The consensus on liver autotransplantation from an international panel of experts

IntroductionMore than 1.0 million patients worldwide are diagnosed with space-occupying lesions in the liver every year, with the number approaching 0.5 million per year in China, and only 20% of the lesions are resectable Due to a lack of available donors, only a limited number of patients underwent allogeneic liver transplantation, the remaining patients simply receive palliative care. Therefore, discovering new options for treating these patients is a high priority. Liver autotransplantation （LAT） is a surgical technique that adopts liver transplantation skills to radically treat spaceoccupying hepatic lesions, benign or malignant,

Challenges for clinicians treating autoimmune pancreatitis:Current perspectives

Autoimmune pancreatitis(AIP)is a rare disease clinically characterized by obstructive jaundice,unintentional weight loss,acute pancreatitis,focal pancreatic mass,and diabetes.AIP is classified into two subtypes-type 1 and type 2-according to pathological findings,clinical features,and serology test results,but some cases may be defined as type not otherwise in the absence of pathological findings and inflammatory bowel disease.To address the differences in diagnostic criteria by country,standard diagnostic criteria for AIP were proposed in 2011 by an international consensus of expert opinions.Differential diagnosis of AIP from pancreatic ductal adenocarcinoma is important but remains challenging for clinicians.Fortunately,all subtypes of AIP show dramatic response to steroid treatment.This review discusses the current perspectives on the diagnosis and management of AIP in clinical practice.

Endoscopic pancreatic necrosectomy in the United States-Mexico border:A cross sectional study

BACKGROUND A recent expert panel issued recommendations about the technical aspects of direct endoscopic necrosectomy(DEN) for pancreatic walled-off necrosis(WON).However, significant technical heterogeneity still exists among endoscopists.AIM To report the outcomes of our DEN technique and how it differs from a recent expert consensus statement and previous studies.METHODS Medical records of patients with WON who underwent DEN from September2016-May 2019 were queried for the following information: Age, gender,ethnicity, etiology of acute pancreatitis, WON location and size, DEN technical information, adverse events(AEs) and outcomes. Adverse events were graded according to the American Society of Gastrointestinal Endoscopy Lexicon grading system. Technical success was defined as adequate lumen apposing metal stent(LAMS) deployment plus removal of ≥ 90% of necrosum. Clinical success was defined as complete resolution of WON cavity by imaging and resolution of symptoms at ≤ 3 months(mo) after last DEN. Data analysis was performed using mean and standard deviation for continuous variables,frequency and proportion for categorical variables, and median and range for interval data.RESULTS A total of 21 patients underwent DEN. Most of them were Hispanic and their mean age was 51 ± 17 years. The majority of the collections were located in the body of the pancreas and the mean size was 13 cm ± 5 cm. The most common indication was persistent vomiting. Antibiotics were administered only in cases of infected necrosis. All LAMS were placed without radiological guidance,dilated the same day of deployment and removed after a mean of 27 ± 11 d.Routine cross-sectional imaging immediately after drainage was not performed.The mean interval between DEN sessions was 7 ± 4 d and the mean number of DEN/patient was 3 ± 2. Technical and clinical success rates were both 95%. AEs were seen in 5 patients and included: Sepsis(2), stent migration(1), stent maldeployment(1), perforation(1). The sensitivity and positive predictive value of an occluded LAMS leading to sepsis was 50% and 0.11 respectively. No fatalities were observed.CONCLUSION Our DEN technique differed significantly from the one recommended by a recent expert panel and the one published in previous studies. Despite these differences excellent clinical outcomes were obtained.