Abstract:
SUMMARY BACKGROUND DATA:The role of early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) remains controversial. Previous studies have included only a relatively small number of patients with predicted severe ABP. We investigated the clinical effects of early ERCP in these patients. METHODS:We performed a prospective, observational multicenter study in 8 university medical centers and 7 major teaching hospitals. One hundred fifty-three patients with predicted severe ABP without cholangitis enrolled in a randomized multicenter trial on probiotic prophylaxis in acute pancreatitis were prospectively followed. Conservative treatment or ERCP within 72 hours after symptom onset (at discretion of the treating physician) were compared for complications and mortality. Patients without and with cholestasis (bilirubin: >2.3 mg/dL [40 mumol/L] and/or dilated common bile duct) were analyzed separately. RESULTS:Of the 153 patients, 81 (53%) underwent ERCP and 72 (47%) conservative treatment. Groups were highly comparable at baseline. Seventy-eight patients (51%) had cholestasis. In patients with cholestasis, ERCP (52/78 patients: 67%), as compared with conservative treatment, was associated with fewer complications (25% vs. 54%, P = 0.020, multivariate adjusted odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.13-0.99, P= 0.049). This included fewer patients with >30% pancreatic necrosis (8% vs. 31%, P = 0.010). Mortality was nonsignificantly lower after ERCP (6% vs. 15%, P = 0.213, multivariate adjusted OR: 0.44, 95% CI: 0.08-2.28, P = 0.330). In patients without cholestasis, ERCP (29/75 patients: 39%) was not associated with reduced complications (45% vs. 41%, P = 0.814, multivariate adjusted OR: 1.36; 95% CI: 0.49-3.76; P = 0.554) or mortality (14% vs. 17%, P = 0.754, multivariate adjusted OR: 0.78; 95% CI: 0.19-3.12, P = 0.734). CONCLUSIONS:Early ERCP is associated with fewer complications in predicted severe ABP if cholestasis is present.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
van Santvoort HC,Besselink MG,de Vries AC,Boermeester MA,Fischer K,Bollen TL,Cirkel GA,Schaapherder AF,Nieuwenhuijs VB,van Goor H,Dejong CH,van Eijck CH,Witteman BJ,Weusten BL,van Laarhoven CJ,Wahab PJ,Tan AC,Schwartz Mdoi
10.1097/SLA.0b013e3181a77bb4subject
Has Abstractpub_date
2009-07-01 00:00:00pages
68-75issue
1eissn
0003-4932issn
1528-1140journal_volume
250pub_type
杂志文章,多中心研究,随机对照试验abstract:OBJECTIVES:This study aimed to compare long-term survival following minimally invasive esophagectomy (MIE) versus open esophagectomy (OE) for esophageal cancer using a nationwide propensity-score matched cohort. SUMMARY BACKGROUND DATA:MIE provides lower postoperative morbidity and mortality, and similar short-term on...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004708
更新日期:2020-12-23 00:00:00
abstract:OBJECTIVE:To investigate the incidence of nodal metastasis in a consecutive series of patients treated at the authors' institution with highly selective criteria, and to determine the impact that lymphatic mapping and sentinel node biopsy have on the detection of nodal metastases in this carefully selected patient popu...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.SLA.0000071564.27229.A9
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVE:To assess whether level of arterial obstruction determines the effectiveness of SET in patients with IC. BACKGROUND DATA:Guidelines advocate SET before invasive treatment for IC, but early revascularization remains widespread, especially in patients with aortoiliac disease. METHODS:Patients were recruited f...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004073
更新日期:2020-07-24 00:00:00
abstract:OBJECTIVE:To determine whether translocation of bacteria or endotoxin occurred into the thoracic duct in patients with multiple organ failure (MOF). SUMMARY BACKGROUND DATA:Translocation of bacteria or endotoxin has been proposed as a causative factor for MOF in patients without an infectious focus, although it has ra...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199901000-00017
更新日期:1999-01-01 00:00:00
abstract::Despite the dramatically increased entry of women into general surgery and surgical subspecialties, traditionally male-dominated fields, there remains a gross under-representation of women in the leadership positions of these departments. Women begin their careers with fewer academic resources and tend to progress thr...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0b013e3182111120
更新日期:2011-04-01 00:00:00
abstract::Six patients with surgically treated Menetrier's disease are presented. Diffuse or focal cystic hyperplasia of mucous secreting epithelium of the fundus with antral sparing characterized the stomachs in all of these cases. In most instances the disorder was found during evaluation of non-specific complaints of pain, n...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197704000-00015
更新日期:1977-04-01 00:00:00
abstract:OBJECTIVE:To evaluate clinical parameters, presurgical diagnostic tests, histologic findings, and the presence of K-ras oncogene mutations in cystic tumors of the pancreas to determine which best predict malignancy. SUMMARY BACKGROUND DATA:Because presurgical, intraoperative, and final pathologic differentiation is di...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199807000-00012
更新日期:1998-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the independent prognostic ability of the American Joint Committee on Cancer (AJCC) tumor regression scores within pathologic stage II and III rectal cancers. BACKGROUND:Response to neoadjuvant chemoradiation (nCRT) has been debated as a biologic surrogate for tumor biology and prognosis in recta...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002719
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:This study compares the quality of valve replacement and repair performed through minimally invasive incisions as compared to the standard operation for aortic and mitral valve replacement. SUMMARY BACKGROUND DATA:With the advent of minimally invasive laparoscopic approaches to orthopedic surgery, urology, g...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199710000-00003
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To demonstrate that alvimopan (6 or 12 mg) accelerates recovery of gastrointestinal (GI) function in patients undergoing laparotomy for bowel resection or radical hysterectomy. SUMMARY BACKGROUND DATA:Postoperative ileus (POI) following laparotomy may increase morbidity and extend hospitalization. Opioids ca...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,meta分析,随机对照试验
doi:10.1097/01.sla.0000141158.27977.66
更新日期:2004-10-01 00:00:00
abstract:OBJECTIVE:We merged direct, multisource, and systematic assessments of surgeon behavior with malpractice claims, to analyze the relationship between surgeon 360-degree reviews and malpractice history. BACKGROUND:Previous work suggests that malpractice claims are associated with a poor physician-patient relationship, w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002742
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:To assess the immediate and long-term clinical results of 2 different surgical procedures for the treatment of asymmetrical multinodular goiter (AMG). BACKGROUND:Half of the patients presenting with a single benign thyroid nodule have contralateral subclinical disease. There is a controversy whether these pa...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0b013e318272df62
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:The Hepp-Couinaud technique describes side-to-side HJ to the main left hepatic duct but a side-to-side approach is not consistently used when repairing other ducts. Compared with end-to-side repairs, side-to-side anastomoses require less dissection, theoretically preserving blood supply to the bile ducts, an...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31819a6b2e
更新日期:2009-03-01 00:00:00
abstract::Diminished poststenotic pressure and flow accompanied experimental application of multiple subcritical arterial stenoses in series. Effects of additional stenoses, causing equivalent constrictions, were cumulative in a nonlinear fashion. Seven-hundred-twenty measurements were performed using 10 cm ileofemoral canine a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197711000-00020
更新日期:1977-11-01 00:00:00
abstract:OBJECTIVE:To review the literature on current management of hepatocellular carcinoma (HCC). BACKGROUND:Hepatocellular carcinoma represents one of the most common malignancies worldwide with a rising incidence in western countries. There have been substantial advances in the surgical and medical treatment of HCC within...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0b013e31820d944f
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:To determine whether increasing distance between helicopter ambulance airbase and either home residence or referring facility is associated with an increased risk of injury-related mortality. BACKGROUND:A dramatic increase in the absolute number and utilization of Helicopter Emergency Medical Services transp...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31827ee6b0
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:We tested the hypothesis that the avoidance of preoperative fasting by hypocaloric nutrition attenuates protein catabolism after surgery. SUMMARY BACKGROUND DATA:Prolonged fasting before major abdominal procedures has been demonstrated to accentuate the catabolic response to surgery. METHODS:Twenty-two pati...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e31818842d8
更新日期:2008-12-01 00:00:00
abstract::Peripheral vascular disease of the extremities causes ischemic pain and, at times, skin ulcerations and gangrene. It has been suggested that epidural spinal electrical stimulation (ESES) could improve peripheral circulation. Since 1978 we have used ESES in 34 patients with severe limb ischemia; all had resting pain an...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198507000-00017
更新日期:1985-07-01 00:00:00
abstract:INTRODUCTION:Intraductal papillary mucinous neoplasms (IPMNs) are being increasingly recognized, and often harbor cancer. Lymph node metastases are an important prognostic factor for patients with invasive intraductal papillary carcinoma (I-IPMC), but the role of lymph node ratio (LNR) in predicting survival after surg...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181cf9155
更新日期:2010-03-01 00:00:00
abstract::Previous studies have demonstrated that administered antibiotics must be active against major anticipated pathogens and must have reached sufficient concentrations in the tissue or body fluid at risk by the time of bacterial challenge if prophylactic therapy is to be maximally effective in reducing the infection rate ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-197906000-00004
更新日期:1979-06-01 00:00:00
abstract:INTRODUCTION:Radiation therapy is increasingly used as adjuvant treatment of many childhood and adult malignancies. Radiation-induced sarcoma is a well recognized if uncommon event. The objective of this study is to determine the prevalence and long-term outcome for patients who develop radiation-induced sarcomas. MET...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000128686.51815.8b
更新日期:2004-06-01 00:00:00
abstract::The objectives of this study were to compare in dogs the effects of massive infusion of Ringer's lactate, 5% dextrose in water, and whole blood. Special interest centered upon lung function, central venous pressure, and dilutional effects upon the blood components. Three groups of 5 healthy dogs each received respecti...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197511000-00018
更新日期:1975-11-01 00:00:00
abstract:OBJECTIVE:To assess the association of 0.9% saline use versus a calcium-free physiologically balanced crystalloid solution with major morbidity and clinical resource use after abdominal surgery. BACKGROUND:0.9% saline, which results in a hyperchloremic acidosis after infusion, is frequently used to replace volume loss...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31825074f5
更新日期:2012-05-01 00:00:00
abstract::Cyclosporine has been used as primary immunosuppression in renal allograft recipients in our unit for the past decade. The overall clinical experience and long-term effects of the agent are reviewed. There were 461 consecutive recipients of kidney grafts; 379 received grafts from cadaver donors (CAD) and 82 from livin...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199107000-00007
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:Clinical coding is the translation of clinical activity into a coded language. Coded data drive hospital reimbursement and are used for audit and research, and benchmarking and outcomes management purposes. METHODS:We undertook a 2-center audit of coding accuracy across surgery. Clinician-auditor multidisci...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000000851
更新日期:2015-06-01 00:00:00
abstract::Twenty-three selected patients presenting with massive bleeding from peptic ulcers underwent emergency parietal cell vagotomy (PCV). Nineteen patients had a duodenal ulcer, two a prepyloric ulcer, and one a gastric ulcer. The patients were studied retrospectively with regard to postoperative mortality and morbidity, e...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198711000-00005
更新日期:1987-11-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to identify the prognostic factors before neoadjuvant chemoradiotherapy (NCRT) in the patients with localized PDAC. Furthermore, to identify the post-surgical survival predictors of patients with LAPC. SUMMARY OF BACKGROUND DATA:Surgical resection may occupy an important position in ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004148
更新日期:2020-07-24 00:00:00
abstract:OBJECTIVES:The American Joint Committee on Cancer (AJCC) staging system for gastric cancer bases N status on absolute number of metastatic nodes, regardless of the number of examined nodes. We examined a modified staging system utilizing node ratio (Nr), the ratio of metastatic to examined nodes. METHODS:A total of 18...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824857e2
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis. SUMMARY BACKGROUND DATA:It has not been determined whether endotoxin translocation in small amounts is a physiological phenomenon or whether it is a potential health hazard. METHODS:Blood endotoxin, ant...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000082711.77096.71
更新日期:2003-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the outcome of artificial anal sphincter implantation for severe fecal incontinence in 37 consecutive patients operated on in a single institution from 1993 through 2001. SUMMARY BACKGROUND DATA:Implantation of an artificial anal sphincter is proposed in severe fecal incontinence when local treat...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200301000-00008
更新日期:2003-01-01 00:00:00