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Pancreatic Cancer and Diabetes Mellitus
AbstractPurpose of reviewThe relationship between pancreatic ductal adenocarcinoma (PDAC) and diabetes mellitus (DM) is complex. We reviewed the recent medical literature regarding the effect of anti-diabetic medication on PDAC risk and survival, risk of PDAC in DM, and role of DM in early detection of PDAC.Recent findingsStudies report that while some anti-diabetic medications (e.g., metformin) may decrease the risk of PDAC, others (insulin, sulfonylureas and incretin-based therapies) may increase the risk. However, these observations may be subject to protopathic biases. Metformin ’s anti-tumor activity may have influe...
Source: Current Treatment Options in Gastroenterology - September 13, 2018 Category: Gastroenterology Source Type: research

Endoscopic Ultrasound-Guided Management of Pain in Chronic Pancreatitis and Pancreatic Cancer: an Update
Opinion statementPurpose of reviewUnrelenting pain from chronic pancreatitis (CP) and pancreatic cancer (PC) remain clinical challenges for the physician and a significant cause of decreased quality of life for the patient. Endoscopic ultrasound (EUS)-guided therapy for each condition is distinct and builds on the endosonographer ’s straightforward access to the celiac axis.Recent findingsOver the past 20  years, generally small studies of modest methodology have surfaced for both EUS-guided celiac plexus block (CPB) and celiac plexus neurolysis (CPN).SummaryOur review aims to synthesize, analyze, and update the latest ...
Source: Current Treatment Options in Gastroenterology - September 12, 2018 Category: Gastroenterology Source Type: research

Management of Intraductal Papillary Mucinous Neoplasms: Controversies in Guidelines and Future Perspectives
AbstractPurpose of reviewManagement of intraductal papillary mucinous neoplasm (IPMN) is currently based on consensus, in the absence of evidence-based guidelines. In recent years, several consensus guidelines have been published, with distinct management strategies. In this review, we will discuss these discrepancies, in order to guide treating physicians in clinical management.Recent findingsThe detection rate of pancreatic cysts has increased substantially with the expanded use of high-quality imaging techniques to up to 45%. Of these cysts, 24 –82% are IPMNs, which harbour a malignant potential. Timely detection of h...
Source: Current Treatment Options in Gastroenterology - September 8, 2018 Category: Gastroenterology Source Type: research

Genomic Profiling and Potentially Targetable Alterations in Pancreatic Ductal Adenocarcinoma
AbstractPurpose of ReviewPancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-associated mortality with continued poor outcome and a short-lived treatment response to conventional therapy. However, with the rapidly evolving field of precision oncology, new and novel genomic information is emerging, identifying tumor subtypes by revealing somatic and germline mutations.Recent FindingsThere is growing interest in determining the tumorBRCA status to guide potential PARP inhibitor targeted therapy and for evaluating tumor microsatellite instability status for immune checkpoint inhibitor therapy which ha...
Source: Current Treatment Options in Gastroenterology - September 3, 2018 Category: Gastroenterology Source Type: research

Management of Intraductal Papillary Mucinous Neoplasms: Controversies in Guidelines and Future Perspectives
AbstractPurpose of reviewManagement of intraductal papillary mucinous neoplasm (IPMN) is currently based on consensus, in the absence of evidence-based guidelines. In recent years, several consensus guidelines have been published, with distinct management strategies. In this review, we will discuss these discrepancies, in order to guide treating physicians in clinical management.Recent findingsThe detection rate of pancreatic cysts has increased substantially with the expanded use of high-quality imaging techniques to up to 45%. Of these cysts, 24 –82% are IPMNs, which harbour a malignant potential. Timely detection of h...
Source: Current Treatment Options in Gastroenterology - September 1, 2018 Category: Gastroenterology Source Type: research

Endoscopic Management of Infected Necrotizing Pancreatitis: an Evidence-Based Approach
AbstractPurpose of ReviewEndoscopic management of infected necrotizing pancreatitis has evolved rapidly over the past years and there have been interesting innovations in this field. This review provides an update on the most recently published literature regarding endoscopic management of infected necrotizing pancreatitis.Recent FindingsA recent randomized trial demonstrated no difference in mortality and major morbidity between endoscopic and surgical step-up treatment of infected necrotizing pancreatitis. However, endoscopic therapy resulted in shorter hospital stay and less pancreatic fistulas. Various innovations have...
Source: Current Treatment Options in Gastroenterology - September 1, 2018 Category: Gastroenterology Source Type: research

Inflammatory Bowel Disease in the Baby to Baby Boomer: Pediatric and Elderly Onset of IBD
AbstractPurpose of reviewEarly- and late-onset of inflammatory bowel disease (IBD) may perhaps be etiologically distinct and potentially attributed to genetics, environmental or microbial factors. We review disease factors and clinical characteristics, as well as unique management and treatment strategies to consider when caring for the “baby” or “baby boomer” with IBD.Recent findingsAround 25% of cases of initial diagnosis of IBD is made before the age of 18  years old, and another 15–20% made after the age of 60. Crohn’s disease (CD) typically presents as ileocolonic and stricturing or penetrating phenotype ...
Source: Current Treatment Options in Gastroenterology - September 1, 2018 Category: Gastroenterology Source Type: research

Training in Endoscopy
AbstractPurpose of the reviewProgress towards the goal of high-quality endoscopy across health economies has been founded on high-quality structured training programmes linked to credentialing practice and ongoing performance monitoring. This review appraises the recent literature on training interventions, which may benefit performance and competency acquisition in novice endoscopy trainees.Recent findingsIncreasing data on the learning curves for different endoscopic procedures has highlighted variations in performance amongst trainees. These differences may be dependent on the trainee, trainer and training programme. Ev...
Source: Current Treatment Options in Gastroenterology - September 1, 2018 Category: Gastroenterology Source Type: research

Outcomes and Management of the Ileal Pouch-Anal Anastomosis in the Elderly
AbstractPurpose of ReviewIleal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients undergoing colectomy to maintain intestinal continuity. Earlier studies have suggested that outcomes are worse in elderly patients who underwent IPAA. However, more recent reports have shown that IPAA outcomes in the elderly are comparable to younger patients. We review the recent medical literature regarding outcomes and treatments for common complications in elderly IPAA patients.Recent FindingsCompared to younger patients, IPAA in the elderly is not associated with increased major surgical complications, but is ...
Source: Current Treatment Options in Gastroenterology - September 1, 2018 Category: Gastroenterology Source Type: research

Diagnosis and Management of Exocrine Pancreatic Insufficiency
AbstractPurpose of reviewRecent studies have documented that many patients with pancreatic exocrine insufficiency (EPI) are not identified and are not treated with appropriate dosages of pancreatic enzyme replacement therapy. This review will summarize the approach to diagnosis, treatment, and monitoring for treatment effect and complications in patients with exocrine insufficiency.Recent findingsWhile chronic pancreatitis is the most commonly identified cause of EPI, pancreatic cancer and pancreatic surgery are increasingly important. The diagnosis of EPI remains challenging, but fecal elastase is the most clinically usef...
Source: Current Treatment Options in Gastroenterology - September 1, 2018 Category: Gastroenterology Source Type: research

Endoscopic Management of Infected Necrotizing Pancreatitis: an Evidence-Based Approach
AbstractPurpose of ReviewEndoscopic management of infected necrotizing pancreatitis has evolved rapidly over the past years and there have been interesting innovations in this field. This review provides an update on the most recently published literature regarding endoscopic management of infected necrotizing pancreatitis.Recent FindingsA recent randomized trial demonstrated no difference in mortality and major morbidity between endoscopic and surgical step-up treatment of infected necrotizing pancreatitis. However, endoscopic therapy resulted in shorter hospital stay and less pancreatic fistulas. Various innovations have...
Source: Current Treatment Options in Gastroenterology - July 20, 2018 Category: Gastroenterology Source Type: research