Role and importance of pancreatic stents in the prevention of post-ERCP pancreatitis
The most frequent complication of endoscopic retrograde cholangiopancreatography is post-ERCP pancreatitis. Several risk factors and a few prophylactic measures have become evident over the past three decades. The most effective preventive method among high-risk patients is the insertion of a small caliber pancreatic stent, the so-called prophylactic pancreatic stent (PPS), although their usage requires appropriate endoscopic practice. In this publication we summarize the relevant knowledge related to PPSs.
Metabolic (Bariatric) Surgery
The incidence of obesity and its co-morbidities, including first of all diabetes type 2, cardio-vascular disease, chronic arthritis, fatty liver disease and sleep apnea are increasing with explosive tendency in most countries of the world. The proportion of the overweight and obese people is getting higher in Hungary too. As the conservative therapeutic methods for weight loss sometimes fail, the attention is focused increasingly on the metabolic surgical interventions, performed more frequently in the last years in our country. The criterias of indication, the types of procedures and their results and risks, and the problems of care after the interventions are often arising questions to answer in everyday medical practice. We summarize these aspects based on our experience and on current literature.
Higher polyp detection rate during screening colonoscopies compared to routine procedures
Introduction: The colorectal cancer (CRC) is not only the most common malignant tumor of the digestive tract, but in the developed countries this is one of the leading causes of death due to the high incidence and mortality rate. It has now been recognized that these tumors have a slow carcinogenesis, so this is a well-screened tumor type. In 2019, the nationwide colon screening program was started in Hungary.
Objectives: The aim of this study was to compare the data of participants in the CRC screening program with those patients who were in the same age but were outside the screening program. Patients, methods: We conducted a retrospective analysis from 1st April 2019 to 31st December 2019. We investigated the demographic data. The polyp, adenoma and tumor detection rates were calculated and compared between the CRC screening group and the same age, but non-screening group.
Results: During our study period 217 persons (50-70 years old) were screened and 1611 patients underwent colonoscopy for other reasons. From the latter, 687 were in the same age group as the screened population. This group of patients was further divided into two. Fecal blood test positivity outside screening was the indication for 71 patients (iFOB+ group). The remaining 616 patient were considered the regular group. The polyp detection rates for screening and iFOB+ groups were 73 vs. 52.1%. For adenoma, these percentages were modified to 66.4 for CRC screening and 46.5 for iFOB+. The tumor detection rate was 5.5% in CRC screening and 2.8% in iFOB+ group. In the regular group the polyp detection was 38.8% and tumor detection was 7.8%.
Discussion: Polyp and adenoma detection rates were found significantly higher in CRC screening participants than in the iFOB+ group. In any of the study groups there were no significant differences in tumor detection rate. Researching for the reason of these differences, the only one difference was found, it was the resolution of the endoscopy. There were no significant differences in the bowel cleanliness rating, in the coecum intubation rates, in the performance of our doctors.
Conclusion: We believe that our initial results already highlight the importance of the colorectal screening program. The long-term continuation of the program and the continuous monitoring of the data are considered to be important.