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Total Cholesterol Level for Assessing Pancreatic Insufficiency Due to Chronic Pancreatitis
( Kenji Hirano ),( Tomotaka Saito ),( Suguru Mizuno ),( Minoru Tada ),( Naoki Sasahira ),( Hiroyuki Isayama ),( Miho Matsukawa ),( Gyotane Umefune ),( Dai Akiyama ),( Kei Saito ),( Shuhei Kawahata ),( 대한소화기학회 2014 Gut and Liver Vol.8 No.5
Background/Aims: To determine the nutritional markers important for assessing the degree of pancreatic insufficiency due to chronic pancreatitis in routine clinical practice. Methods: A total of 137 patients with chronic pancreatitis were followed up for more than 1 year. They were divided into two groups: a pancreatic diabetes mellitus (DM) group, consisting of 47 patients undergoing medical treatment for DM of pancreatic origin, and a nonpancreatic DM group, consisting of 90 other patients (including 86 patients without DM). Serum albumin, prealbumin, total cholesterol, cholinesterase, magnesium, and hemoglobin were compared between the two groups. Results: The total cholesterol was significantly lower in the pancreatic than the nonpancreatic DM group (164 mg/dL vs 183 mg/dL, respectively; p=0.0028). Cholinesterase was significantly lower in the former group (263 U/L vs 291 U/L, respectively; p=0.016). Among the 37 patients with nonalcoholic pancreatitis, there was no difference in the cholinesterase levels between the pancreatic and nonpancreatic (296 U/L vs 304 U/L, respectively; p=0.752) DM groups, although cholesterol levels remained lower in the former (165 mg/dL vs 187 mg/dL, respectively; p=0.052). Conclusions: Cholinesterase levels are possibly affected by concomitant alcoholic liver injury. The total cholesterol level should be considered when assessing pancreatic insufficiency due to chronic pancreatitis. (Gut Liver 2014;8:563-568)
( Kazumichi Kawakubo ),( Hiroyuki Isayama ),( Yousuke Nakai ),( Naoki Sasahira ),( Hirofumi Kogure ),( Takashi Sasaki ),( Kenji Hirano ),( Minoru Tada ),( Kazuhiko Koike ) The Editorial Office of Gut and Liver 2012 Gut and Liver Vol.6 No.3
Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both bili-ary and duodenal self-expandable metal stent placement is necessary to palliate their symptoms, but it was difficult to cross two metal stents. Recently, endoscopic ultrasonogra-phy-guided choledochoduodenostomy (EUS-CDS) was report-ed to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simul-taneous duodenal metal stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered metal stent was placed across the duodenal stricture, EUS-CDS was per-formed. The second case was a 63-year-old man who previ-ously had a covered metal stent placed for malignant biliary obstruction. After removing the previously placed metal stent, EUS-CDS was performed. Then, a duodenal covered metal stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from stent occlusion. EUS-CDS combined with duodenal metal stent placement may be an ideal treatment strategy in pa-tients with pancreatic cancer with both duodenal and biliary malignant obstruction. (Gut Liver 2012;6:399-402)
Yousuke Nakai,Tatsuya Sato,Ryunosuke Hakuta,Kazunaga Ishigaki,Kei Saito,Tomotaka Saito,Naminatsu Takahara,Tsuyoshi Hamada,Suguru Mizuno,Hirofumi Kogure,Minoru Tada,Hiroyuki Isayama,Kazuhiko Koike 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.3
Endoscopic management of bile duct stones is now the standard of care, but challenges remain with difficult bile duct stones. There are some known factors associated with technically difficult bile duct stones, such as large size and surgically altered anatomy. Endoscopic mechanical lithotripsy is now the standard technique used to remove large bile duct stones, but the efficacy of endoscopic papillary large balloon dilatation (EPLBD) and cholangioscopy with intraductal lithotripsy has been increasingly reported. In patients with surgically altered anatomy, biliary access before stone removal can be technically difficult. Endotherapy using two new endoscopes is now utilized in clinical practice: enteroscopy-assisted endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided antegrade treatment. These new approaches can be combined with EPLBD and/or cholangioscopy to remove large bile duct stones from patients with surgically altered anatomy. Since various endoscopic procedures are now available, endoscopists should learn the indications, advantages and disadvantages of each technique for better management of bile duct stones.