PTH-026 Pre-Operative Endoscopic Management of Biliary Obstruction in Pancreatic Cancer: Are Esge Guidelines Relevant and Achievable In The UK?

Gut ◽  
2016 ◽  
Vol 65 (Suppl 1) ◽  
pp. A230.1-A230
Author(s):  
J Chalmers ◽  
M James ◽  
T Archer ◽  
D Gomez
Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1036
Author(s):  
Sangeetha Shyam ◽  
Darren Greenwood ◽  
Chun-Wai Mai ◽  
Seok Shin Tan ◽  
Barakatun Nisak Mohd Yusof ◽  
...  

(1) Background: We studied the association of both conventional (BMI, waist and hip circumference and waist–hip ratio) and novel (UK clothing sizes) obesity indices with pancreatic cancer risk in the UK women’s cohort study (UKWCS). (2) Methods: The UKWCS recruited 35,792 women from England, Wales and Scotland from 1995 to 1998. Cancer diagnosis and death information were obtained from the National Health Service (NHS) Central Register. Cox’s proportional hazards regression was used to evaluate the association between baseline obesity indicators and pancreatic cancer risk. (3) Results: This analysis included 35,364 participants with a median follow-up of 19.3 years. During the 654,566 person-years follow up, there were 136 incident pancreatic cancer cases. After adjustments for age, smoking, education and physical activity, each centimetre increase in hip circumference (HR: 1.03, 95% CI: 1.01–1.05, p = 0.009) and each size increase in skirt size (HR: 1.12, 95% CI: 1.02–1.23, p = 0.041) at baseline increased pancreatic cancer risk. Baseline BMI became a significant predictor of pancreatic cancer risk (HR: 1.04, 95% CI: 1.00–1.08, p = 0.050) when latent pancreatic cancer cases were removed. Only baseline hip circumference was associated with pancreatic cancer risk (HR: 1.03, 95% CI: 1.00–1.05, p = 0.017) when participants with diabetes at baseline were excluded to control for reverse causality. (4) Conclusion: Hip circumference and skirt size were significant predictors of pancreatic cancer risk in the primary analysis. Thus, hip circumference is useful to assess body shape relationships. Additionally, standard skirt sizes offer an economical and objective alternative to conventional obesity indices for evaluating pancreatic cancer risk in women.


2021 ◽  
Vol 53 ◽  
pp. S122-S123
Author(s):  
R. Di Mitri ◽  
A. Bonaccorso ◽  
F. Mocciaro ◽  
E. Conte ◽  
M. Amata ◽  
...  

2018 ◽  
Vol 145 (6) ◽  
pp. 1484-1492 ◽  
Author(s):  
Charlie D Zhou ◽  
Ai Seon Kuan ◽  
Gillian K Reeves ◽  
Jane Green ◽  
Sarah Floud ◽  
...  

2003 ◽  
Vol 4 (3) ◽  
pp. 216-221 ◽  
Author(s):  
Mike Aristides ◽  
Michael Lees ◽  
Nick Botwood ◽  
Jan McKendrick ◽  
Deborah A Stephenson ◽  
...  

2017 ◽  
Vol 34 (04) ◽  
pp. 369-375 ◽  
Author(s):  
Tomas DaVee ◽  
Jeffrey Lee

AbstractPainless jaundice is a harbinger of malignant biliary obstruction, with the majority of cases due to pancreatic adenocarcinoma. Despite advances in treatment, including improved surgical techniques and neoadjuvant (preoperative) chemotherapy, long-term survival from pancreatic cancer is rare. This lack of significant improvement in outcomes is believed to be due to multiple reasons, including the advanced stage at diagnosis and lack of an adequate biomarker for screening and early detection, prior to the onset of jaundice or epigastric pain. Close attention is required to select appropriate patients for preoperative biliary decompression, and to prevent morbid complications from biliary drainage procedures, such as pancreatitis and cholangitis. Use of small caliber plastic biliary stents during endoscopic retrograde cholangiopancreatography should be minimized, as metal stents have increased area for improved bile flow and a reduced risk of adverse events during neoadjuvant therapy. Efforts are underway by translational scientists, radiologists, oncologists, surgeons, and gastroenterologists to augment lifespan for our patients and to more readily treat this deadly disease. In this review, the authors discuss the rationale and techniques of endoscopic biliary intervention, mainly focusing on malignant biliary obstruction by pancreatic cancer.


The Lancet ◽  
2011 ◽  
Vol 378 (9796) ◽  
pp. 1050 ◽  
Author(s):  
The Lancet
Keyword(s):  

2018 ◽  
pp. 387-398
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick

Pancreatic cancer is the tenth most common cancer in the UK and is most often incurable at diagnosis. Presentation is generally with weight loss, jaundice, and or abdominal pain. Abdominal ultrasound, CT and MRI may be diagnostic. Tissue diagnosis is not usually necessary, but endoscopic ultrasound can obtain fine needle samples. The serum marker CA19-9 may be raised, but is not a screening test. Potentially curable lesions need careful multidisciplinary assessment for resectability, and a thorough assessment of patient fitness. The Whipple procedure is discussed as well as laparoscopic pancreatectomy. Adjuvant chemotherapy and palliative gemcitabine therapy are also covered.


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