) contribute to the manifestation and perpetuation of UC. To date, treatment has focused on anti-inflammatory strategies; however, their widespread application is limited by side effects and primary/secondary loss of response. Following the resounding success of fecal microbiota transfer (FMT) to treat Clostridioides difficile infection (CDI), numerous studies have shown that FMT is also effective and safe in UC patients. In this review, we discuss the various modifications (e.g., antibiotic preconditioning, multi-donor concept, extension/intensification of application, long-term therapy, and dietary donor conditioning) that increase the efficacy of FMT. We then describe how the continuous need for healthy donors and the associated medicolegal requirements, limit the large-scale application of FMT. We conclude that FMT will likely be viewed as a transitional technology, which will be superceded by recombinantly produced bioproducts once the therapeutically active substances have been identified.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47110127","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 : 2023-03-09DOI: 10.3389/fgstr.2023.1016915
P. Garg, K. Madan
Acute-on-chronic liver failure (ACLF) is a complex health problem with a high short-term mortality. It is a form of end-stage liver disease (ESLD) characterized by acute hepatic insult on the background of an underlying chronic liver disease leading to other extrahepatic organ failures. Due to its rapid rate of progression, it is a challenge for both hepatologists and intensivists to treat. Many variations exist regarding its definition, leading to descriptions of various clinical phenotypes. Patients who have chronic hepatitis B (CHB) or Hepatitis B virus (HBV)-related cirrhosis are also prone to develop hepatic or extrahepatic failures when they develop a superadded insult. Different severity criteria and prognostic scores have been proposed and validated among various populations and various etiologies including HBV. The management mainly focusses on support of various organ failures while waiting for the liver to regenerate, for liver transplantation, or, in the case of HBV-related ACLF (HBV-ACLF), for the anti-virals to take effect. Liver transplantation still remains the definitive treatment for HACLV in general and even for HBV- ACLF. Medical therapies, such as nucleos(t)ide analogue (NUCs)and artificial liver support, may improve survival in a subset of patients with HBV-related ACLF. This review updates the understanding of HBV-ACLF from epidemiological and clinical studies and provides new insights into the definition, diagnostic criteria, epidemiology, pathogenesis, treatment, and prognostication of HBV-ACLF.
{"title":"Acute-on-chronic liver failure due to hepatitis B","authors":"P. Garg, K. Madan","doi":"10.3389/fgstr.2023.1016915","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1016915","url":null,"abstract":"Acute-on-chronic liver failure (ACLF) is a complex health problem with a high short-term mortality. It is a form of end-stage liver disease (ESLD) characterized by acute hepatic insult on the background of an underlying chronic liver disease leading to other extrahepatic organ failures. Due to its rapid rate of progression, it is a challenge for both hepatologists and intensivists to treat. Many variations exist regarding its definition, leading to descriptions of various clinical phenotypes. Patients who have chronic hepatitis B (CHB) or Hepatitis B virus (HBV)-related cirrhosis are also prone to develop hepatic or extrahepatic failures when they develop a superadded insult. Different severity criteria and prognostic scores have been proposed and validated among various populations and various etiologies including HBV. The management mainly focusses on support of various organ failures while waiting for the liver to regenerate, for liver transplantation, or, in the case of HBV-related ACLF (HBV-ACLF), for the anti-virals to take effect. Liver transplantation still remains the definitive treatment for HACLV in general and even for HBV- ACLF. Medical therapies, such as nucleos(t)ide analogue (NUCs)and artificial liver support, may improve survival in a subset of patients with HBV-related ACLF. This review updates the understanding of HBV-ACLF from epidemiological and clinical studies and provides new insights into the definition, diagnostic criteria, epidemiology, pathogenesis, treatment, and prognostication of HBV-ACLF.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41994090","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 : 2023-03-06DOI: 10.3389/fgstr.2023.1109999
Karimzadeh Mostafa, Carmen Wolf, Johannes Austrup, Frederike Franke, Olav Jansen, M. Both, P. Langguth
Nowadays, a minimally invasive surgical approach is increasingly being chosen to treat distal esophageal tumors. Here, postoperative hiatal herniation has been identified as a potentially severe complication. In such cases, it is still not known whether surgical or conservative treatment is preferable. In this report, we elaborate the case of a 62-year-old male patient who presented at our emergency department with severe chest pain. This patient had undergone minimally invasive esophagectomy with gastric pull-up 2 years prior to this event. Emergency computed tomography revealed a left-sided tension pneumothorax based on transhiatal herniation of the transverse colon causing an intrathoracic closed-loop obstruction with subsequent perforation. Immediate surgical treatment was initiated and the transverse colon could be successfully repositioned and resected. Nevertheless, the patient died due to postoperative septic shock in the setting of fecal peritonitis, mediastinitis, and pleuritis within 48 hours after surgery. We provide a detailed description of this rare case and provide a review of the literature concerning intrathoracic colonic herniations.
{"title":"A rare and severe complication after minimally invasive esophagectomy: First case of a left-sided tension pneumothorax caused by intrathoracic perforation of the herniated transverse colon. Case report and literature review","authors":"Karimzadeh Mostafa, Carmen Wolf, Johannes Austrup, Frederike Franke, Olav Jansen, M. Both, P. Langguth","doi":"10.3389/fgstr.2023.1109999","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1109999","url":null,"abstract":"Nowadays, a minimally invasive surgical approach is increasingly being chosen to treat distal esophageal tumors. Here, postoperative hiatal herniation has been identified as a potentially severe complication. In such cases, it is still not known whether surgical or conservative treatment is preferable. In this report, we elaborate the case of a 62-year-old male patient who presented at our emergency department with severe chest pain. This patient had undergone minimally invasive esophagectomy with gastric pull-up 2 years prior to this event. Emergency computed tomography revealed a left-sided tension pneumothorax based on transhiatal herniation of the transverse colon causing an intrathoracic closed-loop obstruction with subsequent perforation. Immediate surgical treatment was initiated and the transverse colon could be successfully repositioned and resected. Nevertheless, the patient died due to postoperative septic shock in the setting of fecal peritonitis, mediastinitis, and pleuritis within 48 hours after surgery. We provide a detailed description of this rare case and provide a review of the literature concerning intrathoracic colonic herniations.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49005744","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 : 2023-02-21DOI: 10.3389/fgstr.2023.1120795
Y. Bi, Jianzhuang Ren, Xinwei Han
Objective Fully covered self-expandable metallic stents (SEMSs) have been widely used as a salvage therapy for patients with esophageal variceal bleeding. However, the role of fully covered SEMSs in the management of hemorrhage caused by esophageal cancer has not yet been established. We aimed to investigate the safety and efficacy of fully covered SEMSs as a salvage therapy for esophageal cancer-related hemorrhage. Methods From September 2019 to March 2022, 17 patients, who underwent the insertion of fully covered SEMS for malignant esophageal hemorrhages, were retrospectively analyzed. Chest computed tomography (CT) scans and esophagographies were performed routinely to determine the location and length of the tumor. A fully covered SEMS was implanted under fluoroscopy. Baseline demographics were retrospectively collected, that is those for sex, age, previous treatment, comorbidities, lesion type, and stent size. Results A total of 20 metal stents were placed in 17 patients, with a technical success rate of 100% and a hemostasis success rate of 88.2%. Stent removal was performed in three patients because of complications. No perioperative deaths were related to stent placement or removal. Five main complications (29.4%) were found after stent insertion. Stent migration and restenosis were observed in two patients (11.8%). Except for two perioperative deaths and one patient lost to follow-up, all remaining 14 patients were successfully followed up. At the end of follow-up, two patients had survived without obvious symptoms, and a total of 12 patients were dead owing to tumor progression (n = 10), severe infection (n = 1), and cerebrovascular accident (n = 1). The median overall survival was 13.8 months. Conclusion Insertion of a fully covered SEMS may be a safe and effective means of the salvage management of refractory esophageal cancer-related hemorrhage, and its use in this context may lead to the development of innovative methods for compression hemostasis. However, further study with a larger sample size and comparison with other forms of salvage therapy.
{"title":"Compression hemostasis using fully covered self-expandable metallic stents for refractory hemorrhages caused by esophageal cancer: A pilot study","authors":"Y. Bi, Jianzhuang Ren, Xinwei Han","doi":"10.3389/fgstr.2023.1120795","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1120795","url":null,"abstract":"Objective Fully covered self-expandable metallic stents (SEMSs) have been widely used as a salvage therapy for patients with esophageal variceal bleeding. However, the role of fully covered SEMSs in the management of hemorrhage caused by esophageal cancer has not yet been established. We aimed to investigate the safety and efficacy of fully covered SEMSs as a salvage therapy for esophageal cancer-related hemorrhage. Methods From September 2019 to March 2022, 17 patients, who underwent the insertion of fully covered SEMS for malignant esophageal hemorrhages, were retrospectively analyzed. Chest computed tomography (CT) scans and esophagographies were performed routinely to determine the location and length of the tumor. A fully covered SEMS was implanted under fluoroscopy. Baseline demographics were retrospectively collected, that is those for sex, age, previous treatment, comorbidities, lesion type, and stent size. Results A total of 20 metal stents were placed in 17 patients, with a technical success rate of 100% and a hemostasis success rate of 88.2%. Stent removal was performed in three patients because of complications. No perioperative deaths were related to stent placement or removal. Five main complications (29.4%) were found after stent insertion. Stent migration and restenosis were observed in two patients (11.8%). Except for two perioperative deaths and one patient lost to follow-up, all remaining 14 patients were successfully followed up. At the end of follow-up, two patients had survived without obvious symptoms, and a total of 12 patients were dead owing to tumor progression (n = 10), severe infection (n = 1), and cerebrovascular accident (n = 1). The median overall survival was 13.8 months. Conclusion Insertion of a fully covered SEMS may be a safe and effective means of the salvage management of refractory esophageal cancer-related hemorrhage, and its use in this context may lead to the development of innovative methods for compression hemostasis. However, further study with a larger sample size and comparison with other forms of salvage therapy.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47237151","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 : 2023-01-23DOI: 10.3389/fgstr.2023.1063590
Charly Feutseu, M. Kowo, A. Boli, J. Katte, Magellan Guewo-Fokeng, Sylvain Zemsi, M. Dehayem, S. Choukem, E. Sobngwi
Background Several epidemiological studies have established the association between hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM). However, the determinants and reasons for the high prevalence of HCV infection in people with T2DM are not well understood especially in sub-Saharan African populations. In this study, we aimed to assess determinants of the association between HCV infection and T2DM. Methods We performed a cross-sectional study amongst 442 T2DM patients recruited from an out-patient adult diabetes clinic in a tertiary hospital and 442 non-diabetic controls recruited from the general population. Serological testing for HCV antibody was performed using standard ELISA technique. Anti-HCV antibody prevalence was reported by age group in participants with diabetes and the non-diabetic controls. Logistic regression was used to examine for factors associated with the HCV infection in patients with diabetes. Results We reported an overall HCV prevalence of 11.5% [95% CI: 9.4-13.6] irrespective of diabetes status in this study. The seroprevalence of HCV infection in diabetics patients was 17.6% [95% CI: 14.0-21.2] compared to 5.5% [95% CI: 3.4-7.6] in non-diabetics (p< 0.001). We did not find a significant HCV seropositivity difference in diabetic patients with common risk factors of HCV infection. When investigating the HCV seroprevalence by age group in diabetic and non-diabetic patients, no case of HCV infection was found in patients less than 30 years old while the highest HCV seropositivity was reported in patients older than 60 years (36.7% T2DM and 11.1% for non-diabetics) followed by the patients belonging to 50-59 years age group (16% in T2DM and 5.8% in non-diabetics) and those in 40-49 years age group (4.4% in diabetic, 0.8% in non-diabetic). To support this finding, in a multivariate logistic regression, only diabetic patients belonging to age group > 65 years had a significant risk (OR: 16.7 [95% CI: 1.7-160.0]) to acquire HCV infection. Conclusion The seroprevalence of HCV infection is higher among T2DM adult patients than in non-diabetic patients, and is associated with increased age. This age-dependent association may suggest a generational exposure that may no longer exist overtime.
{"title":"Seroprevalence of hepatitis C virus infection in patients with type 2 diabetes mellitus is associated with increased age in sub-Saharan Africa: Results from a cross-sectional comparative analysis","authors":"Charly Feutseu, M. Kowo, A. Boli, J. Katte, Magellan Guewo-Fokeng, Sylvain Zemsi, M. Dehayem, S. Choukem, E. Sobngwi","doi":"10.3389/fgstr.2023.1063590","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1063590","url":null,"abstract":"Background Several epidemiological studies have established the association between hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM). However, the determinants and reasons for the high prevalence of HCV infection in people with T2DM are not well understood especially in sub-Saharan African populations. In this study, we aimed to assess determinants of the association between HCV infection and T2DM. Methods We performed a cross-sectional study amongst 442 T2DM patients recruited from an out-patient adult diabetes clinic in a tertiary hospital and 442 non-diabetic controls recruited from the general population. Serological testing for HCV antibody was performed using standard ELISA technique. Anti-HCV antibody prevalence was reported by age group in participants with diabetes and the non-diabetic controls. Logistic regression was used to examine for factors associated with the HCV infection in patients with diabetes. Results We reported an overall HCV prevalence of 11.5% [95% CI: 9.4-13.6] irrespective of diabetes status in this study. The seroprevalence of HCV infection in diabetics patients was 17.6% [95% CI: 14.0-21.2] compared to 5.5% [95% CI: 3.4-7.6] in non-diabetics (p< 0.001). We did not find a significant HCV seropositivity difference in diabetic patients with common risk factors of HCV infection. When investigating the HCV seroprevalence by age group in diabetic and non-diabetic patients, no case of HCV infection was found in patients less than 30 years old while the highest HCV seropositivity was reported in patients older than 60 years (36.7% T2DM and 11.1% for non-diabetics) followed by the patients belonging to 50-59 years age group (16% in T2DM and 5.8% in non-diabetics) and those in 40-49 years age group (4.4% in diabetic, 0.8% in non-diabetic). To support this finding, in a multivariate logistic regression, only diabetic patients belonging to age group > 65 years had a significant risk (OR: 16.7 [95% CI: 1.7-160.0]) to acquire HCV infection. Conclusion The seroprevalence of HCV infection is higher among T2DM adult patients than in non-diabetic patients, and is associated with increased age. This age-dependent association may suggest a generational exposure that may no longer exist overtime.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46369416","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 : 2023-01-16DOI: 10.3389/fgstr.2022.1039649
C. Conrad, M. Ellrichmann
Introduction Stenting of the pancreas is a challenging task for the interventional gastroenterologist. The indications for pancreatic stent implantation are either prophylactic or therapeutic. We give an overview of currently available literature and techniques for the respective indications of pancreatic stent placement. Methods A structured literature research was conducted (Pubmed.gov) primarily using the following key words: interventional endoscopy, pancreatic stenting, post-ERCP pancreatitis, pancreatic Q8 fistulae, pancreas divisum. Results Prophylactic stent implantation aims to prevent PEP by using thin (3-5 Fr) and short (3-5 cm) designated pancreatic stents at least in high-risk patients. Therapeutic stent placement is intended to restore the proper flow of pancreatic secretion with stenoses, leaks, fistulas or anatomical malformation of the pancreatic duct. Depending on the etiology, plastic stents or SEMSs are used. Another field of pancreatic stenting represents EUS-guided puncture with stent implantation as an alternative access to the main pancreatic duct when transpapillary access is impossible. In addition to the implantation of plastic stents, which achieve good results, LAMS implantation can be discussed as an alternative access route. Discussion The field of pancreatic stenting is complex and belongs in the hands of experienced endoscopists in specialized institutions. This can ensure that the patient receives the optimal treatment with the best possible outcome.
{"title":"Stent placement in pancreatic disease, when, which and why? – a current perspective","authors":"C. Conrad, M. Ellrichmann","doi":"10.3389/fgstr.2022.1039649","DOIUrl":"https://doi.org/10.3389/fgstr.2022.1039649","url":null,"abstract":"Introduction Stenting of the pancreas is a challenging task for the interventional gastroenterologist. The indications for pancreatic stent implantation are either prophylactic or therapeutic. We give an overview of currently available literature and techniques for the respective indications of pancreatic stent placement. Methods A structured literature research was conducted (Pubmed.gov) primarily using the following key words: interventional endoscopy, pancreatic stenting, post-ERCP pancreatitis, pancreatic Q8 fistulae, pancreas divisum. Results Prophylactic stent implantation aims to prevent PEP by using thin (3-5 Fr) and short (3-5 cm) designated pancreatic stents at least in high-risk patients. Therapeutic stent placement is intended to restore the proper flow of pancreatic secretion with stenoses, leaks, fistulas or anatomical malformation of the pancreatic duct. Depending on the etiology, plastic stents or SEMSs are used. Another field of pancreatic stenting represents EUS-guided puncture with stent implantation as an alternative access to the main pancreatic duct when transpapillary access is impossible. In addition to the implantation of plastic stents, which achieve good results, LAMS implantation can be discussed as an alternative access route. Discussion The field of pancreatic stenting is complex and belongs in the hands of experienced endoscopists in specialized institutions. This can ensure that the patient receives the optimal treatment with the best possible outcome.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47047893","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 : 2023-01-10DOI: 10.3389/fgstr.2022.1088133
Gaobo Huang, W. Song, Yanchao Zhang, B. Ren, Y. Lv, Kang-Nian Liu
Background Pancreatic neuroendocrine tumors (pNETs) are a group of uncommon tumors derived from peptide neurons and neuroendocrine cells, and account for roughly 2% to 4% of all pancreatic neoplasms. This study aimed to construct and validate a nomogram for predicting the prognosis of patients with pNETs. Our data came from the SEER database. Methods A total of 5927 pNETs patients between 2004 and 2018 were included in this study. The nomogram was constructed base on eight prognostic factors and validated by C-index, ROC curve and calibration curves. A nomogram based on eight independent prognostic factors (patient age, sex, race, tumor grade, AJCC T, AJCC N, AJCC M, surgery, radiation, chemotherapy, tumor function and marital status) was developed for the prediction of CSS at 3 and 5 years. Results The C-index and AUCs of the nomogram demonstrated that its superiority in discrimination over AJCC staging system. The calibration plots showed the good consistency between predictions and actual observations. Conclusions In conclusion, our nomogram could better predict the prognosis of pNETs patients than AJCC staging system. The nomogram could be improved by integrating more important factors other than SEER database.
{"title":"Construction and validation of a nomogram for patients with pancreatic neuroendocrine tumors: A population study of 5,927 patients","authors":"Gaobo Huang, W. Song, Yanchao Zhang, B. Ren, Y. Lv, Kang-Nian Liu","doi":"10.3389/fgstr.2022.1088133","DOIUrl":"https://doi.org/10.3389/fgstr.2022.1088133","url":null,"abstract":"Background Pancreatic neuroendocrine tumors (pNETs) are a group of uncommon tumors derived from peptide neurons and neuroendocrine cells, and account for roughly 2% to 4% of all pancreatic neoplasms. This study aimed to construct and validate a nomogram for predicting the prognosis of patients with pNETs. Our data came from the SEER database. Methods A total of 5927 pNETs patients between 2004 and 2018 were included in this study. The nomogram was constructed base on eight prognostic factors and validated by C-index, ROC curve and calibration curves. A nomogram based on eight independent prognostic factors (patient age, sex, race, tumor grade, AJCC T, AJCC N, AJCC M, surgery, radiation, chemotherapy, tumor function and marital status) was developed for the prediction of CSS at 3 and 5 years. Results The C-index and AUCs of the nomogram demonstrated that its superiority in discrimination over AJCC staging system. The calibration plots showed the good consistency between predictions and actual observations. Conclusions In conclusion, our nomogram could better predict the prognosis of pNETs patients than AJCC staging system. The nomogram could be improved by integrating more important factors other than SEER database.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49475122","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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