Video
Diagnostic Endosonography – Cystic lesions in the pancreas
Live endoscopy from the HSK Dr. Horst Schmidt Hospitals in Wiesbaden in collaboration with „Video Journal and Encyclopedia of GI Endoscopy“. Recording in the context of the Falk Symposium 185 „Interfaces and Controversies in Gastroenterology“ on October 3rd – 4th, 2012.
©2013 Elsevier. All rights reserved. With the friendly assistance of Falk Foundation e.V., Freiburg.
Presented by:
Erwin Günther, Wiesbaden, HSK Dr. Horst-Schmidt-Kliniken Germany;
Chris Mulder, Vrieje Universiteit Amsterdam, The Netherlands
Summary:
This is the case of a 54-year-old woman without any episodes of acute pancreatitis in her medical history. The patient suffered from intermittent epigastric pain for one year. Sonography and CT scan revealed a subtle cystic structure within the pancreatic head.
Here, a diagnostic endosonography is performed and the differential diagnosis of cystic lesions in the pancreas is discussed.
Take home messages:
- Endosonography is the most sensitive diagnostic tool to visualize small cystic lesions in the pancreas.
- The differential diagnosis in this case includes a serous cystic neoplasia, previously called serous cystadenoma, a mucinous cystic neoplasia, and an intraductal papillary mucinous neoplasia of the „branch duct“ type.
- While serous cystic neoplasias do commonly not progress to malignancy, intraductal papillary mucinous neoplasias are known to be precancerous lesions.
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Link to the video directly:
http://media.drfalkpharma.de/fileadmin/media/130502_pancratic_cyst_FINAL.mp4
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580 x 350 pixels
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Bowel
Watanabe T et al, Gut. 2014;63(3):409–14
Anti-tumor necrosis factor agents reduce non-steroidal anti-inflammatory drug-induced small bowel injury in rheumatoid arthritis patients.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26287
Shahedi K et al, Clin Gastroenterol Hepatol. 2013;11(12):1609–13
Only about 4% of patients with diverticulosis develop acute diverticulitis, contradicting the common belief that diverticulosis has a high rate of progression.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26288
Peyrin-Biroulet L et al, Gut. 2014;63(1):88–95
Half the patients under azathioprine and/or infliximab in clinical remission have endoscopic and/or C-reactive protein evidence of residual active Crohn’s disease, whereas other patients with endoscopic and C-reactive protein normalization have persistent clinical symptoms. Clinical symptoms as scored by CDAI are not a reliable measure of the underlying inflammation. Results from the SONIC-trial.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26289
Liver
Biliary Tracts
Werner JM et al, Gastroenterology. 2013;145(5):1026–34
HBs antigen vaccine-induced immunity protects against future infection but does not provide sterilizing immunity, as evidenced by HBcore- and polymerase-specific CD8+ T cells in vaccinated health care workers with occupational exposure to hepatitis B virus.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26290
Boonstra K et al, Hepatology. 2013;58(6):2045–55
Incidence and prevalence rates of primary sclerosing cholangitis are markedly lower and survival is much longer than previously reported.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26291
Sulkowski MS et al, N Engl J Med. 2014;370(3):211–21
Once-daily oral daclatasvir plus sofosbuvir is associated with approximately 90% rates of sustained virologic response among patients infected with hepatitis C virus genotype 1, 2, or 3, including patients with no response to prior therapy with telaprevir or boceprevir.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26292
Oesophagus
Stomach
Duodenum
El-Serag HB et al, Gut. 2014;63(2):220–9
Visceral abdominal obesity is associated with a significant increase in the risk of Barrett’s esophagus. GERD may mediate some of this association.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26293
Lam JR et al, JAMA. 2013;310(22):2435–42
Gastric acid inhibitor use is significantly associated with the presence of vitamin B12 deficiency.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26294
Schoepfer AM et al, Gastroenterology. 2013;145(6):1230–6
Eosinophilic esophagitis should be treated as early as possible to prevent esophageal strictures.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26295
Pancreas
Hart PA et al, Gut. 2013;62(12):1771–6
Autoimmune pancreatitis is a global disease which uniformly displays a high response to steroid treatment and tendency to relapse in the pancreas and biliary tree. Potential long-term sequelae include pancreatic duct stones and malignancy, however, they were uncommon during the study period and require additional follow-up.
Link:
http://www.drfalkpharma.de/index.php?L=1&id=18860#c26296
Current Falk literature:
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Therapy algorithm
autoimmune hepatitis
Author: H. Bantel
(6 pages)
Bu18e
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