المؤلفون: Christina J. Sperna Weiland, Xavier J.N.M. Smeets, Robert C. Verdonk, Alexander C. Poen, Abha Bhalla, Niels G. Venneman, Wietske Kievit, Hester C. Timmerhuis, Devica S. Umans, Jeanin E. van Hooft, Marc G. Besselink, Hjalmar C. van Santvoort, Paul Fockens, Marco J. Bruno, Joost P.H. Drenth, Erwin J.M. van Geenen

المصدر: Endoscopy International Open, Vol 10, Iss 03, Pp E246-E253 (2022)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Background and study aims Rectal nonsteroidal anti-inflammatory drug (NSAID) prophylaxis reduces incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Direct comparisons to the optimal timing of administration, before or after ERCP, are lacking. Therefore, we aimed to assess whether timing of rectal NSAID prophylaxis affects the incidence of post-ERCP pancreatitis. Patients and methods We conducted an analysis of prospectively collected data from a randomized clinical trial. We included patients with a moderate to high risk of developing post-ERCP pancreatitis, all of whom received rectal diclofenac monotherapy 100-mg prophylaxis. Administration was within 30 minutes before or after the ERCP at the discretion of the endoscopist. The primary endpoint was post-ERCP pancreatitis. Secondary endpoints included severity of pancreatitis, length of hospitalization, and Intensive Care Unit (ICU) admittance. Results We included 346 patients who received the rectal NSAID before ERCP and 63 patients who received it after ERCP. No differences in baseline characteristics were observed. Post-ERCP pancreatitis incidence was lower in the group that received pre-procedure rectal NSAIDs (8 %), compared to post-procedure (18 %) (relative risk: 2.32; 95% confidence interval: 1.21 to 4.46, P = 0.02). Hospital stays were significantly longer with post-procedure prophylaxis (1 day; interquartile range [IQR] 1–2 days vs. 1 day; IQR 1–4 days; P = 0.02). Patients from the post-procedure group were more likely to be admitted to the ICU (1 patient [0.3 %] vs. 4 patients [6 %]; P = 0.002). Conclusions Pre-procedure administration of rectal diclofenac is associated with a significant reduction in post-ERCP pancreatitis incidence compared to post-procedure use.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2364-3722Test; https://doaj.org/toc/2196-9736Test

الوصول الحر: https://doaj.org/article/efabd1ea08f248a580e0e02f94faae81Test

المؤلفون: Lotte Boxhoorn, Robert C Verdonk, Marc G Besselink, Marja Boermeester, Thomas L Bollen, Stefan AW Bouwense, Vincent C Cappendijk, Wouter L Curvers, Cornelis H Dejong, Sven M van Dijk, Hendrik M van Dullemen, Casper HJ van Eijck, Erwin JM van Geenen, Muhammed Hadithi, Wouter L Hazen, Pieter Honkoop, Jeanin E van Hooft, Maarten AJM Jacobs, June EC Kievits, Marnix PM Kop, Eva Kouw, Sjoerd D Kuiken, Michiel Ledeboer, Vincent B Nieuwenhuijs, Lars E Perk, Jan-Werner Poley, Rutger Quispel, Rogier JJ de Ridder, Hjalmar C van Santvoort, Christina J Sperna Weiland, Martijn WJ Stommel, Hester C Timmerhuis, Ben J Witteman, Devica S Umans, Niels G Venneman, Frank P Vleggaar, Roy LJ van Wanrooij, Marco J Bruno, Paul Fockens, Rogier P Voermans

المساهمون: Gastroenterology and hepatology, Internal medicine, Gastroenterology & Hepatology, Surgery, Gastroenterology and Hepatology, Graduate School, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AII - Infectious diseases, Center for Liver, Digestive and Metabolic Diseases (CLDM), MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, Interne Geneeskunde, MUMC+: MA Maag Darm Lever (9)

المصدر: Gut, 72, 1, pp. 66-72
Gut, 72(1):e22325632, 66-72. BMJ Publishing Group
Boxhoorn, L, Verdonk, R C, Besselink, M G, Boermeester, M, Bollen, T L, Bouwense, S A, Cappendijk, V C, Curvers, W L, Dejong, C H, van Dijk, S M, van Dullemen, H M, van Eijck, C H, van Geenen, E J, Hadithi, M, Hazen, W L, Honkoop, P, van Hooft, J E, Jacobs, M A, Kievits, J E, Kop, M P, Kouw, E, Kuiken, S D, Ledeboer, M, Nieuwenhuijs, V B, Perk, L E, Poley, J-W, Quispel, R, de Ridder, R J, van Santvoort, H C, Sperna Weiland, C J, Stommel, M W, Timmerhuis, H C, Witteman, B J, Umans, D S, Venneman, N G, Vleggaar, F P, van Wanrooij, R L, Bruno, M J, Fockens, P & Voermans, R P 2022, ' Comparison of lumen-apposing metal stents versus double-pigtail plastic stents for infected necrotising pancreatitis ', Gut, vol. 72, no. 1, e22325632, pp. 66-72 . https://doi.org/10.1136/gutjnl-2021-325632Test
Gut, 72(1), 66-72. BMJ Publishing Group
Gut, 72, 66-72
Gut, 72(1). BMJ PUBLISHING GROUP
Gut, 72, 66-72. BMJ PUBLISHING GROUP

مصطلحات موضوعية: Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], All institutes and research themes of the Radboud University Medical Center, acute pancreatitis, DRAINAGE, Gastroenterology, MANAGEMENT, FLUID COLLECTIONS, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], endoscopy, GUIDELINES

الوصف: ObjectiveLumen-apposing metal stents (LAMS) are believed to clinically improve endoscopic transluminal drainage of infected necrosis when compared with double-pigtail plastic stents. However, comparative data from prospective studies are very limited.DesignPatients with infected necrotising pancreatitis, who underwent an endoscopic step-up approach with LAMS within a multicentre prospective cohort study were compared with the data of 51 patients in the randomised TENSION trial who had been assigned to the endoscopic step-up approach with double-pigtail plastic stents. The clinical study protocol was otherwise identical for both groups. Primary end point was the need for endoscopic transluminal necrosectomy. Secondary end points included mortality, major complications, hospital stay and healthcare costs.ResultsA total of 53 patients were treated with LAMS in 16 hospitals during 27 months. The need for endoscopic transluminal necrosectomy was 64% (n=34) and was not different from the previous trial using plastic stents (53%, n=27)), also after correction for baseline characteristics (OR 1.21 (95% CI 0.45 to 3.23)). Secondary end points did not differ between groups either, which also included bleeding requiring intervention—5 patients (9%) after LAMS placement vs 11 patients (22%) after placement of plastic stents (relative risk 0.44; 95% CI 0.16 to 1.17). Total healthcare costs were also comparable (mean difference −€6348, bias-corrected and accelerated 95% CI −€26 386 to €10 121).ConclusionOur comparison of two patient groups from two multicentre prospective studies with a similar design suggests that LAMS do not reduce the need for endoscopic transluminal necrosectomy when compared with double-pigtail plastic stents in patients with infected necrotising pancreatitis. Also, the rate of bleeding complications was comparable.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0232c66b1d6b27f21f30aaab8ed58472Test
http://www.scopus.com/inward/record.url?scp=85132369581&partnerID=8YFLogxKTest

المؤلفون: Hester C, Timmerhuis, Sven M, van Dijk, Robert A, Hollemans, Devica S, Umans, Christina J, Sperna Weiland, Marc G, Besselink, Stefan A W, Bouwense, Marco J, Bruno, Peter, van Duijvendijk, Casper H J, van Eijck, Yama, Issa, Sven, Mieog, I Quintus, Molenaar, Martijn W J, Stommel, Thomas L, Bollen, Rogier P, Voermans, Robert C, Verdonk, Hjalmar C, van Santvoort

المساهمون: Gastroenterology & Hepatology, Surgery, MUMC+: MA Heelkunde (9), RS: FHML non-thematic output

المصدر: Annals of Surgery. Lippincott Williams & Wilkins
Annals of Surgery. LIPPINCOTT WILLIAMS & WILKINS

مصطلحات موضوعية: Surgery

الوصف: OBJECTIVE: The aim of this study was to explore the incidence, risk factors, clinical course and treatment of perforation and fistula of the gastrointestinal tract in a large unselected cohort of patients with necrotizing pancreatitis.SUMMARY BACKGROUND DATA: Perforation and fistula of the gastrointestinal (GI)-tract may occur in necrotizing pancreatitis. Data from large unselected patient populations on the incidence, risk factors, clinical outcomes, and treatment are lacking.METHODS: We performed a post-hoc analysis of a nationwide prospective database of 896 patients with necrotizing pancreatitis. GI-tract perforation and fistula were defined as spontaneous or iatrogenic discontinuation of the gastrointestinal wall. Multivariable logistic regression was used to explore risk factors and to adjust for confounders to explore associations of the GI-tract perforation and fistula on the clinical course.RESULTS: A perforation or fistula of the GI-tract was identified in 139 (16%) patients, located in the stomach in 23 (14%), duodenum in 56 (35%), jejunum or ileum in 18 (11%) and colon in 64 (40%). Risk factors were high C-reactive protein within 48-hours after admission (OR 1.19 [95%CI 1.01-1.39]) and early organ-failure (OR 2.76 [95%CI 1.78-4.29]). Prior invasive intervention was a risk factor for developing a perforation or fistula of the lower GI-tract (OR 2.60 [95% CI 1.04-6.60]). While perforation or fistula of the upper GI-tract appeared to be protective for persistent ICU-admission (OR 0.11 [95%CI 0.02-0.44]) and persistent organ failure (OR 0.15 [95%CI 0.02-0.58]), perforation or fistula of the lower GI-tract was associated with a higher rate of new onset organ failure (OR 2.47 [95%CI 1.23-4.84]). When the stomach or duodenum was affected, treatment was mostly conservative (n=54, 68%). Treatment was mostly surgical when the colon was affected (n=38, 59%).CONCLUSIONS: Perforation and fistula of the GI-tract occurred in one out of six patients with necrotizing pancreatitis. Risk factors were high C-reactive protein within 48 hours and early organ-failure. Prior intervention was identified as a risk factor for perforation or fistula of the lower GI-tract. The clinical course was mostly affected by involvement of the lower GI-tract.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::92a455df50bc8b980388b881808f6e10Test
https://doi.org/10.1097/SLA.0000000000005624Test

المؤلفون: Christina J, Sperna Weiland, Evelien C, Verschoor, Alexander C, Poen, Xavier J M N, Smeets, Niels G, Venneman, Abha, Bhalla, Ben J M, Witteman, Hester C, Timmerhuis, Devica S, Umans, Jeanin E, van Hooft, Marco J, Bruno, P, Fockens, Robert C, Verdonk, Joost P H, Drenth, Erwin J M, van Geenen

المصدر: Surgical endoscopy.

الوصف: Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice to remove sludge/stones from the common bile duct (CBD). In a small but clinically important proportion of patients with suspected choledocholithiasis ERCP is negative. This is undesirable because of ERCP associated morbidity. We aimed to map the diagnostic pathway leading up to ERCP and evaluate ERCP outcome.We established a prospective multicenter cohort of patients with suspected CBD stones. We assessed the determinants that were associated with CBD sludge or stone detection upon ERCP.We established a cohort of 707 patients with suspected CBD sludge or stones (62% female, median age 59 years). ERCP was negative for CBD sludge or stones in 155 patients (22%). Patients with positive ERCPs frequently had pre-procedural endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) imaging (44% vs. 35%; P = 0.045). The likelihood of ERCP sludge and stones detection was higher when the time interval between EUS or MRCP and ERCP was less than 2 days (odds ratio 2.35; 95% CI 1.25-4.44; P = 0.008; number needed to harm 7.7).Even in the current era of society guidelines and use of advanced imaging CBD sludge or stones are absent in one out of five ERCPs performed for suspected CBD stones. The proportion of unnecessary ERCPs is lower in case of pre-procedural EUS or MRCP. A shorter time interval between EUS or MRCP increases the yield of ERCP for suspected CBD stones and should, therefore, preferably be performed within 2 days before ERCP.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid________::bbf0d0430c03e0b40cda6f73ced5f397Test
https://pubmed.ncbi.nlm.nih.gov/36163565Test

المؤلفون: Venkata S. Akshintala, Sohail Z. Husain, Todd A. Brenner, Anmol Singh, Vikesh K. Singh, Mouen A. Khashab, Christina J. Sperna Weiland, Erwin J.M. van Geenen, Nikhil Bush, Monique Barakat, Ananta Srivastava, Rakesh Kochhar, Rupjyoti Talukdar, Gajanan Rodge, Clement C.H. Wu, Sundeep Lakhtakia, Saroj K. Sinha, Mahesh K. Goenka, D. Nageshwar Reddy

المصدر: Pancreatology, 22, 7, pp. 887-893
Pancreatology, 22, 887-893

مصطلحات موضوعية: Cholangiopancreatography, Endoscopic Retrograde, Hepatology, Endocrinology, Diabetes and Metabolism, Indomethacin, Calcineurin Inhibitors, Anti-Inflammatory Agents, Non-Steroidal, Gastroenterology, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], Tacrolimus, Pancreatitis, Administration, Rectal, Acute Disease, Humans, Multicenter Studies as Topic, Retrospective Studies, Randomized Controlled Trials as Topic

الوصف: Item does not contain fulltext BACKGROUND: Acute pancreatitis remains the most common and morbid complication of endoscopic retrograde cholangiopancreatography (ERCP). The use of rectal indomethacin and pancreatic duct stenting has been shown to reduce the incidence and severity of post-ERCP pancreatitis (PEP), but these interventions have limitations. Recent clinical and translational evidence suggests a role for calcineurin inhibitors in the prevention of pancreatitis, with multiple retrospective case series showing a reduction in PEP rates in tacrolimus users. METHODS: The INTRO trial is a multicenter, international, randomized, double-blinded, controlled trial. A total of 4,874 patients undergoing ERCP will be randomized to receive either oral tacrolimus (5 mg) or oral placebo 1-2 h before ERCP, and followed for 30 days post-procedure. Blood and pancreatic aspirate samples will also be collected in a subset of patients to quantify tacrolimus levels. The primary outcome of the study is the incidence of PEP. Secondary endpoints include the severity of PEP, ERCP-related complications, adverse drug events, length of hospital stay, cost-effectiveness, and the pharmacokinetics, pharmacodynamics, and pharmacogenomics of tacrolimus immune modulation in the pancreas. CONCLUSIONS: The INTRO trial will assess the role of calcineurin inhibitors in PEP prophylaxis and develop a foundation for the clinical optimization of this therapeutic strategy from a pharmacologic and economic standpoint. With this clinical trial, we hope to demonstrate a novel approach to PEP prophylaxis using a widely available and well-characterized class of drugs. TRIAL REGISTRATION: NCT05252754, registered on February 14, 2022. 01 november 2022

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5be6ef09785aa5388b2a1334ad06ac53Test
https://repository.ubn.ru.nl/handle/2066/288036Test

المؤلفون: Joost P.H. Drenth, Christina J Sperna Weiland, Devica S Umans, Xavier J N M Smeets, Erwin J M van Geenen

المصدر: The Lancet Gastroenterology & Hepatology. 6:686-687

مصطلحات موضوعية: medicine.medical_specialty, Hepatology, business.industry, General surgery, Gastroenterology, Medicine, Post ercp pancreatitis, business

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::a5b35a41aeabda590f4fbc162e5e7960Test
https://doi.org/10.1016/s2468-1253Test(21)00235-1

المؤلفون: Venkata S. Akshintala, Anthony N. Kalloo, Rakesh Kochhar, Kavin Kanthasamy, Joost P.H. Drenth, Cristian Tomasetti, Christina J Sperna Weiland, Merve Gurakar, Dhiraj Yadav, Vikesh K. Singh, D. Nageshwar Reddy, Mahesh K. Goenka, Albert Kuo, Furqan A. Bhullar, B. Joseph Elmunzer, Ayesha Kamal, Mouen A. Khashab, Erwin J M van Geenen

المصدر: Lancet Gastroenterology & Hepatology, 6, 9, pp. 733-742
Lancet Gastroenterology & Hepatology, 6, 733-742

مصطلحات موضوعية: medicine.medical_specialty, medicine.medical_treatment, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], Placebo, Global Health, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Diclofenac, Postoperative Complications, Indometacin, Internal medicine, medicine, Humans, Saline, Cholangiopancreatography, Endoscopic Retrograde, Endoscopic retrograde cholangiopancreatography, Hepatology, medicine.diagnostic_test, business.industry, Incidence, Anti-Inflammatory Agents, Non-Steroidal, Odds ratio, medicine.disease, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Pancreatitis, 030220 oncology & carcinogenesis, Meta-analysis, Fluid Therapy, 030211 gastroenterology & hepatology, Stents, business, medicine.drug

الوصف: Item does not contain fulltext BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs), intravenous fluid, pancreatic stents, or combinations of these have been evaluated in randomised controlled trials (RCTs) for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, but the comparative efficacy of these treatments remains unclear. Our aim was to do an exploratory network meta-analysis of previous RCTs to systematically compare the direct and indirect evidence and rank NSAIDs, intravenous fluids, pancreatic stents, or combinations of these to determine the most efficacious method of prophylaxis for post-ERCP pancreatitis. METHODS: We searched PubMed, Embase, and the Cochrane Central Register from inception to Nov 15, 2020, for full-text RCTs that evaluated the efficacy of NSAIDs, pancreatic stents, intravenous fluids, or combinations of these for post-ERCP pancreatitis prevention in adult (aged ≥18 years) patients undergoing ERCP. Summary data from intention-to-treat analyses were extracted from published reports. We analysed incidence of post-ERCP pancreatitis across studies using network meta-analysis under the frequentist framework, obtaining pairwise odds ratios (ORs) and 95% CIs. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for the confidence rating. This study is registered with PROSPERO, CRD42020172606. FINDINGS: We identified 1503 studies, of which 55 RCTs evaluating 20 interventions in 17 062 patients were included in the network meta-analysis. The mean incidence of post-ERCP pancreatitis in the placebo or active control group was 12·2% (95% CI 11·4-13·0). Normal saline plus rectal indometacin (OR 0·02, 95% CI 0·00-0·40), intramuscular diclofenac 75 mg (0·24, 0·09-0·69), intravenous high-volume Ringer's lactate plus rectal diclofenac 100 mg (0·30, 0·16-0·55), intravenous high-volume Ringer's lactate (0·31, 0·12-0·78), 5-7 Fr pancreatic stents (0·35, 0·26-0·48), rectal diclofenac 100 mg (0·36, 0·25-0·52), 3 Fr pancreatic stents (0·47, 0·26-0·87), and rectal indometacin 100 mg (0·60, 0·50-0·73) were all more efficacious than placebo for preventing post-ERCP pancreatitis in pairwise comparisons. 5-7 Fr pancreatic stents (0·59, 0·41-0·84), intravenous high-volume Ringer's lactate plus rectal diclofenac 100 mg (0·49, 0·26-0·94), intravenous standard-volume normal saline plus rectal indometacin 100 mg (0·04, 0·00-0·66), and rectal diclofenac 100 mg (0·59, 0·40-0·89) were more efficacious than rectal indometacin 100 mg. The GRADE confidence rating was low to moderate for 98·3% of the pairwise comparisons. INTERPRETATION: This systematic review and network meta-analysis summarises the available literature on NSAIDs, pancreatic stents, intravenous fluids, or combinations of these for prophylaxis of post-ERCP pancreatitis. Rectal diclofenac 100 mg is the best performing rectal NSAID in this network meta-analysis. Combinations of prophylaxis might be more effective, but there is little evidence. These findings help to establish prophylaxis of post-ERCP pancreatitis for future research and practice, and could reduce costs and increase adoption of prophylaxis. FUNDING: None.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d2c197d4e48d726ac29f6bd2abb044f1Test
https://doi.org/10.1016/S2468-1253Test(21)00170-9

المؤلفون: Niels G. Venneman, Casper H.J. van Eijck, Muhammed Hadithi, Erwin-Jan M. van Geenen, Jeanin E. van Hooft, Stefan A.W. Bouwense, Cornelis H. C. Dejong, Lotte Boxhoorn, Christina J Sperna Weiland, Marja A. Boermeester, Lars E. Perk, Wouter L. Curvers, Maarten A J M Jacobs, Robert C. Verdonk, Jan-Werner Poley, Marc G. Besselink, Marco J. Bruno, Rogier P. Voermans, Hjalmar C. van Santvoort, Hester C. Timmerhuis, Michiel Ledeboer, Vincent B. Nieuwenhuijs, Roy L.J. van Wanrooij, Ben J.M. Witteman, Frank P. Vleggaar, Thomas L. Bollen, Eva Kouw, Rutger Quispel, Martijn W J Stommel, Sjoerd D. Kuiken, Wouter L. Hazen, Vincent C. Cappendijk, Devica S Umans, Hendrik M. van Dullemen, P. Honkoop, Rogier de Ridder, Sven M. van Dijk, Paul Fockens

المصدر: Gastrointestinal Endoscopy. 93:AB244

مصطلحات موضوعية: Pigtail, medicine.medical_specialty, business.industry, Gastroenterology, medicine, Lumen (anatomy), Radiology, Nuclear Medicine and imaging, business, Necrotizing pancreatitis, Surgery

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::1f3255a78bb2052a960f075016a52b58Test
https://doi.org/10.1016Test/j.gie.2021.03.527