Advances in the Diagnosis and Treatment of Pancreatic Diseases, An Issue of Gastroenterology Clinics Vol 36 Issue 2

Cover......Page 1
Preface......Page 2
Epidemiology of alcohol use and smoking in the United States and selected European countries......Page 4
Epidemiology of alcoholic pancreatitis......Page 6
Risk of alcoholic pancreatitis with increasing alcohol use......Page 9
Smoking......Page 10
Race......Page 11
Alcohol Metabolizing Enzymes......Page 12
Role of CFTR, PRSS-1, and SPINK-1 mutations......Page 13
Model for alcoholic pancreatitis......Page 14
Is acute pancreatitis caused by alcohol more severe than other etiologies?......Page 16
Summary......Page 17
References......Page 18
Autoimmune Pancreatitis......Page 24
Clinical features of autoimmune pancreatitis......Page 25
Imaging studies in autoimmune pancreatitis......Page 26
Serologic markers in autoimmune pancreatitis......Page 27
Histopathology of autoimmune pancreatitis......Page 30
Pathophysiology of autoimmune pancreatitis......Page 33
Diagnostic criteria for autoimmune pancreatitis......Page 34
Summary......Page 37
References......Page 38
Incidence, Risk Factors, and Prevention of Post-ERCP Pancreatitis......Page 43
Mechanisms of post-endoscopic retrograde cholangiopancreatography pancreatitis......Page 45
High-risk patients......Page 46
High-risk endoscopic techniques......Page 48
Endoscopic techniques that reduce post-endoscopic retrograde cholangiopancreatography pancreatitis......Page 50
Pharmacologic prophylaxis......Page 52
Factors influencing the magnitude of inflammatory response......Page 55
Future directions......Page 57
References......Page 58
Risk and Markers of Severe Acute Pancreatitis......Page 61
Recent insights in the pathophysiology of severe acute pancreatitis......Page 62
Monocyte Chemotactic Protein-1......Page 63
Glutathione-S- Transferase-Theta-1......Page 64
Cytokine Polymorphisms as Disease Severity Modifiers......Page 65
Predictors of severe outcome......Page 66
Routine Laboratory Data as Predictors of Pancreatic Necrosis and Mortality......Page 67
Markers of the Inflammatory Response......Page 68
Cytokines and Surface Receptors......Page 71
Pancreatic Zymogens and Enzymes......Page 72
Combination of Serum Markers......Page 73
Summary......Page 74
References......Page 75
Nutrition Support in Severe Acute Pancreatitis......Page 81
Nutritional modulation of the inflammatory response......Page 82
Nutrition and its effect on gastrointestinal immunity......Page 84
Is no feeding an option?......Page 86
The problem with total parenteral nutrition and bowel rest......Page 87
Why enteral feeding is superior to total parenteral nutrition and bowel rest......Page 88
Is pancreatic rest important?......Page 89
Can enteral feeding be given without stimulating the pancreas?......Page 90
Does avoidance of pancreatic stimulation improve outcome?......Page 91
References......Page 93
Initial disease severity assessment and management......Page 97
Diagnosis of Pancreatic Necrosis: Role of Imaging......Page 98
The use of Prophylactic Antibiotics......Page 99
Nutrition......Page 101
Indications for Early Operative Intervention......Page 102
Management of the patient with severe pancreatitis: late-phase interventions......Page 103
Surgical Approaches, Timing, and Complications......Page 104
Summary......Page 105
References......Page 106
Genetic Counseling for Nonsyndromic Pancreatitis......Page 108
Cationic Trypsinogen......Page 110
Cystic Fibrosis Transmembrane Conductance Regulator......Page 111
Other modifier genes......Page 112
Indications for genetic testing for pancreatitis susceptibility......Page 113
References......Page 114
Pain in Chronic Pancreatitis and Pancreatic Cancer......Page 117
Pancreatic duct hypertension......Page 119
Pancreatic tissue pressure......Page 120
Neural alterations......Page 121
Medical Therapy......Page 125
Endoscopic Therapy......Page 127
Extracorporeal shock-wave lithotripsy......Page 128
Surgical treatment......Page 129
Neurolysis and nerve block......Page 131
‘‘Alternative’’ treatments......Page 133
Outcome assessment......Page 137
Summary......Page 138
References......Page 139
Cystic teratoma......Page 147
Inflammatory......Page 148
Serous (microcystic) cystadenoma......Page 150
Mucinous cystic neoplasm (mucinous cystadenoma and cystoadenocarcinoma)......Page 152
Cystic islet cell tumor......Page 155
Summary......Page 156
References......Page 157
Pathologic features......Page 159
Clinical presentation......Page 162
Endoscopic retrograde cholangiopancreatography......Page 163
CT and magnetic resonance cholangiopancreatography......Page 164
Management......Page 166
Surveillance......Page 169
References......Page 170
Multimodality Therapy for Pancreatic Cancer......Page 173
Surgical resection of pancreatic cancer......Page 174
Recurrence after R0 surgical resection......Page 176
Indications for neoadjuvant therapy......Page 177
Current status of adjuvant therapy......Page 178
Risks and Benefits of Neoadjuvant Therapy......Page 179
Neoadjuvant Therapy for Locally Advanced Disease (Stage III-T4 Tumors)......Page 182
Large Scale Trials of Neoadjuvant Therapy......Page 184
Novel therapies: immunotherapy, targeted therapy, and vaccines......Page 186
Summary......Page 187
References......Page 188
Early Detection and Staging of Adenocarcinoma of the Pancreas......Page 194
Current Use of Screening Tests for Pancreatic Adenocarcinoma in High-Risk Individuals......Page 195
Available serum markers for early detection of pancreatic cancer......Page 197
CT Scanning......Page 200
Endoscopic Ultrasound......Page 203
Positron Emission Tomography......Page 204
Endoscopic Retrograde Cholangiopancreatography......Page 205
Summary......Page 206
References......Page 207
Pancreatic Endocrine Tumors......Page 211
PET diagnosis and localization......Page 212
PET prognostication......Page 213
Treatment......Page 214
References......Page 216
Minimally Invasive Treatment of Pancreatic Disease......Page 220
Acute pancreatitis......Page 221
Chronic pancreatitis......Page 222
Laparoscopic Staging and Palliation of Pancreatic Cancer......Page 224
Laparoscopic Treatment of Pancreatic Neoplasms......Page 228
References......Page 231
Endoscopic Palliation of Pancreatic Cancer......Page 234
Endoscopic Management of Biliary Strictures......Page 235
Plastic stents......Page 238
Metal stents......Page 239
Endoscopic versus Surgical versus Percutaneous Palliation for Malignant Biliary Obstruction......Page 241
Metal versus Plastic Stents......Page 242
Enteral Self-expandable Metal Stents......Page 243
Technique of Enteral Stenting......Page 244
Celiac Plexus Neurolysis......Page 246
Pancreatic Stenting......Page 247
Endoscopic Ultrasound-guided Placement of Fiducials for Cyberknife Radiotherapy......Page 248
Endoscopic Ultrasound-guided Placement of Gene Vectors (TNFerade)......Page 249
References......Page 250