Early onset idiopathic chronic pancreatitis: Is there a role for endoscopic treatment?

Editoriale sul possibile ruolo del trattamento endoscopico nel pazienti con pancreatite cronica inizial

Endoscopic Ultrasound Guided Gallbladder Interventions: a Review of the Current Literature

Interventional endoscopic ultrasound (EUS) is a rapidly expanding field with a wide variety of indications, including different drainage procedures and delivery of locoregional treatment mainly for pancreatic solid tumors. Transgastric or transduodenal gallbladder drainage in high-risk patients with acute cholecystitis or biliary decompression in patients with unresectable distal biliary malignant obstruction who failed endoscopic retrograde colangiography is one of the newest areas of EUS-guided intervention. The large-caliber lumen apposing metal stents placed during these procedures allow direct endoscopic gallbladder access and the possibility of performing gallstone treatment or resection of mucosal polyps. The current review presents the indications of endoscopic gallbladder interventions and discusses the results of available studies, foreseeing future potential applications

Endoscopic treatment of ampullary adenomas

review sulla diagnosi ed il trattamento endoscopico delle neoplasie ampollar

Pancreatic sphincterotomy to manage intraductal papillary mucinous neoplasm-related recurrent pancreatitis: are we ready for a controlled trial?

pancreatic sphincterotomya and efficacy oh recurrent pancreatitis in IPM

fabrication of fluidic reactors by a customized 3d printing process

Abstract Microfluidic systems demonstrated to improve the analysis of biological and chemical processes by providing a more controlled fluid-handling environment. Typically, microfluidic systems are created in monolithic form by means of microfabrication techniques that constrain designers to work in a two-dimensional space. In this regard, Additive Manufacturing (AM) is a powerful set of technologies that can deal with the complexity of 3D structures producing flow paths with sections differing in size and direction. In this work, the use of a commercial laser-based stereolithography 3D printer has been firstly explored to fabricate transparent channels for flow reactors. A custom 3D printer, based on Digital Light Processing Stereolithography (DLP-SLA), has then been developed with the aim at gaining flexibility and overcoming typical limitations raised from standard commercial solutions. The effectiveness of the developed DLP-SLA 3D printer has been experienced by printing transparent fluidic devices with embedded channels with a specifically designed three-step printing process

Pseudo solid-appearing pancreatic serous microcystic adenomas: Histologic diagnosis with the EUS core biopsy fork-tip needle

Background and Objectives: Despite rarely, serous cystic adenoma (SCA) can assume a pseudo-solid aspect mimicking other pancreatic neoplasm as neuroendocrine tumor. EUS-FNA cytology has low diagnostic accuracy due to the scant cellularity of the collected samples. Histological diagnosis is usually made after resection. Recently, end-cutting needles for EUS-fine-needle biopsy (EUS-FNB), which obtain tissue cores by penetrating the lesions, have been developed. We aimed to assess the capability of EUS-FNB with SharkCore (TM) needles in the preoperative diagnosis of serous cystic adenoma pseudo-solid-appearing on imaging (Sa-SCA). Materials and Methods: Between January 2016 and January 2018, data from consecutive adult patients, who were referred for EUS-FNB of a solid pancreatic lesion and were diagnosed with having SCA, were retrieved from a single-center institutional database. Results: Two patients were excluded because of microcystic aspect at EUS. Histological diagnosis of SCA was made by EUS-FNB in the remaining 7 patients (5 females; mean age of 62.5 years). Lesions (mean size of 19.8 mm) were hypervascular on cross-sectional imaging, slightly hyperdense magnetic resonance imaging with T2-weighted images can, and negative at Ga-68-somatostatin receptor positron emission tomography and (18)fluoro-deoxyglucose positron emission tomography. EUS-FNB samples were judged adequate for a definitive diagnosis in all cases, achieving specimens suitable for histological evaluation and several ancillary stains. Histochemical positivity for periodic acid-Schiff (PAS) and PAS with diastase digestion was observed in 7/7 cases. Immunohistochemical positivity for alpha-inhibin (7/7), GLUT1 (6/6), MUC6 (5/5), and negativity for synaptophysin (7/7) and chromogranin A (2/2) favored SCA diagnosis. Conclusions: In the case of preoperative workup suspected for Sa-SCA, a "forward acquiring" needle could improve the rate of preoperative histological diagnosis

Preliminary experience with pancreatic sphincterotomy as treatment for intraductal papillary mucinous neoplasm-associated recurrent pancreatitis

\u2002Pancreatic intraductal papillary mucinous neoplasms (IPMN) are cystic tumors of the pancreas characterized by a malignant potential. IPMN have been associated with recurrent pancreatitis (RP). Obstruction of the main pancreatic duct by thick mucus has been postulated to be the cause of pancreatitis. In a few isolated reports, pancreatic sphincterotomy (PS) has been reported to reduce the frequency of pancreatitis. The aim of this study was to assess the efficacy of PS in patients with IPMN-associated RP

Azathioprine Maintenance Therapy to Prevent Relapses in Autoimmune Pancreatitis

Steroids are used to induce remission in autoimmune pancreatitis (AIP). Low-dosage steroid therapy or immunosuppressant (IMs) has been proposed as maintenance therapy to prevent AIP relapse. Few and conflicting data have been published on the efficacy of azathioprine (AZA) in preventing AIP relapse. The aim of this study was to evaluate the indication and efficacy of AZA as maintenance therapy to prevent disease relapse in AIP

PANCREATITE CRONICA

La pancreatite cronica è una patologia multifattoriale e progressiva determinante sia insufficienza esocrina (mal digestione) che endocrina (diabete). E’ importante definire il tipo di malattia: l’approccio terapeutico (medico, endoscopico e chirurgico) è diverso per le differenti forme di pancreatite cronica. Sul piano clinico, la malattia si caratterizza per episodi ricorrenti di dolore addominale in sede epigastrica con irradiazione agli ipocondri (“a barra”) e anche posteriormente (“a cintura”). L’inquadramento diagnostico prevede l’identificazione delle cause di pancreatite cronica (organiche, metaboliche, genetiche) attraverso la valutazione della funzionalità ghiandolare sia esocrina che endocrina e la determinazione dei test bioumorali. La Risonanza Magnetica con secretina rappresenta la metodica diagnostica strumentale di scelta nella valutazione della pancreatite cronica, grazie alla possibilità di fornire dati sia morfologici che funzionali. Obiettivo principale della terapia medica è il controllo della sintomatologia dolorosa e la correzione dell’insufficienza pancreatica. Il trattamento endoscopico è volto a ristabilire un corretto svuotamento di secreto pancreatico in duodeno e si avvale di numerose tecniche (sfinterotomia della papilla di Vater, estrazione di calcoli intraduttali, posizionamento di protesi intraduttali, litotrissia extra-corporea) La chirurgia pancreatica derivativa ha come indicazione principale il dolore non responsivo a terapia medica od endoscopica in presenza di dolore e dilatazione del dotto di Wirsung (>6 mm). La chirurgia pancreatica demolitiva è indicata per forme focali di malattia con dotto pancreatico non dilatato

Long-term treatment of duodenal ulcer with pirenzepine; gastric pH values and incidence of relapses: an open pilot study

Twenty-three endoscopically healed duodenal ulcer patients entered a long-term treatment with pirenzepine for 1 year (two 25-mg tablets at breakfast and two tablets at bedtime). One day before and 7 days after the long-term treatment started, gastric pH and BAO were measured in each patient after fasting. The patients were clinically examined monthly and underwent endoscopy 4, 8 and 12 months after the trial started or when they complained of ulcer symptoms. Blood and urine laboratory tests were carried out before treatment began and 6 and 12 months afterwards. Eighteen of the 22 patients that completed the trial (82%) did not relapse. The statistical analysis tended to show a relationship between absence of pH increase and relapses. No severe side-effects or changes in the results of laboratory tests were observed