Volume 5, Issue 1

  • 2022, January

    editorial

    Worrisome Features for Intraductal Papillary Mucinous Neoplasm: Should We be Worried?Open Access

    PDF322.45 KB 322.45 KB
    Full-Text (HTML)
    Abstract [+]

    Although worrisome features represent an indication to perform endoscopic ultrasound study, recent studies have showed that these conditions are not strictly related to high risk of malignancy. Pancreatic resection for worrisome imaging features often demonstrates pathology consistent with low-grade dysplasia. Worrisome features should be considered as indicators of mostly
    low-grade dysplasia. High-risk stigmata are more consistent for diagnosis of malignant lesions.
    Keywords
    Worrisome features; High-risk stigmata; Intraductal papillary mucinous neoplasm (IPMN); Pancreatic neoplasm; Pancreatic high-grade dysplasia; Pancreatic low-grade dysplasia.


  • 2022, April

    case series

    Efficacy of Minimal Invasive Methods in Management of Traumatic Pancreatic InjuryOpen Access

    PDF452.70 KB 452.70 KB
    Full-Text (HTML)
    Abstract [+]

    Introduction
    Isolated pancreatic injury is relatively uncommon due to its mostly retroperitoneal location. However, if present, it is associated with other visceral injuries and causes serious complications if expected management is delayed.
    Cases
    In this report we have discussed about the different minimal invasive management approaches in two cases of pancreatic injury. The first case had American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) grade IV pancreatic injury with late presentation who underwent ultrasound-guided percutaneous drainage of pseudocyst with video assisted lavage of cavity, followed by endoscopic retrograde cholangiopancreatography (ERCP) guided pancreatic duct stenting. Second case had AAST-OIS grade II pancreatic injury which was managed with serial percutaneous drainage.
    Conclusion
    Management of pancreatic injury is complex. Evolving trend of minimal invasive techniques of management for selected patients with higher grade pancreatic injury is associated with better outcomes.
    Keywords
    Pancreatic injury; Minimal invasive; Serial drainage.


  • 2022, April

    review

    The Global Rise of Diabetes – Time to Think Seriously About Environmental Toxicants as Risk Factors for Development of the DiseaseOpen Access

    PDF548.81 KB 548.81 KB
    Full-Text (HTML)
    Abstract [+]

    Introduction
    It is now estimated that the number of people living with diabetes worldwide in 2045 will be approximately 783 million, rising much faster than the global population growth of about 20%. In addition to the traditional known host risk factors (life-style changes associated with urbanization, physical inactivity, obesity and aging), it is probably prudent to begin to give serious thought to exposure to environmental toxicants, either because of mere geographical location or because of human industrial activity, as possible significant contributors. This knowledge could raise awareness while prompting us to find new ways to protect people and the environment.
    Keywords
    Diabetes; Environmental toxicants; Dioxins; Arsenic; Cadmium.


  • 2022, April

    original research

    Clinical Profile and Management of Chronic Pancreatitis in Tertiary Care CentreOpen Access

    PDF368.59 KB 368.59 KB
    Full-Text (HTML)
    Abstract [+]

    Background
    Constant inflammation and irreversible pancreatic tissue destruction are hallmarks of the disease of chronic pancreatitis (CP), which results in the decrease of both exocrine and endocrine function over time. It is a multifactorial disease, with a wide range of symptoms and geographic variation.
    Aim
    Aim of this study is to study clinical profile and management of CP with respect to demography, clinical findings, lab parameters, imaging investigations and management modalities.
    Methods
    A cross-sectional observational study was conducted which included the patients admitted to the tertiary care center presenting with the clinical diagnosis of CP. The study was conducted over a period of 2-years from November 2019 to October 2021. A total sample size of 71 patients was included.
    Results
    In the study, it was observed that the majority of patients were in the age group of 51-60-years (47.89%) followed by 41-50-years (21.12%) mean age ranges from 56.54±12.63-years. The majority of patients were male (76.06%) and females were 23.94%. The distribution of patients according to aetiology showed that the majority of patients had aetiology of alcoholism (43.66%) followed by idiopathic (29.57%) Gall/Biliary stones (21.12%) and post-operative (5.63%). Majority of patients presented with pain in the abdomen (85.92%). The distribution of patients according to ultrasound sonography test (USG) findings showed that majority of patients shows pancreatic calcification (54.93%) followed by pancreatic pseudocyst (32.39%) and gall stones (19.72%). The distribution of patients according to computed tomography (CT) findings showed that majority of patients shows pancreatic calcification (70.42%). In the present study, it was observed that majority of patients were managed conservatively (43.66%) followed by cystogastrostomy (18.31%) and cystojejunostomy (8.45%). Endoscopic retrograde cholangiopancreatography (ERCP) was done among 14 (19.72%) patients. Lateral pancreaticojejunostomy was done in 6 (8.45%) patients and pancreaticoduodenectomy (Classical Whipple’s) was done in 4 patients (5.63%). The distribution of patients according to pain relief by various management showed that majority of getting relief from pain by surgery (69.23%) followed by ERCP (35.71%) and the least by conservative/analgesics (6.45%).
    Conclusion
    Chronic pancreatitis is progressive inflammatory disease. Alcoholic pancreatitis being most common etiology. Pain is most common presenting symptom. CT scan abdomen most useful in confirming diagnosis in our set up. Pseudocyst being common complication seen. Surgery gives relief of pain in most of the cases. The key to a better outcome is making the right decisions in terms of diagnosis, patient selection for surgery, and surgical type.
    Keywords
    Chronic pancreatitis; Inflammation; Etiology.


  • 2022, April

    short communication

    Tailored Endoscopic Approaches for Pancreatic Traumatic InjuriesOpen Access

    PDF274.52 KB 274.52 KB
    Full-Text (HTML)
    Abstract [+]

    Pancreatic traumatic injuries should be managed by multidisciplinary approach. Standard redo surgery can be avoided or supported by innovative mininvasive approaches both endoscopically and/or radiologically. Pancreatic endotherapy has an increasing role in the management of pancreatic injuries. Understanding the pathophysiology of pancreatic leak is crucial to guide the treatment. Endoscopic treatment must be tailored on the type and site of pancreatic fistula to achieve the optimal clinical outcome: there is not a one-way standard treatment but the best treatment for different types of pancreatic injuries considering both retrograde and endoscopic ultrasound (EUS)-guided approaches.
    Keywords
    Pancreatic fistula; Pancreatic traumatic injury; Endoscopic retrograde cholangiopancreatography (ERCP).