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Article: Therapeutic Endoscopic Ultrasound for Complications of Pancreatic Cancer.

Han, Samuel / Papachristou, Georgios I

2023 Volume 16, Issue 1

Abstract: Progression of pancreatic adenocarcinoma can result in disease complications such as biliary obstruction and gastric outlet obstruction. The recent advances in endoscopic ultrasound (EUS) have transformed EUS from a purely diagnostic technology to a ... ...

Abstract	Progression of pancreatic adenocarcinoma can result in disease complications such as biliary obstruction and gastric outlet obstruction. The recent advances in endoscopic ultrasound (EUS) have transformed EUS from a purely diagnostic technology to a therapeutic modality, particularly with the development of lumen-apposing metal stents. In terms of biliary drainage, EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy offer safe and effective techniques when conventional transpapillary stent placement via ERCP fails or is not possible. If these modalities are not feasible, EUS-guided gallbladder drainage offers yet another salvage technique when the cystic duct is non-involved by the cancer. Lastly, EUS-guided gastroenterostomy allows for an effective bypass treatment for cases of gastric outlet obstruction that enables patients to resume eating within several days. Future randomized studies comparing these techniques to current standard-of-care options are warranted to firmly establish therapeutic EUS procedures within the treatment algorithm for this challenging disease.
Language	English
Publishing date	2023-12-20
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers16010029
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Article ; Online: Intravenous fluid resuscitation in the management of acute pancreatitis.

Machicado, Jorge D / Papachristou, Georgios I

Current opinion in gastroenterology

2020 Volume 36, Issue 5, Page(s) 409–416

Abstract: Purpose of review: In the absence of proven effective pharmacologic therapy in acute pancreatitis, and given its simplicity, wide availability, and perceived safety, intravenous fluid resuscitation remains the cornerstone in the early treatment of acute ...

Abstract	Purpose of review: In the absence of proven effective pharmacologic therapy in acute pancreatitis, and given its simplicity, wide availability, and perceived safety, intravenous fluid resuscitation remains the cornerstone in the early treatment of acute pancreatitis. Herein, we will review the rationale of fluid therapy, critically appraise the published literature, and summarize recent studies. Recent findings: Several observational studies and small clinical trials have raised concern about the efficacy and safety of aggressive fluid resuscitation. Early aggressive fluid therapy among acute pancreatitis patients with predicted mild severity appears to have the highest benefit, whereas aggressive resuscitation in patients with predicted severe disease might be futile and deleterious. Lactated Ringer's solution is the preferred fluid type based on animal studies, clinical trials, and meta-analyses. There is a wide variation of fluid resuscitation approaches in current guideline recommendations, quality indicators, and worldwide practice patterns. Summary: There is lack of high-quality data that supports the use of early aggressive fluid resuscitation. Large, well designed, multicenter randomized controlled trials are needed to determine the optimal timing, fluid type, volume, rate, and duration of fluid resuscitation in acute pancreatitis.
MeSH term(s)	Acute Disease ; Animals ; Fluid Therapy ; Humans ; Isotonic Solutions ; Multicenter Studies as Topic ; Pancreatitis/therapy ; Ringer's Lactate
Chemical Substances	Isotonic Solutions ; Ringer's Lactate
Language	English
Publishing date	2020-06-29
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632571-3
ISSN	1531-7056 ; 0267-1379
ISSN (online)	1531-7056
ISSN	0267-1379
DOI	10.1097/MOG.0000000000000659
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Article ; Online: Pancreatogenic diabetes, acute pancreatitis management, and pancreatic tuberculosis: Appraising the present and setting goals for the future.

Machicado, Jorge D / Papachristou, Georgios I

United European gastroenterology journal

2020 Volume 8, Issue 4, Page(s) 365–368

MeSH term(s)	Diabetes Mellitus/epidemiology ; Diabetes Mellitus/immunology ; Evidence-Based Medicine/methods ; Evidence-Based Medicine/trends ; Forecasting ; Gastroenterology/methods ; Gastroenterology/trends ; Global Burden of Disease ; Goals ; Humans ; Mycobacterium tuberculosis/immunology ; Pancreatitis/epidemiology ; Pancreatitis/immunology ; Pancreatitis/microbiology ; Pancreatitis/therapy ; Pancreatitis, Chronic/complications ; Pancreatitis, Chronic/epidemiology ; Pancreatitis, Chronic/immunology ; Tuberculosis, Endocrine/epidemiology ; Tuberculosis, Endocrine/immunology ; Tuberculosis, Endocrine/microbiology ; Tuberculosis, Endocrine/therapy
Language	English
Publishing date	2020-05-03
Publishing country	England
Document type	Editorial ; Introductory Journal Article
ZDB-ID	2728585-6
ISSN	2050-6414 ; 2050-6406
ISSN (online)	2050-6414
ISSN	2050-6406
DOI	10.1177/2050640620917017
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Article: Management of Severe Acute Pancreatitis.

Lee, Peter J / Papachristou, Georgios I

Current treatment options in gastroenterology

2020 Volume 18, Issue 4, Page(s) 670–681

Abstract: Purpose of review: There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, ... ...

Abstract	Purpose of review: There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications. Recent findings: Recent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be administered with caution to prevent intra-abdominal hypertension and volume overload. Endoscopic retrograde cholangiopancreatography improves outcomes only in AP patients with suspected cholangitis. Early enteral tube-feeding does not appear to be superior to on-demand oral feeding. Abdominal compartment syndrome is a highly lethal complication of SAP that requires percutaneous drainage or decompressive laparotomy. Endoscopic transmural drainage followed by necrosectomy (i.e., "step-up approach") is the treatment strategy of choice in patients with symptomatic or infected walled-off pancreatic necrosis. Summary: SAP is a complex clinical syndrome associated with a high mortality rate. Early prediction of SAP remains challenging due to the limited accuracy of the available prediction tools. Early fluid resuscitation, organ support, enteral nutrition, and prevention of/or prompt recognition of abdominal compartment syndrome remain cornerstones of its management. A step-up, minimally invasive drainage/debridement is the preferred approach for patients with infected pancreatic necrosis.
Language	English
Publishing date	2020-11-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057334-0
ISSN	1534-309X ; 1092-8472
ISSN (online)	1534-309X
ISSN	1092-8472
DOI	10.1007/s11938-020-00322-x
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Article ; Online: New insights into acute pancreatitis.

Lee, Peter J / Papachristou, Georgios I

Nature reviews. Gastroenterology & hepatology

2019 Volume 16, Issue 8, Page(s) 479–496

Abstract: The incidence of acute pancreatitis continues to increase worldwide, and it is one of the most common gastrointestinal causes for hospital admission in the USA. In the past decade, substantial advancements have been made in our understanding of the ... ...

Abstract	The incidence of acute pancreatitis continues to increase worldwide, and it is one of the most common gastrointestinal causes for hospital admission in the USA. In the past decade, substantial advancements have been made in our understanding of the pathophysiological mechanisms of acute pancreatitis. Studies have elucidated mechanisms of calcium-mediated acinar cell injury and death and the importance of store-operated calcium entry channels and mitochondrial permeability transition pores. The cytoprotective role of the unfolded protein response and autophagy in preventing sustained endoplasmic reticulum stress, apoptosis and necrosis has also been characterized, as has the central role of unsaturated fatty acids in causing pancreatic organ failure. Characterization of these pathways has led to the identification of potential molecular targets for future therapeutic trials. At the patient level, two classification systems have been developed to classify the severity of acute pancreatitis into prognostically meaningful groups, and several landmark clinical trials have informed management strategies in areas of nutritional support and interventions for infected pancreatic necrosis that have resulted in important changes to acute pancreatitis management paradigms. In this Review, we provide a summary of recent advances in acute pancreatitis with a special emphasis on pathophysiological mechanisms and clinical management of the disorder.
MeSH term(s)	Acute Disease ; Animals ; Calcium Signaling/physiology ; Disease Management ; Disease Models, Animal ; Endoplasmic Reticulum Stress/physiology ; Humans ; Mutation ; Nutritional Support/methods ; Pancreatitis/diagnosis ; Pancreatitis/etiology ; Pancreatitis/physiopathology ; Pancreatitis/therapy ; Severity of Illness Index ; Terminology as Topic ; Trypsinogen/metabolism
Chemical Substances	Trypsinogen (9002-08-8)
Language	English
Publishing date	2019-05-28
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2493722-8
ISSN	1759-5053 ; 1759-5045
ISSN (online)	1759-5053
ISSN	1759-5045
DOI	10.1038/s41575-019-0158-2
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Zs.A 6020: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MG 97: Show issues

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Article ; Online: Pharmacologic management and prevention of acute pancreatitis.

Machicado, Jorge D / Papachristou, Georgios I

Current opinion in gastroenterology

2019 Volume 35, Issue 5, Page(s) 460–467

Abstract: Purpose of review: The present article will focus in pharmacologic agents that have been studied to improve acute pancreatitis outcomes, and to prevent the disease at different levels.: Recent findings: Too little and too much early fluid ... ...

Abstract	Purpose of review: The present article will focus in pharmacologic agents that have been studied to improve acute pancreatitis outcomes, and to prevent the disease at different levels. Recent findings: Too little and too much early fluid resuscitation can be harmful. The optimal volume, rate, and duration of intravenous fluid therapy is still unknown. Nonopioid analgesics should be the first line of analgesia in patients with acute pancreatitis. A few pharmacologic agents evaluated in acute pancreatitis have resulted in positive pilot trials; however, larger randomized clinical trials (RCTs) are needed before final conclusions. Statin use is associated with lower incidence of acute pancreatitis in the general population and ongoing studies are evaluating its preventive role in acute pancreatitis recurrences. The preventive role of rectal indomethacin in post-endoscopic retrograde cholangiopancreatography pancreatitis is indisputable, with subject selection and timing of administration requiring further investigation. Summary: There is still no proven effective disease-specific pharmacologic therapy that changes the natural history of acute pancreatitis. New therapeutic targets and pharmacologic agents are in the horizon. Careful refinement in study design is needed when planning future RCTs. There is also a need for drug development aiming at reducing the incidence of the disease and preventing its sequelae.
MeSH term(s)	Abdominal Pain/drug therapy ; Abdominal Pain/etiology ; Analgesics/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Enzyme Inhibitors/therapeutic use ; Fluid Therapy/methods ; Gastrointestinal Agents/therapeutic use ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Pancreatitis/complications ; Pancreatitis/physiopathology ; Pancreatitis/prevention & control ; Pancreatitis/therapy ; Randomized Controlled Trials as Topic
Chemical Substances	Analgesics ; Anti-Bacterial Agents ; Enzyme Inhibitors ; Gastrointestinal Agents ; Hydroxymethylglutaryl-CoA Reductase Inhibitors
Language	English
Publishing date	2019-06-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632571-3
ISSN	1531-7056 ; 0267-1379
ISSN (online)	1531-7056
ISSN	0267-1379
DOI	10.1097/MOG.0000000000000563
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Article ; Online: Can Contrast-Enhanced Endoscopic Ultrasound Replace Tissue Acquisition for Pancreatic Lesions?

Lee, Peter J / Papachristou, Georgios I

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

2019 Volume 18, Issue 4, Page(s) 787–788

MeSH term(s)	Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Pancreas/diagnostic imaging ; Pancreatic Neoplasms/diagnostic imaging
Language	English
Publishing date	2019-11-08
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2119789-1
ISSN	1542-7714 ; 1542-3565
ISSN (online)	1542-7714
ISSN	1542-3565
DOI	10.1016/j.cgh.2019.11.020
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Article ; Online: Alterations in exocrine pancreatic function after acute pancreatitis.

Bejjani, Joseph / Ramsey, Mitchell L / Lee, Peter J / Phillips, Anna Evans / Singh, Vikesh K / Yadav, Dhiraj / Papachristou, Georgios I / Hart, Phil A

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

2024

Abstract: Exocrine pancreatic dysfunction (EPD) is a malabsorptive complication of pancreatic disorders that can lead to a host of symptoms ranging from flatulence to diarrhea and contribute to weight loss and metabolic bone disease. It is increasingly recognized ... ...

Abstract	Exocrine pancreatic dysfunction (EPD) is a malabsorptive complication of pancreatic disorders that can lead to a host of symptoms ranging from flatulence to diarrhea and contribute to weight loss and metabolic bone disease. It is increasingly recognized to occur after acute pancreatitis (AP), including episodes with mild severity. The risk of developing EPD after AP is influenced by a range of factors, including the degree of acinar cell destruction and inflammation during AP, and persistent structural derangements following AP. In this article, we discuss the epidemiology, pathophysiology, and clinical management of EPD after AP while highlighting key knowledge gaps.
Language	English
Publishing date	2024-03-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2056680-3
ISSN	1424-3911 ; 1424-3903
ISSN (online)	1424-3911
ISSN	1424-3903
DOI	10.1016/j.pan.2024.03.003
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Article ; Online: Single-session endoscopic ultrasound-directed transgastric endoscopy for treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass.

Burlen, Jordan / Manudhane, Albert / Roberts, Luke / Cecilia Amaral, Anna / Papachristou, Georgios I / Han, Samuel

Endoscopy

2023 Volume 55, Issue S 01, Page(s) E1205–E1206

MeSH term(s)	Humans ; Gastric Bypass/adverse effects ; Cholangiopancreatography, Endoscopic Retrograde ; Laparoscopy ; Endosonography ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/surgery ; Obesity, Morbid/surgery ; Anastomosis, Roux-en-Y ; Endoscopy, Gastrointestinal
Language	English
Publishing date	2023-11-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80120-3
ISSN	1438-8812 ; 0013-726X
ISSN (online)	1438-8812
ISSN	0013-726X
DOI	10.1055/a-2197-9404
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Zs.A 669: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Management of Severe Acute Pancreatitis

Lee, Peter J. / Papachristou, Georgios I.

Curr Treat Options Gastroenterol

Abstract: PURPOSE OF REVIEW: There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, ... ...

Abstract	PURPOSE OF REVIEW: There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications. RECENT FINDINGS: Recent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be administered with caution to prevent intra-abdominal hypertension and volume overload. Endoscopic retrograde cholangiopancreatography improves outcomes only in AP patients with suspected cholangitis. Early enteral tube-feeding does not appear to be superior to on-demand oral feeding. Abdominal compartment syndrome is a highly lethal complication of SAP that requires percutaneous drainage or decompressive laparotomy. Endoscopic transmural drainage followed by necrosectomy (i.e., “step-up approach”) is the treatment strategy of choice in patients with symptomatic or infected walled-off pancreatic necrosis. SUMMARY: SAP is a complex clinical syndrome associated with a high mortality rate. Early prediction of SAP remains challenging due to the limited accuracy of the available prediction tools. Early fluid resuscitation, organ support, enteral nutrition, and prevention of/or prompt recognition of abdominal compartment syndrome remain cornerstones of its management. A step-up, minimally invasive drainage/debridement is the preferred approach for patients with infected pancreatic necrosis.
Keywords	covid19
Publisher	PMC
Document type	Article ; Online
DOI	10.1007/s11938-020-00322-x
Database	COVID19

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