Impact of body mass index on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis

Background: Pancreatitis is a potential major complication after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis; PEP). Obesity has been associated with increased severity of acute pancreatitis. However, the correlation between obesity and PEP is controversial. Therefore, our study aimed to clarify the relationship between body mass index (BMI) and the incidence and severity of PEP. Methods: A retrospective cohort study was conducted to elucidate the relationship between BMI and PEP in all patients who underwent ERCP in a tertiary referral center between January 2009 and October 2016. Patient characteristics and procedure details were collected. PEP was defined by consensus criteria. Multivariate logistic regression was used to determine the association between BMI and PEP. Results: The analysis included 2236 patients whose BMI was recorded and had adequate follow up (921 with BMI≥30 kg/m2, 1315 with BMI<30 kg/m2). PEP was diagnosed in 107 (4.8%) patients. PEP was seen in 49 obese patients (5.3%) and 58 non-obese patients (4.4%). In the univariate and multivariate analysis BMI≥30 kg/m2 was not associated with PEP (odds ratio 1.2, 95%CI 0.8-1.8; P=0.32). A subgroup analysis of different BMI subcategories found that BMI was not associated with the incidence or severity of PEP. Conclusion: In the largest study to date, neither obesity nor low body weight increased the incidence or severity of PEP

Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter

Benefits of ERAS protocol have been well documented; however, it is unclear whether the improvement stems from the protocol or shifts in expectations. Interdisciplinary educational seminars were conducted for all health professionals. However, one test surgeon adopted the protocol. 394 patients undergoing elective abdominal surgery from June 2013 to April 2015 with a median age of 63 years were included. The implementation of ERAS protocol resulted in a decrease in the length of stay (LOS) and mortality, whereas the difference in cost was found to be insignificant. For the test surgeon, ERAS was associated with decreased LOS, cost, and mortality. For the control providers, the LOS, cost, mortality, readmission rates, and complications remained similar both before and after the implementation of ERAS. An ERAS protocol on the single high-volume surgical unit decreased the cost, LOS, and mortality

Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter

Benefits of ERAS protocol have been well documented; however, it is unclear whether the improvement stems from the protocol or shifts in expectations. Interdisciplinary educational seminars were conducted for all health professionals. However, one test surgeon adopted the protocol. 394 patients undergoing elective abdominal surgery from June 2013 to April 2015 with a median age of 63 years were included. The implementation of ERAS protocol resulted in a decrease in the length of stay (LOS) and mortality, whereas the difference in cost was found to be insignificant. For the test surgeon, ERAS was associated with decreased LOS, cost, and mortality. For the control providers, the LOS, cost, mortality, readmission rates, and complications remained similar both before and after the implementation of ERAS. An ERAS protocol on the single high-volume surgical unit decreased the cost, LOS, and mortality

Impact of body mass index on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis

Background: Pancreatitis is a potential major complication after endoscopic retrogradecholangiopancreatography (post-ERCP pancreatitis; PEP). Obesity has been associated withincreased severity of acute pancreatitis. However, the correlation between obesity and PEP iscontroversial. Therefore, our study aimed to clarify the relationship between body mass index(BMI) and the incidence and severity of PEP.Methods: A retrospective cohort study was conducted to elucidate the relationship between BMIand PEP in all patients who underwent ERCP in a tertiary referral center between January 2009and October 2016. Patient characteristics and procedure details were collected. PEP was definedby consensus criteria. Multivariate logistic regression was used to determine the associationbetween BMI and PEP.Results: The analysis included 2236 patients whose BMI was recorded and had adequate follow up(921 with BMI≥30 kg/m2, 1315 with BMI&lt;30 kg/m2). PEP was diagnosed in 107 (4.8%) patients.PEP was seen in 49 obese patients (5.3%) and 58 non-obese patients (4.4%). In the univariate andmultivariate analysis BMI≥30 kg/m2 was not associated with PEP (odds ratio 1.2, 95%CI 0.8-1.8;P=0.32). A subgroup analysis of different BMI subcategories found that BMI was not associatedwith the incidence or severity of PEP.Conclusion: In the largest study to date, neither obesity nor low body weight increased theincidence or severity of PEP

A location-based anatomic classification system for acute pancreatic fluid collections: Roadmap for optimal intervention in the step-up era

Walled-off pancreatic necrosis (WOPN) is a local complication of acute necrotizing pancreatitis frequently requiring intervention. Treatment is typically through the coordinated efforts of a multidisciplinary team. Current management guidelines recommend a step-up approach beginning with minimally invasive techniques (percutaneous or transmural endoscopic drainage) followed by escalation to more invasive procedures if needed. Although the step-up approach is an evidence-based treatment paradigm for management of pancreatic fluid collections, it lacks guidance regarding optimal invasive technique selection based on the anatomic characteristics of pancreatic fluid collections. Similarly, existing cross-sectional imaging-based classification systems of pancreatic fluid collections have been used to predict disease severity and prognosis; however, none of these systems are designed to guide intervention. We propose a novel classification system which incorporates anatomic characteristics of pancreatic fluid collections (location and presence of disconnected pancreatic duct) to guide intervention selection and clinical decision making. We believe adoption of this simple classification system will help streamline treatment algorithms and facilitate cross-study comparisons for pancreatic fluid collections