Robert J. Sealock

Systematic review: the epidemiology of eosinophilic oesophagitis in adults.

Background  The epidemiology of eosinophilic oesophagitis (EoE) in adults remains unclear.

The prevalence of oesophageal eosinophilia and eosinophilic oesophagitis: a prospective study in unselected patients presenting to endoscopy.

Oesophageal eosinophilia (EE) is encountered in clinical practice as oesophageal biopsies are being obtained in patients with GI symptoms other than classical symptoms of eosinophilic oesophagitis (EoE). The prevalence, determinants and clinical relevance of EE identified irrespective of symptoms are unclear.

Pancreatic duct rendezvous with pancreatoscopy through the minor papilla

An 18-year-old woman presented to our hospital with diffuse abdominal pain and visible distention. She reported a history of acute pancreatitis 2 months earlier. Physical examination revealed diffuse abdominal tenderness without rebound and an abdominal fluid wave. CT of the abdomen and pelvis (Figs. 1 and 2) showed a large volume of ascites and marked dilation of the pancreatic duct to 16 mm, with a hypodense filling defect within the pancreatic duct near the head of the pancreas. Diagnostic paracentesis revealed yellow turbid fluid with a serum albumin to ascites gradient of 0.7 g/dL, elevated total protein, and elevated amylase level of 3485 U/L consistent with pancreatic ascites. MRCP revealed similar findings to that of the CT of the abdomen (Fig. 3). On EUS, a hypoechoic heterogeneous intraductal lesion without posterior acoustic shadowing was visualized within the distal pancreatic duct with upstream dilatation to 10 mm. On ERCP, attempts to pass a guidewire through the ampulla of Vater around the pancreatic duct lesion were unsuccessful (Figs. 4 and 5). The cytology aspirate obtained from the pancreatic duct was negative for malignancy. EUS also showed a 14.5-

Cholangioscopy is Safe and Feasible in Elderly Patients

BACKGROUND & AIMS Although cholangioscopy is widely used during endoscopic retrograde cholangiopancreatiography (ERCP), its safety and feasibility for elderly patients are not well established. We aimed to evaluate the safety and feasibility of cholangioscopy in elderly patients. METHODS We performed a retrospective study of all ERCPs with single‐operator cholangioscopy (SOC) performed at 3 tertiary referral hospitals from March 2012 through October 2015. We collected data on patient demographics, procedure indications, findings, complications, and success rates (complete success was achieved if all intended diagnostic and therapeutic procedures were performed, such as tissue sample collection or complete removal of stones). The cohort was divided into 3 groups: patients younger than 65 years (group 1, n = 178), patients 65–75 years old (group 2, n = 86), and patients older than 75 years (group 3, n = 77). We used 1‐way ANOVA, the χ2 test, and the Wilcoxon sum rank test to compare study variables. The primary aim was to assess rates of complications from ERCP with SOC in elderly patients compared with younger patients. RESULTS Baseline clinical features were similar among groups, except for a higher prevalence of co‐morbidities in group 3. The indication for and findings from ERCP with SOC differed among the groups; stricture or tumor was the most common indication in groups 1 and 3—the most common findings were strictures and masses, respectively. In group 2, choledocholithiasis was the most common indication and finding. The success rate, analyzed in a subset of 209 patients, was 88.5% overall and did not differ significantly among groups. The overall rate of complication was 7.33% with no significant difference among groups (7.30% for group 1, 6.98% for group 2, and 7.79% for group 3) (P < .17). CONCLUSIONS In a retrospective analysis of ERCPs with SOCs, we found this procedure to be safe for elderly patients (older than 75 years), who had rates of complications and hospital admission similar to those of younger patients.

GI bleeding from an endoscopic omental patch created for an iatrogenic duodenal perforation

re 1. A, Endoscopic image of the lateral wall of the duodenal bulb with a 10-mm size perforation from the duodenoscope tip. B, Endoscopic image e duodenal perforation site after closure with an over-the-scope clip and endoscopic omental patch. C, Fluoroscopic image demonstrating no extravn of contrast medium outside the duodenal lumen at the site of the duodenal perforation repair; the over-the-scope clip is in place. D, s-sectional CT image with oral contrast medium at the level of the duodenal perforation, demonstrating no active extravasation of contrast medium de the duodenal lumen, over-the-scope clip in position (arrow) and moderate amount of intraperitoneal and retroperitoneal air related to duodenal ration. E, Endoscopic image showing active bleeding from the endoscopically created omental patch at the site of the duodenal perforation. F, Endoic image showing achievement of hemostasis by use of hemostatic clips at the bleeding site of the endoscopic omental patch.

Diabetes and the Exocrine Pancreas

The working unit of the exocrine pancreas is the acinus, Latin for cluster of berries. Analogous to its namesake, acinar morphology consists of individual acinar cells arranged in a spherical cluster with apical regions oriented toward the center. Digestive enzymes synthesized and stored in the acinar cell are secreted across the apical membrane and prevented from passing between acinar cells by intracellular tight junctions. Clusters of acini are themselves arranged into lobules. The lumen of the acinus communicates with intralobular ducts, which empty into interlobular ducts and, in turn, drain into the main pancreatic duct. The lumen of the pancreatic ductal system is lined with the epithelium that specializes in secretion of inorganic ions, especially bicarbonate, in an endocrine signal-dependent and isotonic fashion. In this way, the acinus is primarily responsible for digestive enzyme synthesis, and the ductal epithelium is primarily responsible for inorganic ion and aqueous component of pancreatic secretions.

A Large Pancreatic Pseudocyst Complicating Pregnancy.

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