Background Endoscopic therapy of walled-off pancreatic necrosis (WOPN) via direct intracavitary debridement is described. Objective To compare direct endoscopic necrosectomy with conventional transmural endoscopic drainage for the treatment of WOPN. Design Retrospective, comparative study. Setting Academic tertiary-care center. Patients Patients referred to Mayo Clinic, Rochester, Minnesota, since April 1998 for endoscopic drainage of WOPN. Interventions Each patient underwent standard endoscopi...
Background UK guidelines for gallstone pancreatitis (GSP) advocate definitive treatment during the index admission, or within 2 weeks of discharge. However, this target may not always be achievable. This study reviewed current management of GSP in a university hospital and evaluated the risk associated with interval cholecystectomy.
AIM: The aim of this study was to assess the effect of the implementation of evidence-based guidelines and subsequent feedback to surgeons in the management of acute pancreatitis. METHOD: An evidence-based Pancreatitis Proforma was developed. Data were prospectively recorded (01/06/2005-30/09/2007). Audit feedback (AFB) was performed at 9 months. A final analysis was performed comparing outcomes pre- and post-audit feedback. RESULTS: 372 patients were included. Median age (range) was 57 (12-96) ...
Background: Surgical audit on management of mild acute gallstone pancreatitis at Western Health showed that non-compliance of carrying out laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography and sphincterectomy within 4 weeks had resulted in a high readmission rate. Modification of management was then instituted and audit cycle repeated to assess the outcome. Methods: Medical records of patients with mild acute gallstone pancreatitis between January 2000 and February 2...
OBJECTIVE: To determine the effect of timing of surgical intervention for necrotizing pancreatitis. DESIGN: Retrospective study of 53 patients and a systematic review. SETTING: A tertiary referral center. Main Outcome Measure Mortality. RESULTS: Median timing of the intervention was 28 days. Eighty-three percent of patients had infected necrosis and 55% had preoperative organ failure. The mortality rate was 36%. Sixteen patients were operated on within 14 days of initial admission, 11 patients f...
Last. C J MacKay(Glasgow Royal Infirmary)H-Index: 1
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BackgroundNational guidelines exist for the treatment of acute gallstone pancreatitis, but not for the management of acute cholecystitis (AC).AimsTo establish the preferred management of uncomplicated AC and adherence to guidelines for the management of mild gallstone pancreatitis in the west of Scotland.MethodsA postal survey of all 100 consultant general surgeons in the west of Scotland.Results67 of 71 responses received were suitable for analysis. For uncomplicated AC, 24 (36%) perform urgent...
Abstract Background The Italian Association for the Study of the Pancreas released a diagnostic and therapeutic algorithm for acute pancreatitis in 1999. Aim This study focused on the analysis of the therapeutic approach for the treatment of acute pancreatitis in Italy. Patients One thousand, one hundred and seventy-three patients were recruited: 1006 patients (85.8%) had mild acute pancreatitis (MAP) and 167 (14.2%) had the severe acute pancreatitis (SAP); 161 patients showed pancreatic necrosi...
Abstract Background and aim Up till now, only one study providing practically complete information on acute pancreatitis in Italy has been published. The aim of this prospective study was to evaluate the clinical characteristics, in terms of diagnostic assessment and outcome, of a large series of patients affected by acute pancreatitis in Italy. Materials and methods The study involved 56 Italian centres, homogeneously distributed throughout the entire national territory. Each participating cent...
#1Reza Mofidi(Edin.: University of Edinburgh)H-Index: 16
#2K. K. Madhavan(Edin.: University of Edinburgh)H-Index: 17
Last. Rowan W. Parks(Edin.: University of Edinburgh)H-Index: 52
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Background: The aim of this study was to audit the management of patients with acute pancreatitis against the standards of practice in the British Society of Gastroenterology guidelines. Methods: The study assessed consecutive patients with acute pancreatitis over 5 years. Audit targets were overall mortality below 10 per cent, mortality for severe acute pancreatitis below 30 per cent, correct diagnosis and severity stratification within 48 h, aetiology determined in more than 80 per cent, avail...
Background: Implementation of guidelines for the therapy of acute pancreatitis (e.g. those of the International Association of Pancreatology, IAP) into clinical practice has been as
OBJECTIVES Acute pancreatitis (AP) is a leading cause of inpatient care among gastrointestinal conditions. Our study compares the management of AP and adherence to guidelines among teaching medicine, nonteaching medicine, and surgical services within the same center. METHODS We performed a retrospective chart review of AP patients admitted to our center between January 2016 and January 2017 and analyzed the clinical and epidemiological data. RESULTS Of 115 patients, 65% were admitted to medicine...
OBJECTIVES The trend toward minimally invasive procedures (MIP) in necrotizing pancreatitis is increasing. The optimal timing and technique of cholecystectomy in severe/necrotizing pancreatitis is unclear. This study aims to determine the role of laparoscopic cholecystectomy after severe/necrotizing pancreatitis in the context of MIP. METHODS Retrospective analysis of a prospective database was performed for consecutive patients after cholecystectomy for gallstone pancreatitis between January 20...
OBJECTIVES: This study aimed to evaluate trends in hospitalizations and outcomes of acute pancreatitis (AP) according to first admitting hospital unit and hospital volumes. METHODS: Hospital discharge records of patients with AP admitted in the Veneto Region (Northeast Italy) during the period 2001-2015 were examined. RESULTS: A total of 23,389 patients (54% males; mean age, 62.2 years; standard deviation, 19.3 years) were admitted for AP. Both hospitalization (32.4 to 29.5/100,000 inhabitants p...
Last. Jorge Puelles(Takeda Pharmaceutical Company)H-Index: 9
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Background and objectives The global incidence of hospitalisation due to acute pancreatitis (AP) has been rising in the recent decades. In the USA alone, there was a 13.2% increase between 2009 and 2012 compared with 2002–2005. There remains a lack of approved treatments to prevent disease progression, leaving many liable to developing complications that include multisystem organ failure (OF) and death. This therapeutic deficit raises questions about the scale of the current burden of illness (B...
Walled-off necrosis (WON) is a relatively new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the experti...
To examine the outcomes from minimal access retroperitoneal pancreatic necrosectomy (MARPN) and open pancreatic necrosectomy (OPN) for severe necrotizing pancreatitis in a single center.The optimal management of severe pancreatic necrosis is evolving with a few large center single series.Between 1997 and 2013, patients with necrotizing pancreatitis at the Liverpool Pancreas Center were reviewed. Outcome measures were retrospectively analyzed by intention to treat.There were 394 patients who had ...
Last. Raúl de Pablo(University of Alcalá)H-Index: 14
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Abstract Background The updated Atlanta Classification of acute pancreatitis (AP) in adults defined three levels of severity according to the presence of local and/or systemic complications and presence and length of organ failure. No study focused on complications and mortality of patients with moderately severe AP admitted to intensive care unit (ICU). The main aim of this study is to describe the complications developed and outcomes of these patients and compare them to those with severe AP. ...
Last. Robin S. McLeod(U of T: University of Toronto)H-Index: 13
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Despite existing evidence-based practice guidelines for the management of acute pancreatitis, clinical compliance with recommendations is poor. We conducted a retrospective review of 248 patients admitted between 2010 and 2012 with acute pancreatitis at eight University of Toronto affiliated hospitals. We included all patients admitted to ICU (52) and 25 ward patients from each site (196). Management was compared with the most current evidence used in the Best Practice in General Surgery Managem...
Abstract Introduction Recent reports have demonstrated improvement in the 5-years serviva with resecate ductal adenocarcinoma. The aim of study is to determinate the factor influencing long-term survival after DCP. Materials and methods We have critically reviewed a group of 85 patients how were admitted to our department with diagnosis of ductal adenocarcinoma of the head of pancreas between January 1974 and January 1998. Results Patients were stratified according to stage using TNM classificat...