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New horizons in pancreatic genetics
Purpose of review Pancreatitis remains an intractable disease because no causative treatment is yet available. Recent studies have uncovered some of its underlying pathophysiology, a requirement for identifying potential treatment targets. These advancements were achieved by human genetic studies and by introducing genetic mechanisms into experimental pancreatitis models. Recent findings Cationic trypsin mutations are the most prominent genetic risk factor for pancreatitis. Investigators have now introduced genetically modified trypsin variants into transgenic animals. In this manner they characterized the role of cel...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Precision medicine for pancreatic diseases
We describe and contrast the strengths of precision medicine with Western medicine, and complex trait genetics with Mendelian genetics. Classic genetics focuses on highly penetrant pathogenic variants in a single gene believed to cause or confer a high risk for well-defined phenotypes. However, a minority of disorders have a single gene cause. Further, even individuals with identical Mendelian disease-associated genotypes may exhibit substantial phenotypic variability indicative of genetic and environmental modifiers. Still, most diseases are considered complex traits (or complex diseases). Recent findings New insights ...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Breath testing for the diagnosis of pancreatic disease
Purpose of review Pancreatic function tests are mainly used for the diagnosis of exocrine pancreatic insufficiency (EPI) in patients with pancreatic diseases or after pancreatic or gastric surgery. Breath tests evaluate not just pancreatic secretion but the digestion capacity of the pancreas. These tests are good candidates for the diagnosis of EPI as they are noninvasive, accurate and easy to apply to clinical practice. Recent findings The 13C-labelled mixed triglyceride (MTG) breath test has been optimized and validated against adequate reference methods for the diagnosis of EPI in patients with chronic pancreatitis...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Autoimmune pancreatitis type 2
Purpose of review Type 2 autoimmune pancreatitis (AIP) is a rare inflammatory disease of the pancreas. Very few data have been published on this particular subtype, which differs from the ‘classical’ IgG4-related type 1 AIP in terms of pathological features, epidemiology and risk of relapse. The aim of the current review is to summarize the available literature, suggesting a diagnostic and therapeutic approach to this disease. Recent findings Based on the International Consensus Diagnostic Criteria, to achieve a ‘definitive’ diagnosis of type 2 AIP, histology is required. If a definitive histological diagnosis...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Intravenous fluid resuscitation in the management of acute pancreatitis
Purpose of review In the absence of proven effective pharmacologic therapy in acute pancreatitis, and given its simplicity, wide availability, and perceived safety, intravenous fluid resuscitation remains the cornerstone in the early treatment of acute pancreatitis. Herein, we will review the rationale of fluid therapy, critically appraise the published literature, and summarize recent studies. Recent findings Several observational studies and small clinical trials have raised concern about the efficacy and safety of aggressive fluid resuscitation. Early aggressive fluid therapy among acute pancreatitis patients with ...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Role of endoscopic ultrasonography guided fiducial marker placement in gastrointestinal cancer
Purpose of review Dose escalation radiation therapy such as those delivered by stereotactic body radiation therapy (SBRT) has shown to improve local disease control in multiple types of malignancies. This requires fiducial placement to improve accuracy of treatment and avoid adverse events to adjacent radiosensitive organs during respiration phases. The purpose of this review is to provide updates of recent high-quality articles related to endoscopic ultrasonography (EUS)-guided fiducial placement for gastrointestinal malignancies, particularly in pancreatic cancer, which is expected to be the second leading cause of can...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

The importance of anal cancer screening and high-resolution anoscopy to gastroenterology practice
Purpose of review Although human papillomavirus (HPV)-related anal squamous cell cancer (ASCC) is rare, its incidence has been rising and in high-risk populations exceeds the incidence of cancers for which screening programs are implemented. Therefore, targeted screening techniques are being evaluated with high-resolution anoscopy (HRA) as the current gold standard because of its ability to detect anal intraepithelial dysplasia (AIN) and premalignant high-grade squamous intraepithelial lesions (HSILs). However, a scarcity of trained providers presents a barrier to screening. Recent findings ASCC incidence is rising es...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Best techniques for endoscopic ampullectomy
Purpose of review Endoscopic ampullectomy has proven its safety and efficacy in multiple studies, making it the favorable option for the management of endoscopic ampullectomy. In this review, we plan to review the basic steps every endoscopist should be familiar with before undertaking endoscopic ampullectomy. Recent findings In this review, we plan to discuss the indications, preresection evaluation process including endoscopic ultrasound, endoscopic ampullectomy techniques with side-viewing endoscope and endoscopist experience/comfort with the management of the endoscopic ampullectomy complications. Summary Thing...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Flexible endoscopic strategies for the difficult esophageal stricture
Purpose of review Benign strictures of the esophagus, caused by various causes, are frequently encountered in clinical practice. Although endoscopic dilation is still the standard and first-line therapy, complex and difficult esophageal strictures are still encountered and remain a challenge to endoscopists. The main scope of this review article is to offer a closer look at the different endoscopic modalities and approaches to complex and difficult esophageal strictures. Recent findings In the past few years, endoscopic dilatation, stents including self-expandable and biodegradable types, incisional therapy, and pharm...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Robotics in flexible endoscopy: current status and future prospects
Purpose of review Advanced endoscopy procedures are technically challenging and require extensive training. Recent technological advances made in computer science and robotics have the potential to enhance the performance of complex intraluminal and transluminal interventions and potentially optimize precision and safety. This review covers the different technologies used for robot-assisted interventions in the gastrointestinal tract, organized according to their clinical availability, and focusing on flexible endoscopy-based systems. Recent findings In the curvilinear gastrointestinal anatomy, robotic technology can ...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Endoscope infection transmission state-of-the-art: beyond duodenoscopes to a culture of infection prevention
Purpose of review The elevator mechanism of the duodenoscope was the focus of endoscopically transmitted infections prior to the COVID-19 pandemic. Since that time, the ‘suspicious suspects’ in the endoscopy unit have grown in number in the eyes of both patients and endoscopists. Recent findings This review summarizes the existing guidelines related to infection control in the endoscopy unit and emerging technologies to address gaps, identifies recommendations proposed during the COVID-19 pandemic, and reminds the reader that infection prevention has not changed since the emergence of COVID-19, only the importance...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Editorial: Gastrointestinal endoscopy in the face of the corona virus disease-19 pandemic
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Approaches to diet therapy for eosinophilic esophagitis
Purpose of review The aim of this review is to highlight recent advances in dietary therapy for eosinophilic esophagitis (EoE). Recent findings An empiric elimination diet step-up strategy is now well established as the initial approach for dietary treatment. The most common food triggers are by far cow's milk, followed by wheat and egg. Legumes seem to be important solely in Spain and other Mediterranean countries, where they are regularly consumed. Retrospective efficacy data on cow's milk elimination diet in children vary from 25 to 65%. The recently described esophageal prick test did not detect local reaction to ...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Endoscopic eradication therapy for Barrett's oesophagus: state of the art
Purpose of review Barrett's oesophagus is the only identifiable precursor lesion to oesophageal adenocarcinoma. The stepwise progression of Barrett's oesophagus to dysplasia and invasive carcinoma provides the opportunity to intervene and reduce the morbidity and mortality associated with this lethal cancer. Several studies have demonstrated the efficacy and safety of endoscopic eradication therapy (EET) for the management of Barrett's oesophagus related neoplasia. The primary goal of EET is to achieve complete eradication of intestinal metaplasia (CE-IM) followed by enrolment of patients in surveillance protocols to det...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research