This expert review provides crucial best practice guidance for managing ampullary adenomas, emphasizing improved endoscopic assessment and resection strategies to optimize patient outcomes. Ampullary adenomas can harbor malignancy in 20%-40% of cases; obtaining at least six biopsies is essential for accurate histopathological assessment. Use side-viewing duodenoscopes for better visualization and reduced pancreatitis risk during biopsy; […]
Category: HPB & Spleen
Early Acute Kidney Injury After Hepatectomy Increases Complications
Early acute kidney injury (AKI) post-hepatic surgery significantly raises the risk of major complications and lengthens hospital stays, making careful monitoring essential. In a cohort of 1,658 patients, 11% developed early AKI by postoperative day 2, leading to a median hospital stay of 5 days compared to 3 days for those without AKI (p < […]
Advanced Techniques for Difficult Biliary Cannulation Show Similar Outcomes
A study assessing advanced techniques for difficult biliary cannulation shows they are similarly effective, challenging the notion of a superior method in ERCP. Initial cannulation success rates were 72% for double-guidewire, 68% for transpancreatic sphincterotomy, and 68% for precut fistulotomy (p = .882); all techniques achieved 100% final success. Median cannulation times were comparable, with […]
Morphology-Based Surgery for Chronic Pancreatitis Varies Widely in Europe
A multicenter European study reveals significant variation in surgical approaches for chronic pancreatitis based on morphology, with no improvement in outcomes linked to guideline adherence. In this cohort of 207 patients, 90-day mortality was low at 1.4%, and 72.6% achieved pain relief at 6 months. Surgical techniques differed notably: duodenum-preserving resections were used most for […]
Impact of EUS on Cholangiocarcinoma Surgical Decisions
Endoscopic ultrasound (EUS) significantly influences surgical decisions in cholangiocarcinoma by identifying new findings, leading to 10% of patients being excluded from curative-intent surgery. Overall, EUS findings excluded patients from surgery 10% of the time, with 7% for perihilar cholangiocarcinoma. The incremental benefit of EUS over traditional imaging revealed a further 3% of patients with malignant […]
Endoscopic Submucosal Dissection for Ampullary Tumors Yields High Recurrence
Endoscopic submucosal dissection (ESD) effectively achieves en bloc resection of laterally spreading ampullary tumors, but significant recurrence remains a concern. Among 55 patients analyzed, the 3-year cumulative incidence of residual/recurrent tumors was 33%, with all recurrences confined to the papilla. Positive or indeterminate papillary ductal margins emerged as a leading risk factor, increasing the likelihood […]
Exosomal Biomarker Model Detects Occult Liver Metastasis in PDAC
A new circulating exosomal miRNA model shows promise for preoperatively identifying occult early liver metastasis (early-lim) in pancreatic cancer, which is linked to significantly poorer survival outcomes. Early-lim was associated with a median overall survival of only 9.1 months vs 26.6-31.8 months for other recurrence patterns (p < .001). The 7-exosomal miRNA model achieved an […]
Increased VTE Risk with AirSeal Insufflation in MIPD
Using the valveless AirSeal insufflation system during minimally invasive procedures is associated with a significantly higher risk of early postoperative venous thromboembolism (VTE). VTE occurred in 12 patients (8.5%), with rates of 16.7% in the AirSeal group compared to 4.3% in the standard group (p = 0.012). Symptoms were present in four out of five […]
Laparoscopic Liver Resection Outperforms Radiofrequency Ablation in Elderly
In elderly patients with solitary small hepatocellular carcinoma, laparoscopic liver resection leads to significantly better overall and disease-free survival compared to radiofrequency ablation, despite higher complication rates. Median overall survival for resection was not reached vs. 67.5 months for ablation (5-year: 65.7% vs. 50.0%; p = 0.005). Disease-free survival was also superior at 36.8 months […]
Intrathecal Morphine Offers Effective Pain Control Post-Pancreatectomy
A study shows that single-shot intrathecal morphine (ITM) is non-inferior to continuous wound infiltration (CWI) for pain management after open pancreatoduodenectomy, with a significant advantage in early pain control. ITM resulted in lower mean coughing pain scores at 2 hours (5.7 vs. 6.1) and maintained better pain scores at 24 hours, leading to reduced need […]