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Management of Pancreatic Diseases, An Issue of Gastroenterology Clinics of North America, E-Book

Management of Pancreatic Diseases, An Issue of Gastroenterology Clinics of North America, E-Book

Nuzhat A. Ahmad

(2016)

Additional Information

Abstract

This issue details the latest knowledge of early diagnosis, risk factors, limited surgical treatments, and novel therapies for pancreatic diseases. Clinicians will learn the most prognostic scoring systems for acute pancreatitis, review the basics for early management of the disease, and see how current practice guidelines have evolved. Advances in radiological imaging when applied to the pancreas have resulted in enhanced staging and improved selection for surgical intervention. Endoscopy of the pancreas via both ERCP and endoscopic ultrasound has led to unprecedented access and potential for non-operative intervention. Pancreatic surgery now takes advantage of both minimally invasive approaches and techniques learned from organ transplantation. These latest advances are addressed in this issue by key opinion leaders.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Management of Pancreatic Diseases i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITOR iii
AUTHORS iii
Contents vii
Preface: Advances in Management of Pancreatic Diseases\r vii
Advances in Management of Acute Pancreatitis\r vii
Pancreatic Pseudocysts: Advances in Endoscopic Management\r vii
Autoimmune Pancreatitis: An Update on Diagnosis and Management\r vii
The Role of Endoscopic Retrograde Cholangiopancreatography in Management of Pancreatic Diseases\r viii
Pancreatic Cystic Neoplasms: An Update\r viii
Islet Cell Tumors of the Pancreas\r viii
Imaging of the Pancreas\r viii
Screening for Pancreatic Cancer in High-risk Populations\r ix
Advances in Surgical Management of Pancreatic Diseases\r ix
Pancreas Transplantation in the Modern Era\r ix
GASTROENTEROLOGY\rCLINICS OF NORTH AMERICA x
FORTHCOMING ISSUES x
June 2016 x
September 2016 x
December 2016 x
RECENT ISSUES x
December 2015 x
September 2015 x
June 2015 x
Preface: Advances in Management of Pancreatic Diseases \r xi
Advances in Management of Acute Pancreatitis 1
Key points 1
INTRODUCTION 1
PREDICTING SEVERITY 2
FLUID RESUSCITATION 2
PHARMACOLOGIC STRATEGIES 3
Antibiotics 3
Emerging Pharmacologic Therapies 4
NONPHARMACOLOGIC STRATEGIES 5
Nutrition 5
Management of Underlying Etiology 5
Recurrence 5
SUMMARY 6
REFERENCES 6
Pancreatic Pseudocysts 9
Key points 9
INTRODUCTION 9
INDICATIONS FOR DRAINAGE 10
SURGICAL DRAINAGE 11
PERCUTANEOUS DRAINAGE 12
ENDOSCOPIC DRAINAGE 12
Transpapillary Drainage 13
Transmural Drainage Without Endoscopic Ultrasound Guidance 14
Endoscopic Ultrasonography–guided Transmural Drainage 15
Stent Placement 16
Walled-off Necrosis 18
CLINICAL OUTCOMES OF ENDOSCOPIC DRAINAGE OF PANCREATIC PSEUDOCYSTS 20
Comparison of Endoscopic, Percutaneous, and Surgical Drainage of Pancreatic Pseudocysts 21
Complications of Endoscopic Pseudocyst Drainage 22
SUMMARY AND APPROACH TO PANCREATIC PSEUDOCYSTS 23
REFERENCES 23
Autoimmune Pancreatitis 29
Key points 29
INTRODUCTION 29
Clinical Characteristics 30
Diagnostic Guidelines 30
The Japanese Pancreas Society guidelines 31
The HISORt guidelines 31
The Korean and Asian guidelines 31
The International Consensus Diagnostic Criteria guidelines 31
Pancreatic imaging 32
Serology 36
Other organ involvement 36
Histology 37
Diagnostic trial of corticosteroids 38
Evaluation of the International Consensus Diagnostic Criteria and other diagnostic criteria 38
Therapy 38
Corticosteroids 38
Immunomodulator drugs 39
SUMMARY 40
REFERENCES 40
The Role of Endoscopic Retrograde Cholangiopancreatography in Management of Pancreatic Diseases 45
Key points 45
BACKGROUND 45
ACUTE PANCREATITIS 46
Gallstone Pancreatitis 46
Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis 47
RECURRENT ACUTE PANCREATITIS 48
Pancreas Divisum 48
Sphincter of Oddi Dysfunction 50
CHRONIC PANCREATITIS 51
Pancreatic Duct Strictures 52
Pancreatic Duct Stones 53
Autoimmune Pancreatitis 54
PANCREATIC DUCT LEAKS 55
PANCREATIC CANCER 56
SUMMARY 57
REFERENCES 57
Pancreatic Cystic Neoplasms 67
Key points 67
INTRODUCTION 67
TYPES OF PANCREATIC CYSTIC NEOPLASMS 68
Serous Cystadenoma 68
Intraductal Papillary Mucinous Neoplasm 69
Mucinous Cystic Neoplasm 71
Solid Pseudopapillary Neoplasm 73
DISTINGUISHING BETWEEN CYSTIC NEOPLASMS 74
MANAGEMENT OF PANCREATIC CYSTS: REVIEW OF CURRENT GUIDELINES 74
Management of Cysts Less Than 3 cm 74
Management of Cysts Greater Than 3 cm 76
Indication for Surgery 77
Principles of Surgical Resection 78
Follow-Up After Surgery 78
Extrapancreatic Neoplasms in Patients with Intraductal Papillary Mucinous Neoplasms 78
SUMMARY 79
REFERENCES 79
Islet Cell Tumors of the Pancreas 83
Key points 83
INTRODUCTION 83
EPIDEMIOLOGY 83
SYNDROMIC ASSOCIATION 84
Multiple Endocrine Neoplasia Type I 84
Von Hippel-Lindau Syndrome 84
CLASSIFICATION AND STAGING 84
PATHOPHYSIOLOGIC MECHANISMS 85
CLINICAL PRESENTATION 86
Functional Tumors 86
Nonfunctional Tumors 87
DIAGNOSTIC EVALUATION 87
Laboratory Evaluation 87
Imaging 88
Computed tomography 88
MRI 88
Endoscopic ultrasound 88
Somatostatin-receptor scintigraphy 89
PET 89
TREATMENT 89
Surgery 90
Sporadic lesions 90
Enucleation 90
Central pancreatectomy 90
Pancreaticoduodenectomy and distal pancreatectomy 91
Treatment of hepatic metastases 91
Multiple Endocrine Neoplasia Type I–Associated Lesions 91
Systemic Therapy 92
Well-differentiated pancreatic neuroendocrine tumors 92
Hormonal excess and somatostatin analogues 92
Chemotherapy 93
Targeted molecular therapies 93
Tyrosine kinase inhibitors 93
Mammalian target of Rapamycin inhibitors 93
Bevacizumab 93
Peptide receptor radiotherapy 94
Poorly differentiated pancreatic neuroendocrine tumors 94
SUMMARY 94
REFERENCES 94
Imaging of the Pancreas 101
Key points 101
INTRODUCTION 101
RADIOLOGIC IMAGING OF THE PANCREAS 102
Solid Pancreatic Lesions 102
Pancreatic Cysts 103
ENDOSCOPIC ULTRASOUND SCAN 104
Solid Pancreatic Mass 104
Elastography 105
Contrast-enhanced endoscopic ultrasound scan 106
Endoscopic ultrasound scan fine-needle aspiration 107
Pancreatic Cysts 107
Probe-based confocal laser endomicroscopy 109
Chronic Pancreatitis 111
EMERGING TECHNOLOGIES 112
SUMMARY 112
REFERENCES 112
Screening for Pancreatic Cancer in High-risk Populations 117
Key points 117
INTRODUCTION 117
EPIDEMIOLOGY 118
Familial Pancreatic Cancer 118
Pancreatic Cancer Associated with Inherited Cancer Syndromes 119
Peutz-Jeghers syndrome 119
Familial atypical multiple mole and melanoma 119
Hereditary breast cancer 120
Lynch syndrome 120
Li-Fraumeni syndrome 120
Familial adenomatous polyposis 121
Ataxia-telangiectasia 121
Hereditary pancreatitis 121
GENETIC EVALUATION IN INDIVIDUALS AT RISK FOR HEREDITARY PANCREATIC CANCER 121
MANAGEMENT OF INDIVIDUALS AT RISK FOR PANCREATIC CANCER 122
Prevention Strategies to Reduce Cancer Risk 122
Screening for Early Detection of Pancreatic Cancer 122
Precursors of pancreatic adenocarcinoma 122
Outcomes of screening 122
Screening Modalities 123
Imaging 123
Biomarkers 123
Recommendations for pancreatic cancer screening 124
SUMMARY 124
REFERENCES 124
Advances in Surgical Management of Pancreatic Diseases 129
Key points 129
INTRODUCTION 129
PREOPERATIVE RISK STRATIFICATION IN PANCREATIC SURGERY 130
QUANTIFYING THE MORBIDITY OF POSTPANCREATECTOMY COMPLICATIONS 131
PANCREATIC FISTULA PREDICTION AND MITIGATION STRATEGIES 131
EXPANDING INDICATIONS FOR RESECTION OF PANCREATIC CYSTIC NEOPLASMS 133
BORDERLINE RESECTABLE PANCREATIC DUCTAL ADENOCARCINOMA (PDAC) 134
MINIMALLY INVASIVE PANCREATIC RESECTION 135
MINIMALLY INVASIVE PARADIGM FOR SURGICAL MANAGEMENT OF INFECTED PANCREATIC NECROSIS 137
EMERGING SURGICAL OPTIONS FOR THE MANAGEMENT OF CHRONIC PANCREATITIS 138
SUMMARY 139
REFERENCES 140
Pancreas Transplantation in the Modern Era 145
Key points 145
TRADITIONAL INDICATIONS FOR PANCREAS TRANSPLANTATION 145
CATEGORIES OF PANCREAS TRANSPLANTATION: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANTATION, PANCREAS AFTER KIDNEY TRANSPLANTA ... 147
EXPANDING INDICATIONS FOR PANCREAS TRANSPLANTATION 148
PRETRANSPLANT EVALUATION 149
Age and Body Mass Index 149
Cardiac Evaluation 150
Assessment of Peripheral Vascular Disease 150
Assessment of Insulin Requirements, C-peptide, and Autoimmunity 150
Assessment of Problematic Hypoglycemia 151
Kidney Function 151
Assessment of Autonomic Neuropathy 152
Assessment of Retinopathy 152
Screen for Availability of Living Donors 152
DONOR SELECTION 152
RECIPIENT OPERATION 154
IMMUNOSUPPRESSION 155
SURGICAL COMPLICATIONS AND PANCREAS REJECTION 156
IMPROVING OUTCOMES, BENEFIT TO QUALITY OF LIFE, AND END-ORGAN COMPLICATIONS 160
SUMMARY 162
REFERENCES 162
Index 167