Direct Endoscopic Necrosectomy: Timing and Technique

Walled-off pancreatic necrosis (WOPN) is one of the local complications of acute pancreatitis (AP). Several interventional techniques have been developed over the last few years. The purpose of this narrative review is to explore such methodologies, with specific focus on endoscopic drainage and direct endoscopic necrosectomy (DEN), through evaluation of their indications and timing for intervention. Findings indicated how, after the introduction of lumen-apposing metal stents (LAMS), DEN is becoming the favorite technique to treat WOPN, especially when large solid debris or infection are present. Additionally, DEN is associated with a lower adverse events rate and hospital stay, and with improved clinical outcome.

Biological medications for interventional pain have a lot of clinical data behind them. It is fair to assume they will replace steroid-based interventional techniques, providing patients with longer relief

This overview of current studies on the use and effectiveness of stem cell therapy for chronic pain should serve as a reminder of the growing body of data that supports these therapies, particularly Platelet-rich plasma (PRP) injections. Due to a scarcity of high-quality randomized controlled trials on the subject, the great majority of evidence for chronic pain treatment is graded as level II to level IV. While there are no new panaceas in pain management described in this study, the level of evidence for PRP intra-articular knee injections in terms of pain management should be particularly remarkable. This is a landmark event in the field of interventional pain, and it should serve as evidence that these biological medications have a lot of clinical data behind them.With increasing clinical data and future experimental data into more targeted gene modulation therapies, it is fair to assume that these treatments will ultimately replace present steroid-based interventional techniques, providing patients with longer relief and higher clinical benefit. Furthermore, similar to many other medical areas that have strived to stress the need for preventive medicine, pain management doctors may one day harness the regenerative potential of these medicines to better treat their patients and battle the mounting socioeconomic consequences of this illness.

Coronary Artery Calcification: From Cell to Stent—A Review

Coronary artery calcification (CAC) is a well-known entity, with a high incidence amounting to a third of the total coronary artery disease (CAD) patients. It is also associated with a high complication rate during percutaneous transluminal coronary angioplasty, such as stent nontrackability, stent nonapposition, and underexpansion. The recent technological advances have helped to perform percutaneous coronary intervention in the calcified coronaries with better results. The management of calcified lesion was mainly concentrated on interventional techniques, this article gives a comprehensive review of CAC pathophysiology, its morphology, various diagnostic modalities, newer diagnostic tools, upcoming medical therapies, and interventional techniques. Newer therapies which include vitamin K and myoinositol hexaphosphate, their role in pathogenesis of CAC, and its future role in preventing and treating CAC are covered in this article.

Locally Advanced Pancreatic Cancer: Percutaneous Management Using Ablation, Brachytherapy, Intra-arterial Chemotherapy, and Intra-tumoral Immunotherapy

Purpose of Review Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive neoplasms, bearing a terrible prognosis. Stage III tumors, also known as locally advanced pancreatic cancer (LAPC), are unresectable, and current palliative chemotherapy regimens have only modestly improved survival in these patients. At this stage of disease, interventional techniques may be of value and further prolong life. The aim of this review was to explore current literature on locoregional percutaneous management for LAPC. Recent Findings Locoregional percutaneous interventional techniques such as ablation, brachytherapy, and intra-arterial chemotherapy possess cytoreductive abilities and have the potential to increase survival. In addition, recent research demonstrates the immunomodulatory capacities of these treatments. This immune response may be leveraged by combining the interventional techniques with intra-tumoral immunotherapy, possibly creating a durable anti-tumor effect. This multimodality treatment approach is currently being examined in several ongoing clinical trials. Summary The use of certain interventional techniques appears to improve survival in LAPC patients and may work synergistically when combined with immunotherapy. However, definitive conclusions can only be made when large prospective (randomized controlled) trials confirm these results.

Computed tomography in planning of the treatment of complications after pancreatic surgery

Aim. To evaluate opportunity of computed tomography in diagnosis and decision making in patients with pancreatic surgery complications and possibility of interventional procedures in its treatment.Materials and methods. 50 patients underwent pancreatic surgery in 2018-2020 (45 Whipple procedure and 5 distal pancreatectomies). 45 patients underwent computed tomography in post-surgery course. The complications occur in 29 patients; complications were found by computer tomography in 26 patients.Results. The most frequent complication was pancreatic fistula (24%) in typical places: upper edge of the pancreatojejunostomy (25%) and in the bed of the resected pancreatic head (50%). Delineated fluid collections on computed tomography scans were more prevalent in patients with complicated course (57.9% vs. 26.3%). The average size of fluid collections was increased in the group of complicated courses (51,9 × 28,1 mm vs. 42,2 × 20, 6 mm). Interventional procedures were performed in 18 patients (62% of complicated patients). The average number of such interventions per patient was 2.95. Using interventional techniques as the only method of surgical treatment, 13 patients were cured (50% of complicated patients). In 14 patients, interventions were planned and performed based on control computed tomography. Postoperative bleedings were detected in 8 patients (16%). In 4 cases it revealed ongoing bleeding by computer tomography, in 3 cases – completed, which allowed us to determine further treatment tactics.Conclusion. Performing computed tomography after pancreatic surgery allows to identify postoperative complications before their clinical manifestation and plan their treatment. The optimal time for performing computed tomography is 5–6 days after surgery. Performing CT angiography for suspected bleeding in some cases allows to avoid invasive angiography and choose the method of endovascular hemostasis in appropriate situations. The combination of various interventional techniques allows to avoid relaparotomy in most patients with intraabdominal complications.