Effect of Early Surgery vs Stepped Medical-Endoscopic-Surgical Management on Pain in Patients With Chronic Pancreatitis
This randomized clinical trial compares the effects of pancreatic drainage surgery within 6 weeks vs a stepped medical-endoscopy-surgical approach on pain score and relief over 18 months among patients with chronic pancreatitis.
Opioid use disorder (OUD) has become a public health crisis in the United States. OUD has been shown to have worse outcomes in patients with chronic conditions. Although opioids are widely used for pain management in acute conditions such as acute pancreatitis (AP), the impact of OUD on outcomes in patients with AP remains unknown. We aimed to evaluate the prevalence, trends and impact of OUD on outcomes in hospitalized patients with AP.
Purpose of review Pain is the most common symptom of chronic pancreatitis, having a profound effect on patients and a broad socioeconomic impact. Endoscopy is guideline recommended as first-line management for chronic pancreatitis pain in certain clinical scenarios. Herein, we provide an evidence-based review of the endoscopic treatment of pain due to chronic pancreatitis while highlighting some important confounders in the measurement of this outcome in clinical practice and research. Recent findings Multiple recent studies have reported on the efficacy of current endoscopic therapies for chronic pancreatitis pain. D...
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog aka Tropical Travel Trouble 009 The diagnosis of HIV is no longer fatal and the term AIDS is becoming less frequent. In many countries, people with HIV are living longer than those with diabetes. This post will hopefully teach the basics of a complex disease and demystify some of the potential diseases you need to consider in those who are severely immunosuppressed. While trying to be comprehensive this post can not be exhaustive (as you can imagine any patient with ...
ConclusionAvailable results are promising in terms of ductal clearance and pain relief compared to standard endoscopic techniques and ESWL as the current gold standard for lithotripsy. Interpretation of this data is limited by the small number of cases for POP and the lack of prospective randomized controlled trials.
ConclusionAvailable results are promising in terms of ductal clearance and pain relief compared to standard endoscopic techniques and ESWL as the current gold standard for lithotripsy. Interpretation of this data is limited by the small number of cases for POP and the lacking of prospective randomized controlled trials.This article is protected by copyright. All rights reserved.
Conclusions In selected patients with obstructive chronic calcific pancreatitis, the DPD bypass may be considered as a rescue endoscopic therapy, potentially obviating the need for surgery when standard endoscopic methods and ESWL fail. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | Full text
Conclusion: The FCSEMS appears to be a feasible and potentially effective option for the management of refractory pancreatic duct strictures due to chronic pancreatitis during long-term follow-up. AEs including post-procedure pain, stent-induced ductal changes, migration, and ductitis are issues that need to be resolved. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
Conclusion IOC can be safely and routinely performed in LC. It helps to identify CBD stones, even in patients with no known risk factors, delineate bile duct anatomy and facilitate single-stage management of CBD stones.
A 38-year-old woman came to us because she had experienced moderate to severe central abdominal pain radiating to her back for the previous 2 years. She had received a diagnosis of chronic pancreatitis with intracanalar stones 10 years earlier and had undergone lateral pancreaticojejunostomy (LPJ) 8 years earlier after failed pancreatic endotherapy (ERCP). A CT scan was suggestive of post-LPJ status, diffusely atrophic pancreas, dilated pancreatic duct (PD) in the head (1.5 cm), and 2 calculi measuring 1.4 and 1.6 cm in the head region (Fig. 1A).
A 49-year-old man presented to the cardiology unit with sudden-onset chest pain. His electrocardiogram and cardiac troponin levels were within normal limits. The patient had a history of alcohol abuse and had experienced episodes of abdominal pain for the previous 2 years. Contrast-enhanced CT (CECT) of the chest revealed bilateral pleural effusion and a descending thoracic aorta pseudoaneurysm (Fig. 1A). The surrounding mediastinum had a fluid collection that communicated with the abdominal pseudocyst (Fig. 1A, B).