Variceal bleeding outside the esophagus and stomach is rare but important because of its difficult diagnosis and treatment.Bleeding from cholecystojejunostomy varices has been reported to be a late complication of pal...Variceal bleeding outside the esophagus and stomach is rare but important because of its difficult diagnosis and treatment.Bleeding from cholecystojejunostomy varices has been reported to be a late complication of palliative biliary surgery for chronic pancreatitis.Such ectopic variceal bleeding has never been reported after palliative surgery for pancreatic cancer,probably because of the limited lifespan of these patients. Herein,we report our successful experience using endoscopic cyanoacrylate sclerotherapy to treat bleeding from cholecystojejunostomy varices in a 57-year-old man with pancreatic head cancer.To our knowledge,this is the first case report in the literature of this rare complication.展开更多
AIM To explore the risk factors of developing chronic pancreatitis(CP) in patients with acute pancreatitis(AP) and develop a prediction score for CP.METHODS Using the National Health Insurance Research Database in Tai...AIM To explore the risk factors of developing chronic pancreatitis(CP) in patients with acute pancreatitis(AP) and develop a prediction score for CP.METHODS Using the National Health Insurance Research Database in Taiwan, we obtained large, population-based data of 5971 eligible patients diagnosed with AP from 2000 to 2013. After excluding patients with obstructive pancreatitis and biliary pancreatitis and those with a follow-up period of less than 1 year, we conducted a multivariate analysis using the data of 3739 patients to identify the risk factors of CP and subsequently develop a scoring system that could predict the development of CP in patients with AP. In addition, we validated the scoring system using a validation cohort.RESULTS Among the study subjects, 142 patients(12.98%) devel-oped CP among patients with RAP. On the other hand, only 32 patients(1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP(RAP), alcoholism, smoking habit, and age of onset of < 55 years were the four important risk factors for CP. We developed a scoring system(risk score 1 and risk score 2) from the derivation cohort by classifying the patients into low-risk, moderate-risk, and high-risk categories based on similar magnitudes of hazard and validated the performance using another validation cohort. Using the prediction score model, the area under the curve(AUC) [95% confidence interval(CI)] in predicting the 5-year CP incidence in risk score 1(without the number of AP episodes) was 0.83(0.79, 0.87), whereas the AUC(95%CI) in risk score 2(including the number of AP episodes) was 0.84(0.80, 0.88). This result demonstrated that the risk score 2 has somewhat better prediction performance than risk score 1. However, both of them had similar performance between the derivation and validation cohorts.CONCLUSION In the study,we identified the risk factors of CP and developed a prediction score model for CP.展开更多
文摘Variceal bleeding outside the esophagus and stomach is rare but important because of its difficult diagnosis and treatment.Bleeding from cholecystojejunostomy varices has been reported to be a late complication of palliative biliary surgery for chronic pancreatitis.Such ectopic variceal bleeding has never been reported after palliative surgery for pancreatic cancer,probably because of the limited lifespan of these patients. Herein,we report our successful experience using endoscopic cyanoacrylate sclerotherapy to treat bleeding from cholecystojejunostomy varices in a 57-year-old man with pancreatic head cancer.To our knowledge,this is the first case report in the literature of this rare complication.
文摘AIM To explore the risk factors of developing chronic pancreatitis(CP) in patients with acute pancreatitis(AP) and develop a prediction score for CP.METHODS Using the National Health Insurance Research Database in Taiwan, we obtained large, population-based data of 5971 eligible patients diagnosed with AP from 2000 to 2013. After excluding patients with obstructive pancreatitis and biliary pancreatitis and those with a follow-up period of less than 1 year, we conducted a multivariate analysis using the data of 3739 patients to identify the risk factors of CP and subsequently develop a scoring system that could predict the development of CP in patients with AP. In addition, we validated the scoring system using a validation cohort.RESULTS Among the study subjects, 142 patients(12.98%) devel-oped CP among patients with RAP. On the other hand, only 32 patients(1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP(RAP), alcoholism, smoking habit, and age of onset of < 55 years were the four important risk factors for CP. We developed a scoring system(risk score 1 and risk score 2) from the derivation cohort by classifying the patients into low-risk, moderate-risk, and high-risk categories based on similar magnitudes of hazard and validated the performance using another validation cohort. Using the prediction score model, the area under the curve(AUC) [95% confidence interval(CI)] in predicting the 5-year CP incidence in risk score 1(without the number of AP episodes) was 0.83(0.79, 0.87), whereas the AUC(95%CI) in risk score 2(including the number of AP episodes) was 0.84(0.80, 0.88). This result demonstrated that the risk score 2 has somewhat better prediction performance than risk score 1. However, both of them had similar performance between the derivation and validation cohorts.CONCLUSION In the study,we identified the risk factors of CP and developed a prediction score model for CP.
