| 1. |
- Ansari, Daniel, et al.
(författare)
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Safety of pancreatic resection in the elderly : a retrospective analysis of 556 patients
- 2016
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Ingår i: Annals of Gastroenterology. - : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 29:2, s. 5-221
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The safety of pancreatic resection for elderly patients is still controversial. We examined the postoperative morbidity and mortality in patients aged 75 years or more undergoing pancreatic resection.METHODS: Patients undergoing pancreatic resection were studied retrospectively and the outcomes were compared between patients aged <75 and ≥75 years.RESULTS: Of the 556 patients enrolled, 78 (14%) were ≥75 years old. Elderly patients had significantly more co-morbidities, especially cardiovascular pathology (P=0.005). Also, elderly patients had significantly lower body mass index prior to surgery (P=0.005). There were no significant differences in terms of surgical procedures and tumor types between age groups. The incidence of postoperative pancreatic fistula grade A was significantly lower in the elderly group (P=0.022), but no significant differences were noted in the overall morbidity or the incidence of postpancreatectomy hemorrhage, delayed gastric emptying, bile leakage, cardiac complications, pulmonary complications or septic complications. The 30-day mortality rate was similar between groups (0.8% vs. 1.3%; P=0.532).CONCLUSION: Pancreatic resection is a safe option for selected elderly patients. Our study confirms that age alone should not preclude potentially curative surgical therapy.
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| 2. |
- Byrling, Johannes, et al.
(författare)
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Outcome and evaluation of prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma
- 2017
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Ingår i: Annals of Gastroenterology. - : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 30:5, s. 571-577
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim of the present study was to examine the outcomes and prognostic factors after surgery with curative intent for distal cholangiocarcinoma during a modern timespan, in a Swedish tertiary referral center. Methods All patients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma between April 2008 and December 2015 were identified. Survival was estimated using the Kaplan-Meier analysis. Demographic, clinical, laboratory and histopathological data were evaluated for prognostic factors relating to mortality, using univariable and multivariable statistical analysis. Results Fifty-four patients were included. The mean age was 68±8 years and 21 (39%) of the patients were female. Jaundice was present at diagnosis in 73% of the patients. There was no 90-day mortality. Complications graded as Clavien-Dindo ≥3 occurred in 10 (19%) of the patients. Twenty-eight (52%) received adjuvant therapy. Overall survival rates at 1, 3, and 5 years were 80%, 21%, and 9.2%, respectively. Median survival was 22.2 months. The presence of lymph node metastases was found to be the only independent predictor of survival (hazard ratio 2.88, 95% confidence interval 1.22-6.84; P=0.016). The total number of lymph node metastases, lymph node ratio or total number of resected nodes did not improve the prediction. Conclusions We found that the recurrence rate was higher and the survival poorer after surgery for distal cholangiocarcinoma than has previously been reported. Lymph node status at the time of resection was the most important prognostic factor for survival in the current material.
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| 3. |
- Ek, Weronica E, et al.
(författare)
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The history of genetics in inflammatory bowel disease
- 2014
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Ingår i: Annals of Gastroenterology. - Athens, Greece : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 27:4, s. 294-303
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Forskningsöversikt (refereegranskat)abstract
- The influence of genetics in the etiology of inflammatory bowel disease (IBD) was initially demonstrated by epidemiological data, including differences in prevalence among different ethnic groups, familial aggregation of IBD, concordance in twins, and association with genetic syndromes. These early observations paved the way to molecular genetics in IBD, and culminated in the identification of nucleotide-binding oligomerization domain containing 2 (NOD2) gene as an IBD risk gene in 2001. As in other complex diseases, the advent of Genome Wide Association studies has dramatically improved the resolution of the IBD genome and our understanding of the pathogenesis of IBD. However, the complexity of the genetic puzzle in IBD seems more pronounced today than ever previously. In total, 163 risk genes/loci have been identified, and the corresponding number of possible causal variants is challenging. The great majority of these loci are associated with both Crohn's disease and ulcerative colitis, suggesting that nearly all of the biological mechanisms involved in one disease play some role in the other. Interestingly, a large proportion of the IBD risk loci are also shared with other immune-mediated diseases, primary immunodeficiencies and mycobacterial diseases.
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| 4. |
- Hallerbäck, Bengt, et al.
(författare)
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A prospective nationwide study on the impact of the level of sedation on cannulation success and complications of endoscopic retrograde cholangiopancreatography
- 2020
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Ingår i: Annals of Gastroenterology. - : Hellenic Soc Gastroenterology. - 1108-7471 .- 1792-7463. ; 33:3, s. 299-304
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Tidskriftsartikel (refereegranskat)abstract
- Background: Difficult or unsuccessful cannulation of the papilla of Vater is associated with complications during endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to investigate whether deep sedation facilitates the cannulation and reduces the complication rate.Methods: Nationwide data from ERCP procedures were registered prospectively in the web-based Swedish Registry for Gallstone Surgery and ERCP (GallRiks). These data were used for a case-control study comparing the outcomes when using propofol sedation (PS) or basic sedation (BS) with midazolam in combination with opioids.Results: We analyzed 31,001 ERCP procedures in patients who had no previous ERCP. Of these, 14,907 were performed using PS and 16,094 using BS. The cannulation rate was higher in the PS group than the BS group: 89.0% vs. 86.7%, P<0.0001. The procedure time was longer in the PS group than in the BS group: 35.7 vs. 31.2 min, P<0.0001. The rate of intra-procedural complications was lower in the PS group than in the BS group: 2.9% vs. 3.7%, P<0.0001. The total frequency of post-procedural complications was 13.0% in the PS and 12.6% in the BS group (P=0.2607). The frequency of post-ERCP pancreatitis (PEP) was higher in the PS group than in the BS group: 4.6% vs. 4.0%, P=0.0136.Conclusions: PS in ERCP leads to a significantly higher cannulation success rate and fewer intra-procedural complications, but there was no significant difference in total post-ERCP complications. The procedure time was longer, and PEP was more common in the PS group. A plausible explanation could be that deep sedation might lead to more aggressive attempts to cannulate the papilla, resulting in a higher risk for PEP.
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| 5. |
- Kartalis, Nikolaos, et al.
(författare)
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Recent developments in imaging of pancreatic neuroendocrine tumors
- 2015
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Ingår i: Annals of Gastroenterology. - 1108-7471 .- 1792-7463. ; 28:2, s. 193-202
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatic neuroendocrine tumors (PNETs) are very rare, accounting for 1-2% of all pancreatic neoplasms. They are classified into functioning and non-functioning and their behavior varies widely from benign to highly malignant. For their investigation, a variety of anatomical and functional imaging methods are available. Anatomical methods include computed tomography (CT), magnetic resonance imaging, and ultrasonography. Functional methods include scintigraphy and positron emission tomography (PET). A combination of anatomical and morphological methods results in the so-called hybrid imaging, such as PET/CT. We herein discuss the currently available imaging modalities for the investigation of PNETs and, more specifically, their applications in tumor detection and staging as well as in choice of therapy, imaging follow up and prediction of response, with emphasis on the recent developments.
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| 6. |
- Koulaouzidis, Anastasios, et al.
(författare)
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Macroscopic findings in collagenous colitis : A multi-center, retrospective, observational cohort study
- 2017
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Ingår i: Annals of Gastroenterology. - : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 30:3, s. 309-314
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Tidskriftsartikel (refereegranskat)abstract
- Background Collagenous colitis (CC) is by definition a histological diagnosis. However, colonoscopy often reveals characteristic endoscopic findings. The aim of this study was to evaluate the frequency and type of endoscopic findings in patients diagnosed with CC in 4 participating centers. Methods This was a retrospective study; the databases of 2 university hospitals in Edinburgh (Scotland) and Malmö (Sweden), and 2 district general hospitals in Tomelloso (Spain) and Gateshead (England) were interrogated for patients diagnosed with CC between May 2008 and August 2013. Endoscopy reports and images were retrieved and reviewed; data on lesions, sedation, bowel preparation and endoscopist experience were abstracted. Categorical data are reported as mean±SD. Fischer’s exact, chi-square and t (unpaired) tests were used to compare datasets. A two-tailed P-value of <0.05 was considered statistically significant. Results 607 patients (149 male, mean age 66.9±12.25 years) were diagnosed with CC. A total of 108/607 (17.8%) patients had one or more suggestive endoscopy findings: i.e., mucosal erythema/edema, 91/607 (15%); linear colonic mucosal defects, 12/607 (2%); or mucosal scarring, 5/607 (0.82%). For colonic mucosa erythema, there was no difference in the odds of finding erythema with the use of different bowel preparation methods (P=0.997). For colonic mucosal defects there was some evidence (P=0.005) that patients colonoscoped by experienced endoscopists had 87% less odds of developing such defects. Moreover, there was evidence that analgesia reduced the odds of developing mucosal defects by 84%. Conclusion A significant minority of patients with CC have endoscopic findings in colonoscopy. The description of such findings appears to be related to the endoscopist’s experience.
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| 7. |
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| 8. |
- Spelt, Lidewij, et al.
(författare)
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Parenchyma-sparing hepatectomy (PSH) versus non-PSH for bilobar liver metastases of colorectal cancer
- 2018
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Ingår i: Annals of Gastroenterology. - : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 31:1, s. 115-120
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Tidskriftsartikel (refereegranskat)abstract
- Background Preoperative interventions have increased the resectability of colorectal cancer (CRC) liver metastases. This retrospective study compares outcomes after liver resection for bilobar CRC metastases between patients who underwent parenchyma-sparing hepatectomy (PSH), i.e., segmentectomies and smaller resections on both lobes, and those treated with non-PSH, i.e., hemihepatectomy plus any resection on the other lobe. Methods A cohort of 119 patients who underwent liver resection for bilobar CRC metastases were included. Perioperative course and long-term survival were compared between 59 patients who underwent PSH and 60 patients who underwent non-PSH. Statistical analyses were done using Pearson’s chi-square test, Fisher’s exact test and the Mann-Whitney U test. Overall survival analysis was performed by the Kaplan-Meier estimator and Cox regression analysis. Results The median number of liver metastases was 2 in patients treated with PSH and 3 in those treated with non-PSH (P<0.01). Postoperative mortality, severe complications and radicality did not differ significantly between groups. Median intraoperative bleeding was 250 mL for PSH and 600 mL for non-PSH (P<0.001). Median operation time and hospital stay were significantly shorter for PSH. Overall survival was comparable between groups, also after adjustment for covariates. Conclusions There were no significant differences in outcome, except for differences in bleeding, operation time and postoperative stay, favoring PSH. Furthermore, minimizing resection did not influence radicality. Hence, this study supports the use of PSH for bilobar CRC liver metastases when possible.
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| 9. |
- Svensson, Ellinor, et al.
(författare)
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The incidence of insulinoma in Western Sweden between 2002 and 2019
- 2022
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Ingår i: Annals of Gastroenterology. - : Hellenic Society of Gastroenterology. - 1108-7471 .- 1792-7463. ; 35:1, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Background Insulinoma is a rare pancreatic neuroendocrine neoplasm with an incidence of 0.7-4 cases per million/year. Because of its rarity, epidemiological studies on insulinoma are few and limited by small sample sizes. An increasing incidence of insulinoma has recently been suggested. The primary aim of this study was to investigate the incidence of insulinoma in the Vastra Gotaland Region (VGR) of Sweden. Secondary aims were to evaluate clinical characteristics, diagnostic workup, management and outcome in patients diagnosed with insulinoma. Methods Medical records were reviewed for all patients in the VGR who had received an ICD10 diagnosis code of a benign (D13.7) and/or a malignant (C25.4) tumor in the endocrine part of the pancreas, of hypoglycemia (E.161), and/or a code of a fasting test (AB011), from 2002-2019. Results Forty-two patients with insulinoma were identified, 37 of whom (20 men) were residents in the VGR at the time of diagnosis, giving a mean annual incidence of 1.3 cases per million/year. The mean (istandard deviation) age at diagnosis was 56118 years. Six of the 37 (16%) patients had metastatic insulinoma and 2 patients (5%) had a confirmed multiple endocrine neoplasia type 1 syndrome. At preoperative workup, computed tomography and endoscopic ultrasound detected an insulinoma in 28/36 (78%) and 21/21 (100%) cases, respectively. Conclusions Insulinoma remains a rare tumor in the modern era. The recorded mean annual incidence of 1.3 cases per million/year is compatible with the reported incidence in Sweden during the 1980s. Our results do not support an increasing incidence of insulinoma.
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