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World Journal of Gastroenterology Aug 2014Endoscopic ultrasound (EUS) is an important part of modern gastrointestinal endoscopy and now has an integral role in the diagnostic evaluation of pancreatic diseases.... (Review)
Review
Endoscopic ultrasound (EUS) is an important part of modern gastrointestinal endoscopy and now has an integral role in the diagnostic evaluation of pancreatic diseases. Furthermore, as EUS technology has advanced, it has increasingly become a therapeutic procedure, and the prospect of multiple applications of interventional EUS for the pancreas is truly on the near horizon. However, this review focuses on the established diagnostic and therapeutic roles of EUS that are used in current clinical practice. In particular, the diagnostic evaluation of acute pancreatitis, chronic pancreatitis, cystic pancreatic lesions and solid masses of the pancreas are discussed. The newer enhanced imaging modalities of elastography and contrast enhancement are evaluated in this context. The main therapeutic aspects of pancreatic EUS are then considered, namely celiac plexus block and celiac plexus neurolysis for pain control in chronic pancreatitis and pancreas cancer, and EUS-guided drainage of pancreatic fluid collections.
Topics: Drainage; Endosonography; Humans; Nerve Block; Pancreatic Diseases; Predictive Value of Tests; Treatment Outcome; Ultrasonography, Interventional
PubMed: 25110426
DOI: 10.3748/wjg.v20.i29.9976 -
Current Opinion in Gastroenterology Sep 2014The purpose of this review is to provide an update on the diagnosis and treatment of pancreatic disorders using endoscopy. (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to provide an update on the diagnosis and treatment of pancreatic disorders using endoscopy.
RECENT FINDINGS
The role of endoscopy in the diagnosis and management of pancreatic disorders continues to increase in importance. The use of post-endoscopic retrograde cholangio-pancreatography (ERCP) provides therapy for many pancreatic disorders, including in the treatment of pancreatitis, its complications and pancreatic neoplasia. In recent years, there has been a focus on improving its safety in the prevention of post-ERCP pancreatitis. Pancreatic endotherapy by ERCP for the treatment of biliary strictures and chronic pain in chronic pancreatitis will also be reviewed. Endoscopic ultrasound (EUS) has a vital diagnostic role in pancreatic disorders; however, much of the recent focus has been on its therapeutic role for simple and complex pancreatic fluid collections. As for the role of EUS in pancreatic cancer, recent technical advances in conjunction with on-site cytopathology service continue to improve pancreatic cancer diagnosis. EUS has an increasing role in treatment with fiducial placement for stereotactic body radiation therapy.
SUMMARY
In this review, I will examine the literature over the last year in ERCP and EUS as they apply to specific pancreatic disorders.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Endosonography; Humans; Pancreatic Diseases; Reproducibility of Results
PubMed: 25023381
DOI: 10.1097/MOG.0000000000000095 -
IUBMB Life Jan 2020There is an urgent need for the development of novel therapeutics options for diabetic patients given the high prevalence of diabetes worldwide and that, currently,... (Review)
Review
There is an urgent need for the development of novel therapeutics options for diabetic patients given the high prevalence of diabetes worldwide and that, currently, there is no cure for this disease. The transplantation of pancreatic islets that contain insulin-producing cells is a promising therapeutic alternative, particularly for type 1 diabetes. However, the shortage of organ donors constitutes a major limitation for this approach; thus, developing alternative sources of insulin-producing cells is of critical importance. In the last decade, our knowledge of the molecular mechanisms controlling embryonic pancreas development has significantly advanced. More importantly, this knowledge has provided the basis for the in vitro generation of insulin-producing cells from stem cells. Recent studies have revealed that GATA transcription factors are involved in various stages of pancreas formation and in the adult ß cell function. Here, we review the fundamental role of GATA transcription factors in pancreas morphogenesis and their association with congenital diseases associated with pancreas.
Topics: Animals; GATA Transcription Factors; Gene Expression Regulation, Developmental; Humans; Pancreas; Pancreatic Diseases; Signal Transduction
PubMed: 31580534
DOI: 10.1002/iub.2170 -
Journal of Clinical Gastroenterology Jan 2017Pancreatic fluid collections (PFCs) may develop due to inflammation secondary to acute and/or chronic pancreatitis, trauma, surgery, or obstruction from solid or cystic... (Review)
Review
Pancreatic fluid collections (PFCs) may develop due to inflammation secondary to acute and/or chronic pancreatitis, trauma, surgery, or obstruction from solid or cystic neoplasms. PFCs can be drained percutaneously, surgically, or endoscopically with endoscopic ultrasound-guided cyst gastrostomy and/or transpapillary drainage through endoscopic retrograde cholangiopancreatography. There has been a paradigm shift in the endoscopic management of PFCs in the past few years with newer techniques including utilization of self-expanding metal stents and multiport devices. This review is a comprehensive update on the classification of PFC, indications for drainage, optimal approach, and techniques.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Drainage; Endoscopy, Gastrointestinal; Endosonography; Gastrointestinal Contents; Gastrostomy; Humans; Pancreas; Pancreatic Diseases; Pancreatitis; Stents; Treatment Outcome
PubMed: 27548730
DOI: 10.1097/MCG.0000000000000644 -
Surgical Infections Apr 2016
Topics: Aged; Candida albicans; Enterococcus faecium; Fistula; Humans; Male; Pancreatic Diseases; Pleurisy; Radiography, Abdominal; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 26828566
DOI: 10.1089/sur.2015.156 -
Nature Reviews. Gastroenterology &... Oct 2017The pancreas is a complex organ with exocrine and endocrine components. Many pathologies impair exocrine function, including chronic pancreatitis, cystic fibrosis and... (Review)
Review
The pancreas is a complex organ with exocrine and endocrine components. Many pathologies impair exocrine function, including chronic pancreatitis, cystic fibrosis and pancreatic ductal adenocarcinoma. Conversely, when the endocrine pancreas fails to secrete sufficient insulin, patients develop diabetes mellitus. Pathology in either the endocrine or exocrine pancreas results in devastating economic and personal consequences. The current standard therapy for treating patients with type 1 diabetes mellitus is daily exogenous insulin injections, but cell sources of insulin provide superior glycaemic regulation and research is now focused on the goal of regenerating or replacing β cells. Stem-cell-based models might be useful to study exocrine pancreatic disorders, and mesenchymal stem cells or secreted factors might delay disease progression. Although the standards that bioengineered cells must meet before being considered as a viable therapy are not yet established, any potential therapy must be acceptably safe and functionally superior to current therapies. Here, we describe progress and challenges in cell-based methods to restore pancreatic function, with a focus on optimizing the site for cell delivery and decreasing requirements for immunosuppression through encapsulation. We also discuss the tools and strategies being used to generate exocrine pancreas and insulin-producing β-cell surrogates in situ and highlight obstacles to clinical application.
Topics: Cell- and Tissue-Based Therapy; Cellular Reprogramming Techniques; Humans; Pancreatic Diseases; Regenerative Medicine
PubMed: 28811674
DOI: 10.1038/nrgastro.2017.93 -
Journal of Gastroenterology Jan 2019Accumulated evidence has revealed that endoscopic ultrasonography (EUS) has had a great impact on the clinical evaluation of pancreatic cancers. EUS can provide... (Review)
Review
Accumulated evidence has revealed that endoscopic ultrasonography (EUS) has had a great impact on the clinical evaluation of pancreatic cancers. EUS can provide high-resolution images of the pancreas with a quality regarded as far surpassing that achieved on transabdominal ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI). EUS is particularly useful for the detection of small pancreatic lesions, while EUS and its related techniques such as contrast-enhanced EUS (CE-EUS), EUS elastography, and EUS-guided fine needle aspiration (EUS-FNA) are also useful in the differential diagnosis of solid or cystic pancreatic lesions and the staging (T-staging, N-staging, and M-staging) of pancreatic cancers. In the diagnosis of pancreatic lesions, CE-EUS and EUS elastography play a complementary role to conventional EUS. When sampling is performed using EUS-FNA, CE-EUS and EUS elastography provide information on the target lesions. Thus, conventional EUS, CE-EUS, EUS elastography, and EUS-FNA are essential in the clinical investigation of pancreatic cancer.
Topics: Diagnosis, Differential; Elasticity Imaging Techniques; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Pancreatic Diseases; Pancreatic Neoplasms; Tomography, X-Ray Computed
PubMed: 30406288
DOI: 10.1007/s00535-018-1519-2 -
Abdominal Radiology (New York) Sep 2021To evaluate the relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases.
OBJECTIVE
To evaluate the relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases.
METHODS
A total of 171 patients with benign pancreatic tumors or chronic pancreatitis, whose preoperative fasting blood glucose (FBG) was normal and who underwent partial pancreatectomy were reviewed. The pancreatic volume was measured by CT imaging before and after the operation. According to their different pancreatic resection volume (PRV), 171 patients were divided into five groups: < 30%, 30%-39%, 40%-49%, 50%-59%, and ≥ 60%. The correlation between the PRV and postoperative FBG was investigated. According to the postoperative FBG value, the patients were divided into a hyperglycemia group (HG) and nonhyperglycemia group (non-HG) to explore the best cutoff value of the PRV between the two groups.
RESULTS
There were significant differences in the postoperative FBG among the five groups (PRV < 30%, 30%-39%, 40%-49%, 50%-59%, and ≥ 60%). The PRV was positively correlated with postoperative FBG in the benign tumor group and chronic pancreatitis group (R = 0.727 and 0.651, respectively). ROC curve analysis showed that the best cutoff value of the PRV between the HG (n = 84) and non-HG (n = 87) was 39.95% with an AUC = 0.898; the sensitivity was 89.29%, and the specificity was 82.76%.
CONCLUSION
There was a linear positive correlation between the postoperative FBG level and PRV. Patients with a PRV ≥ 40% are more likely to develop early postoperative hyperglycemia.
Topics: Humans; Hyperglycemia; Pancreas; Pancreatectomy; Pancreatic Diseases; Pancreatic Neoplasms; Postoperative Complications
PubMed: 33813625
DOI: 10.1007/s00261-021-03061-4 -
Veterinary Journal (London, England :... Sep 2016The diagnosis of liver and pancreatic disorders in dogs and cats present their own set of challenges. However, as new diagnostic tests are developed and the optimal ways... (Review)
Review
The diagnosis of liver and pancreatic disorders in dogs and cats present their own set of challenges. However, as new diagnostic tests are developed and the optimal ways in which to use existing tests are determined, the ability of the veterinary profession to make these diagnoses continues to improve. Histopathological assessment is considered to be the reference standard for the diagnosis of many hepatic and pancreatic diseases, but it has some inherent limitations. New classes of diagnostic tests for liver disease that are currently being studied include direct and indirect serum markers of hepatic fibrosis, such as hyaluronic acid; novel markers of hepatocellular injury, such as circulating microRNAs; and quantitative tests of hepatic microsomal function. Assays for pancreas-specific lipase have greatly improved the ability of practitioners to diagnose pancreatitis in dogs and cats. However, further research is needed to fully understand the characteristics of these assays, especially in patients with concurrent non-pancreatic disease. The more common use and refinement of CT and MRI to assess the hepatobiliary system and pancreas of dogs and cats also have huge potential to improve diagnostic capabilities.
Topics: Animals; Cat Diseases; Cats; Diagnostic Tests, Routine; Dog Diseases; Dogs; Liver Diseases; Pancreatic Diseases
PubMed: 26951862
DOI: 10.1016/j.tvjl.2016.02.010 -
World Journal of Gastroenterology Mar 2022Elastography is a non-invasive method widely used to measure the stiffness of the tissues, and it is available in most endoscopic ultrasound machines, using either... (Review)
Review
Elastography is a non-invasive method widely used to measure the stiffness of the tissues, and it is available in most endoscopic ultrasound machines, using either qualitative or quantitative techniques. Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases, together with other imaging tests and clinical data. Elastography can be informative, especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions. However, further studies are necessary to standardize the method, increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses. Moreover, even if promising, elastography still provides little information in the evaluation of benign conditions.
Topics: Elasticity Imaging Techniques; Endosonography; Humans; Pancreatic Diseases; Pancreatic Neoplasms; Reproducibility of Results
PubMed: 35317053
DOI: 10.3748/wjg.v28.i9.909