M.G. Besselink

The Atlanta Classification of acute pancreatitis revisited.

In a complex disease such as acute pancreatitis, correct terminology and clear definitions are important. The clinically based Atlanta Classification was formulated in 1992, but in recent years it has been increasingly criticized. No formal evaluation of the use of the Atlanta definitions in the literature has ever been performed.

Timing and impact of infections in acute pancreatitis

Although infected necrosis is an established cause of death in acute pancreatitis, the impact of bacteraemia and pneumonia is less certain.

Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis

The role of percutaneous catheter drainage (PCD) in patients with (infected) necrotizing pancreatitis was evaluated.

Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality

The impact of nationwide centralization of pancreaticoduodenectomy (PD) on mortality is largely unknown. The aim of this study was to analyse changes in hospital volumes and in‐hospital mortality after PD in the Netherlands between 2004 and 2009.

Staged multidisciplinary step-up management for necrotizing pancreatitis

Some 15 per cent of all patients with acute pancreatitis develop necrotizing pancreatitis, with potentially significant consequences for both patients and healthcare services.

Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis

Surgical intervention in patients with infected necrotizing pancreatitis generally consists of laparotomy and necrosectomy. This is an invasive procedure that is associated with high morbidity and mortality rates. In this report, we present an alternative minimally invasive technique: videoscopic assisted retroperitoneal debridement (VARD). This technique can be considered a hybrid between endoscopic and open retroperitoneal necrosectomy. A detailed technical description is provided and the advantages over various other minimally invasive retroperitoneal techniques are discussed.

Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer

Locally advanced pancreatic cancer (LAPC) is associated with a very poor prognosis. Current palliative (radio)chemotherapy provides only a marginal survival benefit of 2–3 months. Several innovative local ablative therapies have been explored as new treatment options. This systematic review aims to provide an overview of the clinical outcomes of these ablative therapies.

Systematic review of five feeding routes after pancreatoduodenectomy

Current European guidelines recommend routine enteral feeding after pancreato‐duodenectomy (PD), whereas American guidelines do not. The aim of this study was to determine the optimal feeding route after PD.

Timing of cholecystectomy after mild biliary pancreatitis

The aim of the study was to evaluate recurrent biliary events as a consequence of delay in cholecystectomy following mild biliary pancreatitis.

Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility: a systematic review

Controversial opinions exist concerning the effect of laparoscopic adjustable gastric banding on gastroesophageal reflux. MEDLINE and EMBASE databases were searched for relevant studies on patients undergoing adjustable gastric banding. Data are expressed in mean (range). Twenty studies were identified with a total of 3307 patients. The prevalence of reflux symptoms decreased postoperatively from 32.9% (16–57) to 7.7% (0–26.9) and medication use from 27.5% (16–38.5) to 9.5% (3.1–19.2). Newly developed reflux symptoms were found in 15% (6.1–20) of the patients. The percentage of esophagitis decreased postoperatively from 33.3% (19.4–61.6) to 27% (2.3–60.8). Newly developed esophagitis was observed in 22.9% (0–38.4). Pathological reflux was found in 55.8% (34.9–77.4) preoperatively and postoperatively in 29.4% (0–41.7) of the patients. Lower esophageal sphincter pressures increased from 12.9 to 16.9 mmHg (11.3–21.4). Lower esophageal sphincter relaxation decreased from 100% to 79.7% (58–86). The percentage of dysmotility increased from 3.5% (0–10) to 12.6% (0–25). Adjustable gastric banding has anti‐reflux properties resulting in resolution or improvement of reflux symptoms, normalized pH monitoring results and a decrease of esophagitis on short term. However, worsening or newly developed reflux symptoms and esophagitis are found in a subset of patients during longer follow‐up.