Estudio epidemiológico, prospectivo de cohortes de la prevalencia de insuficiencia pancreática exocrina y su impacto clínico en pacientes sometidos a cirugía bariátrica resectiva y malabsortiva

Los diferentes tipos de cirugía bariátrica, tanto restrictivos como malabsortivos se asocian a síntomas gastrointestinales, cambios físicos y psicológicos que afectan la calidad de vida de los pacientes. Los cambios que se producen a nivel de la anatomía gastrointestinal secundarios a la cirugía bariátrica pueden afectar la función pancreática y digestiva, pudiendo ocasionar una insuficiencia pancreática exocrina (IPE). Pacientes con IPE presentan más riesgo de síntomas y deficiencias nutricionales a pesar de estar tratados mediante tratamiento nutricional sustitutivo, pudiendo beneficiarse de tratamiento enzimático sustitutivo que puede mejorar el estado nutricional en este tipo de pacientes.2023-10-2

Acute pancreatitis secondary to topical and oral treatment with mesalamine in a patient with ulcerative colitis

AbstrAct Introduction: Derivatives of 5-aminosalicylic acid (5-AsA) as claversal® used for the treatment of inflammatory bowel disease may induce acute pancreatitis both orally as topically. Mesalazine is the only treatment used in our environment within the compounds of 5-AsA, due to other molecules not being available. It is available for both oral and topical, being topical form highly relevant considering that its compounds are rapidly absorbed once acetylated, resulting in inactive metabolites. Nowadays the mechanism or pathway by which it is produced is not really clear, neither the relationship with the intervals between exposure of treatment nor the onset of clinical symptoms, due to some cases in which there was no relationship with the duration, which was our case. case report: We report one case of 5-AsA induced pancreatitis. A 35-year-old male whose first episode was secondary to oral form with subsequent recurrence after beginning with topical form. conclusion: We would like to point out that after an episode of pancreatitis due to oral mesalamine, topical mesalamine should not be prescribed

Real-world costs and dynamics of surveillance in patients who underwent surgery for low-risk branch duct intraductal papillary mucinous neoplasms

Surveillance costs and appropriateness of surgery of "low-risk" BD-IPMNs are relevant issues. In this study we evaluated the rate of correct indication for pancreatectomy defined as high grade dysplasia (HGD) at histology in 961 patients who underwent surveillance for a median of 5.1 years. Undertreat-ment and overtreatment were defined as invasive cancer and low grade dysplasia (LGD) at histology, respectively. Of the 66 patients (6.9%) who were operated, only 16 (23.8%) had a HGD while 40 (59.7%) had a LGD and 10 (14.9%) an invasive cancer, without differences regarding timing of surgery. The mean surveillance cost was euro 194.9 +/- 107.6 per patient-year, with a median cost of euro 277.1 +/- 148.2 in the correct surgery group compared with euro 222.7 +/- 111.6 and euro 197 +/- 102.7 in the overtreatment and undertreatment groups. The surveillance mean cost from diagnosis to surgery was euro 854.8. Rate of appropriate surgery in BD-IPMNs under surveillance is low.(c) 2022 Published by Elsevier Ltd

Identification of patients with branch-duct intraductal papillary mucinous neoplasm and very low risk of cancer : multicentre study

BACKGROUND: Different surveillance strategies for patients with low-risk branch-duct (BD) intraductal papillary neoplasm (IPMN) have been described. The aim of this study was to describe the natural history of low-risk BD-IPMN, and to identify risk factors for the development of worrisome features (WF)/high-risk stigmata (HRS) and of pancreatic malignancies. METHODS: This was a multicentre retrospective study of patients with BD-IPMN who were under active surveillance between January 2006 and December 2015. Patients were eligible if they had a low-risk lesion and had a minimum follow-up of 24 months. Outcomes were development of WF/HRS or cytologically/histologically confirmed malignant IPMN. RESULTS: Of 837 patients included, 168 (20 per cent) developed WF/HRS. At the end of the observation time, 132 patients (79 per cent) with WF/HRS were still under surveillance without progression to pancreatic cancer. Factors associated with the development of WF or HRS in multivariable analysis included localized nodules (versus diffuse: hazard ratio (HR) 0.43, 95 per cent c.i. 0.26 to 0.68), cyst size 15-19 mm (versus less than 15 mm: HR 1.88, 1.23 to 2.87) or at least 20 mm (versus less than 15 mm: HR 3.25, 2.30 to 4.60), main pancreatic duct size over 3 mm (versus 3 mm or less: HR 2.17, 1.41 to 3.34), and symptoms at diagnosis (versus no symptoms: HR 2.29, 1.52 to 3.45). Surveillance in an endoscopy-oriented centre was also associated with increased detection of WF or HRS (versus radiology-oriented: HR 2.46, 1.74 to 3.47). CONCLUSION: Conservative management of patients with low-risk BD-IPMN is safe and feasible.publishedVersionPeer reviewe