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Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants: Lessons learned from single-balloon enteroscopy-assisted ERCP

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 509-514页

作者： rodrigo garcés-durán Laurent Monino Pierre H Deprez Hubert Piessevaux Tom G Moreels Department of Gastroenterology and Hepatology Universitécatholique de LouvainCliniques Universitaires Saint-LucAvenue Hippocrates 101200 BrusselsBelgium

Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(sBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 sBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary sBE-ERCP was performed in 34 patients and pancreatic sBE-ERCP in 17, including 5 with both indications. From a total of 106 sBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 sBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary sBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary sBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary sBE-ERCP), without serious adverse events. After sBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using sBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. sBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.

关键词： Enteroscopy Endoscopic retrograde cholangiopancreatography Pancreaticoduodenectomy surgically altered anatomy Whipple’s procedure

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Managament Wound Healing: The Importance of a Wound Clinic in Hospital Centers

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Modern Plastic surgery 2023年第4期13卷 118-125页

作者： Alfredo Chama naranjo Cuahutémoc Márquez Espriella Alberto Ignacio Cahuana Quispe Barbosa Villarreal Fernando Ana Priscila Campollo López Mauricio Gutiérrez Álvarez Carlos Emiliano garcía Córdova Jesús Ricardo garcía Corral Cuervo Vergara Marco Antonio Jorge Luis Rosales Becerra Dávila Díaz rodrigo Edgar Alan Guillen Martínez Marín Canto Miguel Eduardo Luis Arturo Herrera Lozano Ochoa Contreras Erick Cesar Martinez Villalobos Claudia nallely Cruz soto Randall Camacho Rodriguez Hayah Ricardo Alberto Pulido López Edwing Michel Jaimes durán Department of Plastic and Restrictive surgery Hospital Central Sur de Alta Especialidad Pemex Mexico City Mexico

Background: In clinical practice, acute and chronic wounds continue to be a challenge. Unfortunately, wound care is often inadequate or inappropriate. The implementation of wound clinics involving an interdisciplinary team for wound care and treatment yields favorable clinical outcomes as well as a reduction in economic expenses due to a higher rate of healing, a decrease in hospital stays, and a reduction in the number of readmissions. The establishment of wound clinics enhances the utilization of diagnostic, preventive, and therapeutic resources, improving the quality of life of patients and facilitating their reintegration into their normal lives. The objective is solely to describe the importance of wound clinics in the medical profession. Methods: A retrospective literature search was conducted to include articles no more than 10 years old that reported measures or results of the study in order to perform a literature review and describe the importance of wound clinics in medical practice. Results: A total of 7 articles were obtained with the inclusion criteria, the most recent being from the year 2023 and the oldest from 2013. Conclusion: An important area for improvement in the healthcare industry is the management and treatment of complex wounds. The establishment of wound clinics offers comprehensive and specialized care for both acute and chronic complex wounds with the goal of enhancing secondary illness patients’ prevention, treatment, and rehabilitation.

关键词： Wound Clinic Pressure Ulcer Chronic Wound Wound Healing Quality of Life

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