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Magyar D, Fábián A, Vasas B, Nacsev K, Dubravcsik Z, Bősze Z, Tóth T, Bacsur P, Bálint A, Farkas K, Molnár T, Resál T, Bor R, Szepes Z. [Analysis of efficacy and safety of colonoscopic screening program at the University of Szeged and the Bács-Kiskun County Teaching Hospital between 2019 and 2022]. Orv Hetil 2024; 165:221-231. [PMID: 38341829 DOI: 10.1556/650.2024.32979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 02/13/2024]
Abstract
Bevezetés: Magyarországon 2019-ben indult az 50–70 éves
populáció körében a kétlépcsős vastagbélszűrő program, melynek célja a
colorectalis carcinoma kialakulásának megelőzése. Célkitűzés:
Kutatásunk célja volt a Szegedi Tudományegyetemen és a Bács-Kiskun Vármegyei
Oktatókórházban a szűrőprogram keretein belül végzett kolonoszkópiák minőségi
mutatóinak és kimeneteli indikátorainak, valamint a betegbiztonságnak a
vizsgálata a magyar szakmai ajánlás tükrében. Módszerek:
Intervencióval nem járó, obszervációs kohorszvizsgálatunkban az adatgyűjtés
során felhasználtuk a Nemzeti Népegészségügyi és Gyógyszerészeti Központ által
működtetett regiszter prospektív adatait, melyeket retrospektíven
kiegészítettünk az egészségügyi nyilvántartási rendszer segítségével.
Eredmények: Összesen 1739 szűrő kolonoszkópiára
(átlagéletkor 62,36 ± 5,86 év, férfiarány 56,81%) került sor 97,07%-os
coecumintubációs arány mellett. A béltisztaság az esetek 90,28%-ában megfelelő
volt, ezen belül az esetek 63,31%-ában kiváló. Az eszközvisszahúzási időről 1397
komplett kolonoszkópia esetén volt adat, mely 96,35%-ban meghaladta az irányelv
által javasolt 6 percet, átlagos hossza 9,51 ± 5,76 perc volt. Szedációt a
páciensek 40,37%-a igényelt, melynek során 92,02%-ban midazolámot alkalmaztak. A
kolonoszkópiák 62,51%-ában találtak neoplasztikus és 27,03%-ában csak nem
neoplasztikus laesiót. Összesen 2879 polipot találtak 1064 páciensnél
(polipfelismerési arány 61,18%), melyek közül a legrelevánsabbnak a mérete az
esetek 39,38%-ában meghaladta az 1 cm-t, és 72,97%-a a bal colonfélben
helyezkedett el. A páciensek 98,97%-a az index- és komplettáló kolonoszkópiák
során polipmentessé vált. Adenoma 871 esetben igazolódott, ez 50,09%-os
adenomafelismerési arányt jelent. Colorectalis carcinomát 80 páciensnél (4,60%)
fedeztek fel. Szövődmény 10 főnél (0,58%) lépett fel, beavatkozással összefüggő
halálozás nem következett be. Tisztázó gasztroszkópia a negatív eredményű
kolonoszkópiák 24,08%-ában történt, ezek során 1 főnél nyelőcső-laphámcarcinoma
igazolódott. Az utánkövetési időszakban 114 páciensnél (6,56%) történt ismételt
kolonoszkópia, melynek során intervallum colorectalis carcinomát 1 esetben
(0,06%) találtak. Következtetés: A kutatás során vizsgált két
centrumban végzett szűrő kolonoszkópiák megfeleltek a magyar irányelvben
meghatározott minőségi és kimeneteli mutatóknak, valamint betegbiztonsági
szempontoknak. Ugyanakkor a regiszterbe történő adatbevitel és a negatív
kolonoszkópiákat követő tisztázó gasztroszkópiák aránya korrekcióra szorul. Orv
Hetil. 2024; 165(6): 221–231.
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Affiliation(s)
- Dániel Magyar
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged Magyarország
| | - Anna Fábián
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Béla Vasas
- 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Patológiai Intézet Szeged Magyarország
| | | | | | - Zsófia Bősze
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Tibor Tóth
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Péter Bacsur
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Anita Bálint
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Klaudia Farkas
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Tamás Molnár
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Tamás Resál
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Renáta Bor
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
| | - Zoltán Szepes
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika Szeged, Kálvária sgt. 57., 6725 Magyarország
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Czakó L, Gyökeres T, Hritz I, Madácsy L, Illés D, Szepes Z, Dubravcsik Z, Péterfi Z, Nagy A, Szücs Á, Vincze Á. [Cholangitis and cholecystitis: diagnostic criteria and management]. Orv Hetil 2023; 164:770-787. [PMID: 37210716 DOI: 10.1556/650.2023.32770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/12/2023] [Indexed: 05/23/2023]
Abstract
In developed countries, diseases of the gallbladder and the biliary tract count as some of the most frequent gastrointestinal disorders. The inflammation of the gallbladder/biliary tree is a potentially severe, even lethal condition that requires rapid diagnosis and early multidisciplinary approach to be treated. Although the frequency of these diseases is high, the treatment is not unified in Hungary yet. The aim of the evidence-based recommendation is to clarify the diagnostic criteria and severity grading of these diseases and to highlight the indications and rules of proper application of the numerous available therapeutic interventions. The recent guideline is based on the consensus of the Board members of the Endoscopic Section of the Hungarian Gastroenterology Society in contribution with renown experts of surgery, infectology as well as interventional radiology and it counts as a clear and easy applicable guide during the all-day healthcare practice. Our guidelines are based on Tokyo guidelines established on the basis of the consensus reached in the International Consensus Meeting held in Tokyo which were revised in 2013 (TG13) and in 2018 (TG18). Orv Hetil. 2023; 164(20): 770-787.
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Affiliation(s)
- László Czakó
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Belgyógyászati Klinika, Gasztroenterológiai Osztály Szeged, Pf. 469, 6701 Magyarország
| | - Tibor Gyökeres
- 2 Észak-Pesti Centrumkórház - Honvédkórház, Gasztroenterológiai Osztály Budapest Magyarország
| | - István Hritz
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - László Madácsy
- 4 Endo-Kapszula Magánorvosi Centrum Székesfehérvár Magyarország
| | - Dóra Illés
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Belgyógyászati Klinika, Gasztroenterológiai Osztály Szeged, Pf. 469, 6701 Magyarország
| | - Zoltán Szepes
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Belgyógyászati Klinika, Gasztroenterológiai Osztály Szeged, Pf. 469, 6701 Magyarország
| | - Zsolt Dubravcsik
- 5 Bács-Kiskun Megyei Oktatókórház, Gasztroenterológiai Osztály Kecskemét Magyarország
| | - Zoltán Péterfi
- 6 Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika Pécs Magyarország
| | - András Nagy
- 7 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Radiológiai Klinika Szeged Magyarország
| | - Ákos Szücs
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Áron Vincze
- 6 Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika Pécs Magyarország
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Dubravcsik Z, Gyökeres T, Novák P, Budai A, Mohácsi S, Velkei T, Madácsy L. Az endoszkópos retrográd cholangiopancreatographia szövődményei. Orv Hetil 2022; 163:911-919. [DOI: 10.1556/650.2022.32433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022]
Abstract
Az endoszkópos retrográd cholangiopancreatographia (ERCP) a több mint 50 éves
története során diagnosztikus módszerből szinte kizárólag terápiás beavatkozássá
vált. Köszönhető ez a kevésbé invazív vizsgálati módszerek kialakulásának,
illetve annak a felismerésnek is, hogy számos szövődmény kialakulásának
veszélyét hordozza magában. Ezek ismerete manapság alapvető fontosságú. Az
eltelt évtizedek során a szövődmények hajlamosító tényezőiről, illetve a
megelőzés lehetőségeiről jelentős ismeretanyag gyűlt össze, melyhez magyar
szakemberek komoly eredményekkel járultak hozzá. Jelen közleményünkben az ERCP
szövődményeit, azok definícióját, súlyossági osztályozásukat, kockázati
tényezőiket, a profilaktikus lehetőségeket és az endoszkópos ellátás módjait
foglaljuk össze. Orv Hetil. 2022; 163(23): 911–919.
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Affiliation(s)
- Zsolt Dubravcsik
- Bács-Kiskun Megyei Oktatókórház, Gasztroenterológiai Osztály Kecskemét, Nyíri út 38., 6000 Magyarország
| | - Tibor Gyökeres
- Magyar Honvédség Egészségügyi Központ, Honvédkórház, Gasztroenterológiai Osztály Budapest Magyarország
| | - Péter Novák
- Bács-Kiskun Megyei Oktatókórház, Gasztroenterológiai Osztály Kecskemét, Nyíri út 38., 6000 Magyarország
| | - Annamária Budai
- Bács-Kiskun Megyei Oktatókórház, Gasztroenterológiai Osztály Kecskemét, Nyíri út 38., 6000 Magyarország
| | - Szilvia Mohácsi
- Bács-Kiskun Megyei Oktatókórház, Gasztroenterológiai Osztály Kecskemét, Nyíri út 38., 6000 Magyarország
| | - Tamás Velkei
- Bács-Kiskun Megyei Oktatókórház, Gasztroenterológiai Osztály Kecskemét, Nyíri út 38., 6000 Magyarország
| | - László Madácsy
- Endo-Kapszula Magánorvosi Centrum Székesfehérvár Magyarország
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Keczer B, Dubravcsik Z, †Szepes A, Madácsy L, Szijártó A, Hritz I. Az endoszkópos ultrahangvizsgálat diagnosztikus érzékenysége epeúti kövesség gyanúja esetén. Orv Hetil 2022; 163:400-406. [DOI: 10.1556/650.2022.32393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/10/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló.
Bevezetés: Az epeúti kövesség meglétének valószínűsége
különböző klinikai prediktorok alapján megbecsülhető, e faktorok szenzitivitása
és specificitása azonban nem kielégítő. Az endoszkópos ultrahangvizsgálat az
epeúti kövesség diagnosztizálásának szemiinvazív precíz eszköze.
Célkitűzés: Célunk az endoszkópos ultrahangvizsgálat
diagnosztikus érzékenységének vizsgálata gyanított epeúti kövesség esetén.
Módszer: A prospektív vizsgálat során a betegeket az
Amerikai Emésztőszervi Endoszkópos Társaság (ASGE) ajánlása szerint
meghatározott prediktorok alapján közepes és magas valószínűségi csoportokba
osztottuk, és endoszkópos ultrahangvizsgálatot, valamint amennyiben szükséges
volt, endoszkópos retrográd kolangiopankreatográfiát (ERCP) végeztünk.
Eredmények: Összesen 95 beteget vizsgáltunk. Az endoszkópos
ultrahangvizsgálat 53 (56%) beteg esetében írt le epeúti kövességet: 55%-ban
(39/71) a közepes valószínűségi és 58%-ban (14/24) a magas valószínűségi
csoportban. Az ERCP mindegyik choledocholithiasisos esetet megerősítette. A két
valószínűségi csoport között nem volt szignifikáns különbség (p = 0,56) az ERCP
által igazolt epeúti kövesség tekintetében. Az ERCP csupán 1 esetben detektált
epeúti kövességet a negatív endoszkópos ultrahangvizsgálat ellenére. Az
endoszkópos ultrahangvizsgálat specificitása 100%, szenzitivitása 98%, míg
pozitív és negatív prediktív értéke 100%, valamint 98% volt.
Megbeszélés: Az epeúti kövesség meglétének becslése
különböző klinikai prediktorok alapján kihívást jelenthet.
Következtetés: Az endoszkópos ultrahangvizsgálat szenzitív
és pontos diagnosztikus eszköz a choledocholithiasis kimutatására és
értékelésére, olyan esetekben is, amelyeknél az előzetes képalkotók nem találtak
kövességet. Orv Hetil. 2022; 163(10): 400–406.
Summary.
Introduction: The likelihood of common bile duct stones can be
prognosticated by various clinical predictors, however, the sensitivity and
specificity of these factors are moderate. Endoscopic ultrasonography has been
shown to be a semi-invasive precise test for the detection of common bile duct
stones. Objective: Our aim was to assess the diagnostic
accuracy of endoscopic ultrasonography in patients with suspected
choledocholithiasis. Method: Patients of this prospective study
were categorized and divided into intermediate likelihood and high likelihood
groups according to the clinical predictors defined by the American Society of
Gastrointestinal Endoscopy (ASGE) guidelines and referred for linear
endosonography. Endoscopic retrograde cholangiopancreatography (ERCP) was
performed if needed. Results: A total of 95 patients were
assessed. Common bile duct stones were detected by endoscopic ultrasonography
overall in 53 (56%) patients: 55% (39/71) in the intermediate likelihood and 58%
(14/24) in the high likelihood group of patients. The detected common bile duct
stones in all patients were confirmed by ERCP. There was no significant
difference (p = 0.56) in the detection of stones by ERCP between the two
likelihood groups. ERCP confirmed choledocholithiasis only in one patient whose
preceding endosonography did not detect stone. The specificity and sensitivity
of endoscopic ultrasonography were 100% and 98%, the positive predictive value
and negative predictive value were 100% and 98%, respectively.
Discussion: Estimating the likelihood of
choledocholithiasis based on various clinical predictors might be challenging.
Conclusion: Endoscopic ultrasonography is a highly
sensitive and accurate diagnostic tool for the detection and evaluation of
common bile duct stones also in patients with previous normal imaging findings.
Orv Hetil. 2022; 163(10): 400–406.
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Affiliation(s)
- Bánk Keczer
- Semmelweis Egyetem, Általános Orvostudományi Kar, I. Sebészeti és Intervenciós Gasztroenterológiai Klinika Budapest, Üllői út 78.; 1082 Magyarország
| | - Zsolt Dubravcsik
- Bács-Kiskun Megyei Oktatókórház, Gasztroenterológiai Osztály Kecskemét Magyarország
| | | | - László Madácsy
- Endo-Kapszula Magánorvosi Centrum Székesfehérvár Magyarország
| | - Attila Szijártó
- Semmelweis Egyetem, Általános Orvostudományi Kar, I. Sebészeti és Intervenciós Gasztroenterológiai Klinika Budapest, Üllői út 78.; 1082 Magyarország
| | - István Hritz
- Semmelweis Egyetem, Áltlános Orvostudományi Kar, I. Sebészeti és Intervenciós Gasztroenterológiai Klinika, Invazív Endoszkópos Centrum Budapest Magyarország
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Gonczi L, Szanto K, Farkas K, Molnar T, Szamosi T, Schafer E, Golovics PA, Barkai L, Lontai L, Lovasz B, Juhasz M, Patai A, Sarang K, Vincze A, Sarlos P, Farkas A, Dubravcsik Z, Toth TG, Miheller P, Ilias A, Lakatos PL. Clinical efficacy, drug sustainability and serum drug levels in Crohn's disease patients treated with ustekinumab - A prospective, multicenter cohort from Hungary. Dig Liver Dis 2022; 54:207-213. [PMID: 34344576 DOI: 10.1016/j.dld.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although efficacy of ustekinumab (UST) has been demonstrated through randomized trials, data from real-life prospective cohorts are still limited. Our aim was to evaluate clinical efficacy, drug sustainability, dose intensification and results from therapeutic drug monitoring in UST treated patients with Crohn's disease (CD) using a prospective, nationwide, multicenter cohort. METHODS Patients from 10 Inflammatory Bowel Disease centers were enrolled between 2019 January and 2020 May. Patient demographics, disease phenotype, treatment history, clinical disease activity (Crohn's Disease Activity Index(CDAI), Harvey Bradshaw Index(HBI)), biomarkers, and serum drug levels were obtained. Evaluations were performed at week8 (post-induction), w16-20, w32-36, and w52-56 follow-up visits. RESULTS A total of 142 patients were included [57.4% female; complex disease behavior (B2/B3):48%, previous anti-TNF exposition:97%]. Clinical response and remission rates after induction(w8) were 78.1% and 57.7% using CDAI, and 82.5% and 51.8% based on HBI scores. The one-year clinical remission rate was 58%/57.3%(CDAI/HBI). Composite clinical and biomarker remission (CDAI<150 and C-reactive protein<10 mg/L) rates were 35.4%; 33.3%; 38.6% and 36.6% at w8/w16-20/w32-36 and w52-56. Drug sustainability was 81.9%(standard deviation(SD): 3.4) at 1 year(1y). Probability of dose intensification was high and introduced early, 42.2%(SD:4.2) at ~w32 and 51.9%(SD:4.4%) at 1y. CONCLUSION Ustekinumab showed favorable drug sustainability and clinical efficacy in a patient population with severe disease phenotype and previous anti-tumor necrosis factor (anti-TNF) failure, however frequent dose intensification was required.
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Affiliation(s)
- Lorant Gonczi
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Kata Szanto
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamas Molnar
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamas Szamosi
- Department of Gastroenterology, Military Hospital-State Health Center, Budapest, Hungary
| | - Eszter Schafer
- Department of Gastroenterology, Military Hospital-State Health Center, Budapest, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Military Hospital-State Health Center, Budapest, Hungary
| | - Laszlo Barkai
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Livia Lontai
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Barbara Lovasz
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Mark Juhasz
- Department of Medicine, St. Margit Hospital, Budapest, Hungary
| | - Arpad Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Krisztina Sarang
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Aron Vincze
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Patricia Sarlos
- First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Alexandra Farkas
- Department of Gastroenterology, Bács-Kiskun County Hospital, Kecskemet, Hungary
| | - Zsolt Dubravcsik
- Department of Gastroenterology, Bács-Kiskun County Hospital, Kecskemet, Hungary
| | - Tamas G Toth
- Department of Gastroenterology, St. Janos Hospital, Budapest, Hungary
| | - Pal Miheller
- 1st Department of Surgery and Interventional Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Akos Ilias
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Peter L Lakatos
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary; McGill University Health Center, Montreal General Hospital, Canada.
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Gyökeres T, Bor R, Czakó L, Dubravcsik Z, Szepes Z, Szőnyi M, Vincze Á. Az endoszkópia minőségi követelményei. Magy Seb 2021; 74:75-103. [PMID: 34564062 DOI: 10.1556/1046.74.2021.3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A tápcsatorna endoszkópiája a gasztrointesztinális rendszer betegségeinek legfontosabb vizsgáló eljárása, a diagnosztikán túl egyre szélesedő körben terápiás beavatkozási lehetőséget is magában foglal. A jó minőségben végzett endoszkópia javítja az esetlegesen fennálló betegség kimenetelét és növeli a betegelégedettséget. A nemzetközi emésztőszervi endoszkópos társaságok elsőrendű fontosságúnak határozták meg az endoszkópia minőségének javítását célzó törekvéseket. Az endoszkópos tevékenységek minőségének ellenőrzésében és javításában a meghatározott indikátorok folyamatos követése fontos feladat, ezek révén biztosítható betegeink számára a legmagasabb szintű ellátás. A bizonyítékon alapuló minőségi indikátorok lehetővé teszik az egyes endoszkóposok és az endoszkópos vizsgálóhelyek összehasonlítását és az általuk nyújtott szolgáltatás értékelését. A fenntartónak betegbiztonsági és költséghatékonysági szempontból is fontos ismerni, hogy melyik szolgáltató tudja teljesíteni a minimálisan elvárt és fejlődési célként kitűzött teljesítménymutatókat, melyik ellátónál milyen tényezőket szükséges megváltoztatni, javítani. A szerzők az európai útmutatókat alapul véve a felső tápcsatorna endoszkópiája, az alsó tápcsatorna endoszkópia, a pancreatobiliaris endoszkópia, a vékonybél endoszkópia, a kapszula endoszkópia és az endoszkópos szolgáltatás területén határozták meg a klinikailag releváns teljesítménymutatók auditálható magyar rendszerét. Az egységesség, a jobb digitalizálhatóság és könnyebb auditálhatóság céljából a felső, az alsó, a pancreatobiliaris, a vékonybél és a kapszula endoszkópia vonatkozásában a magyar ajánlásban a minőségi alterületeket egységesen (1-8) számozták, minden szám ugyanazon szempontrendszert jelenti. Az endoszkópos szolgáltatás komplex minőségi mutatóinál szigorúan ragaszkodtak az európai irányelvhez, itt 9 különböző alterületbe foglalták össze a 30 minőségi mutatót. A szűrő kolonoszkópia kiemelt jelentősége miatt a jelen minőségi endoszkópos útmutatóba foglalták bele eltérő szerkezettel a szűrő kolonoszkópos program során alkalmazott minőségi mutatókat, illetve a bélelőkészítést érintő néhány alapvetést is. Summary. Nowadays, endoscopy is the cornerstone in the diagnosis and therapy of gastrointestinal diseases. Good quality endoscopy can improve outcome of the disease and patients experience. International endoscopy societies prioritized efforts improving quality of endoscopy. The highest level of patient care can be provided through continuous assessment and improvement of relevant quality indicators. The comparison of these evidence based performance measures between endoscopists and endoscopy providers allow the objective evaluation of the service. Furthermore, from the point of view of patient safety and cost effectiveness the health care provider should know the minimum standards and target goals, as well, to make grounded decisions about fields of necessary changes and improvements. The authors based on European guidelines worked out this comprehensive auditable Hungarian system of performance measures in the fields of upper endoscopy, lower endoscopy, pancreatobiliary endoscopy, capsule endoscopy, enteroscopy and general endoscopy service. Due to commonality all domains were counted similarly (1-8) in different endoscopic procedures. The general endoscopy service is an exception with 9 domains and 30 quality parameters. The outstanding importance of colorectal cancer screening required involving this topic into this guideline with separate structure, as well as the basics of bowel preparation.
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Affiliation(s)
- Tibor Gyökeres
- 1 Magyar Honvédség Egészségügyi Központ, Honvédkórház, Gasztroenterológiai Osztály, Budapest
| | - Renáta Bor
- 2 Szent-Györgyi Albert Klinikai Központ, Szegedi Tudományegyetem, I. sz. Belgyógyászati Klinika, Szeged
| | - László Czakó
- 2 Szent-Györgyi Albert Klinikai Központ, Szegedi Tudományegyetem, I. sz. Belgyógyászati Klinika, Szeged
| | - Zsolt Dubravcsik
- 3 Bács-Kiskun Megyei Kórház, Belgyógyászat-Gasztroenterológiai Osztály, Kecskemét
| | - Zoltán Szepes
- 2 Szent-Györgyi Albert Klinikai Központ, Szegedi Tudományegyetem, I. sz. Belgyógyászati Klinika, Szeged
| | - Mihály Szőnyi
- 4 Szent Imre Egyetemi Oktatókórház, Gasztroenterológiai Osztály, Budapest
| | - Áron Vincze
- 5 Pécsi Tudományegyetem Klinikai Központ, I. sz. Belgyógyászati Klinika, Pécs
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Dubravcsik Z, Hritz I, Keczer B, Novák P, Lovász BD, Madácsy L. Network meta-analysis of prophylactic pancreatic stents and non-steroidal anti-inflammatory drugs in the prevention of moderate-to-severe post-ERCP pancreatitis. Pancreatology 2021; 21:704-713. [PMID: 33926821 DOI: 10.1016/j.pan.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is an ongoing debate that non-steroidal anti-inflammatory drugs (NSAID) or prophylactic pancreatic stents (PPS) are more beneficial in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). In our present network meta-analysis, we aimed to compare PPSs to rectal NSAIDs in the prevention of moderate and severe PEP in average- and high-risk patients. METHODS We performed a systematic search for randomized controlled trials (RCT) from MEDLINE (via PubMed), Embase and Cochrane Central databases. RCTs using prophylactic rectal NSAIDs or PPSs in patients subjected to ERCP at average- and high-risk population were included. The main outcome was moderate and severe PEP defined by the Cotton criteria. Pairwise Bayesian network meta-analysis was performed, and interventions were ranked based on surface under cumulative ranking (SUCRA) values. RESULTS Seven NSAID RCTs (2593 patients), and 2 PPS RCTs (265 patients) in the average-risk, while 5 NSAID RCTs (1703 patients), and 8 PPS RCTs (974 patients) in the high-risk group were included in the final analysis. Compared to placebo, only PPS placement reduced the risk of moderate and severe PEP in both patient groups (average-risk: RR = 0.07, 95% CI [0.002-0.58], high-risk: RR = 0.20, 95% CI [0.051-0.56]) significantly. Rectal NSAID also reduced the risk, but this effect was not significant (average-risk: RR = 0.58, 95% CI [0.22-1.3], high-risk: RR = 0.58, 95% CI [0.18-2.3]). Based on SUCRA, PPS placement was ranked as the best preventive method. CONCLUSION Prophylactic pancreatic stent placement but not rectal NSAID seems to prevent moderate-to-severe PEP better both, in average- and high-risk patients.
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Affiliation(s)
- Zsolt Dubravcsik
- Department of Gastroenterology, BKM Hospital, Kecskemét, Hungary.
| | - István Hritz
- Center for Therapeutic Endoscopy, 1st Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Bánk Keczer
- Center for Therapeutic Endoscopy, 1st Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Novák
- Department of Gastroenterology, BKM Hospital, Kecskemét, Hungary
| | | | - László Madácsy
- Department of Gastroenterology, BKM Hospital, Kecskemét, Hungary; Endo-kapszula Private Medical Center, Székesfehérvár, Hungary
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8
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Bor R, Szántó KJ, Fábián A, Farkas K, Szűcs M, Rutka M, Tóth T, Bálint A, Milassin Á, Dubravcsik Z, Szepes Z, Molnár T. Effect of COVID-19 pandemic on workflows and infection prevention strategies of endoscopy units in Hungary: a cross-sectional survey. BMC Gastroenterol 2021; 21:98. [PMID: 33657994 PMCID: PMC7927759 DOI: 10.1186/s12876-021-01670-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/16/2021] [Indexed: 02/08/2023] Open
Abstract
Background Health care professionals in endoscopic labs have an elevated risk for COVID-19 infection, therefore, we aimed to determine the effect of current pandemic on the workflow and infection prevention and control strategies of endoscopy units in real-life setting. Methods All members of Hungarian Society of Gastroenterology were invited between 7 and 17 April 2020 to participate in this cross-section survey study and to complete an online, anonymous questionnaire. Results Total of 120 endoscopists from 83 institutes were enrolled of which 35.83% worked in regions with high cumulative incidence of COVID-19. Only 33.33% of them had undergone training about infection prevention in their workplace. 95.83% of endoscopists regularly used risk stratification of patients for infection prior endoscopy. While indications of examinations in low risk patients varied widely, in high-risk or positive patients endoscopy was limited to gastrointestinal bleeding (95.00%), removal of foreign body from esophagus (87.50%), management of obstructive jaundice (72.50%) and biliary pancreatitis (67.50%). Appropriate amount of personal protective equipment was available in 60.85% of endoscopy units. In high-risk or positive patients, surgical mask, filtering facepiece mask, protective eyewear and two pairs of gloves were applied in 30.83%, 76.67%, 90.00% and 87.50% of cases, respectively. Personal protective equipment fully complied with European guideline only in 67.50% of cases. Conclusions Survey found large variability in indications of endoscopy and relative weak compliance to national and international practical recommendations in terms of protective equipment. This could be improved by adequate training about infection prevention.
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Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary.
| | - Kata Judit Szántó
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Tibor Tóth
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Zsolt Dubravcsik
- Department of Gastroenterology and Endoscopy, Bács-Kiskun County Hospital, Kecskemet, Hungary
| | | | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
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Hegyi PJ, Soós A, Tóth E, Ébert A, Venglovecz V, Márta K, Mátrai P, Mikó A, Bajor J, Sarlós P, Vincze Á, Halász A, Izbéki F, Szepes Z, Czakó L, Kovács G, Papp M, Dubravcsik Z, Varga M, Hamvas J, Németh BC, Macarie M, Ince AT, Bordin DS, Dubtsova EA, Kiryukova MA, Khatkov IE, Bideeva T, Mickevicius A, Ramírez-Maldonado E, Sallinen V, Erőss B, Pécsi D, Szentesi A, Párniczky A, Tiszlavicz L, Hegyi P. Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model. Sci Rep 2021; 11:1367. [PMID: 33446814 PMCID: PMC7809468 DOI: 10.1038/s41598-020-80532-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/18/2020] [Indexed: 12/19/2022] Open
Abstract
Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. In this study, data from 1315 and 318 patients were analysed from acute pancreatitis (AP) and CP registries, respectively. The population from the AP registry was divided into AP (n = 983), recurrent AP (RAP, n = 270) and CP (n = 62) groups. The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5 + was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. Laboratory, imaging and clinical biomarkers highlighted that patients with RAP3 + do not show a significant difference between RAPs and CP. Data from CP registries showed 98% of patients had at least one AP and the average number of episodes was four. We mimicked the human RAPs in a mouse model and found that three or more episodes of AP cause early chronic-like morphological changes in the pancreas. We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP).The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. They can be used in hospitals with no additional costs in healthcare.
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Affiliation(s)
- Péter J Hegyi
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.,Department of Gastroenterology, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Alexandra Soós
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Emese Tóth
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Attila Ébert
- Department of Pharmacology and Pharmacotherapy, Szeged, Hungary
| | | | - Katalin Márta
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Mátrai
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Alexandra Mikó
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Adrienn Halász
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Zoltán Szepes
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - László Czakó
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - György Kovács
- Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Debrecen, Hungary
| | - Mária Papp
- Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Debrecen, Hungary
| | | | | | - József Hamvas
- Peterfy Hospital and Trauma, Trauma Emergency Room, Esztergom, Hungary
| | - Balázs C Németh
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Melania Macarie
- County Emergency Clinical Hospital - Gastroenterology and, University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
| | - Ali Tüzün Ince
- School of Medicine, Hospital of Bezmialem Vakif University, Istanbul, Turkey
| | - Dmitry S Bordin
- A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia.,Tver State Medical University, Tver, Russia.,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | | | - Igor E Khatkov
- A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia.,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Artautas Mickevicius
- Clinic of Gastroenterology, Nephrourology and Abdominal Surgery, Faculty of Medicine, Vilnius University, Vilnius,, Lithuania
| | | | - Ville Sallinen
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Pécsi
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Párniczky
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | | | - Péter Hegyi
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary. .,Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary. .,Department of Medicine, University of Szeged, Szeged, Hungary.
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Dubravcsik Z, Hritz I, Szepes A, Madácsy L. Prophylactic stents in the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. Orv Hetil 2021; 162:31-38. [PMID: 33388737 DOI: 10.1556/650.2021.31934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Az endoszkópos retrográd cholangiopancreatographiát (ERCP) követő pancreatitis (PEP) incidenciája a magas kockázatú betegcsoportban 14,7%. Célkitűzés: A munkacsoportunk által szerzett tapasztalatok elemzése. Módszerek: A profilaktikus pancreassztentes (PPS), magas kockázatú betegek adatait tartalmazó prospektív adatbázisunkat elemeztük retrospektív módon. Az adatokat a PEP-incidencia és a súlyosság tekintetében összehasonlítottuk a korábbi, hasonlóan magas kockázatú, sztent nélküli beteganyagunkkal, illetve a sztenteléssel kapcsolatos szövődményeket és a különböző sztenttípusokat is elemeztük. A Cotton-kritériumok szerint értékeltük a PEP-t. Eredmények: A 317, magas kockázatú betegből 288 esetben (90,9%) volt sikeres a PPS-implantáció. A sztent nélküli kontrollcsoportba 121, magas kockázatú beteget választottunk be. A sikeresen sztentelt betegekben a PEP incidenciája 10,0% volt. Ez és a PEP súlyossága (enyhe: 8,3%, középsúlyos: 1,4%, súlyos: 0,3%) is szignifikánsan alacsonyabb volt a PPS nélküli beteganyaghoz (PEP: 31,4%, enyhe: 15,7%, középsúlyos: 10,7%, súlyos: 5,0%) és a sikertelenül sztentelt betegekhez (PEP: 41,3%, enyhe: 24,1%, középsúlyos: 13,8%, súlyos: 3,4%) képest. Az utóbbi két csoport közötti különbség nem volt szignifikáns. A sztenttel kapcsolatos szövődmények közül a leggyakrabban a korai sztentkicsúszást (5/288 beteg, 1,74%) és a proximalis sztentmigrációt (3/288 beteg, 1,04%) észleltük. A sztenttípusok közül a legkedvezőbb mellékhatás-profilúnak a Freeman-típusú, belső füllel és külső "pigtail" véggel ellátott sztenteket találtuk. Következtetés: A profilaktikus pancreassztentelés hatékonyan csökkenti a PEP incidenciáját, és a súlyosságát az enyhébb esetek felé tolja el. Alkalmazása viszonylag egyszerű, azonban ismerni kell használatának megfelelő technikáját, időben történő eltávolításának és a szövődmények felismerésének fontosságát. Eredményeink és a nemzetközi ajánlások alapján magas PEP-rizikójú betegekben a PPS rutinszerű alkalmazása minden ERCP-laborban ajánlott. Orv Hetil. 2021; 162(1): 31-38. SUMMARY INTRODUCTION The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP). Its incidence in the high-risk patient population is 14.7%. OBJECTIVE To analyze 10 years experiences of our working group. METHODS We retrospectively analyzed our prospective database of high-risk patients treated with prophylactic pancreatic stents (PPS) including the period between 2009 and 2014. We compared PEP incidence and severity findings with our historical data of pre-PPS period of similarly high-risk patients (no-stent group), furthermore analyzed the complications of PPS insertion and different stent types. PEP was defined and categorized according to the Cotton criteria. RESULTS In 317 high-risk patients, PPS implantation was successful in 288 cases (90.9%). The no-stent group comprised of 121 patients. Incidence and the severity of PEP in the successfully stented group (all: 10.0%; mild: 8.3%, moderate: 1.4%, severe: 0.3%) were significantly lower compared to the no-stent group (all: 31.4%; mild: 15.7%, moderate: 10.7%, severe: 5.0%) and the unsuccessfully stented group (all: 41.3%; mild: 24.1%, moderate: 13.8%, severe: 3.4%). The difference between the latter two groups was not significant. Only early dislodgment (5/288 patients, 1.74%) and proximal migration (3/288 patients, 1.04%) were observed as stent-related complications. Freeman type (single inner flange, outer pigtail end) stent was the best based on the complication profile. CONCLUSION Prophylactic pancreatic stenting effectively lowers the incidence and severity of PEP. We should recognize the proper technic of its application and the importance of proper timing of its extraction and identification of complications. Utilization of PPSs in high-risk patients is strongly recommended in every ERCP center. Orv Hetil. 2021; 162(1): 31-38.
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Affiliation(s)
- Zsolt Dubravcsik
- 1 Bács-Kiskun Megyei Kórház, Belgyógyászat, Gasztroenterológia, Kecskemét, Nyíri út 38., 6000
| | - István Hritz
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Sebészeti Klinika, Invazív Endoszkópos Centrum, Budapest
| | - Attila Szepes
- 1 Bács-Kiskun Megyei Kórház, Belgyógyászat, Gasztroenterológia, Kecskemét, Nyíri út 38., 6000
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11
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Pécsi D, Gódi S, Hegyi P, Hanák L, Szentesi A, Altorjay I, Bakucz T, Czakó L, Kovács G, Orbán-Szilágyi Á, Pakodi F, Patai Á, Szepes Z, Gyökeres T, Fejes R, Dubravcsik Z, Vincze Á. ERCP is more challenging in cases of acute biliary pancreatitis than in acute cholangitis - Analysis of the Hungarian ERCP registry data. Pancreatology 2021; 21:59-63. [PMID: 33309622 DOI: 10.1016/j.pan.2020.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is an important therapeutic modality in acute biliary pancreatitis (ABP) cases with cholangitis or ongoing common bile duct obstruction. Theoretically, inflammation of the surrounding tissues would result in a more difficult procedure. No previous studies examined this hypothesis. OBJECTIVES ABP and acute cholangitis (AC) without ABP cases were compared to assess difficulty of ERCP. METHODS The rate of successful biliary access, advanced cannulation method, adverse events, cannulation and fluoroscopy time were compared in 240 ABP cases and 250 AC cases without ABP. Previous papillotomy, altered gastroduodenal anatomy, and cases with biliary stricture were excluded. RESULTS Significantly more pancreatic guidewire manipulation (adjusted odds ratio (aOR) 1.921 [1.241-2.974]) and prophylactic pancreatic stent use (aOR 4.687 [2.415-9.098]) were seen in the ABP than in AC group. Average cannulation time in the ABP patients (248 vs. 185 s; p = 0.043) were longer than in AC cases. No difference was found between biliary cannulation and adverse events rates. CONCLUSION ERCP in ABP cases seem to be more challenging than in AC. Difficult biliary access is more frequent in the ABP cases which warrants the involvement of an experienced endoscopist.
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Affiliation(s)
- Dániel Pécsi
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary; Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Szilárd Gódi
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Lilla Hanák
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - István Altorjay
- Second Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Bakucz
- Department of Gastroenterology, Medical Centre Hungarian Defence Forces, Budapest, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - György Kovács
- Second Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ákos Orbán-Szilágyi
- Department of Gastroenterology, Medical Centre Hungarian Defence Forces, Budapest, Hungary
| | - Ferenc Pakodi
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Árpád Patai
- First Department of Gastroenterology and Medicine, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Gyökeres
- Department of Gastroenterology, Medical Centre Hungarian Defence Forces, Budapest, Hungary
| | - Roland Fejes
- First Department of Medicine, Szent György University Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Zsolt Dubravcsik
- Bács-Kiskun County University Teaching Hospital, Kecskemét, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.
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12
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Mosztbacher D, Hanák L, Farkas N, Szentesi A, Mikó A, Bajor J, Sarlós P, Czimmer J, Vincze î, Hegyi P, Eross B, Takács T, Czakó L, Németh B, Izbéki F, Halász A, Gajdán L, Hamvas J, Papp M, Földi I, Fehér K, Varga M, Csefkó K, Török I, Hunor-Pál F, Mickevicius A, Ramirez Maldonado E, Sallinen V, Novák J, Tüzün Ince A, Galeev S, Bod B, Sümegi J, Pencik P, Dubravcsik Z, Illés D, Gódi S, Kui B, Márta K, Pécsi D, Varjú P, Szakács Z, Darvasi E, Párniczky A, Hegyi P. Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology 2020. [DOI: 10.1016/j.pan.2020.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Lovász BD, Szalai M, Oczella L, Finta Á, Dubravcsik Z, Madácsy L. Improved adenoma detection with linked color imaging technology compared to white-light colonoscopy. Scand J Gastroenterol 2020; 55:877-883. [PMID: 32657195 DOI: 10.1080/00365521.2020.1786850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Linked color imaging (LCI) is a new endoscopic technology that may increase colorectal adenoma detection rate (ADR) and polyp detection rate (PDR) by virtual chromoendoscopy. Aim of the present study was to evaluate the effectiveness of LCI in ADR and PDR compared to the HD white-light colonoscopy (WLC) technique. MATERIALS AND METHODS Between October 2016 and June 2018, we enrolled consecutive outpatients prospectively. Eligible patients allocated randomly to undergo HD WLC or LCI colonoscopy technique during instrument withdrawal. Each colonoscopy was performed in a single center by the same three expert endoscopists (with expertise more than 5000 colonoscopies). RESULTS A total of 1278 patients underwent colonoscopy in the study period. ADR and PDR were significantly higher in the LCI group compared to the WLC group (34.4% vs. 26.8%; p = .007; and 53.3% vs 46.4%; p = .023, respectively). Similarly, the mean number of adenomas per patient (MAP) was significantly higher with the LCI than WLC (0.64 vs 0.44, respectively; p = .002). The mean age of patients at the time of colonoscopy was 51.95 years (SD = 13.861) in the LCI group and 51.96 years (SD = 14.028) in the WLC group. No significant differences observed in patient demographic characteristics (there was no difference in gender and age distribution, p = .986), quality of colonoscopy preparation and withdrawal times (WT) between the two groups (WLC and the LCI groups, 493.9 (SD: 143.5) and 514.0 (SD: 139.5) sec, respectively). CONCLUSIONS According to our results, LCI virtual chromoendoscopic technology was superior compared to conventional HD WLC in detecting colorectal polyps and adenomas.
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Affiliation(s)
- Barbara Dorottya Lovász
- Institute of Applied Health Sciences, Semmelweis University, Budapest, Hungary.,Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Milán Szalai
- Endoscopy Unit, Endo-Kapszula Health Centre, Székesfehérvár, Hungary
| | - László Oczella
- Institute of Applied Health Sciences, Semmelweis University, Budapest, Hungary
| | - Ádám Finta
- Endoscopy Unit, Endo-Kapszula Health Centre, Székesfehérvár, Hungary
| | - Zsolt Dubravcsik
- Department of Gastroenterology, OMCH Endoscopy Unit, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - László Madácsy
- Endoscopy Unit, Endo-Kapszula Health Centre, Székesfehérvár, Hungary
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14
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Mosztbacher D, Hanák L, Farkas N, Szentesi A, Mikó A, Bajor J, Sarlós P, Czimmer J, Vincze Á, Hegyi PJ, Erőss B, Takács T, Czakó L, Németh BC, Izbéki F, Halász A, Gajdán L, Hamvas J, Papp M, Földi I, Fehér KE, Varga M, Csefkó K, Török I, Farkas HP, Mickevicius A, Maldonado ER, Sallinen V, Novák J, Ince AT, Galeev S, Bod B, Sümegi J, Pencik P, Dubravcsik Z, Illés D, Gódi S, Kui B, Márta K, Pécsi D, Varjú P, Szakács Z, Darvasi E, Párniczky A, Hegyi P. Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology 2020; 20:608-616. [PMID: 32402696 DOI: 10.1016/j.pan.2020.03.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hypertriglyceridemia is the third most common cause of acute pancreatitis (AP). It has been shown that hypertriglyceridemia aggravates the severity and related complications of AP; however, detailed analyses of large cohorts are contradictory. Our aim was to investigate the dose-dependent effect of hypertriglyceridemia on AP. METHODS AP patients over 18 years old who underwent triglyceride measurement within the initial three days were included into our cohort analysis from a prospective international, multicenter AP registry operated by the Hungarian Pancreatic Study Group. Data on 716 AP cases were analyzed. Six groups were created based on the highest triglyceride level (<1.7 mmol/l, 1.7-2.19 mmol/l, 2.2-5.59 mmol/l, 5.6-11.29 mmol/l, 11.3-22.59 mmol/l, ≥22.6 mmol/l). RESULTS Hypertriglyceridemia (≥1.7 mmol/l) presented in 30.6% of the patients and was significantly and dose-dependently associated with younger age and male gender. In 7.7% of AP cases, hypertriglyceridemia was considered as a causative etiological factor (≥11.3 mmol/l); however, 43.6% of these cases were associated with other etiologies (alcohol and biliary). Hypertriglyceridemia was significantly and dose-dependently related to obesity and diabetes. The rates of local complications and organ failure and maximum CRP level were significantly and dose-dependently raised by hypertriglyceridemia. Triglyceride above 11.3 mmol/l was linked to a significantly higher incidence of moderately severe AP and longer hospital stay, whereas triglyceride over 22.6 mmol/l was significantly associated with severe AP as well. CONCLUSION Hypertriglyceridemia dose-dependently aggravates the severity and related complications of AP. Diagnostic workup for hypertriglyceridemia requires better awareness regardless of the etiology of AP.
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Affiliation(s)
- Dóra Mosztbacher
- First Department of Paediatrics, Faculty of Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary; Doctoral School of Theoretical Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Lilla Hanák
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary; Centre for Translational Medicine, First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Alexandra Mikó
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Judit Bajor
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Patrícia Sarlós
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - József Czimmer
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Jenő Hegyi
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Takács
- First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Balázs Csaba Németh
- First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Adrienn Halász
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - László Gajdán
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | | | - Mária Papp
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Földi
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Krisztina Eszter Fehér
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Márta Varga
- Department of Gastroenterology, Dr. Réthy Pál Hospital of County Békés, Békéscsaba, Hungary
| | - Klára Csefkó
- Department of Gastroenterology, Dr. Réthy Pál Hospital of County Békés, Békéscsaba, Hungary
| | - Imola Török
- County Emergency Clinical Hospital, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Hunor Pál Farkas
- George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Artautas Mickevicius
- Vilnius University Hospital Santaros Clinics, Clinics of Abdominal Surgery, Nephrourology and Gastroenterology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Ville Sallinen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - János Novák
- Pándy Kálmán Hospital of County Békés, Gyula, Hungary
| | - Ali Tüzün Ince
- Hospital of Bezmialem Vakif University, School of Medicine, Istanbul, Turkey
| | - Shamil Galeev
- Saint Luke Clinical Hospital, St. Petersburg, Russia
| | | | - János Sümegi
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Petr Pencik
- Centrum Péče o Zažívací Trakt, Vítkovická Nemocnice a.s., Ostrava, Czech Republic
| | - Zsolt Dubravcsik
- Department of Gastroenterology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Dóra Illés
- First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Szilárd Gódi
- Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Balázs Kui
- First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Katalin Márta
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Pécsi
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Varjú
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary; First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary
| | - Erika Darvasi
- Centre for Translational Medicine, First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Párniczky
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary; Doctoral School of Theoretical Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary; Department of Gastroenterology, Heim Pál Children's Hospital, Budapest, Hungary.
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Center, Medical School, University of Pécs, Pécs, Hungary; Centre for Translational Medicine, First Department of Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary; Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary; Hungarian Academy of Sciences-University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary.
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Dubravcsik Z, Hritz I, Szepes A, Madácsy L. Risk factors of post-ERCP pancreatitis in high-risk patients despite prevention with prophylactic pancreatic stents. Scand J Gastroenterol 2020; 55:95-99. [PMID: 31852319 DOI: 10.1080/00365521.2019.1701069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: To analyze risk factors of post-ERCP pancreatitis (PEP) in high risk patients in whom prophylactic pancreatic stents (PPSs) were intended to use to prevent endoscopic retrograde cholangiography (ERCP)-related complications.Patients and methods: Three hundred and seventeen high-risk patients for developing PEP were considered for preventive pancreatic stent placement in our endoscopy unit over 5 years. 5 Fr, 3-5 cm long PPSs were used. All data were collected in a predefined database. Development of PEP despite PPS placement was analyzed.Results: PEP occurred in 29 of 288 successfully stented patients (10.07%; 24 mild, four moderate, one severe). PPS was protective against all risks factors except for sphincter of Oddi dysfunction (SOD). PPS related complication rate was 2.78% (n = 8). Unsuccessful stenting occurred in 29 patients (9.15%), PEP developed in 41.38% (n = 12; seven mild, four moderate, one severe). Those patients who had more patient related risk factors were more likely to develop PEP despite preventive measures with PPS. On the contrary, PPS placement was less successful in patients who had more procedure related risk factors.Conclusions: PPS is protective against all risks factors of PEP except for SOD in high-risk patients. More vulnerable patients who have more patient-related risk factors are more likely to develop PEP despite PPS is used, while more complex procedures predispose to unsuccessful PPS placement in patients with more procedure-related risk factors. PPS insertion in high-risk patients is effective and safe preventive method and the procedure related complication rate is reasonably low.
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Affiliation(s)
- Zsolt Dubravcsik
- Department of Gastroenterology, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
| | - István Hritz
- Department of Gastroenterology, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
| | - Attila Szepes
- Department of Gastroenterology, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
| | - László Madácsy
- Department of Gastroenterology, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
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Balázs A, Ruffert C, Hegyi E, Hritz I, Czakó L, Takács T, Szepes Z, Németh BC, Gervain J, Izbéki F, Halász A, Kelemen D, Szmola R, Novák J, Crai S, Illés A, Vincze Á, Molnár Z, Varga M, Bod B, Farkas G, Sümegi J, Szepes A, Dubravcsik Z, Lásztity N, Párniczky A, Hamvas J, Andorka C, Veres G, Szentkereszty Z, Rakonczay Z, Maléth J, Sahin-Tóth M, Rosendahl J, Hegyi P. Genetic analysis of the bicarbonate secreting anion exchanger SLC26A6 in chronic pancreatitis. Pancreatology 2015; 15:508-513. [PMID: 26372434 DOI: 10.1016/j.pan.2015.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic ductal HCO3(-) secretion is critically dependent on the cystic fibrosis transmembrane conductance regulator chloride channel (CFTR) and the solute-linked carrier 26 member 6 anion transporter (SLC26A6). Deterioration of HCO3(-) secretion is observed in chronic pancreatitis (CP), and CFTR mutations increase CP risk. Therefore, SLC26A6 is a reasonable candidate for a CP susceptibility gene, which has not been investigated in CP patients so far. METHODS As a first screening cohort, 106 subjects with CP and 99 control subjects with no pancreatic disease were recruited from the Hungarian National Pancreas Registry. In 60 non-alcoholic CP cases the entire SLC26A6 coding region was sequenced. In the Hungarian cohort variants c.616G > A (p.V206M) and c.1191C > A (p.P397=) were further genotyped by restriction fragment length polymorphism analysis. In a German replication cohort all exons were sequenced in 40 non-alcoholic CP cases and variant c.616G > A (p.V206M) was further analyzed by sequencing in 321 CP cases and 171 controls. RESULTS Sequencing of the entire coding region revealed four common variants: intronic variants c.23 + 78_110del, c.183-4C > A, c.1134 + 32C > A, and missense variant c.616G > A (p.V206M) which were found in linkage disequilibrium indicating a conserved haplotype. The distribution of the haplotype did not show a significant difference between patients and controls in the two cohorts. A synonymous variant c.1191C > A (p.P397=) and two intronic variants c.1248 + 9_20del and c.-10C > T were detected in single cases. CONCLUSION Our data show that SLC26A6 variants do not alter the risk for the development of CP.
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Affiliation(s)
- Anita Balázs
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Claudia Ruffert
- Department of Internal Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, University of Leipzig, Leipzig, Germany
| | - Eszter Hegyi
- First Department of Medicine, University of Szeged, Szeged, Hungary; 2nd Department of Pediatrics, Comenius University Medical School, University Children's Hospital, Bratislava, Slovakia
| | - István Hritz
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Takács
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Balázs Csaba Németh
- Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118, USA
| | - Judit Gervain
- Szent György University Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Ferenc Izbéki
- Szent György University Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | - Adrienn Halász
- Szent György University Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | | | - Richárd Szmola
- Department of Interventional Gastroenterology, National Institute of Oncology, Budapest, Hungary
| | - János Novák
- Pándy Kálmán County Hopsital, Gyula, Hungary
| | - Stefan Crai
- Pándy Kálmán County Hopsital, Gyula, Hungary
| | - Anita Illés
- First Department of Medicine, University of Pécs, Hungary
| | - Áron Vincze
- First Department of Medicine, University of Pécs, Hungary
| | - Zsolt Molnár
- Department of Anestesiology and Intensive Care, University of Szeged, Szeged, Hungary
| | | | | | - Gyula Farkas
- Department of Surgery, University of Szeged, Hungary
| | - János Sümegi
- B-A-Z County Hopspital and University Teaching Hospital, Miskolc, Hungary
| | - Attila Szepes
- Department of Gastroenterology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Zsolt Dubravcsik
- Department of Gastroenterology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | | | | | | | - Csilla Andorka
- 1st Department of Pediatrics, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Gábor Veres
- 1st Department of Pediatrics, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Zsolt Szentkereszty
- Institute of Surgery, University of Debrecen, Clinical Center, Debrecen Hungary
| | - Zoltán Rakonczay
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - József Maléth
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Miklós Sahin-Tóth
- Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA 02118, USA
| | - Jonas Rosendahl
- Department of Internal Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, University of Leipzig, Leipzig, Germany
| | - Péter Hegyi
- First Department of Medicine, University of Szeged, Szeged, Hungary; MTA-SZTE Translational Gastroenterology Research Group, Szeged, Hungary.
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Dubravcsik Z, Szepes A, Hritz I, Madácsy L. Small-caliber rescue pancreatic stenting for severe post-ERCP pancreatitis: a useful tool to pull the pancreas out of the fire. Endoscopy 2015; 47:467-8. [PMID: 25910009 DOI: 10.1055/s-0034-1391309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Párniczky A, Czakó L, Dubravcsik Z, Farkas G, Hegyi P, Hritz I, Kelemen D, Morvay Z, Oláh A, Pap Á, Sahin-Tóth M, Szabó F, Szentkereszti Z, Szmola R, Takács T, Tiszlavicz L, Veres G, Szücs Á, Lásztity N. [Pediatric pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group]. Orv Hetil 2015; 156:308-25. [PMID: 25662148 DOI: 10.1556/oh.2015.30062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pediatric pancreatitis is a rare disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 clinical topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant questions were defined. Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical statements were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care in pediatric pancreatitis and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.
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Affiliation(s)
| | - László Czakó
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | | | - Gyula Farkas
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Sebészeti Klinika Szeged
| | - Péter Hegyi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged MTA-SZTE Lendület Gasztroenterológiai Multidiszciplináris Kutatócsoport Szeged
| | - István Hritz
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged Bács-Kiskun Megyei Kórház Gasztroenterológia Kecskemét
| | - Dezső Kelemen
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Klinikai Központ, Sebészeti Klinika Pécs
| | - Zita Morvay
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Radiológiai Klinika Szeged
| | - Attila Oláh
- Petz Aladár Megyei Oktató Kórház Sebészeti Osztály Győr
| | - Ákos Pap
- Péterfy Sándor utcai Kórház-Rendelőintézet Budapest
| | - Miklós Sahin-Tóth
- Boston University Henry M. Goldman School of Dental Medicine Department of Molecular and Cell Biology Boston Massachusetts USA
| | - Flóra Szabó
- Hepatology and Nutrition, Cincinnati Children's Hospital Division of Pediatric Gastroenterology Cincinnati Ohio USA
| | - Zsolt Szentkereszti
- Debreceni Egyetem, Általános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum Sebészeti Klinika Debrecen
| | - Richárd Szmola
- Országos Onkológiai Intézet Intervenciós Gasztroenterológiai Részleg Budapest
| | - Tamás Takács
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | - László Tiszlavicz
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Pathologiai Intézet Szeged
| | - Gábor Veres
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika Budapest
| | - Ákos Szücs
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Sebészeti Klinika Budapest
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Takács T, Czakó L, Dubravcsik Z, Farkas G, Hegyi P, Hritz I, Kelemen D, Lásztity N, Morvay Z, Oláh A, Pap Á, Párniczky A, Patai Á, Sahin-Tóth M, Szentkereszti Z, Szmola R, Tiszlavicz L, Szücs Á. [Chronic pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group]. Orv Hetil 2015; 156:262-88. [PMID: 25661971 DOI: 10.1556/oh.2015.30060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading symptoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 123 relevant clinical questions in 11 topics were defined. Evidence was classified according to the UpToDate® grading system. The draft of the guidelines were presented and discussed at the consensus meeting in September 12, 2014. All clinical questions were accepted with total or strong agreement. The present guideline is the first evidence based guideline for chronic pancreatitis in Hungary. This guideline provides very important and helpful data for tuition, everyday practice and proper financing of chronic pancreatitis. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.
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Affiliation(s)
- Tamás Takács
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | - László Czakó
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | | | - Gyula Farkas
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Sebészeti Klinika Szeged
| | - Péter Hegyi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged MTA-SZTE Lendület Gasztroenterológiai Multidiszciplináris Kutatócsoport Szeged
| | - István Hritz
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged Bács-Kiskun Megyei Kórház Gasztroenterológia Kecskemét
| | - Dezső Kelemen
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Klinikai Központ, Sebészeti Klinika Pécs
| | | | - Zita Morvay
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Radiológiai Klinika Szeged
| | - Attila Oláh
- Petz Aladár Megyei Oktató Kórház Sebészeti Osztály Győr
| | - Ákos Pap
- Péterfy Sándor utcai Kórház-Rendelőintézet Budapest
| | | | - Árpád Patai
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest
| | - Miklós Sahin-Tóth
- Boston University Henry M. Goldman School of Dental Medicine Department of Molecular and Cell Biology Boston Massachusetts USA
| | - Zsolt Szentkereszti
- Debreceni Egyetem, Általános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum Sebészeti Klinika Debrecen
| | - Richárd Szmola
- Országos Onkológiai Intézet Intervenciós Gasztroenterológiai Részleg Budapest
| | - László Tiszlavicz
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Pathologiai Intézet Szeged
| | - Ákos Szücs
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Sebészeti Klinika Budapest
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Dubravcsik Z, Farkas G, Hegyi P, Hritz I, Kelemen D, Lásztity N, Morvay Z, Oláh A, Pap Á, Párniczky A, Sahin-Tóth M, Szentkereszti Z, Szmola R, Takács T, Tiszlavicz L, Szücs Á, Czakó L. [Autoimmune pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group]. Orv Hetil 2015; 156:292-307. [PMID: 25662147 DOI: 10.1556/oh.2015.30061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Autoimmune pancreatitis is a rare disease which can even mimic pancreatic tumor, however, unlike the latter, it requires not surgical but conservative management. Correct diagnosis and differential diagnosis of autoimmune pancreatitis and treatment of these patients requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 29 relevant clinical questions in 4 topics were defined (Basics; Diagnosis; Differential diagnostics; Therapy). Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinial questions were accepted with almost total (more than 95%) agreement. The present guideline is the first evidence based autoimmune pancreatitis guideline in Hungary. The guideline may provide very important and helpful data for tuition of autoimmune pancreatitis, for everyday practice and for establishing proper finance. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.
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Affiliation(s)
| | - Gyula Farkas
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Sebészeti Klinika Szeged
| | - Péter Hegyi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged MTA-SZTE Lendület Gasztroenterológiai Multidiszciplináris Kutatócsoport Szeged
| | - István Hritz
- Bács-Kiskun Megyei Kórház Gasztroenterológia Kecskemét Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | - Dezső Kelemen
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Klinikai Központ, Sebészeti Klinika Pécs
| | | | - Zita Morvay
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Radiológiai Klinika Szeged
| | - Attila Oláh
- Petz Aladár Megyei Oktató Kórház Sebészeti Osztály Győr
| | - Ákos Pap
- Péterfy Sándor utcai Kórház-Rendelőintézet Budapest
| | | | - Miklós Sahin-Tóth
- Boston University Henry M. Goldman School of Dental Medicine Department of Molecular and Cell Biology Boston Massachusetts USA
| | - Zsolt Szentkereszti
- Debreceni Egyetem, Általános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum Sebészeti Klinika Debrecen
| | - Richárd Szmola
- Országos Onkológiai Intézet Intervenciós Gasztroenterológiai Részleg Budapest
| | - Tamás Takács
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | - László Tiszlavicz
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Pathologiai Intézet Szeged
| | - Ákos Szücs
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Sebészeti Klinika Budapest
| | - László Czakó
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
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21
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Szmola R, Farkas G, Hegyi P, Czakó L, Dubravcsik Z, Hritz I, Kelemen D, Lásztity N, Morvay Z, Oláh A, Párniczky A, Rubovszky G, Sahin-Tóth M, Szentkereszti Z, Szücs Á, Takács T, Tiszlavicz L, Pap Á. [Pancreatic cancer. Evidence based management guidelines of the Hungarian Pancreatic Study Group]. Orv Hetil 2015; 156:326-39. [PMID: 25662149 DOI: 10.1556/oh.2015.30063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pancreatic cancer is a disease with a poor prognosis usually diagnosed at a late stage. Therefore, screening, diagnosis, treatment and palliation of pancreatic cancer patients require up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available scientific evidence and international guidelines. The preparatory and consultation board appointed by the Hungarian Pancreatic Study Group translated and complemented/modified the recent international guidelines. 37 clinical statements in 10 major topics were defined (Risk factors and genetics, Screening, Diagnosis, Staging, Surgical care, Pathology, Systemic treatment, Radiation therapy, Palliation and supportive care, Follow-up and recurrence). Evidence was graded according to the National Comprehensive Cancer Network (NCCN) grading system. The draft of the guideline was presented and discussed at the consensus meeting in September 12, 2014. Statements were accepted with either total (more than 95% of votes, n = 15) or strong agreement (more than 70% of votes, n = 22). The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.
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Affiliation(s)
- Richárd Szmola
- Országos Onkológiai Intézet Intervenciós Gasztroenterológiai Részleg Budapest Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest
| | - Gyula Farkas
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Sebészeti Klinika Szeged
| | - Péter Hegyi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged MTA-SZTE Lendület Gasztroenterológiai Multidiszciplináris Kutatócsoport Szeged
| | - László Czakó
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | | | - István Hritz
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged Bács-Kiskun Megyei Kórház Gasztroenterológia Kecskemét
| | - Dezső Kelemen
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Klinikai Központ, Sebészeti Klinika Pécs
| | | | - Zita Morvay
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Radiológiai Klinika Szeged
| | - Attila Oláh
- Petz Aladár Megyei Oktató Kórház Sebészeti Osztály Győr
| | | | - Gábor Rubovszky
- Országos Onkológiai Intézet B Belgyógyászati-Onkológiai és Klinikai Farmakológiai Osztály Budapest
| | - Miklós Sahin-Tóth
- Boston University Henry M. Goldman School of Dental Medicine Department of Molecular and Cell Biology Boston Massachusetts USA
| | - Zsolt Szentkereszti
- Debreceni Egyetem, Általános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum Sebészeti Klinika Debrecen
| | - Ákos Szücs
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Sebészeti Klinika Budapest
| | - Tamás Takács
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | - László Tiszlavicz
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Pathologiai Intézet Szeged
| | - Ákos Pap
- Péterfy Sándor utcai Kórház-Rendelőintézet Budapest
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Hritz I, Czakó L, Dubravcsik Z, Farkas G, Kelemen D, Lásztity N, Morvay Z, Oláh A, Pap Á, Párniczky A, Sahin-Tóth M, Szentkereszti Z, Szmola R, Szücs Á, Takács T, Tiszlavicz L, Hegyi P. [Acute pancreatitis. Evidence-based practice guidelines, prepared by the Hungarian Pancreatic Study Group]. Orv Hetil 2015; 156:244-61. [PMID: 25661970 DOI: 10.1556/oh.2015.30059] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute pancreatitis is one of the most common diseases of the gastrointestinal tract associated with significant morbidity and mortality that requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare evidence based guideline for the medical and surgical management of acute pancreatitis based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and, if it was necessary, complemented and/or modified the international guidelines. All together 42 relevant clinical questions were defined in 11 topics (Diagnosis and etiology, Prognosis, Imaging, Fluid therapy, Intensive care management, Prevention of infectious complications, Nutrition, Biliary interventions, Post-endoscopic retrograde cholangio-pancreatography pancreatitis, Indication, timing and strategy for intervention in necrotizing pancreatitis, Timing of cholecystectomy [or endoscopic sphincterotomy]). Evidence was classified according to the UpToDate® grading system. The draft of the guideline was presented and discussed at the consensus meeting on September 12, 2014. 25 clinical questions with almost total (more than 95%) and 17 clinical questions with strong (more than 70%) agreement were accepted. The present guideline is the first evidence based acute pancreatitis guideline in Hungary. The guideline may provide important help for tuition, everyday practice and for establishment of proper finance of acute pancreatitis. Therefore, the authors believe that these guidelines will widely become as basic reference in Hungary.
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Affiliation(s)
- István Hritz
- Bács-Kiskun Megyei Kórház Gasztroenterológia Kecskemét
| | - László Czakó
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | | | - Gyula Farkas
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Sebészeti Klinika Szeged
| | - Dezső Kelemen
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Klinikai Központ, Sebészeti Klinika Pécs
| | | | - Zita Morvay
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Radiológiai Klinika Szeged
| | - Attila Oláh
- Petz Aladár Megyei Oktató Kórház Sebészeti Osztály Győr
| | - Ákos Pap
- Péterfy Sándor utcai Kórház-Rendelőintézet Budapest
| | | | - Miklós Sahin-Tóth
- Boston University Henry M. Goldman School of Dental Medicine Department of Molecular and Cell Biology Boston Massachusetts USA
| | - Zsolt Szentkereszti
- Debreceni Egyetem, Általános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum Sebészeti Klinika Debrecen
| | - Richárd Szmola
- Országos Onkológiai Intézet Intervenciós Gasztroenterológiai Részleg Budapest
| | - Ákos Szücs
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Sebészeti Klinika Budapest
| | - Tamás Takács
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged
| | - László Tiszlavicz
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ Pathologiai Intézet Szeged
| | - Péter Hegyi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ I. Belgyógyászati Klinika Szeged MTA-SZTE Lendület Gasztroenterológiai Multidiszciplináris Kutatócsoport Szeged
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Dubravcsik Z, Madácsy L, Gyökeres T, Vincze Á, Szepes Z, Hegyi P, Hritz I, Szepes A. Preventive pancreatic stents in the management of acute biliary pancreatitis (PREPAST trial): pre-study protocol for a multicenter, prospective, randomized, interventional, controlled trial. Pancreatology 2015; 15:115-23. [PMID: 25754525 DOI: 10.1016/j.pan.2015.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 02/10/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The outcome of the most common biliary form of acute pancreatitis has not changed even with the better described indications for early endoscopic intervention. It may be due to the fact that this intrevention theoretically can cause further pancreatic injury or cannot always relieve the pancreatic duct obstruction. We hypothesize that maintaining the outflow of the pancreatic duct with preventive pancreatic stents at the early ERCP improves the outcome of acute biliary pancreatitis. METHODS/DESIGN PREPAST is a prospective, randomized, controlled, multicenter trial. Patients with acute biliary pancreatitis with coexisting cholangitis are randomized to undergo urgent endoscopic intervention with or without pancreatic stenting within 48 h from the onset of pain, and in addition patients without signs of cholangitis but cholestasis are randomly allocated to recieve conservative treatment or early endoscopic intervention with or without pancreatic stenting within 48 h from the onset of pain. Patients without acute cholangitis and signs of cholestasis recieve conservative treatment. 230 patients are planned to be enrolled during a 48 months period from different centers. The primary endpoint is the outcome of acute biliary pancreatitis as described by the latest guidelines. Secondary endpoints include mortality data, and other variables not analyzed as a primary endpoint but related to the pancreatitis or the pancreatic stenting. DISCUSSION The PREPAST trial is designed to show whether early endoscopic intervention with the usage of preventive pancreatic stenting improves the outcome of acute biliary pancreatitis. The study has been registered at the International Standard Randomised Controlled Trial Number (ISRCTN) Register (trial ID: ISRCTN13517695).
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Affiliation(s)
- Zsolt Dubravcsik
- Department of Gastroenterology and Endoscopy, Bács-Kiskun County Hospital, Nyíri út 38, 6000 Kecskemét, Hungary.
| | - László Madácsy
- 2nd Department of Internal Medicine, Semmelweis University, Szentkirályi u. 46, 1088 Budapest, Hungary
| | - Tibor Gyökeres
- Department of Gastroenterology, State Health Centre, Podmaniczky u. 111, 1062 Budapest, Hungary
| | - Áron Vincze
- 1st Department of Internal Medicine, University of Pécs, Rákóczi út 2, 7622 Pécs, Hungary
| | - Zoltán Szepes
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720 Szeged, Hungary
| | - Péter Hegyi
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720 Szeged, Hungary; MTA-SZTE Lendület Translational Gastroenterology Research Group, Korányi fasor 8-10, 6720 Szeged, Hungary
| | - István Hritz
- Department of Gastroenterology and Endoscopy, Bács-Kiskun County Hospital, Nyíri út 38, 6000 Kecskemét, Hungary; 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720 Szeged, Hungary
| | - Attila Szepes
- Department of Gastroenterology and Endoscopy, Bács-Kiskun County Hospital, Nyíri út 38, 6000 Kecskemét, Hungary
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Czakó L, Dubravcsik Z, Gasztonyi B, Hamvas J, Pakodi F, Szepes A, Szepes Z. The role of endoscopic ultrasound in the diagnosis and therapy of gastrointestinal disorders. Orv Hetil 2014; 155:526-540. [PMID: 24681675 DOI: 10.1556/oh.2014.29866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Endoscopic ultrasound is one of those diagnostic methods in gastrointestinal endoscopy which has developed rapidly in the last decade and has became exceedingly available to visualize the walls of the internal organs in details corresponding to histological layers, or analyze the adjacent structures. Fine needles and other endoscopic accessories can be introduced into the neighbouring tissues under the guidance of endoscopic ultrasound, and diagnostic and minimally invasive therapeutic interventions can be performed. The endoscopic ultrasound became more widely available in Hungary in the recent years. This review focuses on the indications, benefits and complications of diagnostic and therapeutic endoscopic ultrasound. We dedicate this article for gastroenterologists, surgeons, internists, pulmonologists, specialists in oncology and radiology. This recommendation was based on the consensus of the Board members of the Endoscopic Ultrasound Section of the Hungarian Gastroenterological Society. Orv. Hetil., 2014, 155(14), 526–540.
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Affiliation(s)
- László Czakó
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Pf. 427 6701
| | | | | | - József Hamvas
- Bajcsy-Zsilinszky Kórház I. Belgyógyászat-Gasztroenterológia Budapest
| | - Ferenc Pakodi
- Pécsi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Pécs
| | - Attila Szepes
- Bács-Kiskun Megyei Kórház Gasztroenterológiai Osztály Kecskemét
| | - Zoltán Szepes
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Pf. 427 6701
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Dubravcsik Z, Hritz I, Fejes R, Szepes A, Madácsy L. Endoscopic Therapy of Refractory Post-Papillotomy Bleeding With Electrocautery Forceps Coagulation Method Combined With Prophylactic Pancreatic Stenting. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.vjgien.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
INTRODUCTION Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the posterior mediastinum is technically a relatively simple and safe procedure, and it can provide important information for the further management of patients. AIM To analyze and compare the results of mediastinal endoscopic ultrasound-guided fine needle aspiration with the data available in the literature. PATIENTS AND METHODS The authors retrospectively analyzed their prospective database on mediastinal endoscopic ultrasound-guided fine needle aspiration of 49 patients referred to their endoscopy centre between 1 November 2009 and 1 November 2012. For the fine needle aspiration 22 and 25 G needles were used. Two to six needle passes were performed in each patient. All slides were prepared at the endoscopy unit and analyzed at the cytology laboratory. RESULTS The authors performed mediastinal endoscopic ultrasound-guided fine needle aspiration for enlarged lymph nodes or suspected mediastinal malignancy in all but 4 patients (2 suspected oesophageal cancers, 1 suspected benign oesophageal stenosis with wall thickening and 1 cardia tumour, all with non-diagnostic endoscopic biopsies). Five patients were excluded from the analysis since fine needle aspiration was not performed in them. Benign lesions were suspected based on the endoscopic ultrasound morphology in 7, and malignant disease in 37 patients. In 3 cases samples obtained by biopsy were not informative for cytological analysis. Cytology confirmed all benign lesions and showed malignancy in 28 cases. Cytology failed to reveal malignancy in 6 patients, although it was suspected based upon endoscopic ultrasound finding. Furthermore, endoscopic ultrasound-guided fine needle aspiration provided the diagnosis in 15 of the 17 patients when bronchoscopy was non-diagnostic. The diagnostic accuracy of the EUS-FNA was the following: sensitivity 82%, specificity 100%, positive predictive value 1.0, negative predictive value 0.54. Only one infectious complication was encountered after fine needle aspiration despite antibiotic prophylaxis. DISCUSSION Endoscopic ultrasound-guided fine needle aspiration of mediastinal pathology is an accurate, safe and technically relatively easy procedure, however it requires practice and skills in mediastinal anatomy. It has an excellent positive predictive value, a very good sensitivity, but slightly poor negative predictive value. The results of this study are concordant with the literature data. The authors suggest that at least 4 needle passes in the absence of on-site pathologist should be performed in order to minimize the number of false-negative results.
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Affiliation(s)
- Zsolt Dubravcsik
- Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktatókórháza Belgyógyászat-Gasztroenterológia Osztály Kecskemét.
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Szepes A, Dubravcsik Z, Madácsy L. [The effect of endoscopic sphincterotomy on the motility of the gallbladder and of the sphincter of Oddi in patients with acalculous biliary pain syndrome]. Orv Hetil 2013; 154:306-13. [PMID: 23419531 DOI: 10.1556/oh.2013.29555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sphincter of Oddi dysfunction usually occurs after cholecystectomy, but it can sometimes be detected in patients with intact gallbladder too. The diagnostic value of the non-invasive functional tests is not established in this group of patients and the effects of sphincterotomy on transpapillary bile outflow and gallbladder motility are unknown. AIMS The aim of this study was to determine the effect of endoscopic sphincterotomy on the gallbladder ejection fraction, transpapillary bile outflow and the clinical symptoms of patients with acalculous biliary pain syndrome. PATIENTS AND METHODS 36 patients with acalculous biliary pain syndrome underwent quantitative hepatobiliary scintigraphy, and all of them had decreased cholecytokinin-induced gallbladder ejection fraction. The endoscopic manometry of the sphincter of Oddi showed abnormal sphincter function in 26 patients who were enrolled the study. Before and after endoscopic sphincterotomy all patients had ultrasonographic measurement of cholecystokinin-induced gallbladder ejection fraction with and without nitroglycerin pretreatment and scintigraphy was repeated as well. The effects of sphincterotomy on gallbladder ejection fraction and transpapillary biliary outflow were evaluated. In addition, changes in biliary pain score with a previously validated questionnaire were also determined. RESULTS All 26 patients had decreased gallbladder ejection fraction before sphincterotomy measured with scintigraphy (19+18%) and ultrasound (16+9.7%), which was improved after nitroglycerin pretreatment (48.2+17%; p<0.005). Detected with both methods, the ejection fraction was in the normal range after sphincterotomy (52+37% and 40.8+16.5%), but nitroglycerin pretreatment failed to produce further improvement (48.67+22.2%, NS). Based on scintigraphic examination sphincterotomy significantly improved transpapillary biliary outflow (common bile duct half time 63±33 min vs. 37±17 min; p<0.05). According to results obtained from questionneries, 22 of the 26 patients gave an account of significant symptom improvement after sphincterotomy. CONCLUSIONS Endoscopic sphincterotomy improves cholecystokinin-induced gallbladder ejection fraction, transpapillary biliary outflow as well as biliary symptoms in patients with acalculous biliary pain syndrome and sphincter of Oddi dysfunction. Cholecystokinin-induced gallbladder ejection fraction with nitroglycerin pretreatment, measured with ultrasonography can be useful to select a subgroup of patients who can benefit from sphincterotomy.
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Affiliation(s)
- Attila Szepes
- Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktató Kórháza Belgyógyászati Osztály.
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Balogh G, Dubravcsik Z, Szepes A, Madácsy L. [Endoscopic submucosal dissection in our practice -- new possibilities in the endoscopic treatment of neoplastic changes in the alimentary canal]. Orv Hetil 2012; 153:824-33. [PMID: 22617372 DOI: 10.1556/oh.2012.29382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED Endoscopic submucosal dissection is a promising new endoscopic technique for en block resection of early, superficial, flat, and laterally spreading gastrointestinal neoplasms. The primary aims of this prospective study were to summarize the first Hungarian experience with endoscopic submucosal dissection, and to compare the experimental in vivo procedures in pigs with the human application of this technique in two academic centers. METHODS The ex vivo Erlangen pig model was used until initial competence was achieved. Thereafter 15 endoscopic submucosal dissection procedures were performed in up to 5 sessions in living pigs under general anesthesia. After submucosal injection with saline Fujinone ball tip, a Flush knife was used with a transparent hood for circumferential incision and submucosal dissection. The following variables were analyzed: specimen size, complete and en bloc resection rate, total duration of the procedure, and complications. Furthermore, between 2009 and 2012, 14 endoscopic submucosal dissections were carried out in humans; 1 duodenal, 3 gastric and 10 colorectal interventions were performed due to large laterally spreading intramucosal neoplasms. The specimen size, en bloc resection rate, total duration of the procedure and complications were next analyzed. RESULTS 87% complete resection rate, 29.4 ± 19.5 cm2 specimen size and 136.2 ± 26.8 min of procedure duration were achieved in the live pig models. Nontransmural damages of the muscular layer occurred in 3/15 (20%) cases which were successfully closed with hemoclips, except in one pig that died due to fatal esophageal perforation. All bleedings were easily managed with hot biopsy forceps coagulation and hemoclips without hemodynamic instability. In humans, endoscopic submucosal dissection was accomplished with an 11/14 (79%) en block resection rate, with average resected specimen size of 11.56 ± 4.9 cm2 and with 157 ± 55 min of operating time. Two cases of bleeding and 2 cases of perforation occurred (14%), all of which were managed endoscopically. After 1.5 year of average follow up, local recurrence occurred in one case only. In addition, due to the 3 incomplete resections and unsuccessful endoscopic submucosal dissection, surgical intervention was required in 4 cases altogether. CONCLUSIONS This study demonstrates the first Hungarian experience with endoscopic submucosal dissection. Training in live pig models could help endoscopists to overcome the learning curve and minimize the risk of complications before starting the procedure in humans. Reduction in the resection time and low risk of complications, especially bleeding, could be achieved by the application of a flush knife.
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Affiliation(s)
- Gábor Balogh
- Kaposi Mór Oktató Kórház Általános Mellkas- és Érsebészeti Osztály Kaposvár Pipacs u. 37. 7400.
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Dubravcsik Z, Hritz I, Fejes R, Balogh G, Virányi Z, Hausinger P, Székely A, Szepes A, Madácsy L. Early ERCP and biliary sphincterotomy with or without small-caliber pancreatic stent insertion in patients with acute biliary pancreatitis: better overall outcome with adequate pancreatic drainage. Scand J Gastroenterol 2012; 47:729-36. [PMID: 22414053 DOI: 10.3109/00365521.2012.660702] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To analyze the efficacy of pancreatic duct (PD) stenting following endoscopic sphincterotomy (EST) compared with EST alone in reducing complication rate and improving overall outcome in acute biliary pancreatitis (ABP). METHODS Between 1 January 2009 and 1 July 2010, 141 nonalcoholic patients with clinical, laboratory and imaging evidence of ABP were enrolled. Emergency endoscopic retrograde cholangiopancreatography (ERCP) was performed within 72 h from the onset of pain. Seventy patients underwent successful ERCP, EST, and stone extraction (control group); 71 patients (PD stent group) had EST, stone extraction and small-caliber (5 Fr, 3-5 cm) pancreatic stent insertion. All patients were hospitalized for medical therapy and jejunal feeding and were followed up. RESULTS The mean age, Glasgow score, symptom to ERCP time, mean amylase and CRP levels at initial presentation were not significantly different in the PD stent group compared to the control group: 60.6 vs. 64.3, 3.21 vs. 3.27, 34.4 vs. 40.2, 2446.9 vs. 2114.3, 121.1 vs. 152.4, respectively. Complications (admission to intensive care unit, pancreatic necrosis with septicemia, large (>6 cm) pseudocyst formation, need for surgical necrosectomy) were less frequent in the PD stent group resulting in a significantly lower overall complication rate (9.86% vs. 31.43%, p < 0.002). Mortality rates (0% vs. 4.28%) were comparable, reasonably low and without any significant differences. CONCLUSIONS Temporary small-caliber PD stent placement may offer sufficient drainage to reverse the process of ABP. Combined with EST the process results in a significantly less complication rate and better clinical outcome compared with EST alone during the early course of ABP.
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Affiliation(s)
- Zsolt Dubravcsik
- Bács-Kiskun County Hospital, Kecskemét, Teaching Hospital of the University of Szeged, Kecskemet, Hungary
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Hritz I, Dubravcsik Z, Szepes A, Madácsy L. Does removal of prophylactic pancreatic stents induce acute pancreatitis? Gastrointest Endosc 2011; 74:1429-30; author reply 1430. [PMID: 22136790 DOI: 10.1016/j.gie.2011.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 02/08/2023]
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Czakó L, Gyökeres T, Topa L, Sahin P, Takács T, Vincze A, Dubravcsik Z, Szepes A, Pap A, Földesi I, Terzin V, Tiszlavicz L, Wittmann T. Autoimmune pancreatitis in Hungary: a multicenter nationwide study. Pancreatology 2011; 11:261-7. [PMID: 21625197 DOI: 10.1159/000327092] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 03/04/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND To date, most cases of autoimmune pancreatitis (AIP) have been reported from Japan. The aim of the present study was to assess the clinical features and management of AIP cases in Hungary. METHODS The demographics, clinical presentation, laboratory and imaging findings, extrapancreatic involvement, treatment response and recurrence were evaluated in the first 17 patients diagnosed with AIP in Hungary. RESULTS The mean age at presentation was 42.7 years (range: 16-74); 47% of the patients were women. New-onset mild abdominal pain (76%), weight loss (41%) and jaundice (41%) were the most common symptoms, with inflammatory bowel disease being the most frequent (36%) extrapancreatic manifestation. Diffuse pancreatic swelling was seen in 7 patients (41%) and a focal pancreatic mass in 8 (47%). Endoscopic retrograde cholangiopancreatography revealed pancreatic duct strictures in all study patients. The serum IgG4 level at presentation was elevated in 62% of the 8 patients in whom it was measured. All the percutaneous core biopsies (5 patients) and surgical specimens (2 patients), and 2 of the 4 biopsies of the papilla of Vater revealed the typical characteristic findings of AIP: a diffuse lymphoplasmacytic infiltration, marked interstitial fibrosis and obliterative phlebitis. Immunostaining indicated IgG4-positive plasma cells in 62% of the 8 patients in whom it was performed. Granulocytic epithelial lesions (GEL) were present in 3 patients. The patients without GELs were older (mean age 59 years), while those with GEL were younger (mean age 34 years), and 2 of 3 were female and had ulcerative colitis. A complete response to steroid treatment was achieved in all 15 patients. Because of the suspicion of a pancreatic tumor, 2 patients with focal AIP underwent partial pancreatectomy. One patient relapsed, but responded to azathioprine. CONCLUSIONS This first Hungarian series has confirmed several previously reported findings on AIP. AIP with GEL was relatively frequent among our patients: these patients tended to be younger than in earlier studies and displayed a female preponderance with a high coincidence of ulcerative colitis. Performance of a percutaneous biopsy is strongly recommended. The response to immunosuppressive therapy was excellent. and IAP.
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Affiliation(s)
- László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary.
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Mihaly A, Szente M, Dubravcsik Z, Boda B, Kiraly E, Nagy T, Domonkos A. Parvalbumin- and calbindin-containing neurons express c-fos protein in primary and secondary (mirror) epileptic foci of the rat neocortex. Brain Res 1997; 761:135-45. [PMID: 9247076 DOI: 10.1016/s0006-8993(97)00317-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The present experiments aimed at the description and further immunocytochemical characterization of activated neocortical neurons expressing the c-fos gene. Focal seizures were induced by the topical application of isotonic, isohydric 4-aminopyridine solution to the frontal neocortex of adult anesthetized Wistar rats. The EEG of both hemispheres was recorded from the surface of the skull. The animals were perfused with fixative, coronal plane vibratome sections were cut and stained with cocktails containing polyclonal c-fos and monoclonal calbindin or parvalbumin antibodies. The polyclonal c-fos antibody was tested with Western blotting and the diffusion of 4-aminopyridine investigated with autoradiography of [3H]4-aminopyridine. The c-fos protein was detected in every layer of the neocortex (primary focus) and in some allocortical areas of the treated hemisphere. Scattered immunostained nuclei were observed in layers II, III, IV and VI of the contralateral neocortex (mirror focus). Several parvalbumin- and calbindin-positive neurons contained the c-fos protein in both foci. The medium-sized non-pyramidal parvalbumin neurons were found in layers II-IV and VI of the neocortex and in stratum multiforme of the prepiriform cortex. The c-fos protein was colocalized with calbindin mainly in layers II and III in small and medium-sized non-pyramidal neurons. The results prove that focal epileptiform activity of the neocortex activates diverse inhibitory neuronal populations. As concluded, the inhibitory control is probably more effective in the contralateral hemisphere (mirror focus) than on the side of 4-APY treatment (primary focus).
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Affiliation(s)
- A Mihaly
- Department of Anatomy, Faculty of Medicine, University of Kuwait
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