Background: Tumors that arise in the region of the major duodenal papilla account for 5% of GI neoplasms and 36% of resectable pancreaticoduodenal tumors. There is limited published literature that addresses the safet...Background: Tumors that arise in the region of the major duodenal papilla account for 5% of GI neoplasms and 36% of resectable pancreaticoduodenal tumors. There is limited published literature that addresses the safety of endoscopic excision of the papilla. Although there is consensus about prophylactic pancreatic- duct stent placement, there is little supporting prospective data. The aim of this randomized, controlled trial was to compare the rates of postsnare ampullectomy pancreatitis in patients who did/did not receive prophylactic pancreatic- duct stent placement. Methods: Consecutive patients who were to undergo en bloc snare ampullectomy were randomized to placement of pancreatic- duct stent after ampullectomy or to no stent placement. Results: In total, 19 patients were enrolled, and 10 received pancreatic stents. Postprocedure pancreatitis occurred in 3 patients in the 24 hours after endoscopy, all cases occurred in the unstented group, 33% vs. 0% (stented group), p = 0.02. Median peak amylase level was 3692 U/L (range 1819- 4700 U/L) and median peak lipase level was 11450 U/L (range 5900- 17,000 U/L). All 3 patients were hospitalized for a median of 2 days (range 1- 6), and all made a complete recovery. Conclusions: Our findings suggest that a protective effect is conferred by pancreatic stent placement in reducing postampullectomy pancreatitis. Future large- scale studies are required to confirm this benefit.展开更多
Health care costs are an increasingly important study outcome. Endoscopic pra ctice consumes a large proportion of gastroenterology- related health expenses. An economic comparison of several currently accepted endosc...Health care costs are an increasingly important study outcome. Endoscopic pra ctice consumes a large proportion of gastroenterology- related health expenses. An economic comparison of several currently accepted endoscopic practices was p erformed, ranking them according their cost- effectiveness, as viewed from the payer perspective. The cost- effectiveness of four currently accepted standard endoscopic practices was examined: small bowel biopsy to assess for celiac sprue , colonoscopic biopsy to assess formicroscopic colitis, surveillance of Barrett’ s esophagus, and surveillance of chronic ulcerative colitis (CUC). Parameter est imates were obtained from the published literature. Charges were based on Medica re professional plus facility/technical fees. Performing colonoscopic biopsies f or microscopic colitis in the setting of chronic nonbloody diarrhea was the most cost- effective practice (＄ 2447/case detected), while small bowel biopsy for sprue in the setting of a patient with a first- degree relative with sprue (＄ 3042/case detected) or with anemia (＄ 2982/case detected) was also a cost- ef fective approach. Small bowel biopsy in the setting of diarrhea (＄ 3900/case de tected) was less cost- effective, while CUC surveillance (＄ 14,119/ detection of dysplasia) and performance of small bowel biopsy in an asymptomatic patient ( ＄ 15,209/case detected) were clearly the least economical. As efforts are made to reduce the costs of health care, more attention will be focused on the cost- effectiveness of routine endoscopic practices. Although, our findings put endos copic practices into economic perspective, future perspective, future prospectiv e trials are required to confirm the validity of these findings.展开更多
文摘Background: Tumors that arise in the region of the major duodenal papilla account for 5% of GI neoplasms and 36% of resectable pancreaticoduodenal tumors. There is limited published literature that addresses the safety of endoscopic excision of the papilla. Although there is consensus about prophylactic pancreatic- duct stent placement, there is little supporting prospective data. The aim of this randomized, controlled trial was to compare the rates of postsnare ampullectomy pancreatitis in patients who did/did not receive prophylactic pancreatic- duct stent placement. Methods: Consecutive patients who were to undergo en bloc snare ampullectomy were randomized to placement of pancreatic- duct stent after ampullectomy or to no stent placement. Results: In total, 19 patients were enrolled, and 10 received pancreatic stents. Postprocedure pancreatitis occurred in 3 patients in the 24 hours after endoscopy, all cases occurred in the unstented group, 33% vs. 0% (stented group), p = 0.02. Median peak amylase level was 3692 U/L (range 1819- 4700 U/L) and median peak lipase level was 11450 U/L (range 5900- 17,000 U/L). All 3 patients were hospitalized for a median of 2 days (range 1- 6), and all made a complete recovery. Conclusions: Our findings suggest that a protective effect is conferred by pancreatic stent placement in reducing postampullectomy pancreatitis. Future large- scale studies are required to confirm this benefit.
文摘Health care costs are an increasingly important study outcome. Endoscopic pra ctice consumes a large proportion of gastroenterology- related health expenses. An economic comparison of several currently accepted endoscopic practices was p erformed, ranking them according their cost- effectiveness, as viewed from the payer perspective. The cost- effectiveness of four currently accepted standard endoscopic practices was examined: small bowel biopsy to assess for celiac sprue , colonoscopic biopsy to assess formicroscopic colitis, surveillance of Barrett’ s esophagus, and surveillance of chronic ulcerative colitis (CUC). Parameter est imates were obtained from the published literature. Charges were based on Medica re professional plus facility/technical fees. Performing colonoscopic biopsies f or microscopic colitis in the setting of chronic nonbloody diarrhea was the most cost- effective practice (＄ 2447/case detected), while small bowel biopsy for sprue in the setting of a patient with a first- degree relative with sprue (＄ 3042/case detected) or with anemia (＄ 2982/case detected) was also a cost- ef fective approach. Small bowel biopsy in the setting of diarrhea (＄ 3900/case de tected) was less cost- effective, while CUC surveillance (＄ 14,119/ detection of dysplasia) and performance of small bowel biopsy in an asymptomatic patient ( ＄ 15,209/case detected) were clearly the least economical. As efforts are made to reduce the costs of health care, more attention will be focused on the cost- effectiveness of routine endoscopic practices. Although, our findings put endos copic practices into economic perspective, future perspective, future prospectiv e trials are required to confirm the validity of these findings.
