Neoadjuvant therapy in pancreatic cancer: a review and update on recent trials
Purpose of review Neoadjuvant therapy (NAT) has been enthusiastically embraced for patients with operable pancreatic cancer (PDAC) in hopes of improving survival. However, the rapid integration of clinical trial data has made it difficult to discern optimal treatment strategies. The goal of this review is to summarize notable recent trials and their contributions to the field. Recent findings The results of ESPAC-5F, NEOLAP-AIO-PAK-0113, SWOG1505, PREOPANC, HyperAcutePancreas, and ALLIANCE A021501 are reviewed in detail. These studies sequentially evaluate the different neoadjuvant treatment strategies, use of n...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav, Asbjorn M. Drewes and Soren Olesen Source Type: research

Type 3 autoimmune pancreatitis (immune checkpoint inhibitor-induced pancreatitis)
Purpose of review Type 3 auto-immune pancreatitis (AIP) is a rare immune-related adverse event (irAE) because of immune checkpoint inhibitor (ICI) therapy employed in the management of advanced malignancies. The evaluation and management of this disease entity is not well documented in the literature. We summarize the available information on the clinical profile, diagnosis, and treatment of this disorder. Recent findings ICI-pancreatic injury (ICI-PI) is a form of AIP, recently termed type 3 AIP, which may present as an asymptomatic lipase elevation or clinical pancreatitis, that is, abdominal pain and elevated...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav, Asbjorn M. Drewes and Soren Olesen Source Type: research

The spectrum of diabetes in acute and chronic pancreatitis
Purpose of review To discuss the spectrum of diabetes related to acute and chronic pancreatitis (which are types of pancreatogenic diabetes) and its overlapping features with type 1 and type 2 diabetes. Recent findings Patients with diabetes related to acute and chronic pancreatitis present clinically within a spectrum of overlapping features with other forms of diabetes. In this spectrum, glucose metabolism alterations range from increased insulin resistance following acute pancreatitis (resembling type 2 diabetes) towards a permanent loss of beta-cell function and impaired insulin secretion in end-stage chroni...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav, Asbjorn M. Drewes and Soren Olesen Source Type: research

Clinical and translational markers of severity and prognosis in chronic pancreatitis
Purpose of review The incidence of chronic pancreatitis as a progressive inflammation and fibrosis syndrome is on the rise due to increasing awareness and improved imaging modalities. Numerous classification systems have been suggested in recent years to describe the disease, but only few of them have been used to classify the severity and prognostic significance of the disease. Biomarkers for severity and (early) chronic pancreatitis diagnosis are not yet ready for clinical application. Recent findings In using the M-ANNHEIM and Chronic Pancreatitis Prognosis Score (COPPS) classification system, the severity as...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav, Asbjorn M. Drewes and Soren Olesen Source Type: research

Optimizing nutrition in chronic pancreatitis
Purpose of review This review aims to discuss recent developments in the nutritional management in chronic pancreatitis. Recent findings Nutritional assessment should be comprehensive and include dietary history, anthropometry, and biochemical nutritional parameters. Micronutrients should be evaluated at least yearly and dual-energy X-ray absorptiometry (DEXA) at every 2-yearly intervals. Studies on pancreatic enzyme replacement therapy (PERT) have primarily evaluated coefficient of fat excretion (CFA), coefficient of nitrogen excretion (CNA), and stool weight. Two RCTs, in which patients were treated with PERT ...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav, Asbjorn M. Drewes and Soren Olesen Source Type: research

Update on pain management in acute pancreatitis
Purpose of review This review discusses the analgesic options available from randomized controlled trials and recent systematic reviews. The evidence from other settings is considered and the evidence specific to acute pancreatitis emphasized. This highlights the options that are best supported by evidence but also the options that warrant further clinical trials. Recent findings Nonsteroidal anti-inflammatory drugs and paracetamol can provide adequate pain relief in patients with acute pancreatitis when compared with opioids. Epidural analgesia provides optimum pain relief in the first 24 h of onset of acute ...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav, Asbjorn M. Drewes and Soren Olesen Source Type: research

Clinical insights into drug-associated pancreatic injury
Purpose of review Drug-induced pancreatitis is one of the top three causes of acute pancreatitis. A drug exposure is traditionally determined to be the cause of pancreatitis only after other possible and common causes of pancreatitis have been excluded. Recent findings In this review, we challenge this traditional notion of drug-induced pancreatitis as a diagnosis of exclusion. Instead, we propose to shift the paradigm of conceptualizing what we term drug-associated pancreatic injury (DAPI); as a continuum of pancreatic injury that can be concomitant with other risk factors. The aims of this targeted review are ...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav, Asbjorn M. Drewes and Soren Olesen Source Type: research

Editorial: Introduction to the issue: state of the art for managing pancreatic diseases
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav, Asbjorn M. Drewes and Soren Olesen Source Type: research

Bulking agents in gastrointestinal endoscopy: present applications and future advances
Purpose of review Bulking agents are inert materials injected into an organ to affect the physical properties of the organ for a therapeutic purpose. Various agents have been developed to aid in the treatment of diseases like gastroesophageal reflux disease (GERD), fecal incontinence, obesity, malignancy, hemostasis, and tissue dissection. Here, we review the state of the art in bulking agents in gastrointestinal endoscopy, past failures, current limitations, and where we see the field heading in the future. Recent findings Though bulking agents have been trialed for various different gastrointestinal diseases, ...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Medical malpractice and gastrointestinal endoscopy
Purpose of review Medical liability is a perennial issue that most physicians will face at some point in their careers. Gastroenterologists routinely perform endoscopic procedures to aid in the diagnosis and treatment of their patients. Advances in endoscopic techniques and technology have accelerated movement of the field into a more surgical realm. These developments warrant consideration of pitfalls that may expose gastroenterologists to liability. This review will explore trends in malpractice facing gastroenterologists and offer strategies to deliver high quality and safe patient care. Recent findings Despi...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Role of endoscopy on enteral feeding
Purpose of review The present review states current findings on the topic of enteral feeding and endoscopy. It is divided into two parts. First, important parts of the European Society of Gastrointestinal Endoscopy and European Society for Clinical Nutrition and Metabolism guidelines will be summarized and discussed. Second, important publications in the field of enteral nutrition published in the year 2021 will be discussed. Recent findings (1)Guidelines state that enteral nutrition of patients after esophagectomy is an integral part of a successful therapy. However, recent meta-analyses suggest that there ...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Current endoscopic approaches to biliary strictures
Purpose of review To summarize the current status and future perspectives of the endoscopic management of biliary strictures. Recent findings In addition to conventional diagnostic modalities, such as cross-sectional imaging and endoscopic ultrasonography (EUS), per-oral cholangioscopy is helpful for indeterminate biliary strictures. It allows direct visualization of the biliary tract and targeted biopsy. For distal malignant biliary obstruction (MBO), a self-expandable metal stent (SEMS) via endoscopic retrograde cholangiopancreatography (ERCP) is a standard of care. EUS-guided biliary drainage (EUS-BD) is an e...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Upper gastrointestinal bleeding in coronavirus disease 2019 patients
Purpose of review Upper gastrointestinal bleeding (UGIB) has significant morbidity and UGIB cases have been described in coronavirus disease 2019 (COVID-19) patients. Management of this condition can be challenging considering both the possible severe COVID-19-related pneumonia as well as the risk of the virus spreading from patients to health operators. The aim of this paper is to review the most recent studies available in the literature in order to evaluate the actual incidence of UGIB, its clinical and endoscopic manifestations and its optimal management. Recent findings UGIB has an incidence between 0.5% an...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Endoscopic methods for the detection and treatment of gastric cancer
This article highlights the role of endoscopic submucosal dissection in the treatment of focal and diffuse gastric dysplasia and early gastric cancer with a discussion of indications, complications and outcomes. We review several recent guidelines addressing the surveillance strategies for individuals at high-risk for developing gastric cancer, such as those with atrophic gastritis and intestinal metaplasia, how gastric dysplasia and early gastric cancer can be endoscopically managed, and recommended surveillance after endoscopic intervention. Summary Endoscopic approaches are evolving rapidly that will improve dete...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Safe, efficient, and effective screening colonoscopy
Purpose of review Colorectal cancer continues to be one of the most common causes of cancer-related death. Widespread dissemination of screening colonoscopy in the United States has led to a significant reduction in the incidence and mortality. Here we review current literature with an aim to highlight recent improvements in the safety, efficiency, and effectiveness of screening colonoscopy. Recent findings Colon capsule endoscopy is an emerging noninvasive method to capture images of colonic mucosa for select patients with appreciable sensitivity for polyp detection. Recent literature supports the use of the no...
Source: Current Opinion in Gastroenterology - August 10, 2022 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research