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.

/pdf/classification-of-acute-pancreatitis-2012-revision-of-the-608d2rjeud.pdf

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

Su1402 Post-ERCP Pancreatitis Following Orthotopic Liver Transplantation: The Mayo Clinic Experience

https://www.nature.com/articles/ajg2008318.pdf

Response to Dr. Matsushita et al.

https://www.cghjournal.org/article/S1542-3565(09)00799-X/pdf

Viral seeding of a percutaneous endoscopic gastrostomy tract from oral herpes.

Nonoperative Management of Pancreatic Fistula: Why Not an Endoscopic Approach?

We describe the case of a 63-year-old patient with end-stage renal disease who underwent endoscopic ampullectomy of a large ampullary adenoma. A side-viewing duodenoscope was utilized to evaluate the mass. A large frondlike villous mass, 40mm in diameter, was seen at the major papilla (▶Fig. 1). The mass was resected using a dedicated thin-wire braided snare (cold snare) in a piecemeal fashion, and retrieved with a retrieval net (▶Video 1). The snare deformed with repeated use and a total of four snares were required to complete the procedure. Following resection, the ventral pancreatic duct was deeply cannulated with a short-nosed traction sphincterotome and guidewire. There was no extension of the polyp into the pancreatic duct, and a temporary plastic stent was placed (▶Fig. 2). The patient tolerated the procedure without immediate complications. Pathology from the specimen revealed adenoma with high-grade dysplasia. Endoscopic ampullectomy is a safe and successful alternative to surgery for removal of selected ampullary adenomas. Recent studies have suggested that ampullary adenomas may be endoscopically removed either piecemeal or en bloc using electrocautery [1]. A recent study in Japan evaluated 136 patients with laterally spreading ampullary adenomas [2]. A single treatment session was possible in 104 (83.2%) of the 125 patients in the en bloc resection group and in 8 (72.7%) of the 11 in the piecemeal resection group. The total resection rate including additional treatments was 98.4% in the en bloc group and 100% in the piecemeal group. This suggests that piecemeal resection using electrocautery is comparable to en bloc resection. Cold snare resection of colonic polyps is gaining acceptance and there are reports of cold snare removal of large polyps [3]. To our knowledge this is the first case to date of successful cold snare ampullectomy in a patient at high risk for postprocedural bleeding.

/pdf/cold-snare-piecemeal-resection-of-a-large-ampullary-adenoma-1eitlm6c4u.pdf

Todd H. Baron

Papers

Su1402 Post-ERCP Pancreatitis Following Orthotopic Liver Transplantation: The Mayo Clinic Experience

Response to Dr. Matsushita et al.

Viral seeding of a percutaneous endoscopic gastrostomy tract from oral herpes.

Nonoperative Management of Pancreatic Fistula: Why Not an Endoscopic Approach?

Cold snare piecemeal resection of a large ampullary adenoma