Is long-term follow-up solely by imaging tests safe in non-operated pancreatic neuroendocrine tumors?

Introduction: the diagnosis of asymptomatic sporadic nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) has increased significantly due to the widespread use of high-resolution imaging tests, which is why the most appropriate management at the time of diagnosis is the subject of debate, as is how to follow-up patients. Aims: the objective of this study was to analyze the frequency of imaging and endoscopic studies performed during long-term follow-up. Methods: a retrospective review was performed of a database collected between January 2008 and December 2020 of patients with an incidental diagnosis of small NF-PNETs; follow-up was closed in March 2023. The imaging tests performed at the time of diagnosis and long-term follow-up were recorded. Growing less than 1 mm per year has not been considered as a worrisome feature. Follow-up was performed through imaging tests, considering endoscopic cytology for lesions with a faster grow rate. Results: fifty-eight patients were included; the median age was 69 years. The initial mean size of the lesions studied was 12.79 mm (5-27). Follow-up was carried out only with computed tomography (CT) or magnetic resonance imaging (MRI). The initial size did not influence the behavior of the lesion in a statistically significant manner. Twenty-eight tumors (45 %) increased in size, with a growth equal to or less than 4 mm in 24 cases. The mean follow-up time was 82.41 months (12-164). No patient developed metastasis or died from PNET progression. Conclusions: the follow-up of neuroendocrine tumors of small size can be performed safely with only imaging tests. (AU)

Is long-term follow-up solely by imaging tests safe in non-operated pancreatic neuroendocrine tumors?

INTRODUCTION: the diagnosis of asymptomatic sporadic nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) has increased significantly due to the widespread use of high-resolution imaging tests, which is why the most appropriate management at the time of diagnosis is the subject of debate, as is how to follow-up patients. AIMS: the objective of this study was to analyze the frequency of imaging and endoscopic studies performed during long-term follow-up. METHODS: a retrospective review was performed of a database collected between January 2008 and December 2020 of patients with an incidental diagnosis of small NF-PNETs; follow-up was closed in March 2023. The imaging tests performed at the time of diagnosis and long-term follow-up were recorded. Growing less than 1 mm per year has not been considered as a worrisome feature. Follow-up was performed through imaging tests, considering endoscopic cytology for lesions with a faster grow rate. RESULTS: fifty-eight patients were included; the median age was 69 years. The initial mean size of the lesions studied was 12.79 mm (5-27). Follow-up was carried out only with computed tomography (CT) or magnetic resonance imaging (MRI). The initial size did not influence the behavior of the lesion in a statistically significant manner. Twenty-eight tumors (45 %) increased in size, with a growth equal to or less than 4 mm in 24 cases. The mean follow-up time was 82.41 months (12-164). No patient developed metastasis or died from PNET progression. CONCLUSIONS: the follow-up of neuroendocrine tumors of small size can be performed safely with only imaging tests.

"Hemosuccus pancreaticus:" an uncommon form of presentation of pancreatic intraductal papillary mucinous neoplasm.

"Hemosuccus pancreaticus" (HP), "wirsungorrhagia" or "pseudohemobilia" is a rare cause of upper gastrointestinal bleeding consisting of blood loss along the duct of Wirsung with exteriorization through the ampulla of Vater. Due to its rarity, the literature on HP is limited to retrospective studies, case reports, and case series.

Estudio de la calidad asistencial prestada en consultas externas a pacientes con cirrosis hepática / No disponible

INTRODUCCIÓN: la calidad de la asistencia prestada a los pacientes cirróticos se puede medir analizando una serie de indicadores. Los estudios publicados hasta la actualidad muestran una tasa de adherencia a las indicaciones de las guías clínicas del 40-80 %. OBJETIVO: valorar la calidad de la asistencia prestada en un hospital docente de tercer nivel. MÉTODOS: estudio observacional retrospectivo en pacientes cirróticos controlados durante un semestre en consultas externas. Se han revisado 324 historias clínicas recogiendo 14 indicadores de calidad de cinco dominios diferentes y se ha estudiado la adherencia global y en relación a la experiencia del médico responsable. RESULTADOS: excelentes (más del 90 % de adherencia) en indicadores relacionados con documentación de la etiología de la cirrosis y profilaxis de la hemorragia digestiva por varices; aceptables (60-90 %) en despistaje del carcinoma hepatocelular y valoración de la gravedad de la enfermedad; y malos (menos del 50 %) en vacunaciones. Los residentes obtuvieron significativamente mejores resultados que los adjuntos en etiología, valoración de la gravedad y dos indicadores de profilaxis de hemorragia digestiva. Por su parte, los adjuntos presentaron mejores resultados en el despistaje de carcinoma hepatocelular. CONCLUSIONES: a pesar de haber obtenido excelentes resultados en algunos indicadores, muchos deben ser mejorados, especialmente las vacunaciones. La calidad asistencial prestada por los residentes es igual o incluso mejor que la prestada por los adjuntos. Analizar la calidad asistencial es esencial para medir y mejorar la atención prestada a los pacientes cirróticos, y puede ser una herramienta muy eficaz para supervisar a los especialistas en formación

No disponible

Quality of care provided to outpatients with hepatic cirrhosis in a teaching hospital.

INTRODUCTION: a set of indicators to measure the quality of care of cirrhotic patients has been established and previously published studies report an adherence rate to clinical guide indications of 40-80 %. OBJECTIVE: to assess the adherence to quality indicators in a tertiary teaching hospital. METHODS: a retrospective observational study was performed of all cirrhotic outpatients seen during one semester in 2017. The charts were studied of 324 patients and quality indicators related to five domains were collected. An overall adherence to 14 quality indicators was recorded and analyzed based on the attending physician's experience. RESULTS: the results were excellent (more than 90 % adherence) for quality indicators related to prophylaxis of variceal bleeding and documentation of cirrhosis etiology, acceptable (60-90 % adherence) for hepatocellular carcinoma screening and disease severity assessment, and poor (less than 50 %) for vaccinations. Residents had significantly better results than experienced physicians in etiology, disease severity assessment and two indicators of prophylaxis of bleeding. Experienced physicians only presented a better adherence to hepatocellular carcinoma screening. CONCLUSIONS: despite excellent results for some quality indicators, most required improvement, especially vaccinations. The quality of care achieved by residents is equal to and even better than that of experienced physicians. Measuring quality of care is essential to analyze and improve the health care of cirrhotic outpatients and may be a useful tool for supervising specialists in training.