In our small case series, endoscopic necrosectomy through a percutaneous SEMS seemed beneficial and safe in the treatment of infected WON.

BackgroundEmergency Departments (ED) have a high flow of patients and time is often crucial. New technologies for laboratory analysis have been developed, including Point of Care Technologies (POCT), which can reduce the transport time and time of analysis significantly compared with central laboratory services. However, the question is if the time to clinical action is also reduced if a decisive laboratory answer is available during the first contact between the patient and doctor. The present study addresses this question: Does a laboratory answer, provided by POCT to the doctor who first attends the patient on admission, change the time to clinical decision in commonly occurring diseases in an ED compared with the traditional service from a central laboratory?MethodsWe performed a randomised clinical trial with parallel design and allocation ratio 1:1. The eligibility Criteria were: All patients referred from General Practitioner or another referring doctor suspected for a deep venous thrombosis (DVT), acute coronary syndrome (ACS), acute appendicitis (AA) or acute infection (ABI). The outcome measure was the time spend from the blood sample was taken to a clinical decision was made.ResultsThe study period took place in October--November 2009 and from February to April 2010. 239 patients were eligible for the study. There was no difference between the groups suspected for DVT, ACS and AA, but a significant reduction in time for the ABI group (p:0.009), where the median time to decision was reduced from 7 hours and 33 minutes to 4 hours and 38 minutes when POCT was used. Only in the confirmation of ABI the time to action was significantly shorter.ConclusionsFast laboratory answers by POCT in an ED reduce the time to clinical decision significantly for bacterial infections. We suggest further studies which include a sufficient number of patients on deep venous thrombosis, acute appendicitis and acute coronary syndrome.

Objectives Pancreatic exocrine insufficiency (PEI) is a common complication in patients with chronic pancreatitis (CP), leading to increased morbidity and mortality if not treated adequately. Pancreatic enzyme replacement therapy|pancreas enzyme replacement therapy (PERT) is the cornerstone in treatment of patients with PEI. In the present study, we use data from the Scandinavian Baltic Pancreatic Club database to examine adherence of PERT according to United European Gastroenterology evidence‐based guidelines treatment of CP. Patients and methods Patients with definitive or probable CP according to M‐ANNHEIM diagnostic criteria were included. We collected information on exposures, exocrine function, intake of pancreatic enzymes, and markers of nutrition. Fecal elastase <200 μg/g was defined as a marker for PEI. Enzyme replacement therapy of 100,000 lipase units or more was defined as adequate treatment. Results We included 1006 patients from 8 centers in five countries. Sixty‐four percent of the patients were correctly treated. Twenty‐five per cent of PEI patients were not taking enzymes at all, and 20% of PEI patients were undertreated with insufficient PERT doses according to the guidelines. Fourteen percent of patients with sufficient pancreatic function were receiving enzymes despite normal exocrine pancreatic function. There were center differences. Current smoking was associated with lack of treatment and alcohol abuse was associated with under‐treatment. There were no associations between “no treatment” or “under‐treatment” for underweight or vitamin D deficiency. Conclusion In our CP expert centers, the adherence to guidelines for enzyme treatment is insufficient. Both patient factors and center differences have influence on treatment adherence.

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