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The American Journal of Gastroenterology Mar 2024Acute pancreatitis (AP), defined as acute inflammation of the pancreas, is one of the most common diseases of the gastrointestinal tract leading to hospital admission in...
Acute pancreatitis (AP), defined as acute inflammation of the pancreas, is one of the most common diseases of the gastrointestinal tract leading to hospital admission in the United States. It is important for clinicians to appreciate that AP is heterogenous, progressing differently among patients and is often unpredictable. While most patients experience symptoms lasting a few days, almost one-fifth of patients will go on to experience complications, including pancreatic necrosis and/or organ failure, at times requiring prolonged hospitalization, intensive care, and radiologic, surgical, and/or endoscopic intervention. Early management is essential to identify and treat patients with AP to prevent complications. Patients with biliary pancreatitis typically will require surgery to prevent recurrent disease and may need early endoscopic retrograde cholangiopancreatography if the disease is complicated by cholangitis. Nutrition plays an important role in treating patients with AP. The safety of early refeeding and importance in preventing complications from AP are addressed. This guideline will provide an evidence-based practical approach to the management of patients with AP.
Topics: Humans; Pancreatitis; Acute Disease; Cholangiopancreatography, Endoscopic Retrograde; United States
PubMed: 38857482
DOI: 10.14309/ajg.0000000000002645 -
Gastrointestinal Endoscopy Clinics of... Oct 2023Endoscopic therapy is the first line of management for chronic pancreatitis (CP)-related benign biliary strictures. Multiple plastic stents (MPS) exchanged at regular... (Review)
Review
Endoscopic therapy is the first line of management for chronic pancreatitis (CP)-related benign biliary strictures. Multiple plastic stents (MPS) exchanged at regular intervals and temporary placement of fully covered self-expanding metal stents (FCSEMS) are preferred modalities of endotherapy. FCSEMS placement is non-inferior to MPS and requires fewer sessions of endoscopic retrograde cholangiopancreatography than MPS placement. The presence of head calcifications, severe CP, and length of stricture are predictors of failure or recurrence after endotherapy. Failure of endotherapy should be considered after 1 year when surgery should be considered.
Topics: Humans; Constriction, Pathologic; Cholangiopancreatography, Endoscopic Retrograde; Pancreatitis, Chronic; Stents
PubMed: 37709414
DOI: 10.1016/j.giec.2023.04.002 -
BMJ Case Reports Jan 2024A woman in her 30s presented to the emergency department with a month-long history of postprandial epigastric pain radiating to her back. The diagnosis of...
A woman in her 30s presented to the emergency department with a month-long history of postprandial epigastric pain radiating to her back. The diagnosis of cholecystolithiasis and suspected choledocholithiasis was made, and the patient underwent cholecystectomy with cholangiography using standard technique. The surgery was complicated by an intrahepatic bile duct injury attributed to high injection pressure during cholangiography. She developed an intrahepatic collection that was drained and confirmed the diagnosis of biloma. In this case report, we discuss a rare complication of intraoperative cholangiography during laparoscopic cholecystectomy and consider a way to prevent it.
Topics: Female; Humans; Digestive System Diseases; Cholangiography; Cholecystectomy; Abdominal Injuries; Abdominal Pain
PubMed: 38182172
DOI: 10.1136/bcr-2023-257688 -
Applied Radiation and Isotopes :... Sep 2023This study investigated the effect of varying x-ray tube voltage and additional filtration thicknesses on radiation dose and image quality in digital radiography system....
This study investigated the effect of varying x-ray tube voltage and additional filtration thicknesses on radiation dose and image quality in digital radiography system. The polymethylmethacrylate (PMMA) phantoms of different thicknesses simulating both the adult chest and abdomen and the pediatric patient's chest examinations were used. X-ray tube voltage range of 70-125 kVp was used for adult patient chest radiography, 70-100 kVp for adult patient abdominal radiography, and 50-70 kVp for pediatric 1-year-old chest examination. 0.1-0.3 mm Cu and 1.0 mm Al filters were used as additional filters. Patient doses were measured with an ionization chamber, considering the irradiation parameters recommended for radiographic examinations performed in radiology clinics in the EUR 16260 protocol. The Entrance Skin Dose (ESD) was calculated from the air kerma value measured at the entrance surface of the PMMA phantoms. Effective dose values were calculated by employing PCXMC 2.0 program. For image quality evaluations, CDRAD, LCD-4, Beam stop and Huttner test object used together with PMMA phantoms and Alderson RS-330 Lung/Chest phantom were used. Figure of Merit (FOM), which allows quantitative assessment in terms of image quality and patient dose, has been calculated. Based on the calculated FOM values were evaluated at the tube voltages and additional filter thicknesses recommended in the EUR 16260 protocol. Entrance Skin Dose and Inverse Image Quality Figure (IQF) value obtained from contrast detail analysis decreased with increasing filter thickness and tube voltage. Decrease in ESD and IQF with increasing tube voltage without additional filter was 56% and 21% for adult chest radiography, 69% and 39% for adult abdominal radiography and 34% and 6% for 1-year-old pediatric chest radiography. When calculated FOM values are examined, it can be recommended to use a 0.1 mm Cu filter at 90 kVp and a 0.1 mm Cu + 1.0 mm Al filter at 125 kVp for adult chest radiography. For adult abdominal radiography, 0.2 mm Cu filter at 70 and 80 kVp and 0.1 mm Cu filter at 90 and 100 kVp were found to be appropriate. It was determined that the appropriate additional filter at 70 kVp for 1-year-old chest radiography was 1.0 mm Al+0.1 mm Cu.
Topics: Adult; Child; Humans; Infant; Radiographic Image Enhancement; X-Rays; Radiation Dosage; Polymethyl Methacrylate; Radiography; Phantoms, Imaging; Radiography, Thoracic
PubMed: 37321050
DOI: 10.1016/j.apradiso.2023.110893 -
Pediatric Emergency Care Nov 2023Intussusception is one of the most common surgical emergencies in children. We aimed to analyze the current clinical characteristics of intussusception.
OBJECTIVES
Intussusception is one of the most common surgical emergencies in children. We aimed to analyze the current clinical characteristics of intussusception.
METHODS
We retrospectively reviewed 209 children diagnosed with intussusception, who were admitted to our hospital between January 2009 and August 2022. We grouped the patients according to symptom duration (before and after 12 hours and before and after 24 hours) and age (younger and older than 1 year, and younger and older than 2 years).
RESULTS
The median age at admission was 31 months (2-204 months). The median symptom duration was 12 hours (1-420 hours). Most patients (91.4%) were admitted due to abdominal pain, irritability, and/or vomiting. The most common symptoms were vomiting (70.8%) and abdominal pain (60.6%). The classical triad of symptoms was seen in 9 cases (4.3%). In patients aged younger than 1 year, bloody stool, abnormal abdominal radiography findings, and a longer intussusceptum segment were more frequent. In patients aged younger than 2 years, abdominal pain, fever, and defense on physical examination were less frequent, and irritability, bloody stool, and recurrence were more frequent. Patients aged younger than 2 years had a longer intussusceptum segment and less lymphadenopathy based on ultrasonography (USG). The patients admitted more than 12 hours after symptom onset had more diarrhea, fever, abnormal x-ray, peritoneal fluid on USG, and recurrences, and less vomiting. After the symptoms had lasted for 24 hours, fever, mass palpation, and abnormal abdominal radiography findings were more frequent.
CONCLUSIONS
We recommend performing abdominal USG, especially in young children admitted to the emergency department with complaints of abdominal pain and/or vomiting, to rule out intussusception. In countries that have reported a high mortality rate from intussusception, we advise precautions such as increasing the availability of USG in emergency departments and educating the population to seek early medical assistance.
Topics: Child; Humans; Infant; Child, Preschool; Aged; Intussusception; Retrospective Studies; Abdomen; Abdominal Pain; Vomiting; Gastrointestinal Hemorrhage
PubMed: 37783201
DOI: 10.1097/PEC.0000000000003061 -
Digestive Endoscopy : Official Journal... Nov 2023The exchange of gastrointestinal endoscopy between Japan and China began in 1972. Half a century ago, Japan's endoscope technology was still developing. At the request... (Review)
Review
The exchange of gastrointestinal endoscopy between Japan and China began in 1972. Half a century ago, Japan's endoscope technology was still developing. At the request of the Japan-China Friendship Association, I was invited to Peking Union Medical Hospital and gave a demonstration of gastrointestinal endoscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography.
Topics: Humans; Gastroenterology; Japan; Endoscopy, Gastrointestinal; Colonoscopy; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 37338169
DOI: 10.1111/den.14618 -
Endoscopy Dec 2023
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Catheterization; Pancreatic Ducts; Arteries
PubMed: 37040892
DOI: 10.1055/a-2058-8615 -
Applied Radiation and Isotopes :... Dec 2023Undertaking medical imaging examinations on obese patients can present practical challenges. Choosing optimal imaging protocols can be difficult, especially when...
INTRODUCTION
Undertaking medical imaging examinations on obese patients can present practical challenges. Choosing optimal imaging protocols can be difficult, especially when promoting the ALARA principle. The aim of this study was to assess the effects of increasing body part thickness on image quality (IQ) and effective dose (ED) during upper abdominal radiography. A secondary aim was to determine the optimum exposure settings for larger sized patients.
METHODS
Underweight, standard, overweight and obese abdomen sizes were simulated using an anthropomorphic upper abdomen phantom, without and with additional fat layers (6, 10 and 16 cm). Phantoms were imaged using a variety of tube potentials (70-110 kVp), automatic exposure control (AEC) and a source-to-image distance of 120 cm. IQ was assessed visually using a relative visual grading analysis (VGA) method. Radiation dose was evaluated by calculating the ED using the Monte Carlo PCXMC 2.0 computer program.
RESULTS
IQ values showed a statistical reduction (p = 0.006) with increasing phantom size across all examined tube potentials. The highest IQ scores (3.3, 2.8, 2.5 and 2.2, respectively) were obtained at 70/75 kVp for all phantom thicknesses. As tube potential increased the IQ was also shown to decrease. ED showed a statistically significant increase (p < 0.001) with increasing phantom thicknesses.
CONCLUSION
Higher EDs were evident when applying lower tube potentials. Using an AEC with high tube potentials (105/110 kVp) can lead to a considerable decrease in ED with acceptable IQ when undertaking upper abdomen radiography on patients with large body part thicknesses.
IMPLICATION FOR PRACTICE
Applying higher values of tube potentials for patients who have a thicker abdomen can lead to decreased ED.
Topics: Humans; Radiation Dosage; Radiography; Radiography, Abdominal; Phantoms, Imaging; Obesity
PubMed: 37806283
DOI: 10.1016/j.apradiso.2023.111060 -
Radiologie (Heidelberg, Germany) Nov 2023Dynamic magnetic resonance imaging (MRI) of the pelvic floor plays a key role in imaging complex pelvic floor dysfunction. High-quality examination is crucial for... (Review)
Review
BACKGROUND
Dynamic magnetic resonance imaging (MRI) of the pelvic floor plays a key role in imaging complex pelvic floor dysfunction. High-quality examination is crucial for diagnostic benefit but can be technically challenging.
OBJECTIVES
The most important technical aspects (patient selection, patient preparation, MRI technology, MRI scan protocol, success control) for obtaining a state-of-the-art dynamic MRI of the pelvic floor are summarized.
MATERIALS AND METHODS
Review of the scientific literature on dynamic pelvic MR imaging with special consideration of the joint recommendations provided by the expert panels of European Society of Urogenital Radiology/European Society of Gastrointestinal and Abdominal Radiology (ESUR/ESGAR) in 2016 and Society of Abdominal Radiology (SAR) in 2019.
RESULTS
Examination with at least 1.5 T and a surface coil after rectal instillation of ultrasound gel is clinical standard. Dynamic MRI in a closed magnet with the patient in supine position is the most widespread technique. No clinically significant pathologies of the pelvic floor are missed compared to the sitting position in an open magnet. The minimum scan protocol should encompass static, high-resolution T2-imaging (i.e., T2-TSE) in three planes and dynamic sequences with high temporal resolution in sagittal (and possibly axial) plane (i.e., steady-state or balanced steady-state free precession) during squeezing, straining and evacuation. Detailed patient instruction and practicing prior to the scan improve patients' compliance and hence diagnostic quality.
CONCLUSIONS
A technically flawless dynamic MRI of the pelvic floor according to these standards can provide information missed by other imaging modalities and hence alter therapeutic strategies.
Topics: Humans; Pelvic Floor; Radiography, Abdominal; Magnetic Resonance Imaging; Sitting Position; Administration, Rectal
PubMed: 37831100
DOI: 10.1007/s00117-023-01212-w -
Endoscopy Dec 2023The first commercialized single-use duodenoscope was cleared by the US Food and Drug Administration in December 2019. Data regarding endoscopic retrograde... (Clinical Trial)
Clinical Trial
BACKGROUND
The first commercialized single-use duodenoscope was cleared by the US Food and Drug Administration in December 2019. Data regarding endoscopic retrograde cholangiopancreatography (ERCP) using a single-use duodenoscope are needed on a broader range of cases conducted by endoscopists with varying levels of experience in a wide range of geographic areas.
METHODS
61 endoscopists at 22 academic centers in 11 countries performed ERCP procedures in adult patients aged ≥ 18. Outcomes included ERCP completion for the intended indication, rate of crossover to a reusable endoscope, device performance ratings, and serious adverse events (SAEs).
RESULTS
Among 551 patients, 236 (42.8 %) were aged > 65, 281 (51.0 %) were men, and 256 (46.5 %) had their procedure as an inpatient. ERCPs included 196 (35.6 %) with American Society for Gastrointestinal Endoscopy complexity of grades 3-4. A total of 529 ERCPs (96.0 %) were completed: 503 (91.3 %) using only the single-use duodenoscope, and 26 (4.7 %) with crossover to a reusable endoscope. There were 22 ERCPs (4.0 %) that were not completed, of which 11 (2.0 %) included a crossover and 11 (2.0 %) were aborted cases (no crossover). Median ERCP completion time was 24.0 minutes. Median overall satisfaction with the single-use duodenoscope was 8.0 (scale of 1 to 10 [best]). SAEs were reported in 43 patients (7.8 %), including 17 (3.1 %) who developed post-ERCP pancreatitis.
CONCLUSIONS
In academic medical centers over a wide geographic distribution, endoscopists with varying levels of experience using the first marketed single-use duodenoscope had good ERCP procedural success and reported high performance ratings for this device.
Topics: Adult; Male; Humans; Female; Cholangiopancreatography, Endoscopic Retrograde; Duodenoscopes; Endoscopy, Gastrointestinal; Pancreatitis
PubMed: 37463599
DOI: 10.1055/a-2131-7180