Dataset Information

Hepatobiliary and pancreatic ascariasis.

ABSTRACT: Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides, in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one such region, HPA is the etiological factor for 36.7%, 23%, 14.5% and 12.5% of all biliary diseases, acute pancreatitis, liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.

SUBMITTER: Khuroo MS

PROVIDER: S-EPMC5011666 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Hepatobiliary and pancreatic ascariasis.

Khuroo Mohammad S MS Rather Ajaz A AA Khuroo Naira S NS Khuroo Mehnaaz S MS

World journal of gastroenterology 20160901 33

Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides, in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one suc ...[more]

PMID: 27672273

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Project description:BACKGROUND: A rapidly growing knowledge base has evolved describing recently developed diagnostic and therapeutic techniques in the management of hepatic-pancreatic-biliary (HPB) disease. As such, it is expected that the current literature should reflect these trends in the emerging specialty of HPB surgery. METHODS: The content of 10 leading surgical journals was assessed for the separate years 1998 and 2002 using a combination of hand searching and Medline searching using the Pubmed search engine. Data retrieved for each journal included: total number/type of publication, specialty category, disease focus and comment on surgical technique. RESULTS: A total of 817 HPB articles were reviewed (386 in 1998,431 in 2002). Half of the journals showed an absolute increase in the number of HPB articles published; the largest increase was for Surgery (12%; 2002: 64/431; 1998: 10/386, p<0.0001), while the British Journal of Surgery displayed the greatest decrease (11%; 2002: 56/431; 1998: 94/386, p<0.0001). Publication by the nature of disease revealed that overall, there was a trend towards a greater volume of publications on malignant disease over the 4-year period (1998: 41%; 2002: 56%). Furthermore, 91% (10/11) of articles published by the Canadian Journal of Surgery related to benign disease; while almost all (97%) of the articles published by the Annals of Surgical Oncology were on malignant disease. There was a difference in the pathology focus for each sub-category of HPB topics. Fifty percent (150/302) of the articles on hepatic disease focused on malignancy, as compared with 46% (124/272) of those on pancreatic disease and 21% (44/213) of those on biliary disease. A comment on surgical technique was uniform across all categories (47% hepatic, 48% pancreatic and 44% biliary). DISCUSSION: Articles dealing with HPB topics are published widely across all reviewed journals. Although the absolute number of HPB articles published increased over a 4-year period, there is significant variability in overall topics and focus of publication between journals. Overall, there was a uniform paucity of basic science articles, evidence-based reviews and/or meta-analyses, indicating an opportunity for growth in the future.

Project description:This project aims to assess the impact of the introduction of a hepatobiliary and pancreatic (HPB) Quality Improvement Program (QIP) on postoperative complications following liver, biliary and pancreatic surgery. A prospective analysis of postoperative complications over a six month period was performed. Complications were analysed and graded according to internationally agreed definitions. Justification was sought and errors identified. Weekly meetings were performed to review each complication enabling an action plan to be created to prevent future recurrence. Rates were compared with previously audited and published results, using the chi-square test. A total of 326 procedures were performed over the six months including 30 pancreatectomies, 45 liver resections and 251 other procedures. 37 patients developed complications (11.3%) with 47 complications in total including two deaths. Using the ISGPS grading, eight complications were identified; two grade A, four grade B and two grade C. There were three grade A ISGLS complications and one grade B. 30 complications were justified as unavoidable, 16 as avoidable and one as indeterminate. Action plans included continued monitoring (n=41), formulation of new policy (n=3), individual counselling (n=4), educational offering (n=4). When compared with 2010 complication rates, 114 complications occurred in 233 liver operations during the baseline period, compared with 17 complications in 45 liver operations during the QIP period, OR=0.63 (95% CI: 0.33 to 1.22), p=0.17 and 86 complications occurred in 99 pancreatic resections during the baseline period, compared with 20 complications in 30 pancreatic resections during the QIP period OR=0.30 (95% CI: 0.12 to 0.79), p=0.01 The HPB QIP is a rigorous approach to grade every complication and death. A statistically significant reduction in pancreas related complications has already been obtained. Further work is required to determine the persistence and magnitude of this quality improvement.

Dataset Information

Hepatobiliary and pancreatic ascariasis.

Publications

Hepatobiliary and pancreatic ascariasis.

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