[Show abstract][Hide abstract] ABSTRACT: We investigated the efficacy of prophylactic pancreatic stent placement for preventing postprocedure pancreatitis in patients undergoing endoscopic papillectomy.
This retrospective study included 82 consecutive patients who underwent endoscopic papillectomy for benign ampullary neoplasm at Samsung Medical Center between August 2002 and June 2011. The patients were subdivided into two groups, namely, those who received prophylactic pancreatic stent placement and those who did not. Patient demographics, baseline blood test, tumor characteristics, and endoscopic treatment data were collected. The primary endpoint was postprocedure pancreatitis.
There was no difference in the development of postprocedure pancreatitis between the stent group and the no stent group (6/54, 10.5% and 2/28, 7.14%, respectively; p=1.00). At baseline, there were no significant differences between the two groups in terms of their risk factors for pancreatitis except pancreatic duct dye injection. The stent group was more likely to have dye injection than the nonstent group (100% vs 42.8%, p<0.001). However, in a logistic regression analysis, no significant difference was observed in the risk factors for pancreatitis including dye injection.
Our data suggest that routine prophylactic pancreatic duct stent placement in all patients undergoing endoscopic papillectomy may not be necessary and that large-scale prospective studies are required to identify the subgroup of patients who would benefit.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: The goal of this study was to identify clinicoradiologic characteristics to distinguish metastatic cancer to the pancreas (MCP) from double primary pancreatic cancer (DPPC). METHODS: From 2000 to 2011, we retrospectively identified MCP and DPPC patients among patients with histories of other primary malignancies. RESULTS: A total of 94 patients with histories of other primary malignancies were histologically confirmed to have pancreatic cancer. Among them, 34 patients had MCP and 60 patients had DPPC, which were ductal adenocarcinomas. The kidney was the most common primary cancer site that metastasized to the pancreas (12, 35.3%). In the DPPC group, the stomach was the most common primary cancer site (11, 18.3%). There were 21 patients (61.8%) with metachronous pancreatic cancer in the MCP group and 29 (48.3%) in the DPPC group (P=0.210). Among the metachronous pancreatic cancer patients, the disease-free interval was 88.3months in the MCP group, and 49.6months in the DPPC group (P=0.062). The number of the patients who showed elevated CA 19-9 levels was higher in the DPPC group than in the MCP group (39 (65%) vs. 9 (26.5%); P=0.001). Total bilirubin (P=0.006) and fasting plasma glucose (P=0.050) were also higher in the DPPC group. The numbers of patients who showed pancreatic duct dilatation (P=0.002) and pancreatic atrophy (P=0.008) on radiographs were meaningfully higher in the DPPC group than in the MCP group. On the other hand, the numbers of patients who showed well demarcated tumor margin (P<0.000), tumor necrosis (P=0.002), enhancement (P=0.005) and distant metastasis (P=0.028) were significantly higher in the MCP group than in the DPPC group. We evaluated differences in survival between the two groups. The median survival time in the MCP group (55months) was significantly longer than that in the DPPC group (20months). CONCLUSIONS: Other than elevated levels of CA 19-9, total bilirubin and fasting glucose, radiologic findings were the most reliable factors for distinguishing the MCP from the DPPC.
Gastroentérologie Clinique et Biologique 06/2012; · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is associated with multiple adenomatous polyps and advanced neoplasm. This study aims to investigate the influence of NAFLD on the tumor characteristics and prognosis in patients with colorectal cancer (CRC).
We analyzed 227 patients who were first diagnosed with CRC and underwent abdominal ultrasonography within six months prior to diagnosis at Samsung Medical Center between 2000 and 2005.
Of the study population, 26.0% were diagnosed with NAFLD. Upon baseline comparison, CRC patients with NAFLD had higher BMI and ALT values than CRC patients without NAFLD (25.3 ± 2.7 vs. 22.6 ± 3.0, P=0.000 and 26.6 ± 17.4 vs. 21.2 ± 14.0, P=0.018, respectively). Additionally, CRC patients with NAFLD were diagnosed earlier than CRC patients without NAFLD (P=0.004). However, there were no significant differences between two groups with regard to location and differentiation of tumors, CEA or numbers of synchronous adenoma and advanced adenoma. The cumulative 1-, 3-, and 5-year survival rates in CRC patients with NAFLD were 98.3%, 89.8%, and 86.4%, respectively, which were higher but statistically not significant than 90.4%, 79.6%, and 74.8%, respectively, in CRC patients without NAFLD (P=0.079). During follow-up, freedom from recurrence was similarly observed in CRC patients with and without NAFLD (89.8% and 87.3%, respectively, P=0.614).
The results of this study suggest that the presence of NAFLD does not influence on the prognosis in CRC patients, especially with respect to disease recurrence during follow-up.
Gastroentérologie Clinique et Biologique 11/2011; 36(1):78-83. · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: We investigated the clinical and radiological features of focal mass-forming autoimmune pancreatitis (FMF AIP) to help physicians avoid performing unnecessary surgery because of an improper diagnosis.
Methods: We evaluated 23 patients with chronic inflammatory pancreatic masses and who underwent pancreatectomy for presumed pancreatic cancer from April 1995 to December 2005. These patients were distinguished into 8 FMF AIP patients and 15 ordinary chronic pancreatitis patients through a histological review, along with considering the immunoglobulin G4 staining. Twenty-six randomly selected pancreatic cancer patients were also evaluated as a control group.
Results: On the portal venous phase of computed tomography, 6 (85.7%) of 7 FMF AIP patients showed homogeneous enhancement, whereas only 3 chronic pancreatitis patients (25%) and none of the pancreatic cancer patients showed homogeneous enhancement (P < 0.001). None of the FMF AIP patients showed upstream main pancreatic duct dilatation greater than 5 mm or proximal pancreatic atrophy.
Conclusions: For patients with a pancreatic mass, if their radiological images show homogeneous enhancement on the portal venous phase, the absence of significant upstream main pancreatic duct dilatation greater than 5 mm, and the absence of proximal pancreatic atrophy, then conducting further evaluations should be considered to avoid performing unnecessary surgery.
[Show abstract][Hide abstract] ABSTRACT: A case of catecholamine cardiomyopathy associated with paraganglioma, which was rescued by percutaneous cardiopulmonary support system (PCPS), is presented. Unlike typical apical ballooning, transthoracic echocardiography and left ventriculography revealed severe left ventricular (LV) dysfunction and an abnormal contractile pattern, consisting of akinesis of the basal and midventricular segments and hyperkinesis of the apical segments. Because of the intractable cardiogenic shock, despite conventional treatment, PCPS was performed. The underlying disease was paraganglioma. Catecholamine excess may induce not only transient LV apical ballooning but also atypical LV ballooning without involvement of the LV apex. Early use of PCPS is important for the patient with a catecholamine crisis who is not stabilized by intra-aortic balloon pump as well as infusion of fluid and inotropic agents.