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I. SCHEERS (1), G. ROEYEN (2), F. BERREVOET (3), I. HOFFMAN (4), A. LHOMME (5), O. BAURAIND (6), M. DELHAYE (7), P. DEPREZ (8) / [1] Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium, Pediatric gastroenterology, hepatology and nutrition, [2] Antwerp University Hospital, Edegem, Belgium, Hepatobiliary, Endocrine, and Transplantation Surgery, [3] Ghent University Hospital, Ghent, Belgium, General Hepatobiliary Surgery and Liver Transplantation, [4] UZ Leuven, Leuven, Belgium, Pediatric Gastroenterology and Nutrition, [5] CHR La Citadelle, , Belgium, Pediatric Gastroenterology, [6] Hopital CHC Liège, , Belgium, Pediatric Gastroenterology, [7] Erasme Hospital, Brussels, Belgium, Gastroenterology, Hepatopancreatology and Digestive Oncology, [8] Cliniques universitaires Saint-Luc, Brussels, Belgium, Gastroenterology and Hepatology Introduction Pancreatic trauma is the fourth most frequent cause of abdominal trauma in children. Few studies focused on the impact of trauma severity and therapeutic management (surgery vs endoscopy vs observation) on mid- and long-term outcomes. Aim The aim of this study was to determine the mid and long-term outcome of children with grade III-V pancreas trauma and correlate this data with the initial patient management. Methods The charts of 47 children aged <18 years admitted in one of the 7 participating Belgian tertiary Hospitals between 01/2010 and 01/2020 for an abdominal trauma involving the pancreas were retrospectively reviewed. Data about trauma characteristics, clinical symptoms, imaging, therapeutic management and short to long-term complications were recorded. Results We identified 25 patients (11/22, 50% boys) aged 2-17 years (median: 9,2y; IQR 7-12,4). Fourteen patients had a grade III trauma following AAST, 10 had a grade IV and 1 a grade V. In 8/25 (32%) patients, pancreas trauma was associated to another organ lesion. Clinical symptoms are nonspecific to diagnose pancreatic involvement: pain (23/24, 96%) and n

Background and Aims: Minimally invasive treatments of anastomotic benign biliary stricture (BBS) after orthotopic liver transplantation (OLT) include endoscopic placement of multiple plastic stents or fully covered self-expandable metal stents (FCSEMSs). No multiyear efficacy data are available on FCSEMS treatment after OLT. Methods: We prospectively studied long-term efficacy and safety of FCSEMS treatment in adults aged ≥18 years with past OLT, cholangiographically confirmed BBS, and an indication for ERCP with stent placement. Stent removal was planned after 4 to 6 months, with subsequent follow-up until 5 years or stricture recurrence. Long-term outcomes were freedom from stricture recurrence, freedom from recurrent stent placement, and stent-related serious adverse events (SAEs). Results: In 41 patients, long-term follow-up began after FCSEMS removal (n = 33) or observation of complete distal migration (CDM) (n = 8). On an intention-to-treat basis, the 5-year probability of remaining stent-free after FCSEMS removal or observation of CDM was 48.9% (95% confidence interval [CI], 33.2%-64.7%) among all patients and 60.9% (95% CI, 43.6%-78.2%) among 31 patients with over 4 months of FCSEMS indwell time. In 28 patients with stricture resolution at FCSEMS removal or observed CDM (median, 5.0 months indwell time), the 5-year probability of no stricture recurrence was 72.6% (95% CI, 55.3%-90%). Sixteen patients (39%) had at least 1 related SAE, most commonly cholangitis (n = 10). Conclusions: By 5 years after temporary FCSEMS treatment of post-OLT BBS, approximately half of all patients remained stent-free on an intention-to-treat basis. Stent-related SAEs (especially cholangitis) were common. FCSEMS placement is a viable long-term treatment option for patients with post-OLT BBS. (Clinical trial registration number: NCT01014390.)

Contains fulltext : 194572.pdf (publisher's version ) (Open Access), Abdominal pain is an important symptom in most patients with pancreatic ductal adenocarcinoma (PDAC). Adequate control of pain is often unsatisfactory due to limited treatment options and significant variation in local practice, emphasizing the need for a multidisciplinary approach. This review contends that improvement in the management of PDAC pain will result from a synthesis of best practice and evidence around the world in a multidisciplinary way. To improve clinical utility and evaluation, the evidence was rated according to the GRADE guidelines by a group of international experts. An algorithm is presented, which brings together all currently available treatment options. Pain is best treated early on with analgesics with most patients requiring opioids, but neurolytic procedures are often required later in the disease course. Celiac plexus neurolysis offers medium term relief in a substantial number of patients, but other procedures such as splanchnicectomy are also available. Palliative chemotherapy also provides pain relief as a collateral benefit. It is stressed that the assessment of pain must take into account the broader context of other physical and psychological symptoms. Adjunctive treatments for pain, depression and anxiety as well as radiotherapy, endoscopic therapy and neuromodulation may be required in selected patients. There are few comparative studies to help define which combination and order of these treatment options should be applied. New pain therapies are emerging and could for example target neural transmitters. However, until better methods are available, management of pain should be individualized in a multidisciplinary setting to ensure optimal care.

Contains fulltext : 177751.pdf (publisher's version ) (Open Access), Abdominal pain is the foremost complication of chronic pancreatitis (CP). Pain can be related to recurrent or chronic inflammation, local complications or neurogenic mechanisms with corresponding changes in the nervous systems. Both pain intensity and the frequency of pain attacks have been shown to reduce quality of life in patients with CP. Assessment of pain follows the guidelines for other types of chronic pain, where the multidimensional nature of symptom presentation is taken into consideration. Quantitative sensory testing may be used to characterize pain, but is currently used in a research setting in advanced laboratories. For pain relief, current guidelines recommend a simple stepwise escalation of analgesic drugs with increasing potency until pain relief is obtained. Abstinence from alcohol and smoking should be strongly advised. Pancreatic enzyme therapy and antioxidants may be helpful as initial treatment. Endoscopic treatment can be used in patients with evidence of ductal obstruction and may be combined with extracorporeal shock wave lithothripsy. The best candidates are those with distal obstruction of the main pancreatic duct and in early stage of disease. Behavioral interventions should be part of the multidisciplinary approach to chronic pain management particularly when psychological impact is experienced. Surgery should be considered early and after a maximum of five endoscopic interventions. The type of surgery depends on morphological changes of the pancreas. Long-term effects are variable, but high success rates have been reported in open studies and when compared with endoscopic treatment. Finally, neurolytical interventions and neuromodulation can be considered in difficult patients.

AIMS: This multi-centre prospective observational study aims to improve the knowledge regarding epidemiology of chronic pancreatitis (CP). METHODS: All patients for this study were deemed eligible based on the diagnosis of CP using imaging tests. 809 patients were included between 1/9/2014 and 31/8/2015. Data gathered included epidemiological, etiological items as well as CP complications (exocrine and endocrine insufficiency, pain) and type of treatment received. RESULTS: The majority of patients were male (74%) and were out-patients (69%). The median age of onset of symptoms was 47 (38-47) years; at the time of inclusion the median duration of the disease was 7 (3-13) years and the median Izbicki pain score (IPS) was 96 (0-195). The main etiological risk factors according to the TIGARO classification system were alcohol and tobacco (67%) followed by idiopathic causes in 19% of cases. Current alcohol drinkers had a lower BMI (21 vs 25 kg/m2, P < 0.001), a higher IPS (121 vs 90, P < 0.001) and higher inability to work. Similarly, active smoking was linked to lower BMI (21 vs 25 kg/m2, P < 0.0001) and higher IPS (137 vs 82, P < 0.001). Endocrine and exocrine insufficiencies were reported in 41% and 36% respectively. Patients with a BMI <20 kg/m2 had significantly more exocrine insufficiency (44 vs 34 %), weight loss (32% vs 16%), experienced increased pain levels (IPS: 146 vs 75) and included more smokers (78% vs 46%) and alcohol drinkers (30 vs 15 %), (P < 0.001). Highest IPS were reported in patients ongoing endoscopy with or without surgery, 244/400 and 163/ 400 respectively. Of the 15% of patients who had previously had surgery, 25% amongst them had initial surgery without previous endoscopic treatment. CONCLUSIONS: This national Belgian study on 809 CP patients could provide a useful tool to emphasize the management of these patients in terms of complications and treatment.

Objectives Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. Design Retrospective multinational study including SCN diagnosed between 1990 and 2014. Results 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4- 140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/ year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1).