https://www.medpagetoday.com/upload/2014/3/3/02536-1.pdf

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

Background and objective The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. Methods A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. Results The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. Conclusions This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.

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Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus

Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN, FAHA, Biykem Bozkurt, MD, PhD, FACC, FAHA, Ralph G. Brindis, MD, MPH, MACC, Mark A. Creager, MD, FACC, FAHA[§§][1], Lesley H. Curtis, PhD, FAHA, David DeMets, PhD,

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

BACKGROUND In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer. METHODS We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group). RESULTS Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6). CONCLUSIONS These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.)

/pdf/colonoscopic-polypectomy-and-long-term-prevention-of-26sw5itn6w.pdf

Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths

We report the successful closure of fistulae at the site of a benign colocolonic anastomotic stricture using self-expandable metal stents (SEMS). The stricture and fistulae developed after sigmoid colon resection for diverticulitis. After closure of the fistulae with a covered stent and resolution of inflammation, 10 months later the patient elected to undergo one-stage resection of the diseased colon and stent. Although there have been previously reported cases of SEMS for closure of malignant colonic fistula, there are limited reports of SEMS for closure of benign colonic fistulae and none demonstrate long-term success. We conclude that this patient exemplifies the potential applications of SEMS as definitive therapy for benign colorectal disease.

Endoscopic treatment of a benign colocutaneous and enterocolic fistula by insertion of overlapping self‐expandable metal stents

A 39-year-old male presented 9 months prior with acute alcoholic necrotizing pancreatitis. A 21 cm × 7cm walled-off pancreatic necrosis (WOPN) developed with main pancreatic duct disruption and upstream pancreatic ductal disconnection. A percutaneous pigtail drain was placed. After resolution of the collection, high volume output from the pancreaticocutaneous fistula remained. Endoscopic retrograde cholangiopancreatography showed complete main pancreatic duct obstruction [Figure 1]. A prophylactic pancreatic stent was placed. Contrast injection through the percutaneous drain filled the upstream pancreatic duct. EUS-guided internalization was undertaken. A linear echoendoscope (Olympus GFUCT-180, Center Valley, PA, USA) was positioned in the stomach. Endosonographically, the pigtail drain was visualized [Figure 2]. The residual cavity, marked by the internal pigtail was punctured transgastrically with a 19-gauge fine-needle aspiration needle (Expect, Boston Scientific, Marlborough, MA, USA) [Figure 3]. A 0.035” guidewire (450 cm Hydra Jagwire, Boston Scientific) was advanced through the needle and passed out the percutaneous tract. The gastric wall was balloon dilated to 6 mm (HurricaneTM, Boston Scientific) [Figure 4]. The echoendoscope was removed; a standard side-viewing endoscope was introduced alongside the initial wire. A second guidewire was advanced and coiled inside the pigtail cavity [Figure 5]. The pancreaticogastrostomy was then stented with two 7 Fr 3 cm double pigtail stents [Figure 6]. The patient’s percutaneous drain was removed during the procedure. The pancreaticocutaneous fistula output ceased several days later. There were no adverse events, and the patient was clinically well 4 months later.

Endoscopic ultrasound-guided internalization of a pancreaticocutaneous fistula without need for percutaneous manipulation.

Tu1738 Time of Day: A Predictor of ERCP Outcomes?

Endoscopic Balloon Dilation of Crohnʼs Disease Strictures: Safety, Efficacy and Clinical Impact: 685

https://www.giejournal.org/article/S0016-5107(05)00601-2/pdf

Todd H. Baron

Papers

Endoscopic treatment of a benign colocutaneous and enterocolic fistula by insertion of overlapping self‐expandable metal stents

Endoscopic ultrasound-guided internalization of a pancreaticocutaneous fistula without need for percutaneous manipulation.

Tu1738 Time of Day: A Predictor of ERCP Outcomes?

Endoscopic Balloon Dilation of Crohnʼs Disease Strictures: Safety, Efficacy and Clinical Impact: 685

The Frequency, Severity, and Spectrum of Adverse Events Associated with Direct Percutaneous Endoscopic Jejunostomy (DPEJ)