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- Swahn, Fredrik, et al.
(författare)
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Endoscopic retrograde cholangiopancreatography with rendezvous cannulation reduces pancreatic injury
- 2013
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Ingår i: World Journal of Gastroenterology. - : Baishideng Publishing Group Inc.. - 1007-9327 .- 2219-2840. ; 19:36, s. 6026-6034
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To examine whether rendezvous endoscopic retrograde cholangiopancreatography (ERCP) is associated with less pancreatic damage, measured as leakage of proenzymes, than conventional ERCP. METHODS: Patients (n = 122) with symptomatic gallstone disease, intact papilla and no ongoing inflammation, were prospectively enrolled in this case-control designed study. Eighty-one patients were subjected to laparoscopic cholecystectomy and if intraoperative cholangiography suggested common bile duct stones (CBDS), rendezvous ERCP was performed intraoperatively (n = 40). Patients with a negative cholangiogram constituted the control group (n = 41). Another 41 patients with CBDS, not subjected to surgery, underwent conventional ERCP. Pancreatic proenzymes, procarboxypeptidase B and trypsinogen-2 levels in plasma, were analysed at 0, 4, 8 and 24 h. The proenzymes were determined in-house with a double-antibody enzyme linked immunosorbent assay. Pancreatic amylase was measured by an enzymatic colourimetric modular analyser with the manufacturer's reagents. All samples were blinded at analysis. RESULTS: Post ERCP pancreatitis (PEP) occurred in 3/41 (7%) of the patients cannulated with conventional ERCP and none in the rendezvous group. Increased serum levels indicating pancreatic leakage were significantly higher in the conventional ERCP group compared with the rendezvous ERCP group regarding pancreatic amylase levels in the 4- and 8-h samples (P = 0.0015; P = 0.03), procarboxypeptidase B in the 4- and 8-h samples (P < 0.0001; P < 0.0001) and trypsinogen-2 in the 24-hour samples (P = 0.03). No differences in these markers were observed in patients treated with rendezvous cannulation technique compared with patients that underwent cholecystectomy alone (control group). Post procedural concentrations of pancreatic amylase and procarboxypeptidase B were significantly correlated with pancreatic duct cannulation and opacification. CONCLUSION: Rendezvous ERCP reduces pancreatic enzyme leakage compared with conventional ERCP cannulation technique. Thus, laparo-endoscopic technique can be recommended with the ambition to minimise the risk for post ERCP pancreatitis. (C) 2013 Baishideng. All rights reserved.
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- Thorlacius, Henrik, et al.
(författare)
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Updated Swedish guidelines for endoscopic surveillance after colorectal polypectomy : [Nya riktlinjer: endoskopisk kontroll efter kolorektal polypektomi]
- 2022
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 119:46-47
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Tidskriftsartikel (refereegranskat)abstract
- These new guidelines are based on the recommendations published by European Society of Gastrointestinal Endoscopy (ESGE) in 2020. Low risk patients, i.e. after removal of 1-4 <10 mm adenomas with low grade dysplasia (irrespective of villous components), or any serrated lesion (hyperplastic polyp, sessile serrated lesion, or traditional serrated adenoma) <10 mm without dysplasia, are not recommended a surveillance colonoscopy. High-risk patients, i.e. after removal of at least one adenoma ≥10 mm or with high grade dysplasia or any serrated lesion ≥10 mm or with dysplasia, should undergo a surveillance colonoscopy after 3 years. If high-risk lesions are detected at surveillance colonoscopy, a 3-year repetition of the next endoscopic examination is recommended. If a high-risk patient has no high-risk lesions at surveillance colonoscopy, a 5-year period is recommended until the next surveillance colonoscopy. In general, follow-up should be terminated at 80 years of age.
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- Winsnes, Annika
(författare)
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Evaluating an experimental model consecutive to abdominal wall hernia repair outcome
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Abdominal wall hernia is a common surgically treated condition. Patients with primary umbilical hernia are operated with suture or mesh repair, but recurrence and complication rates have been debated.Larger abdominal wall hernias need implantation of reinforcing material for repair. Synthetic implants are dominating. In complex hernia cases neither synthetic nor biologic implants are optimal. A randomized controlled trial has revealed satisfactory results from autologous full thickness skin grafts (FTSGs) in onlay position. Further application intraperitoneally (IPOM) in laparoscopic surgery and for repair of parastomal hernia in humans, must be based on a translational concept including animal and morphologic studies since the IPOM position has not been evaluated systematically. This thesis aims to be a link in a translational chain, focused on establishing an experimental model for FTSG evaluation.Problem formulations: - Does synthetic mesh decrease the probability of recurrence and/or complications in primary umbilical hernia?- Can FTSG be evaluated for IPOM versus onlay position in a transgenic mouse model using luminescence from substrate activated by the enzyme luciferase expressed in donor tissue?- How does the FTSG in IPOM position perform compared to FTSG in onlay position?Results:Recurrence rate at a median of 6.8 years follow-up was 9% for suture- and 8% for mesh repair, odds ratio (OR) 0.9, 95% confidence interval (CI) 0.40-2.02, in 306 patients investigated patients. Surgical complications were in favor of suture repair, OR 6.6, 95% CI 2.29-20.38.In an experimental evaluation of FTSG, 20 mice received intervention with either onlay or IPOM graft. Survival of FTSG was revealed for 8 weeks by luminescence detection. All animals regained weight within 8 days in median. At sacrifice 8 weeks postoperatively, adhesions were evaluated by a modified Jenkins’ scale. No onlay mice displayed adhesions while two IPOM mice had firm and one dense adhesions. Inflammatory response evaluated in four animals expressing nuclear factor ĸB (NF-ĸB) showed a peak at day 2 and returned to stable low levels from day 5 until end of the 33-day follow up. FTSG in IPOM position showed similar morphology and immunohistochemistry stain patterns as controls in onlay position. There was a low expression of the inflammatory markers tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and myeloperoxidase. Vascular structures were visualized by von Willebrand factor-stain. In Picrosirius red stain, collagen bundles in dermis of FTSG in both IPOM and onlay position was thicker, compared to internal controls. FTSG extracellular matrix had metamorphosed mainly into thick collagen bundles, with partially degraded skin appendages. Matrix metalloproteinases (MMP)-stain from MMP-1, MMP-8 and MMP-9 were not co-distributed with their respective collagen substrates.Conclusions:Synthetic mesh does not decrease the probability of recurrence but significantly increase complications in repair of small umbilical hernia. FTSG can be evaluated in IPOM and onlay position in an experimental transgenic mouse model. The two positions were similar in terms of graft survival, few adhesions, micro-vessel formation, low grade inflammation, cyst formation and collagen distribution. FTSG implanted in IPOM position does not exhibit any systematic differences from onlay position, thus from this perspective no difference in biomechanical behavior can be anticipated.
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