Endoscopic ultrasound-guided drainage of pancreatic fluid collections: The impact of evolving experience and new technologies in diagnosis and treatment over the last two decades

Background: Endoscopic ultrasound (EUS)-guided drainage is the preferred approach for drainage of pan- creatic uid collections (PFCs) due to the better experience and signi cant progress using newer stents and access devices during last decade. This study aimed to evaluate the role of the evolving experience and possible in uence of new technological devices on the outcome of patients evaluated for PFCs and submitted to EUS-guided drainage during two different periods: the early period at the beginning of experience when a standardized technique was used and the late period when the increased experience of the operator, combined with different stents quality were introduced in the management of PFCs. Methods: We retrospectively analyzed the clinical data of a cohort of 91 consecutive patients, who underwent EUS-guided drainage of symptomatic PFCs from October 2001 to September 2017. Demographic, therapeutic results, complications, and outcomes were compared between early years’ group (2001 2008) and late years’ group (2009 2017). Results: Endoscopic treatment was successfully achieved in 55.6% (20/36) of patients in the early years’ group, and in 96.4% (53/55) in the late years’ group. Eighteen patients (12 in early years’ and 6 in the late year’s group) required additional open surgery. Procedural complications were observed in 5 patients, 4 in early years’ and 1 in late years’ group. Mortality was registered in two patients (2.2%), one for each group. Conclusions: During our long-term survey using EUS-guided endoscopic drainage of PFCs, signi cantly better outcomes in term of improved success rate and decrease complications rate were observed during the late period.

Applications of endoscopic ultrasound elastography in pancreatic diseases: From literature to real life

Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical data.Elastography can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions.However,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses.Moreover,even if promising,elastography still provides little information in the evaluation of benign conditions.

Liver-side of inflammatory bowel diseases:Hepatobiliary and druginduced disorders

Hepatobiliary disorders are among the most common extraintestinal manifestations in inflammatory bowel diseases(IBD),both in Crohn’s disease and ulcerative colitis(UC),and therefore represent a diagnostic challenge.Immunemediated conditions include primary sclerosing cholangitis(PSC)as the main form,variant forms of PSC(namely small-duct PSC,PSC-autoimmune hepatitis overlap syndrome and IgG4-related sclerosing cholangitis)and granulomatous hepatitis.PSC is by far the most common,presenting in up to 8%of IBD patients,more frequently in UC.Several genetic foci have been identified,but environmental factors are preponderant on disease pathogenesis.The course of the two diseases is typically independent.PSC diagnosis is based mostly on typical radiological findings and exclusion of secondary cholangiopathies.Risk of cholangiocarcinoma is significantly increased in PSC,as well as the risk of colorectal cancer in patients with PSC and IBD-related colitis.No disease-modifying drugs are approved to date.Thus,PSC management is directed against symptoms and complications and includes medical therapies for pruritus,endoscopic treatment of biliary stenosis and liver transplant for end-stage liver disease.Other nonimmune-mediated hepatobiliary disorders are gallstone disease,whose incidence is higher in IBD and reported in up to one third of IBD patients,non-alcoholic fatty liver disease,pyogenic liver abscess and portal vein thrombosis.Druginduced liver injury(DILI)is an important issue in IBD,since most IBD therapies may cause liver toxicity;however,the incidence of serious adverse events is low.Thiopurines and methotrexate are the most associated with DILI,while the risk related to anti-tumor necrosis factor-αand anti-integrins is low.Data on hepatotoxicity of newer drugs approved for IBD,like anti-interleukin 12/23 and tofacitinib,are still scarce,but the evidence from other rheumatic diseases is reassuring.Hepatitis B reactivation during immunosuppressive therapy is a major concern in IBD,and adequate screening and vaccination is warranted.On the other hand,hepatitis C reactivation does not seem to be a real risk,and hepatitis C antiviral treatment does not influence IBD natural history.The approach to an IBD patient with abnormal liver function tests is complex due to the wide range of differential diagnosis,but it is of paramount importance to make a quick and accurate diagnosis,as it may influence the therapeutic management.

Cardiovascular injuries and SARS-COV-2 infection:focus on elderly people

The novel coronavirus disease(COVID-19)has hit the healthcare system worldwide.The risk of severe infection and mortality increases with advancing age,especially in subjects with comorbidities such as cardiovascular disease,hypertension,diabetes,obesity and cancer.Moreover,cardiovascular complications such as myocardial injury,heart failure and thromboembolism are frequently observed in COVID-19 cases,and several biomarkers(troponin,NTpro BNP and D-Dimer)have been identified as prognostic indicators of disease severity and worst outcome.Currently,there is no specific therapy against SARS-Co V-2,although many medications are under investigation.The aim of this review will be to explore the intertwined relationship between COVID-19 disease and the cardiovascular system,focusing on elderly population.The available supportive treatments along with the related concerns in elderly patients,due to their comorbidities and polypharmacotherapy,will be explored.

Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction:outcomes of a tertiary referral center and predictors of early prosthetic infection

We aimed to evaluate ten-year outcomes of penile prosthesis(PP)implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection(EPI).We identified 549 men who underwent 576 PP placements between 2008 and 2018.Univariate and multivariate analyses were used to identify potential predictors of EPI.An EPI predictive nomogram was developed.Thirty-five(6.1%)cases of EPI were recorded with an explant rate of 3.1%.In terms of satisfaction,82.0%of the patients defined themselves as“satisfied,”while partner’s satisfaction was 88.3%.Diabetes(P=0.012),longer operative time(P=0.032),and reinterventions(P=0.048)were associated with EPI risk,while postoperative ciprofloxacin was inversely associated with EPI(P=0.014).Rifampin/gentamicin-coated 3-piece inflatable PP(r/g-c 3IPP)showed a higher EPI risk(P=0.019).Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients,redo surgeries,or when a r/g-c 3IPP was used(all P<0.03).We showed that diabetes,longer operative time,and secondary surgeries were the risk factors for EPI.Postoperative ciprofloxacin was associated with a reduced risk of EPI,while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant.After further validation,the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

Commentary on “Clinical outcome of pediatric and young adult subclinical varicoceles: a single-institution experience”

We read with interest the study by Cho et al.1 regarding the features of subclinical varicocele in a pediatric and young adult single-center population.Out of 98 patients identified,the majority had a rightsided subclinical varicocele(69%,n=25),usually with a contralateral clinical varicocele.Testicular asymmetry(>20%volume difference of the affected side by testicular atrophy index formula)was assessed in nine patients with unilateral subclinical varicocele without contralateral varicocele,either clinical or subclinical.Interestingly,of 17 patients with a mean follow-up of 32 months,3(17.6%)progressed to clinical varicocele without asymmetric testicular volume,as most remained subclinical or had subsequent resolution by ultrasound.The authors concluded that subclinical varicoceles appeared unlikely to progress to a clinical disease,to affect testicular volume,or to lead to surgery.