Extracorporeal shockwave lithotripsy in combination with endoscopy as a treatment modality for painful chronic obstructive pancreatitis ­ a case report

Chronic pancreatitis (CP) is a serious condition with a great impact on the quality of life, and it can lead to some serious long-term consequences such as pancreatic cancer or secondary diabetes mellitus. Associated pancreatic exocrine insufficiency leads to malnutrition with weight loss; however, the main symptom of the disease is abdominal pain, often very severe. The primary treatment option for painful CP is pharmacotherapy (pancreatic enzyme replacement therapy, analgesics). If this is not effective, CP can be treated via endoscopy, extracorporeal shockwave lithotripsy (ESWL), their combination, or surgery. We present a case of painful chronic obstructive pancreatitis in a patient successfully treated with ESWL in combination with endoscopy.

Pancreatic cancer in chronic pancreatitis ­ the diagnostic and therapeutic dilemma; an overview of cases

Introduction: Any mass in chronic pancreatitis (CP) is a difficult diagnostic and therapeutic problem. The aim of the study is a) to use our own group to determine the actual incidence of non-malignant masses in CP where any mass is highly suspected of being malignant; and b) to determine the actual incidence of malignant tumors in CP. Methods: We present a retrospective analysis of our group of patients operated in 2015­2019 for CP, a mass in CP and suspected malignancy in the mass in CP. Additionally, we present difficult cases in terms of preoperative diagnosis. Results: Thirty-three of 340 (9.7%) pancreatic resection were done due to any form of chronic pancreatitis in 2015­2019. A mass in the pancreatic head was present in 16 (48%) patients; of these, pancreatic ductal adenocarcinoma (PDAC) was suspected in 10 (62%) patients based on EUS, CT or PETCT, and also based on positive tissue diagnosis using EUS-FNA in 6 cases. Bypass or Frey procedure were done in 59 patients (HJA, PJA, Frey). Preoperative tissue sampling was done in 8 (13%) patients and malignancy was suspected in 25%. Intraoperatively, malignancy was confirmed only in one patient assessed as non-malignant in the preoperative period. The clinical course in 3 other patients undergoing HJA, although tumor-free at the time of the surgery, indicated PDAC in CP. Conclusion: The ability to detect malignant cells in a mass in CP remains poor even using all of the available sophisticated methods and the success depends on many variable factors. The rate of "unnecessary" right-sided resections of a mass in CP reached 48% in our patient group, while the rate of resections which should have been performed instead of bypass procedures was 7%. A certain percentage of the so-called excessive pancreatic resections, as well as the failure to perform a resection due to an undetected/unrecognized pancreatic tumor in CP should continue to be expected.

Percutaneous endoscopic cecostomy in the treatment of recurrent colonic pseudo-obstruction a case report of the first procedure in the Czech Republic.

We present the case of an 89-year-old polymorbid female patient with recurrent acute colonic pseudo-obstruction who was treated by performing percutaneous endoscopic cecostomy as the first procedure of its kind in the Czech Republic. The patient presented repeatedly with ileous conditions without evidence of an organic cause. Surgical colostomy was proposed with a possibility of subtotal colectomy as an ultimum refugium due to an insufficient effect of maximum conservative management and a need for repeated endoscopic decompression. In this particular patient, however, any kind of surgical intervention posed a major risk and was eventually abandoned. Finally, percutaneous endoscopic cecostomy was proposed as an alternative to resolve the situation. The procedure was carried out without complications and with an immediate effect. The patient has been free of the symptomatology of intestinal obstruction in the long term having the option of intermittent intestinal decompression as needed.

[Combination of endoscopic mucosal resection and full-thickness resection in the treatment of local residual neoplasia of the colon two case reports]. / Kombinace endoskopické sliznicní resekce a transmurální resekce v lécbe lokálních reziduálních neoplazií tracníku popis dvou prípadu.

We present the case of a 61-year-old patient with local residual neoplasia (LRN) of the rectum and the case of a 65-year-old patient with LRN of the cecum. In both cases, the lesion measured 25 mm in diameter and its center was fixed by submucosal fibrosis causing the non-lifting sign. For endoscopic treatment, which was uneventful,a combination of endoscopic mucosal resection (EMR) and full-thickness resection (FTR) was used. In both cases, histological examination showed completely resected tubular adenoma with HGIN.Key words: colorectal carcinoma local residual neoplasia full-thickness resection endoscopic mucosal resection.

Cool water vs warm water immersion for minimal sedation colonoscopy: a double-blind randomized trial.

AIM: Water-aided insertion as an alternative colonoscopy technique reduces patient discomfort. Warm water has been used in most published trials, but the use of cool water is easier and, if equally effective, could support the use of the water-aided technique in routine practice. METHOD: A double-blind, randomized, single-centre study was performed in which 201 patients were randomized to either cool (20-24 °C) or warm (37 °C) water immersion insertion. The primary outcome was caecal intubation time. The success rate of minimal sedation and patient discomfort were also assessed. RESULTS: The caecal intubation time for cool and warm water was similar (6.9 ± 3.5 vs 7.0 ± 3.4 min, P = 0.64). The respective success rates of minimal sedation colonoscopy (89.1% vs 90%, P = 1.00) and discomfort (P = 0.51) were no different. All other outcomes except a greater need for abdominal compression in the cool water arm (P = 0.04) were similar including the total procedure time, terminal ileum intubation rate, adenoma detection, length of the inserted scope, water volume, non-standard position rate, difficulty of the procedure and the patient's temperature sensation. CONCLUSION: The use of cool water did not modify the caecal intubation time compared with warm water. Exception for abdominal compression, all other end-points were no different. Cool water immersion is an alternative to the technically more demanding warm water immersion colonoscopy.

[Precancerous conditions and lesions of the stomach]. / Prekancerózy zaludku.

Gastric carcinoma is a common malignant disease associated with an unfavorable prognosis in the case of late dia-gnosis. The most significant precancerous condition is chronic atrophic gastritis and intestinal metaplasia caused by Helicobacter pylori infection. These longlasting changes may lead to formation of dysplastic precancerous lesions. Upper endoscopy and histologic examination of forceps bio-psy specimens play a key role in the dia-gnosis of gastric precancerous conditions and lesions. Helicobacter pylori eradication therapy and endoscopic surveillance are main therapeutic modalities of gastric precancerous conditions. Localized precancerous lesions and early gastric neoplasia without the risk of lymphatic spread could be cured by means of endoscopic resection techniques.

Endoscopic Perspective in Cholangiocarcinoma Diagnostic Process.

Cholangiocarcinoma is a malignancy arising from the epithelial lining of the intrahepatic or extrahepatic biliary tract. Timely diagnosis is challenging due to its silent clinical course. As reliable laboratory markers are lacking, diagnostic imaging plays a pivotal role. While cross-sectional imaging studies are usually conclusive for intrahepatic lesions, endoscopy plays an essential role in cases of extrahepatic tumors. Rational utilization of different diagnostic methods based on available evidence is needed. This article focuses on the diagnostic role of advanced biliary endoscopy, including endoscopic retrograde cholangiopancreatography, cholangioscopy, endoscopic ultrasonography, and intraductal sonography.