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Background: Traumatic pancreaticobiliary injuries are challenging to diagnose and manage. Endoscopic retrograde cholangiopancreatography (ERCP) has potential diagnostic and therapeutic utility in cases of traumatic pancreaticobiliary injuries. Methods: In this single-center retrospective study, we assessed 25 cases of abdominal trauma in which the patients underwent ERCP for management of suspected pancreaticobiliary injuries. We analyzed basic patient demographics, mechanism of trauma, method of diagnosis, ERCP results, surgical treatments, and outcomes. Results: Of the 25 assessed patients, 12 (48%) had pancreatic injuries, 12 (48%) had biliary injuries, and 1 (4%) patient had both. The median age was 28 years [IQR 25-35], and 84% of patients were males. Fifty-six percent of injuries were from blunt trauma, while 44% were from penetrating trauma. In cases of ERCP-confirmed biliary leaks (n=11), 100% of leaks were resolved in the 8 patients who underwent repeat ERCP after initial ERCP with stenting. In cases of ERCP-conirmed pancreatic duct leaks (n=10), 57% of duct leaks were resolved in the 7 patients who underwent repeat ERCP after initial ERCP with stenting. One patient in the biliary trauma cohort developed post-ERCP pancreatitis and sepsis. Conclusion: ERCP was a useful diagnostic and therapeutic intervention in this population of patients with pancreaticobiliary trauma. [ABSTRACT FROM AUTHOR]

Objective of the work: Pancreatic cancer (PC) is a deadly disease that is most commonly diagnosed at an incurable stage. Early diagnosis is the most important factor for improving prognosis. Evidence is beginning to accumulate that screening and surveillance may lead to the early detection of precursor lesions and/or pancreatic cancer in asymptomatic individuals. Proper screening methods and identification of such precursor lesions may enable effective pre-emptive interventions to prevent further fatalities. The primary objective of this project was to examine the feasibility of identifying precursor or early cancerous lesions in high-risk individuals by endoscopic ultrasound (EUS) screening to prevent the deaths from pancreatic cancer. Research aim: Pancreatic cancer screening guidelines, based on consensus opinions, have been applied in various tertiary centers around the world; however, evidence for effectiveness is lacking. At Rambam Health Care Campus, we have established a cohort of high-risk individuals, and we report our local 10-year experience results of screening for pancreatic cancer. Methods: Between 2008 and 2018, a cohort of 123 asymptomatic high-risk individuals came for annual/biannual EUS screening for pancreatic cancer. Retrospective and prospectively collected data were obtained, analyzed, and compared on the basis of several variables. These variables include age at beginning of screening, gender, smoking, obesity, diabetes, and presence of tumor markers, as well as the patients' personal and family history of cancers. Findings on each EUS are described. Results: Three patients out of 123 underwent potentially life-saving surgery as a result of this screening program. All of these three had only one first-degree relative (FDR) with pancreatic cancer at the time of their first screenings, but two eventually had a second FDR with PC. Findings from 296 EUS exams regarding smoking, obesity, and other risk factors are presented. Minor, possibly trivial, EUS findings are found to be common. Detection of precursor pancreatic lesions is feasible with EUS screenings. Conclusions: Adherence was an important limiting factor in screening. Better stratification of patients according to specific risk factors, including thorough genetics and family history, may direct when and how to initiate screening. International collaborations, such as the International Cancer of Pancreas Screening (CAPS) Consortium, of which Rambam is a collaborating partner, are needed to collate evidence for impact of screening to prevent pancreatic cancer morbidity and mortality, and are essential to achieve proof of concept. Different countries with varying health-care systems and budgets can find variance of appropriateness of screening procedures. [ABSTRACT FROM AUTHOR]