Beyond the Basics: Recommended Approach to Severe Acute Pancreatitis Management in the Critical Care Setting.

Acute Pancreatitis (AP) poses a significant healthcare burden globally. While most cases present with a mild course, approximately one-fifth progress to severe forms characterized by severe pancreatitis and systemic complications, leading to a mortality rate of up to 40%. Effective management of severe acute pancreatitis necessitates a multidisciplinary approach involving gastroenterologists, interventional radiologists, intensive care teams, and surgeons.

Rising incidence and impact of early-onset colorectal cancer in the Asia-Pacific with higher mortality in females from Southeast Asia: a global burden analysis from 2010 to 2019.

Background And Aim: Early-onset colorectal cancer (CRC) is a growing global health concern, especially in the Asia-Pacific region. However, comprehensive research on this topic from the region is lacking. Our study aims to investigate trends in early-onset CRC in Asia over 10 years, filling this research gap.

Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Diagnosis of Pancreatic Metastases Secondary to Ovarian Carcinoma.

Pancreatic metastases from ovarian carcinoma are rare. We present a case of a patient with pancreatic metastasis from primary ovarian carcinoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Our case illustrates a unique presentation of a patient with ovarian carcinoma presenting with symptoms secondary to common bile duct dilatation from a pancreatic head mass confirmed through a much less invasive approach.

Gastric vascular abnormalities: diagnosis and management.

Purpose Of Review: Gastric vascular abnormalities are a well known cause of gastrointestinal bleeding. Due to their recurrent bleeding tendency and potential to cause life-threatening blood loss, gastric vascular abnormalities can result in significant morbidity and cost.

Recent Findings: There have been novel advances in medical and endoscopic management of gastric vascular lesions.

The Impact of Laparoscopic Cholecystectomy on 30-Day Readmission Rate for Acute Cholangitis Patients: A Single-Center Study.

Objectives: Laparoscopic cholecystectomy (LC) following acute gallstone cholangitis reduces the recurrence of biliary symptoms; however, the timing of LC has not been determined yet. The aim of our study was to evaluate the impact of performing LC during admission on the 30-day readmission rate.

Methods: We conducted a retrospective cohort study of acute gallstone cholangitis patients who underwent endoscopic clearance (EC) of the bile duct through endoscopic retrograde cholangiopancreatography between April 2013 and May 2018.

Somatic molecular analysis augments cytologic evaluation of pancreatic cyst fluids as a diagnostic tool.

Better tools are needed for early diagnosis and classification of pancreatic cystic lesions (PCL) to trigger intervention before neoplastic precursor lesions progress to adenocarcinoma. We evaluated the capacity of molecular analysis to improve the accuracy of cytologic diagnosis for PCL with an emphasis on non-diagnostic/negative specimens. In a span of 7 years, at a tertiary care hospital, 318 PCL endoscopic ultrasound-guided fine needle aspirations (EUS-FNA) were evaluated by cytologic examination and molecular analysis.

Quality of Care Indicators in Patients with Acute Pancreatitis.

Background: Acute pancreatitis (AP) is a common and expensive condition. Improving quality of care in AP is vital to minimizing cost and improving patient outcomes. However, there has been little work accomplished toward developing and validating explicit quality indicators (QIs) in AP.

Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees.

Background And Aims: Minimum EUS and ERCP volumes that should be offered per trainee in "high quality" advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an "average" advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs.

Methods: American Society for Gastrointestinal Endoscopy (ASGE)-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool.

Advances in management of nonvariceal upper gastrointestinal bleeding.

Purpose Of Review: To review new advances in managing nonvariceal upper gastrointestinal hemorrhage.

Recent Findings: Implementation of various scoring systems in combination with video capsule endoscopy assists in stratifying and managing nonvariceal upper gastrointestinal bleeding. New techniques such as thermocoagulation and hemoclips are useful to treat bleeding.

Exocrine Pancreatic Insufficiency and Malnutrition in Chronic Pancreatitis: Identification, Treatment, and Consequences.

Objectives: The purpose of this study was to examine the impact of exocrine pancreatic insufficiency (EPI) on chronic pancreatitis (CP) patients and to identify challenges with its diagnosis and treatment.

Methods: Ninety-one patients with CP diagnosed with endoscopic ultrasound were identified and assessed for symptoms of EPI, fat-soluble vitamin levels, dual-energy x-ray absorptiometry scan T-scores, and treatment with pancreatic enzyme replacement therapy. All patients were also screened with the Malnutrition Universal Screening Test.

Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice.

Background & Aims: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence.

Methods: We performed a prospective multicenter cohort study of invited participants from 62 training programs.

Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience.

Introduction: Mature peripancreatic fluid collection (MPFC) is a known and often challenging consequence of acute pancreatitis and often requires intervention. The most common method accepted is the "step-up approach," which consists of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal necrosectomy. Our paper aims to distinguish between plastic stents and lumen-apposing stents in the endoscopic management of MPFC in terms of morbidity, mortality, and haste of fluid collection resolution.

Quality of life comparison between smokers and non-smokers with chronic pancreatitis.

Objectives: The aim of this study was to evaluate the impact of smoking on quality of life in patients with chronic pancreatitis.

Methods: This is a cross-sectional study of chronic pancreatitis patients followed at a single institution comparing smokers with non-smokers. The primary outcome was quality of life and secondary outcomes included demographics, drug and alcohol use, anxiety and depression, pain level, nutritional status, and metabolic factors.

Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones.

Background & Aims: It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones.

Methods: We performed a retrospective analysis of 407 patients (60.

Gastric interventional endoscopy.

Purpose Of Review: To review new advances in gastric interventional endoscopy.

Recent Findings: Implementation of gastric endoscopy as a therapeutic option in obesity, gastric cancer, and gastroparesis.

Summary: Less invasive new gastric endoscopic procedures can potentially replace currently offered laparoscopic approaches in many fields.

Telephone-Based Mindfulness Therapy Intervention for Patients with Chronic Pancreatitis.

Background: Patients with chronic pancreatitis (CP) have substantially impaired quality of life (QOL) both physically and mentally. Mindfulness therapy is a form of treatment that has been shown to be beneficial in many medical conditions but has not been evaluated in the CP patient population.

Aims: The aims of this study were (1) to test the feasibility and usability of a novel telephone-based mindfulness therapy service for patients with CP and (2) to determine whether there was any effect on CP quality of life.

An update in the endoscopic management of gastric cancer.

Purpose Of Review: Gastric cancer remains a leading cause of mortality worldwide and gastroenterologists are playing an increasingly larger role in its management. This article reviews the endoscopic management of gastric cancer, with emphasis on recent advances in the field.

Recent Findings: Long-term studies comparing surgery and endoscopic resection for early gastric cancer have shown no difference in 10-year survival rates.

Pancreatitis Quality of Life Instrument: A Psychometric Evaluation.

Objectives: Chronic pancreatitis is a significant medical problem that impacts a large number of patients worldwide. In 2014, we developed a disease-specific instrument for the evaluation of quality of life in this group of patients: pancreatitis quality of life instrument (PANQOLI). The goal of this study was to evaluate its psychometric properties: its reliability and its construct validity.

Smoking Cessation in a Chronic Pancreatitis Population.

Objectives: Smoking is a known risk factor for developing chronic pancreatitis and accelerates disease progression. Smoking cessation remains an important treatment recommendation, but little is known about its effects. This study evaluated smoking cessation in this population and its impact on quality of life.

Thirty-day outcomes underestimate endocrine and exocrine insufficiency after pancreatic resection.

Background: Long-term incidence of endocrine and exocrine insufficiency after pancreatectomy is poorly described. We analyze the long-term risks of pancreatic insufficiency after pancreatectomy.

Methods: Subjects who underwent pancreatectomy from 2002 to 2012 were identified from a prospective database (n = 227).