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Trends in Endocrinology and Metabolism:... Oct 2020Although it is well established that diabetes can also develop as a result of diseases or maneuvers on the exocrine pancreas, the complex relationship between glucose... (Review)
Review
Although it is well established that diabetes can also develop as a result of diseases or maneuvers on the exocrine pancreas, the complex relationship between glucose disorders and underlying pancreatic disease is still debated. There is evidence that several features linked to pancreatic diseases can modify endocrine and metabolic conditions before and after surgery. However, pancreatic surgery provides a rare opportunity to correlate in vivo endocrine and metabolic pathways with ex vivo pancreatic samples, to examine the endocrine and metabolic effects of acute islet removal, and finally to clarify the pathogenesis of diabetes. This approach could therefore represent a unique method to shed light on the molecular mechanisms, predicting factors, and metabolic consequences of insulin resistance, islet plasticity, β cell failure, and type 2 diabetes.
Topics: Animals; Diabetes Mellitus, Type 2; Humans; Islets of Langerhans; Pancreatectomy; Pancreatic Diseases; Precision Medicine
PubMed: 32830029
DOI: 10.1016/j.tem.2020.07.003 -
The Surgical Clinics of North America Dec 2020The evolution of advanced pancreaticobiliary endoscopy in the past 50 years is remarkable. Endoscopic retrograde cholangiopancreatography (ERCP) has progressed from a... (Review)
Review
The evolution of advanced pancreaticobiliary endoscopy in the past 50 years is remarkable. Endoscopic retrograde cholangiopancreatography (ERCP) has progressed from a diagnostic test to an almost entirely therapeutic procedure. The endoscopist must have a clear understanding of the indications for ERCP to avoid unnecessary complications, including post-ERCP pancreatitis. Endoscopic ultrasound initially was used as a diagnostic tool but now is equipped with accessary channels allowing endoscopic ultrasound-guided interventions in various pancreaticobiliary conditions. This review discusses the endoscopic management of common pancreatic and biliary diseases along with the techniques, indications, outcomes, and complications of pancreaticobiliary endoscopy.
Topics: Biliary Tract Diseases; Cholangiopancreatography, Endoscopic Retrograde; Endoscopy, Digestive System; Endosonography; Humans; Pancreatic Diseases
PubMed: 33128885
DOI: 10.1016/j.suc.2020.08.006 -
Gastrointestinal Endoscopy Clinics of... Oct 2023Disconnected pancreatic duct (DPD) is common after acute necrotizing pancreatitis (ANP). Its clinical implications vary according to the course of disease. In the early... (Review)
Review
Disconnected pancreatic duct (DPD) is common after acute necrotizing pancreatitis (ANP). Its clinical implications vary according to the course of disease. In the early phase of ANP, parenchymal necrosis along with disruption of pancreatic duct cause acute necrotic collection that evolves into walled-off necrosis (WON). In the later phase, DPD becomes evident as confirmed by magnetic resonance cholangiopancreatography. Clinical manifestations of DPD can vary from being asymptomatic, recurrent pain, recurrent pancreatic fluid collection (PFC), obstructive pancreatitis, or external pancreatic fistula (EPF). Few patients develop new-onset diabetes. Long-term indwelling plastic stents have been proposed to prevent the recurrent PFC.
Topics: Humans; Pancreas; Cholangiopancreatography, Magnetic Resonance; Bile Duct Diseases; Necrosis; Pancreatic Diseases; Pancreatic Ducts
PubMed: 37709409
DOI: 10.1016/j.giec.2023.04.004 -
Gastrointestinal Endoscopy Clinics of... Jul 2024With the introduction of endoscopic retrograde cholangiopancreatography and linear endoscopic ultrasound, interventional pancreaticobiliary (PB) endoscopy has had an... (Review)
Review
With the introduction of endoscopic retrograde cholangiopancreatography and linear endoscopic ultrasound, interventional pancreaticobiliary (PB) endoscopy has had an enormous impact in the management of pancreatic and biliary diseases. Continuous efforts to improve various devices and techniques have revolutionized these treatment modalities as viable alternatives to surgery. In recent years, trends toward combining endoscopic techniques with other modalities, such as laparoscopic and radiological interventions, for complex PB diseases have emerged using a multidisciplinary approach. Ongoing research and clinical experience will lead to refinements in interventional PB endoscopic techniques and subsequently improve outcomes and reduce complication rates.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Pancreatic Diseases; Biliary Tract Diseases; Endosonography; History, 20th Century; History, 21st Century; Endoscopy, Digestive System
PubMed: 38796288
DOI: 10.1016/j.giec.2023.12.001 -
Gut and Liver Jan 2020As ultrasound (US) is simple and less invasive than other imaging modalities, this technique is widely used for mass screening. However, visualizing the entire pancreas... (Review)
Review
As ultrasound (US) is simple and less invasive than other imaging modalities, this technique is widely used for mass screening. However, visualizing the entire pancreas due to complicated anatomy, obesity and overlying gas can be difficult. US plays a key role in the diagnosis of pancreatic carcinoma (PC), of which tumors smaller than 10 mm (TS1a) and pancreatic carcinoma are expected to have good prognosis. To detect these forms of PC, main pancreatic duct (MPD) dilatation (3 mm or more) and pancreatic cysts (5 mm or larger) are US findings of high-risk individuals (HRIs), and these subjects should be observed periodically. Scanning maneuvers are also important for both screening for PC and follow-up of HRIs. As lesions in the groove area and ventral pancreas do not affect the MPD or extrahepatic bile duct, we should pay attention to these areas. Visualization of the tail is also challenging due to gas and stool in the alimentary tract. As the position of the pancreas changes depending on the body posture, and several different body positions should be employed, such as the right lateral decubitus, sitting, and upright positions, rather than only applying strong compression with the transducer. In cases with poor visualization, the liquid-filled stomach method is highly recommended.
Topics: Adult; Aged; Carcinoma; Early Detection of Cancer; Endosonography; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Risk Factors; Stomach; Ultrasonography
PubMed: 31009959
DOI: 10.5009/gnl18567 -
Biomolecules Feb 2024Recent studies have shown that a pro-inflammatory diet and dysbiosis, especially a high level of trimethylamine-N-oxide (TMAO), are associated with various adverse... (Review)
Review
Recent studies have shown that a pro-inflammatory diet and dysbiosis, especially a high level of trimethylamine-N-oxide (TMAO), are associated with various adverse health conditions. Cardiovascular diseases and pancreatic diseases are two major morbidities in the modern world. Through this narrative review, we aimed to summarize the association between a pro-inflammatory diet, gut microbiota, and cardiovascular and pancreatic diseases, along with their underlying mechanisms. Our review revealed that TMAO is associated with the development of cardiovascular diseases by promoting platelet aggregation, atherosclerotic plaque formation, and vascular inflammation. TMAO is also associated with the development of acute pancreatitis. The pro-inflammatory diet is associated with an increased risk of pancreatic cancer and cardiovascular diseases through mechanisms that include increasing TMAO levels, activating the lipopolysaccharides cascade, and the direct pro-inflammatory effect of certain nutrients. Meanwhile, an anti-inflammatory diet decreases the risk of cardiovascular diseases and pancreatic cancer.
Topics: Humans; Gastrointestinal Microbiome; Cardiovascular Diseases; Acute Disease; Pancreatitis; Methylamines; Pancreatic Neoplasms
PubMed: 38397447
DOI: 10.3390/biom14020210 -
Pediatric Clinics of North America Feb 2021Pulmonary manifestations of gastrointestinal (GI) diseases are often subtle, and underlying disease may precede overt symptoms. A high index of suspicion and a low... (Review)
Review
Pulmonary manifestations of gastrointestinal (GI) diseases are often subtle, and underlying disease may precede overt symptoms. A high index of suspicion and a low threshold for consultation with a pediatric pulmonologist is warranted in common GI conditions. This article outlines the pulmonary manifestations of different GI, pancreatic, and liver diseases in children, including gastroesophageal reflux disease, inflammatory bowel disease, pancreatitis, alpha1-antitrypsin deficiency, nonalcoholic fatty liver disease, and complications of chronic liver disease (hepatopulmonary syndrome and portopulmonary hypertension).
Topics: Child; Echocardiography; Gastrointestinal Diseases; Humans; Liver Diseases; Lung Diseases; Pancreatic Diseases; Respiratory Function Tests
PubMed: 33228942
DOI: 10.1016/j.pcl.2020.09.002 -
Current Gastroenterology Reports Dec 2019Pancreatic duct stones are sequela of chronic pancreatitis. They can cause pancreatic duct obstruction which is the most important cause of pain in chronic pancreatitis.... (Review)
Review
PURPOSE OF REVIEW
Pancreatic duct stones are sequela of chronic pancreatitis. They can cause pancreatic duct obstruction which is the most important cause of pain in chronic pancreatitis. Stone resolution has shown to improve pain. The goal of this review is to highlight recent endoscopic and surgical advancements in treatment of pancreatic duct stones.
RECENT FINDINGS
Stone fragmentation by extracorporeal shock wave lithotripsy has become first line and the mainstay of treatment for majority of patients with pancreatic duct stones. Introduction of digital video pancreatoscopy in the last few years with the capability of guided lithotripsy has provided a robust therapeutic option where extracorporeal shock wave lithotripsy is unsuccessful or unavailable. Historically, surgery has been considered a more reliable and durable option when feasible. However, it had not been compared with more effective endoscopic therapy. Lithotripsy (extracorporeal and pancreatoscopy guided) is evolving as a strong treatment modality for pancreatic stones.
Topics: Calculi; Cholangiopancreatography, Endoscopic Retrograde; Humans; Laser Therapy; Lithotripsy; Pancreatic Diseases; Pancreatic Ducts; Pancreatitis, Chronic; Prognosis
PubMed: 31797163
DOI: 10.1007/s11894-019-0727-0 -
Cleveland Clinic Journal of Medicine Mar 2020Endoscopic ultrasonography (EUS) has been used since the mid-1980s. Initially a diagnostic tool, it has since evolved into a therapeutic, minimally invasive surgical... (Review)
Review
Endoscopic ultrasonography (EUS) has been used since the mid-1980s. Initially a diagnostic tool, it has since evolved into a therapeutic, minimally invasive surgical tool with significant impact on the diagnosis and management of a range of benign and malignant conditions. The authors review current indications, safety, and efficacy of EUS for diseases of the upper and lower gastrointestinal tract, posterior mediastinum, pancreas, bile duct, gallbladder, retroperitoneum, liver, adrenal glands, and kidneys.
Topics: Biliary Tract Diseases; Endosonography; Gastrointestinal Diseases; Gastrointestinal Tract; Humans; Pancreatic Diseases
PubMed: 32127442
DOI: 10.3949/ccjm.87a.19003 -
European Journal of Radiology Nov 2023Pancreatic diseases are difficult to diagnose due to their insidious onset and complex pathophysiological developmental characteristics. In recent years, dual-energy... (Review)
Review
Pancreatic diseases are difficult to diagnose due to their insidious onset and complex pathophysiological developmental characteristics. In recent years, dual-energy computed tomography (DECT) imaging technology has rapidly advanced. DECT can quantitatively extract and analyze medical imaging features and establish a correlation between these features and clinical results. This feature enables the adoption of more modern and accurate clinical diagnosis and treatment strategies for patients with pancreatic diseases so as to achieve the goal of non-invasive, low-cost, and personalized treatment. The purpose of this review is to elaborate on the application of DECT for the diagnosis, biological characterization, and prediction of the survival of patients with pancreatic diseases (including pancreatitis, pancreatic cancer, pancreatic cystic tumor, pancreatic neuroendocrine tumor, and pancreatic injury) and to summarize its current limitations and future research prospects.
Topics: Humans; Tomography, X-Ray Computed; Pancreatic Diseases; Pancreatic Neoplasms; Pancreas; Radiography, Dual-Energy Scanned Projection
PubMed: 37742372
DOI: 10.1016/j.ejrad.2023.111090