RESUMO
BACKGROUND AND AIMS: We sought to compare the efficacy and safety between endoscopic radiofrequency ablation (RFA) and stent placement alone in patients with unresectable extrahepatic biliary cancer (EBC). METHODS: In this randomized controlled trial, patients with locally advanced or metastatic cholangiocarcinoma (CCA) or ampullary cancer who were unsuitable for surgery were recruited from 3 tertiary centers. Eligible patients were randomly assigned to RFA plus plastic stent placement (RFA group) or plastic stent placement alone (stent placement alone group) in a 1:1 ratio. Both groups underwent 2 scheduled interventions with an interval of approximately 3 months. The primary outcome was overall survival (OS). RESULTS: Altogether, 174 participants completed the 2 index endoscopic interventions. No significant differences in baseline characteristics were noted between the 2 groups. The median OS was significantly higher in the RFA group (14.3 vs 9.2 months; hazard ratio, .488; 95% confidence interval, .351-.678; P < .001). A survival benefit was also shown in patients with CCA (13.3 vs 9.2 months; hazard ratio, .546; 95% confidence interval, .386-.771; P < .001). However, no significant between-group differences were found in jaundice control or stent patency duration. The postprocedural Karnofsky performance scores were significantly higher in the RFA group until 9 months (all P < .001). Adverse events were comparable between the 2 groups (27.6% vs 19.5%, P = .211), except for acute cholecystitis, which was more frequently observed in the RFA group (9 vs 0, P = .003). CONCLUSIONS: Compared with stent placement alone, additional RFA may improve OS and quality of life of patients with inoperable primary EBC who do not undergo systemic treatments. (Clinical trial registration number: NCT01844245.).
Assuntos
Ampola Hepatopancreática , Neoplasias dos Ductos Biliares , Ablação por Cateter , Neoplasias do Ducto Colédoco , Ablação por Radiofrequência , Ampola Hepatopancreática/cirurgia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Humanos , Plásticos , Qualidade de Vida , Stents , Resultado do TratamentoRESUMO
INTRODUCTION: Pancreaticopleural fistula (PPF) is a rare but serious complication of pancreatic disorders. As the clinical presentations of PPF are often deceptive, it can cause a delay in the timely diagnosis and proper treatment. PPF is extremely uncommon in pediatric patients, and diagnostic and management strategies for PPF among pediatric patients are scanty. PATIENT CONCERNS: A 12-year-old girl presented with cough and dyspnea owing to massive right-side pleural effusion confirmed by Chest X-ray. Biochemical examination of pleural effusion revealed a significant elevation of amylase level. Imaging modalities showed dilated pancreatic duct and fistulous tract connecting pancreatic duct and right thorax. DIAGNOSIS: Chronic pancreatitis with PPF was diagnosed. INTERVENTIONS: Medical therapy was initially attempted for 2 weeks. Endoscopic therapy with naso-pancreatic drainage tube placement was then performed without any complications after failed medical therapy. OUTCOMES: The patient has remained healthy and symptom-free during 2 years of follow-up. CONCLUSION: When pediatric patients presented with recurrent pleural effusion with unknown etiology, PPF should be taken into consideration. Pleural effusion amylase level is the most important laboratory test and magnetic resonance cholangiopancreatography is recommended to visualize the fistula. Optimal management of PPF should be based on pancreatic duct morphology.
Assuntos
Drenagem/métodos , Fístula Pancreática/cirurgia , Fístula do Sistema Respiratório/cirurgia , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/métodos , Feminino , Humanos , Masculino , Fístula Pancreática/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Fístula do Sistema Respiratório/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the T lymphocyte subgroups and the levels of serum zinc (Zn), selenium (Se), iron (Fe), copper (Cu) in patients with diarrhea type of irritable bowel syndrome (D-IBS). METHODS: A total of 30 D-IBS patients and 30 control subjects were enrolled in this study, and their peripheral blood samples were collected. The percentage of peripheral CD3, CD4, CD8 T lymphocytes were analyzed by flow cytometry, and the ratio of CD4/CD8 was calculated. Serum Zn, Fe and Cu levels were determined by atomic absorption spectrometry(AAS), and the Se level by atomic fluorometry. RESULT: Compared with control group,the percentage of CD4 T lymphocyte and the ratio of CD4/CD8 in D-IBS group were significantly lower (P<0.01). However, there was no significant difference in serum Zn, Se, Fe, Cu levels between two groups (P>0.05). CONCLUSION: The declines of peripheral blood CD4 T lymphocytes and the ratio of CD4/CD8 may suggest a cellular immune abnormality in D-IBS patients. There was no significant difference in trace elements levels between the two groups.
Assuntos
Síndrome do Intestino Irritável/sangue , Síndrome do Intestino Irritável/imunologia , Subpopulações de Linfócitos T/imunologia , Oligoelementos/sangue , Adulto , Relação CD4-CD8 , Estudos de Casos e Controles , Cobre/sangue , Diarreia/etiologia , Feminino , Humanos , Ferro/sangue , Síndrome do Intestino Irritável/complicações , Masculino , Pessoa de Meia-Idade , Selênio/sangue , Zinco/sangueRESUMO
Endoscopic pancreatic stenting has been widely used in various pancreatic conditions. With the increasing use of pancreatic stents, many complications have been recognized. Especially, proximal stent migration presents a serious condition because of subsequent pancreatic duct obstruction, impaired drainage, ductal dilation, and pancreatic pain. Although endoscopic retrieval is the preferred treatment for proximally migrated pancreatic stents, it is not always successful, resulting in conversion to surgery. To date, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has never been reported for treatment of pancreatic duct obstruction caused by proximally migrated pancreatic stent. We herein describe a case of pancreatic duct rupture and obstruction caused by proximally migrated pancreatic stent that was successfully treated by EUS-guided pancreaticogastrostomy while keeping the former stent in situ after failed endoscopic retrograde cholangiopancreatography. We believe that this report adds to the increasing evidence of symptomatic pancreatic duct obstruction being successfully treated by EUS-PD.
RESUMO
Heterotopic pancreas (HP) is a relatively uncommon entity that is defined as pancreatic tissue without a true anatomical or vascular connection to the pancreas. HP does not cause symptoms in most cases but can occasionally produce various manifestations, including nausea, vomiting, abdominal pain, and even heterotopic pancreatitis. Here, we report an unusual case in which heterotopic pancreatitis complicated by the formation of a pseudocyst that caused gastric outlet obstruction was diagnosed based on serum hyperamylasemia and findings from endoscopic ultrasonography (EUS)-guided fine needle aspiration (EUS-FNA) cytology. EUS-guided single pigtail stent insertion was successfully performed for recurrent gastric outlet obstruction. The patient has remained healthy and symptom-free during 4 years of surveillance. In the context of the relevant literature, the described case is a rare case of HP complicated by a pseudocyst treated via EUS-FNA and stent insertion.
Assuntos
Coristoma/complicações , Cistos/cirurgia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Obstrução da Saída Gástrica/cirurgia , Pâncreas , Pancreatite/complicações , Gastropatias/complicações , Dor Abdominal/etiologia , Adulto , Coristoma/diagnóstico por imagem , Coristoma/patologia , Cistos/diagnóstico por imagem , Cistos/etiologia , Cistos/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Obstrução da Saída Gástrica/diagnóstico por imagem , Obstrução da Saída Gástrica/etiologia , Humanos , Masculino , Náusea/etiologia , Pancreatite/diagnóstico por imagem , Pancreatite/patologia , Stents , Gastropatias/diagnóstico por imagem , Gastropatias/patologia , Sucção/métodos , Tomografia Computadorizada por Raios X , Vômito/etiologiaRESUMO
BACKGROUND: Nonalcoholic fatty liver disease (NAFLDéis a common chronic liver disease in China, of which diabetic fatty liver (DFLéaccounts for a large proportion in clinic. DFL is a disease without specific clinical features and lacking of confirmatory laboratory tests, and the etiology of hepatic steatosis remains poorly understood. The aim of this paper was to explore the clinical characteristics and to determine associated risk factors in type 2 diabetes patients with fatty liver. METHODS: A total of 166 patients, 53 in DFL group and 113 in NDFL (diabetes without fatty liverégroup participated in this study. Serum fasting blood glucose (FBG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphate (AKP), gamma glutamyl transpeptidase (GGT), total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C)were measured in both groups. And these variables were analyzed by using Student's t test and logistic regression model. RESULTS: A progressive increase in the level of FBG, ALT, AST, AKP, GGT, TG (P < 0.05) and a decrease of HDL-C (P < 0.01) were observed from DFL group to NDFL group. And there was no statistical difference in the level of TC between the two groups. CONCLUSIONS: Dyslipidemia, dysglycemia and elevation of liver enzyme can be seen more frequently in the DFL patients than in the NDFL patients. The successive escalation of serum ALT and TG levels and the lower HDL-C level are the independent risk factors of DFL.