Impact of Serum Glucose Levels on Outcomes in Acute Pancreatitis: A Retrospective Analysis.

Background and Objectives: The risk of developing glycemic dysregulation up to overt diabetes mellitus (DM) after an episode of acute pancreatitis (AP) is increasingly being analyzed. We aimed to assess the changes in serum glucose levels associated with the first episode of AP, as well as the impact of dysglycemia on outcomes such as the severity of inflammation, the length of hospitalization, mortality, and the persistence of hyperglycemia at follow-up. Materials and Methods: All patients experiencing their first episode of AP, who presented to the Emergency Room (ER) between 1 January 2020 and 31 December 2023, were retrospectively included. On-admission serum glucose and peak serum glucose during hospitalization were the biological markers used to assess glucose metabolism impairment, and they were correlated with outcomes of AP. Results: Our study included 240 patients, 46.67% (112 patients) having a biliary etiology for an AP flare. Patients with COVID-19-associated AP exhibited the highest on-admission and peak serum glucose levels (244.25 mg/dL and 305.5 mg/dL, respectively). A longer hospital stay was noted in patients with peak serum glucose levels of ≥100 mg/dL (9.49 days) compared to normoglycemic patients (6.53 days). Both on-admission and peak glucose levels were associated with elevated CRP levels during hospitalization. A total of 83.78% of patients who received antibiotics exhibited on-admission hyperglycemia, and 72.07% had peak serum glucose levels of ≥100 mg/dL. The presence of hyperglycemia at follow-up was associated with both on-admission and peak serum glucose levels of ≥100 mg/dL, as well as with a longer stay, higher CRP levels, and antibiotic use during index admission. Conclusions: On-admission hyperglycemia predicts a higher inflammatory response in patients at the first episode of AP, while the presence of hyperglycemia during hospitalization is associated with imaging and biological severity and longer hospitalizations, indicating a more severe disease course. Both on-admission and peak in-hospital hyperglycemia were identified as risk factors for sustained hyperglycemia at follow-up.

Endoscopic Treatment of Benign Esophageal Fistulas Using Fully-covered Metallic Esophageal Stents.

Non-malignant esophageal fistulas have a wide spectrum of clinical and pathological features and it`s important to learn to detect and treat them, due to significant morbidity, mortality and costs. The need for minimally invasive, efficient and also quick procedures is imperative. Esophageal stenting using fully-covered expandable stents has become an increasingly preferred option and addresses to fistulas which arise from 2-3 cm beyond Killian's mouth and up to the gastroesophageal junction. The long-term purpose of the procedure is closure of the fistula and thus healing. A second goal would be avoiding the complications generated by long-term wearing of the stent, such as gastrointestinal perforation and stenosis. OBJECTIVES: This review focuses on the efficacy of fully-covered metallic stents in treating benign esophageal fistulas. To this effect, we performed a retrospective study on 21 patients admitted in our clinic between January 2014 and April 2017 for non-malignant esophageal fistulas. The selection criteria were the following: post-operative fistulas (gastric sleeve, fundoplication for transhiatal gastric hernia, even malignancies for which surgical tumor removal was performed), foreign body acquired fistulas, post-traumatic fistulas. Esophago-jejunal anastomotic fistulas were also included in the study (following complete gastrectomy). Results: The efficacy of esophageal stenting was proven in 76% of the cases, resulting in fistula closure. The rest of the patients either didn't achieve fistula closure or couldn't tolerate the stent, calling for early removal of the prosthesis. Reintervention procedures such as stent repositioning or stent replacement (with higher diameter) were carried out in 42% of the cases. A percentage of 19% of the patients who achieved fistula closure developed esophageal stricture on stent-induced ulcers and needed recalibration stenting or esophageal Savary dilation. 22% of the cases needed surgical drainage for infected collections developed simultaneously. We recorded 2 deaths, unrelated to the stenting procedure. Patients who didn't acquire fistula closure were referred to thoracic surgery in good physical condition. Conclusions: Fully-covered metallic esophageal stents can be successfully used to treat benign esophageal fistulas. Follow-up of the patient in order to see if stent repositioning or replacement is needed is crucial. Special design esophageal stents are highly recommended and must not lack. Close cooperation with thoracic surgery is indispensable.