Managing Incidental Pancreatic Cysts.

PURPOSE OF REVIEW: The goal of this review is to critically analyze the current literature regarding the management of incidental pancreatic cysts. Given their increased rates of detection due to the frequent use of cross-sectional imaging, correctly identifying the subset of high risk lesions that are appropriate for surgical resection is critical. However, the existing consensus and societal guidelines discussed in this review lack high quality data to create evidence-based recommendations, making achieving this important aim challenging. RECENT FINDINGS: Several recent studies have focused on the natural history of pancreatic cysts and defining the role of endoscopic ultrasound, which remains unclear. EUS-guided diagnostic tools include molecular analysis of obtained fluid; EUS-guided FNA, FNB, and intracystic forceps biopsy of the cyst wall; and confocal endomicroscopy. While their precise role in diagnosing pancreatic cystic neoplasms remains to be defined, they represent promising innovations that may play a future role in cyst assessment and management. Large, long-term, prospective studies of incidentally identified pancreatic cysts are essential to fully understand their natural history and potential for neoplastic progression. Given the absence of such data at present, an individualized patient approach is recommended.

Weight loss and improved quality of life with a nonsurgical endoscopic treatment for obesity: clinical results from a 3- and 6-month study.

BACKGROUND: The TransPyloric Shuttle™ (TPS) is a nonsurgical device that is endoscopically delivered to and removed from the stomach to treat obesity. The device consists of a large spherical bulb connected to a smaller cylindrical bulb by a flexible tether. The larger bulb prevents migration from the stomach, while the smaller bulb passes freely into the duodenum to position the TPS across the pylorus. Transpyloric positioning may delay gastric emptying, reducing caloric intake and enabling weight loss. The purpose of this feasibility study was to evaluate the safety and efficacy of the clinical procedure and device. METHODS: Twenty patients with a mean body mass index (BMI) of 36.0 kg/m(2) were assigned to 2 groups of 10 patients scheduled to have the device for 3 or 6 months. Primary outcomes included % excess weight loss (%EWL), % excess BMI loss (%EBMIL), % weight loss (%WL), and adverse events. RESULTS: Devices were deployed and retrieved in all patients with no complications. Three-month patients had mean %EWL of 25.1%, mean %EBMIL of 33.1%, and mean %WL of 8.9%. Six-month patients had mean %EWL of 41.0%, mean %EBMIL of 50.0%, and mean %WL of 14.5%. Early device removal occurred in 2 patients due to symptomatic gastric ulcerations, which resolved after device removal. CONCLUSIONS: The TPS is a promising technology that provides a, nonsurgical, ambulatory method for weight loss.