Chronic pancreatic pain successfully treated by endoscopic ultrasound-guided pancreaticogastrostomy using fully covered self-expandable metallic stent

One of the most common symptoms presenting in patients with chronic pancreatitis is pancreatic-type pain.Obstruction of the main pancreatic duct in chronic pancreatitis can be treated by a multitude of therapeutic approaches,ranging from pharmacologic,endoscopic and radiologic treatments to surgical interventions.When the conservative treatment approaches fail to resolve symptomatic cases,however,endoscopic retrograde pancreatography with pancreatic duct drainage is the preferred second approach,despite its well-recognized drawbacks.When the conventional transpapillary approach fails to achieve the necessary drainage,the patients may benefit from application of the less invasive endoscopic ultrasound(EUS)-guided pancreatic duct interventions.Here,we describe the case of a 42-year-old man who presented with severe abdominal pain that had lasted for 3 mo.Computed tomography scanning showed evidence of chronic obstructive pancreatitis with pancreatic duct stricture at genu.After conventional endoscopic retrograde pancreaticography failed to eliminate the symptoms,EUS-guided pancreaticogastrostomy(PGS)was applied using a fully covered,self-expandable,10-mm diameter metallic stent.The treatment resolved the case and the patient experienced no adverse events.EUS-guided PGS with a regular biliary fully covered,self-expandable metallic stent effectively and safely treated pancreatictype pain in chronic pancreatitis.

Impact of alcohol consumption on treatment outcome of hepatocellular carcinoma patients with viral hepatitis who underwent transarterial chemoembolization

BACKGROUND Alcohol consumption increases the risk of hepatocellular carcinoma(HCC)in patients with pre-existing liver disease,including viral hepatitis.However,studies on the impact of alcohol consumption on the outcomes of HCC are limited.We hypothesized that alcohol had an additional effect with chronic viral hepatitis infection on treatment outcomes after transarterial chemoembolization(TACE)in patients with intermediate-stage HCC(Barcelona Clinical Liver Cancer[BCLC]-B).AIM To evaluate the additional effect of alcohol on treatment outcomes of TACE among HCC patients with viral hepatitis.METHODS This study,conducted at Hatyai Hospital in Thailand,included HCC patients over 18 years of age with chronic viral hepatitis.Records of HCC patients with viral hepatitis classified as BCLC-B who underwent TACE as the first treatment modality between 2014 and 2019 were retrospectively reviewed.Patients with chronic viral hepatitis only were categorized under group A,and those with chronic viral hepatitis and concurrent alcohol consumption were categorized under group B.Both groups were compared,and the Cox proportional-hazards model was used to identify the survival-influencing variables.RESULTS Of the 69 patients,53 were categorized in group A and 16 in group B.There were no statistically significant differences in tumor characteristics between the two patient groups.However,Group A had a statistically significantly higher proportion of complete response(24.5%vs 0%,P=0.030)and a higher median survival rate(26.2 mo vs 8.4 mo;log-rank P=0.012)compared to group B.Factors associated with decreased survival in the proportional-hazards model included alcohol consumption(hazards ratio[HR],2.377;95%confidence interval[CI],1.109-5.095;P=0.026),presence of portal hypertension(HR,2.578;95%CI,1.320–5.037;P=0.006),largest tumor size>5 cm(HR,3.558;95%CI,1.824-6.939;P<0.001),and serum alpha-fetoprotein level>100 ng/mL(HR,2.536;95%CI,1.377-4.670;P=0.003).CONCLUSION In HCC BCLC B patients with chronic viral hepatitis,alcohol consumption is an independent risk factor for increased mortality and decreases the rate of complete response and survival after TACE.