Kevin P. Block

Oral allopurinol does not prevent the frequency or the severity of post-ERCP pancreatitis.

BACKGROUND Pancreatitis is the most common major complication of ERCP. Efforts have been made to identify pharmacologic agents capable of reducing its incidence and severity. The aim of this trial was to determine whether prophylactic allopurinol, an inhibitor of oxygen-derived free radical production, would reduce the frequency and severity of post-ERCP pancreatitis. Methods A total of 701 patients were randomized to receive either allopurinol or placebo 4 hours and 1 hour before ERCP. A database was prospectively collected by a defined protocol on patients who underwent ERCP. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis. RESULTS The groups were similar with regard to patient demographics and to patient and procedure risk factors for pancreatitis. The overall incidence of pancreatitis was 12.55%. It occurred in 46 of 355 patients in the allopurinol group (12.96%) and in 42 of 346 patients in the control group (12.14%; p = 0.52). The pancreatitis was graded mild in 7.89%, moderate in 4.51%, and severe in 0.56% of the allopurinol group, and mild in 6.94%, moderate in 4.62%, and severe in 0.58% of the control group. There was no significant difference between the groups in the frequency or the severity of pancreatitis. CONCLUSIONS Prophylactic oral allopurinol did not reduce the frequency or the severity of post-ERCP pancreatitis.

Gastrointestinal bleeding from a brunner's gland hamartoma: characterization by endoscopy, computed tomography, and endoscopic ultrasound

Brunner’s gland hamartoma (also referred to as adenoma or Brunneroma) is a rare tumor of the duodenum that was first described by Salvioli in 1876 (1). Although commonly an incidental finding, Brunner’s gland hamartomas can lead to clinically significant symptoms including GI bleeding, abdominal pain, and intestinal obstruction (1–11). The natural history of these lesions has not been well defined. We describe the endoscopic, the endoscopic ultrasound (EUS), and the computed tomography (CT) characteristics of a large Brunner’s gland hamartoma that was present for two decades and resulted in upper GI bleeding.

Glucocorticoid regulation of muscle branched-chain amino acid metabolism.

Branched-chain alpha-keto acid dehydrogenase (BCKAD) is a multisubunit complex regulated by phosphorylation and is considered to be rate-limiting for branched-chain amino acid (BCAA) metabolism in skeletal muscle. Glucocorticoids increase net protein degradation in muscle; associated with this increased breakdown of muscle protein is an elevated rate of BCAA oxidation. The effects of glucocorticoids on skeletal muscle BCKAD were investigated in different rat models. BCKAD was activated after glucocorticoid treatment (both acutely, within 2 h, and chronically). The amount of enzyme per muscle cell increased after 5 d of cortisone acetate treatment. Insulin administration partially blocked the acute effects of glucocorticoids on muscle BCKAD. Activation was also observed during metabolic acidosis, insulinopenic diabetes mellitus, and endotoxic shock, three conditions characterized by elevated circulating glucocorticoids, increased BCAA oxidation, and increased net protein breakdown. Activation of BCKAD may account for the increased oxidation of BCAA observed during hypercortisolemia. The sequelae of this accelerated catabolism may include increased glutamine and alanine production for gluconeogenesis and provision of ATP for muscle work.

Medical device evaluation by the Food and Drug Administration (FDA).

VOLUME 53, NO. 7, 200

Endoscopic appearance of gastroduodenal artery aneurysm

Uncommon causes of upper GI bleeding include Dieulafoy’s lesion, arteriovenous malformation, and benign and malignant tumors.1 We describe a case of an elderly man with a gastroduodenal artery (GDA) aneurysm presenting as a bleeding duodenal mass. A Medline search of articles published from 1966 to 1999 failed to reveal a study of the endoscopic appearance of GDA aneurysms. Recognition of such a lesion is essential in preventing endoscopically related adverse outcomes.

⁎4700 Intraductal tissue sampling in mucin-secreting and cystic tumors of the pancreas - a multicenter series.

INTRODUCTION: Optimal management of patients with mucin secreting and cystic pancreatic neoplasms is dependent on the accurate detection of malignancy. AIM: This large multicenter series reports the cancer detection sensitivity of endoscopic pancreatic intraductal tissue and juice sampling techniques. METHODS: A series of 206 mucin-secreting or cystic tumors of the pancreas have been recorded by the Midwest Pancreaticobiliary Group. Of these, 92 patients underwent ERCP with tissue and/or juice sampling and have surgical pathology to confirm the final diagnosis. The sampling technique was at the discretion of the endoscopist. Specimens were reported as benign or malignant and for the purposes of this analysis, all grades of cellular atypia were classified as benign. RESULTS: See table. All 38 benign lesions had at least 1 benign and no malignant tissue specimens. Twelve of the 54 (22%) malignant lesions had at least one positive specimen. SUMMARY: The sensitivity of multiple tissue sampling techniques in detecting malignant mucin secreting or cystic pancreatic tumors was only 22%. All benign pancreatic lesions sampled had benign tissue specimens. CONCLUSIONS: Improved endoscopic tissue sampling techniques are required in order to classify mucin secreting and cystic lesions of the pancreas as either benign or malignant. **And Members of the Midwest Pancreatobiliary Group.