Acute pancreatitis.<i>Evidence based management guidelines of the Hungarian Pancreatic Study Group</i>

Hritz, István; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Sahin–Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Szücs, Ákos; Takács, Tamás; Tiszlavicz, László; Hegyi, Péter

doi:10.1556/oh.2015.30059

Cited by 49 publications

(37 citation statements)

References 57 publications

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“…To achieve our aims we (i) developed an electronic data registry for patients (www. pancreas.hu), (ii) published the currently available evidencebased medicine (EBM) guidelines [9][10][11][12][13], (iii) established specific study sessions including the pancreatic cancer one, (iv) and organized multicenter clinical trials [14][15][16][17].…”

Section: Methodsmentioning

confidence: 99%

Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group

Lakatos

Balázs

Kui

et al. 2016

JGLD

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Background & Aims: Pancreatic cancer is a devastating disease with poor prognosis. There is very limited information available regarding the epidemiology and treatment strategies of pancreatic cancer in Central Europe. The purpose of the study was to prospectively collect and analyze data of pancreatic cancer in the Hungarian population. Methods: The Hungarian Pancreatic Study Group (HPSG) organized prospective, uniform data collection. Altogether 354 patients were enrolled from 14 Hungarian centers. Results: Chronic pancreatitis was present in 3.7% of the cases, while 33.7% of the patients had diabetes. Family history for pancreatic cancer was positive in 4.8%. The most frequent presenting symptoms included pain (63.8%), weight loss (63%) and jaundice (52.5%). The reported frequency of smoking and alcohol consumption was lower than expected (28.5% and 27.4%, respectively). The majority of patients (75.6%) were diagnosed with advanced disease. Most patients (83.6%) had a primary tumor located in the pancreatic head. The histological diagnosis was ductal adenocarcinoma in 90.7% of the cases, while neuroendocrine tumor was present in 5.3%. Biliary stent implantation was performed in 166 patients, 59.2% of them received metal stents. Primary tumor resection was performed in 60 (16.9%) patients. Enteral or biliary bypass was done in 35 and 49 patients, respectively. In a multivariate Cox-regression model, smoking status and presence of gemcitabine-based chemotherapy were identified as independent predictors for overall survival. Conclusion: We report the first data from a large cohort of Hungarian pancreatic cancer patients. We identified smoking status and chemotherapy as independent predictors in this cohort. Abbreviations: EBM: evidence-based medicine; EPI: exocrine pancreatic insufficiency; FNAB: fine needle aspiration biopsy; HPSG: Hungarian Pancreatic Study Group; MDCT: multi-detector computed tomography; OS: overall survival; PC: pancreatic cancer; RPP: Registry for Pancreatic Patients

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Section: Methodsmentioning

confidence: 99%

Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group

Lakatos

Balázs

Kui

et al. 2016

JGLD

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“…Not surprisingly, enteral nutrition (EN) has almost been the only therapeutic change in recent decades to be highly beneficial and to be widely utilized in severe AP (SAP) [14]. However, in mild and moderate AP (MAP), the primary therapy is still the nil per os diet (NPO) [15]. Since the results in basic science have demonstrated the crucial role of energy breakdown in the early phase of AP, in this study we performed a systemic review of the literature followed by a meta-analysis to understand whether enteral feeding should be the primary therapy not only in severe AP, but in mild and moderate AP as well.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

2017

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Abstract:The recently published guidelines for acute pancreatitis (AP) suggest that enteral nutrition (EN) should be the primary therapy in patients suffering from severe acute pancreatitis (SAP); however, none of the guidelines have recommendations on mild and moderate AP (MAP). A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). The following PICO (problem, intervention, comparison, outcome) was applied: P: nutrition in AP; I: enteral nutrition (EN); C: nil per os diet (NPO); and O: outcome. There were 717 articles found in Embase, 831 in PubMed, and 10 in the Cochrane database. Altogether, seven SAP and six MAP articles were suitable for analyses. In SAP, forest plots were used to illustrate three primary endpoints (mortality, multiorgan failure, and intervention). In MAP, 14 additional secondary endpoints were analyzed (such as CRP (C-reactive protein), WCC (white cell count), complications, etc.). After pooling the data, the Mann-Whitney U test was used to detect significant differences. Funnel plots were created for testing heterogeneity. All of the primary endpoints investigated showed that EN is beneficial vs. NPO in SAP. In MAP, all of the six articles found merit in EN. Analyses of the primary endpoints did not show significant differences between the groups; however, analyzing the 17 endpoints together showed a significant difference in favor of EN vs. NPO. EN is beneficial compared to a nil per os diet not only in severe, but also in mild and moderate AP.

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“…Az elmúlt évtizedben a PEP gyakoriságának és súlyos-ságának a csökkentésére számos sikeres módszert vezettek be, amelyek nyomán több nemzetközi és hazai ajánlás született [5,6,7]. Az ajánlások közötti ellentmondásokat számos összefoglalóban próbálták értel-mezni, így mi magunk is [8].…”

Section: öSszefoglaló Közleményunclassified

Az endoszkópos retrográd cholangiopancreatographiát követő heveny hasnyálmirigy-gyulladás megelőzése

et al. 2015

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Állomány-egészségtani és Állatorvosi Etológia Tanszék, BudapestMagyarországon az évente elvégzett több mint 14 000 endoszkópos retrográd cholangiopancreatographia következ-tében hozzávetőlegesen 1400 pancreatitis kialakulásával, ezen belül 10 beteg halálával kell számolni. A szerzők átte-kintik az endoszkópos retrográd cholangiopancreatographiát követő heveny hasnyálmirigy-gyulladás megelőzésére vonatkozó szakirodalmat, ismertetik saját tapasztalataikat. Utalnak a diagnosztikus endoszkópos retrográd cholangiopancreatographia háttérbe szorulására. Hangsúlyozzák a beavatkozás javallatának gondos mérlegelését, a kockázati tényezők elemzését. Fontosnak tartják a kanülálások számának csökkentését, a korai előmetszést, a nagy kockázatú betegekben a pancreasstent beültetését, az indometacin vagy a diclofenac alkalmazását és a megfelelő intravénás folyadékbevitelt. Orv. Hetil., 2015, 156(18), 715-719. Kulcsszavak: endoszkópos retrográd cholangiopancreatographia, szövődmények, post-ERCP-s pancreatitis, megelőzés Prevention of pancreatitis following endoscopic retrograde cholangiopancreatographyOver 14 000 endoscopic retrograde cholangiopancreatographies are performed in Hungary annually, and approximately 1400 patients are calculated to develop pancreatititis including 10 cases with lethal outcome. This article is aimed to review recent relevant literature and to present a practical guide based on the authors' own experience for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. The authors emphasize the importance of careful consideration of indications, analysis of risk factors, avoiding unnecessary diagnostic intervention, a decrease of the attempts for cannulation, early precut, implantation of pancreatic stent in high risk patients, administration of rectal indomethacin or diclofenac and adequate intravenous fl uid replacement. Keywords: endoscopic retrograde cholangiopancreatography, complications, Post-ERCP pancreatitis, preventionPatai, Á., Patai, Á. V., Solymosi, N., Tulassay, Z., Herszényi, L. [Prevention of pancreatitis following endoscopic retrograde cholangiopancreatography]. Orv. Hetil., 2015, 156(18), 715-719.

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Acute pancreatitis.Evidence based management guidelines of the Hungarian Pancreatic Study Group

Cited by 49 publications

References 57 publications

Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group

Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group

Meta-analysis of early nutrition: the benefits of enteral feeding compared to a nil per os diet not only in severe, but also in mild and moderate acute pancreatitis

Az endoszkópos retrográd cholangiopancreatographiát követő heveny hasnyálmirigy-gyulladás megelőzése

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