Present and future role of endoscopic retrograde cholangiography in primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a rare, inflammatory cholestatic liver disease that causes biliary strictures which can lead to secondary complications. About 30-50% of PSC patients develop dominant strictures (DS) in the biliary tree, which are both the cause of jaundice and bacterial cholangitis as well as predilection spots for development of neoplastic development. Cancer is the most common cause of death in PSC. A central concern is to distinguish malignant from benign strictures, which eventually is done by invasive methods to obtain a brush cytology or biopsy sample, in most cases via endoscopic retrograde cholangiography-pancreatography (ERCP). Since medical therapies, like ursodesoxycholic acid or immunosuppressive drugs have no proven effect, therapeutic ERCP has become the primary management strategy to improve symptoms and in some patients may slow down disease progression. This article aims at outlining the current and emerging methods in ERCP in PSC patients.

Conservative Treatment of Chronic Pancreatitis: A Practical Approach

BACKGROUND

Chronic pancreatitis is a long-standing, inflammatory condition of the pancreas that leads to the progressive damage and loss of function of pancreatic parenchyma and to the development of possible locoregional and systemic medical complications.

MATERIALS AND METHODS

In this review, we tried to summarize the current evidence on non-surgical treatment trying to suggest a practical approach to the management of chronic pancreatitis.

RESULTS

Besides the unclear pathophysiological mechanism and a poorly unknown epidemiology, chronic pancreatitis is a complex syndrome that displays different possible challenges for physicians. Despite being traditionally considered as a benign disease, chronic pancreatitis encompasses 10-year mortality rates which are superior to the ones reported for some of the most common cancers.

CONCLUSIONS

Chronic pancreatitis encompasses the management of multiple and complex medical co-morbidities that needs to be understood and addressed in a multidisciplinary specialist context.

Causes and mechanisms in acute pancreatitis

Acute pancreatitis (AP) presents clinically with either mild or severe clinical course. There are no effective specific drugs for treatment of AP today. Basic knowledge about pathophysiological processes is the key for the development of novel therapeutic principles. This article provides a review on the pathophysiological mechanisms involved in the early phase of AP.

[Percutaneous, ultrasound-targeted fine-needle puncture biopsy (liver, pancreas, intestine) and ultrasound-targeted pancreatic duct puncture]

Ultrasonically guided fine-needle aspirations were done in the liver of 42 cases of malignancy established later by autopsy and biopsy. The sensitivity was 95.3%. Only in one case, in a metastasis of renal carcinoma, precise tumour classification was not possible cytologically. Pancreatic malignancies were biopsied in 28 cases with later verified diagnoses at post mortem and biopsy; the sensitivity was 85.7%. One pancreatic head adenocarcinoma tumour classification was not possible cytologically. In 16 cases of gastrointestinal carcinoma verified by operation the sensitivity was 93.8%. In one cirrhotic gastric carcinoma only insufficient cytological material could be aspirated despite several biopsies. There were no false positive results in any puncture. The cytological results in all malignancies (n = 86) agreed in 97.7% with later established histological tumour classifications. Two clinically relevant complications were observed (biliary peritonitis, haemoperitoneum). In 15 percutaneous fine-needle pancreaticographies it has been shown to be an advantage that pancreatic juice can be aspirated prior to contrast medium filling of the pancreatic duct. Hyperinstillation into the organ can thus be prevented. In addition, the pancreatic juice aspirate can be investigated cytochemically. Only part of the patients (indurating changes of the pancreas such as chronic pancreatitis) experienced an unpleasant or painful sensation. For this reason such patients should be given analgesics.

Percutaneous decompression of an intraintestinal balloon--case report

A study was designed in order to determine whether waterfilled intragastric balloons are superior to airfilled balloons for facilitating weight reduction. In the first volunteer the small intestine was obstructed by the dislocated waterfilled balloon. This complication was successfully treated by transabdominal fine needle puncture of the balloon. In contrast to airfilled balloons waterfilled balloons offer two advantages: water does not escape through the very thin wall of the balloon; the intraabdominal location of a waterfilled balloon is easily checked by sonography.

[Effect of gliquidone and glibenclamide following oral administration]

Gliquidone shows a good blood sugar lowering effect over the wide dose range of 30-60 mg in fasting subjects with a healthy metabolism, in spite of the wide range. This behavior suggests that a good therapeutic application is to be expected in diabetics being treated with sulfonylureas.