Diagnostic and Therapeutic Challenges in Pancreatobiliary Diseases

A special issue of Gastroenterology Insights (ISSN 2036-7422). This special issue belongs to the section "Pancreas".

Deadline for manuscript submissions: closed (31 August 2022) | Viewed by 20417

Special Issue Editors


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Guest Editor
Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
Interests: pancreatobiliary diseases; endoscopic ultrasound; ERCP; colorectal cancer screening

E-Mail Website
Guest Editor
Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
Interests: young-onset colorectal cancer; fecal microbiota transplantation; digestive oncology

Special Issue Information

Dear Colleagues,

Clinical management of pancreatobiliary diseases can be challenging since symptoms and signs of various benign and malignant conditions of the pancreatobiliary system may overlap. Accurate diagnosis of the underlying pathology would help to guide subsequent clinical management, but differentiation between benign and malignant pathologies of the pancreatobiliary system may not always be straightforward. In patients with suspected pancreatobiliary diseases, prompt evaluation by blood tests, cross-sectional imaging and endoscopy (eg, EUS, ERCP) tailored to the presenting symptoms and signs would often help to clarify the diagnosis and triage appropriate treatment.

Despite advances in technology, diagnostic dilemma and therapeutic challenges are not uncommon in patients with benign and malignant pancreatobiliary diseases. Because a multi-disciplinary approach is often necessary to optimize care of these patients, this Special Issue is devoted to publication of review articles and original research to highlight the latest developments in the field of endoscopy, surgery, and oncology in patients with difficult to manage pancreatobiliary conditions.

Dr. Raymond Tang
Dr. Rashid N. Lui
Guest Editors

Manuscript Submission Information

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Keywords

  • indeterminate biliary strictures
  • cholangiocarcinoma
  • pancreatic cancer
  • ERCP
  • cholangioscopy
  • EUS

Published Papers (5 papers)

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Review

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17 pages, 3232 KiB  
Review
An Insight on Pharmacological and Mechanical Preventive Measures of Post-ERCP PANCREATITIS (PEP)—A Review
by Yinqiu Zhang, Yan Liang and Yadong Feng
Gastroenterol. Insights 2022, 13(4), 387-403; https://doi.org/10.3390/gastroent13040038 - 2 Dec 2022
Viewed by 4178
Abstract
Pancreatitis is the most common complication following endoscopic retrograde cholangio-pancreatography (ERCP). With the progress of research in many drugs and technologies, promising efficacy has been achieved in preventing post-ERCP pancreatitis (PEP). Recently, combined prevention has received more attention in order to further reduce [...] Read more.
Pancreatitis is the most common complication following endoscopic retrograde cholangio-pancreatography (ERCP). With the progress of research in many drugs and technologies, promising efficacy has been achieved in preventing post-ERCP pancreatitis (PEP). Recently, combined prevention has received more attention in order to further reduce the incidence of PEP. However, there is no review about the combined prevention of PEP. This review summarizes the medication and ERCP techniques that are used to prevent PEP and emphasizes that appropriate combination prevention approaches should be based on risk stratification. Full article
(This article belongs to the Special Issue Diagnostic and Therapeutic Challenges in Pancreatobiliary Diseases)
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14 pages, 3171 KiB  
Review
The Role of Cholangioscopy and EUS in the Evaluation of Indeterminate Biliary Strictures
by Wilson Siu and Raymond S. Y. Tang
Gastroenterol. Insights 2022, 13(2), 192-205; https://doi.org/10.3390/gastroent13020020 - 14 Jun 2022
Cited by 3 | Viewed by 3243
Abstract
Bile duct stenosis continues to present a diagnostic dilemma for clinicians. It is important to establish the benign or malignant nature of the stricture early in order to avoid any unnecessary delay in medical treatment or surgery. Tissue acquisition for histological diagnosis is [...] Read more.
Bile duct stenosis continues to present a diagnostic dilemma for clinicians. It is important to establish the benign or malignant nature of the stricture early in order to avoid any unnecessary delay in medical treatment or surgery. Tissue acquisition for histological diagnosis is particularly crucial when the initial diagnostic work up is inconclusive. The diagnostic yield from the conventional endoscopic retrograde cholangiopancreatography (ERCP) with brushing and biopsy is suboptimal. Patients with indeterminate biliary strictures (IDBSs) often require a multi-disciplinary diagnostic approach and additional endoscopic evaluation, including cholangioscopy and endoscopic ultrasound, before a final diagnosis can be reached. In this article, we discuss the recent endoscopic advancements in the diagnosis of biliary stricture with a focus on the roles of cholangioscopy and endoscopic ultrasound (EUS). Full article
(This article belongs to the Special Issue Diagnostic and Therapeutic Challenges in Pancreatobiliary Diseases)
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10 pages, 291 KiB  
Review
The Role of EUS-Guided Drainage in the Management of Postoperative Fluid Collections after Pancreatobiliary Surgery
by Lester Wei Lin Ong and Charing Ching Ning Chong
Gastroenterol. Insights 2021, 12(4), 433-442; https://doi.org/10.3390/gastroent12040041 - 5 Nov 2021
Cited by 3 | Viewed by 2537
Abstract
Postoperative fluid collection (POFC) is a challenging complication following pancreatobiliary surgery. Traditional treatment with surgical drainage is associated with significant morbidity, while percutaneous drainage is associated with a higher rate of recurrence and the need for repeated interventions. Studies have shown that endoscopic [...] Read more.
Postoperative fluid collection (POFC) is a challenging complication following pancreatobiliary surgery. Traditional treatment with surgical drainage is associated with significant morbidity, while percutaneous drainage is associated with a higher rate of recurrence and the need for repeated interventions. Studies have shown that endoscopic ultrasound (EUS)-guided drainage may offer a promising solution to this problem. There are limited data on the ideal therapeutic protocol for EUS-guided drainage of POFC including the timing for drainage; type, size, and number of stents to use; and the need for endoscopic debridement and irrigation. Current practices extrapolated from the treatment of pancreatic pseudocysts and walled-off necrosis may not be applicable to POFC. There are increasing data to suggest that drainage procedures may be performed within two weeks after surgery. While most authors advocate the use of double pigtail plastic stents (DPPSs), there have been a number of reports on the use of novel lumen-apposing metal stents (LAMSs), although no direct comparisons have been made between the two. Full article
(This article belongs to the Special Issue Diagnostic and Therapeutic Challenges in Pancreatobiliary Diseases)
8 pages, 857 KiB  
Review
Neuropathic Pain in Pancreatic Cancer: An Update of the Last Five Years
by Raffaele Pezzilli
Gastroenterol. Insights 2021, 12(3), 302-309; https://doi.org/10.3390/gastroent12030027 - 25 Jun 2021
Cited by 3 | Viewed by 6345
Abstract
Pain is the main symptom of pancreatic cancer (pancreatic ductal adenocarcinoma, PDAC). Pain in pancreatic cancer may be visceral, somatic or neuropathic in origin. Pain is produced by tissue damage, inflammation, ductal obstruction and infiltration. Visceral nociceptive signals caused by damage to the [...] Read more.
Pain is the main symptom of pancreatic cancer (pancreatic ductal adenocarcinoma, PDAC). Pain in pancreatic cancer may be visceral, somatic or neuropathic in origin. Pain is produced by tissue damage, inflammation, ductal obstruction and infiltration. Visceral nociceptive signals caused by damage to the upper abdominal viscera are carried along sympathetic fibers, which travel to the celiac plexus nerves and ganglia, which are found at the T12-L2 vertebral levels, anterolateral to the aorta near the celiac trunk. From here, the signals are transmitted through the splanchnic nerves to the T5-T12 dorsal root ganglia and then on to the higher centers of the central nervous system. Somatic and neuropathic pain may arise from tumor extension into the surrounding peritoneum, retroperitoneum and bones and, in the latter case, into the nerves, such as the lumbosacral plexus. It should also be noted that other types of pain might arise because of therapeutic interventions, such as post-chemoradiation syndromes, which cause mucositis and enteritis. Management with non-steroidal anti-inflammatory agents and narcotics was the mainstay of therapy. In recent years, celiac plexus blocks and neurolysis, as well as intrathecal therapies have been used to control severe pain, at times resulting in a decreased need for drugs, avoiding their unwanted side effects. Pain may impair the patient’s quality of life, negatively affecting patient outcome and resulting in increased psychological stress. Even after recognizing the negative effect of cancer pain on patient overall health, studies have shown that cancer pain is still undertreated. This review focuses on neuropathic pain, which is difficult to handle; thus, the most recent literature was reviewed in order to diagnose neuropathic pain and its management. Full article
(This article belongs to the Special Issue Diagnostic and Therapeutic Challenges in Pancreatobiliary Diseases)
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Other

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8 pages, 4309 KiB  
Case Report
Chronic Calcifying Pancreatitis Associated with Secondary Diabetes Mellitus and Hepatosplenic Abscesses in a Young Male Patient: A Case Report
by Cristina Maria Marginean, Mihaela Popescu, Corina Maria Vasile, Mihaela Stanciu, Iulian Alin Popescu, Viorel Biciusca, Daniela Ciobanu, Amelia Dobrescu, Larisa Daniela Sandulescu, Simona Bondari, Marian Sorin Popescu and Paul Mitrut
Gastroenterol. Insights 2022, 13(3), 305-312; https://doi.org/10.3390/gastroent13030031 - 19 Sep 2022
Cited by 1 | Viewed by 2747
Abstract
Background: Chronic pancreatitis (CP) has been described as a multifactorial, ongoing inflammatory condition of the pancreas of varying intensity that produces persistent pain, leading to exocrine and endocrine insufficiency and a decreased lifespan. Currently, there are three primary forms of chronic pancreatitis: chronic [...] Read more.
Background: Chronic pancreatitis (CP) has been described as a multifactorial, ongoing inflammatory condition of the pancreas of varying intensity that produces persistent pain, leading to exocrine and endocrine insufficiency and a decreased lifespan. Currently, there are three primary forms of chronic pancreatitis: chronic autoimmune pancreatitis (steroid-sensitive pancreatitis), chronic obstructive pancreatitis, and chronic calcific pancreatitis, the latter being closely related to excessive alcohol consumption for one or even two decades before the onset of symptoms. Case report: We present the case of a 29 year old man who required medical attention for a significant unintentional weight loss and a history of upper abdominal pain. Blood tests revealed substantial abnormalities, and the patient was admitted for further investigation. CT and MRI confirmed the presence of a pancreatic pseudocyst and extensive pancreatic parenchymal calcifications and revealed multiple hepatosplenic microabscesses of fungal etiology. Conclusions: Chronic calcifying pancreatitis is a complex clinical entity that can lead to secondary diabetes due to progressive destruction of the pancreatic parenchyma. Protein malnutrition, caused by malabsorption syndrome, immune cell dysfunction, and a high glucose environment caused by diabetes mellitus, may create a state of immunodeficiency, predisposing the patient to opportunistic infections. Full article
(This article belongs to the Special Issue Diagnostic and Therapeutic Challenges in Pancreatobiliary Diseases)
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