Endoscopic Ultrasound in the Diagnosis of Pancreatoduodenal Groove Pathology: Report of Three Cases and Brief Review of the Literature

The pancreatoduodenal groove is a small area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla of Vater, and retroperitoneum converge. Despite great advances in imaging techniques, a definitive preoperative diagnosis is challenging because of the complex anatomy of this area. Therefore, surgical intervention is frequently required because of the inability to completely exclude malignancy. We report 3 cases of patients with different groove pathologies but similar clinical and imaging presentation, and show the essential role of endoscopic ultrasound (EUS) in making a specific preoperative diagnosis, excluding malignancy in the first case, changing diagnosis in the second case, and confirming malignancy in the third case. EUS was a fundamental tool in this cohort of patients, not only because of its ability to provide superior visualization of a difficult anatomical region, but because of the ability to guide precise, real-time procedures, such as fine-needle aspiration

Recomendaciones para el diagnóstico y tratamiento del adenocarcinoma ductal de páncreas

n/

Neoplasia mucinosa intraductal papilar del páncreas: Comunicación de un caso y revisión de la literatura

Las neoplasias mucinosas papilares intraductales pancreáticas o intraductal papillary mucinous neoplasias (IPMN) son detectadas con una frecuencia creciente en la práctica diaria debido tanto a una mayor conciencia de su existencia como al uso masivo de estudios complementarios por imágenes. Los IPMN se diagnostican de manera incidental en la mayoría de los casos y se clasifican en IPMN de las ramas laterales, IPMN del conducto pancreático principal e IPMN mixtos. Los últimos dos tipos presentan un comportamiento biológico más agresivo y se recomienda su tratamiento quirúrgico. Además, existen cuatro subtipos de epitelio neoplásico en estos tumores (intestinal, pancreatobiliar, gástrico y oncocítico), los cuales determinan diferencias en la historia natural de estas neoplasias y esto también parece tener un valor pronóstico. Comunicamos el caso de un paciente con una IPMN de tipo mixto, a quien se le realizó una duodeno-pancreatectomía y cuyo estudio anatomopatológico reveló una IPMN de subtipo intestinal con displasia de alto grado y carcinoma coloide. Asimismo, revisamos la literatura y describimos los aspectos más relevantes de este tipo particular de tumores quísticos del páncreas

Survey on initial management of acute pancreatitis in Latin America

Objective: The population of Latin America harbors the highest incidence of gallstones and acute biliary pancreatitis, yet little is known about the initial management of acute pancreatitis in this large geographic region. Participants and methods: We performed a post hoc analysis of responses from physicians based in Latin America to the international multidisciplinary survey on the initial management of acute pancreatitis. The questionnaire asked about management of patients during the first 72 h after admission, related to fluid therapy, prescription of prophylactic antibiotics, feeding and nutrition, and timing of cholecystectomy. Adherence to clinical guidelines in this region was compared with the rest of the world. Results: The survey was completed by 358 participants from 19 Latin American countries (median age, 39 years [33–47]; women, 27.1%). The proportion of participants in Latin America vs. the rest of the world who chose non-compliant options with clinical guidelines were: prescription of fluid therapy rate other than moderate (42.2% vs 34.3%, P = .02); prescription of prophylactic antibiotics for severe (10.6% vs 18.0%, P = .002), necrotizing (28.5% vs 36.9%, P = .008), or systemic inflammatory response syndrome-associated (21.2% vs 30.6%, P = .002) acute pancreatitis; not starting an oral diet to patients with oral tolerance (77.9% vs 71.1%, P = .02); and delayed cholecystectomy (16.2% vs 33.8%, P < .001). Conclusions: Surveyed physicians in Latin America are less likely to prescribe antibiotics and to delay cholecystectomy when managing patients in the initial phase of acute pancreatitis compared to physicians in the rest of the world. Feeding and nutrition appear to require the greatest improvement.Revisión por pare