Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Treatment Options in Gastroenterology
Published in: Current Treatment Options in Gastroenterology 3/2016

01-09-2016 | Pancreas (T Stevens, Section Editor)

Role of ERCP in Patients With Idiopathic Recurrent Acute Pancreatitis

Authors: Piyush Somani MD, Udayakumar Navaneethan MD

Published in: Current Treatment Options in Gastroenterology | Issue 3/2016

Login to get access

Opinion statement

Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. RAP is differentiated from chronic pancreatitis based on the presence of a normal morphological appearance of the pancreas between episodes. RAP can be due to a variety of etiologies including common bile duct stones or sludge, sphincter of Oddi dysfunction (SOD), pancreas divisum (PD), anomalous pancreaticobiliary junction, genetic mutations, and alcohol related. In approximately 30 % of patients, the etiology of RAP is unclear and the term “idiopathic” is used. Endoscopic retrograde cholangiopancreatography (ERCP) can be utilized in both the diagnosis and the initial management of RAP, but it has known limitations and risks. Since gallbladder sludge and SOD account for most cases with RAP, cholecystectomy and, eventually, endoscopic biliary and/or pancreatic sphincterotomy are performed as a part of management. In patients with PD-associated RAP, data from uncontrolled and primarily retrospective studies point toward a benefit from minor papillary endoscopic intervention. However, given the lack of quality data from prospective randomized controlled trials (RCTs), endoscopic management in such patients remains an individualized decision, and RCTs are needed to ascertain its true long-term benefit. Future studies to investigate the role of endoscopic therapy in preventing progression to chronic pancreatitis are needed.
Literature
1.
Roberts JR, Romagnuolo J. Endoscopic therapy for acute recurrent pancreatitis. Gastrointest Endosc Clin N Am. 2013;23(4):803–19.PubMedCrossRef
2.
Levy MJ, Geenen JE. Idiopathic acute recurrent pancreatitis. Am J Gastroenterol. 2001;96(9):2540–55.PubMedCrossRef
3.
Das R, Yadav D, Papachristou GI. Endoscopic treatment of recurrent acute pancreatitis and smoldering acute pancreatitis. Gastrointest Endosc Clin N Am. 2015;25(4):737–48.PubMedCrossRef
4.•
Yadav D, O’Connell M, Papachristou GI. Natural history following the first attack of acute pancreatitis. Am J Gastroenterol. 2012;107(7):1096–103. One of the the largest population based studies on the natural history of patients following a sentinel attack of acute pancreatitis.PubMedCrossRef
5.
Lankisch PG, Breuer N, Bruns A, Weber-Dany B, Lowenfels AB, Maisonneuve P. Natural history of acute pancreatitis: a long-term population-based study. Am J Gastroenterol. 2009;104(11):2797–805. quiz 2806.PubMedCrossRef
6.
Seidensticker F, Otto J, Lankisch PG. Recovery of the pancreas after acute pancreatitis is not necessarily complete. Int J Pancreatol Off J Int Assoc Pancreatol. 1995;17(3):225–9.
7.
Romagnuolo J, Guda N, Freeman M, Durkalski V. Preferred designs, outcomes, and analysis strategies for treatment trials in idiopathic recurrent acute pancreatitis. Gastrointest Endosc. 2008;68(5):966–74.PubMedCrossRef
8.
Sarles H, Sarles JC, Camatte R, Muratore R, Gaini M, Guien C, et al. Observations on 205 confirmed cases of acute pancreatitis, recurring pancreatitis, and chronic pancreatitis. Gut. 1965;6(6):545–59.PubMedPubMedCentralCrossRef
9.
Chari ST, Singer MV. The problem of classification and staging of chronic pancreatitis. Proposals based on current knowledge of its natural history. Scand J Gastroenterol. 1994;29(10):949–60.PubMedCrossRef
10.
Singer MV, Gyr K, Sarles H. Revised classification of pancreatitis. Report of the Second International Symposium on the Classification of Pancreatitis in Marseille, France, March 28–30, 1984. Gastroenterology. 1985;89(3):683–5.PubMedCrossRef
11.
Sarles H, Adler G, Dani R, Frey C, Gullo L, Harada H, et al. The pancreatitis classification of Marseilles-Rome 1988. Scand J Gastroenterol. 1989;24(6):641–2.PubMedCrossRef
12.
13.
Cavestro GM, Leandro G, Di Leo M, Zuppardo RA, Morrow OB, Notaristefano C, et al. A single-centre prospective, cohort study of the natural history of acute pancreatitis. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2015;47(3):205–10.
14.
Pelli H, Sand J, Laippala P, Nordback I. Long-term follow-up after the first episode of acute alcoholic pancreatitis: time course and risk factors for recurrence. Scand J Gastroenterol. 2000;35(5):552–5.PubMedCrossRef
15.••
Sankaran SJ, Xiao AY, Wu LM, Windsor JA, Forsmark CE, Petrov MS. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology. 2015;149(6):1490–500. A well done meta-analysis reporting on the frequency of progression from acute to chronic pancreatitis.PubMedCrossRef
16.••
Ahmed Ali U, Issa Y, Hagenaars JC, et al. Dutch Pancreatitis Study Group. Risk of recurrent pancreatitis and progression to chronic pancreatitis after a first episode of acute pancreatitis. Clin Gastroenterol Hepatol. 2016;14:738–46. A well done cross-sectional survey of a prospectively collected multicenter patient cohort in Netherlands reporting on the role of smoking in recurrent acute pancreatitis.PubMedCrossRef
17.
Venu RP, Geenen JE, Hogan W, Stone J, Johnson GK, Soergel K. Idiopathic recurrent pancreatitis. An approach to diagnosis and treatment. Dig Dis Sci. 1989;34(1):56–60.PubMedCrossRef
18.
19.
Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis. N Engl J Med. 1992;326(9):589–93.PubMedCrossRef
20.
Testoni PA, Caporuscio S, Bagnolo F, Lella F. Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment. Am J Gastroenterol. 2000;95(7):1702–7.PubMedCrossRef
21.
Ros E, Navarro S, Bru C, Garcia-Pugés A, Valderrama R. Occult microlithiasis in “idiopathic” acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology. 1991;101(6):1701–9.PubMedCrossRef
22.
Kapetanos D. Endoscopic management of acute recurrent pancreatitis. Ann Gastroenterol. 2010;23(1):31–7.
23.
Kaw M, Brodmerkel GJ. ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Gastrointest Endosc. 2002;55(2):157–62.PubMedCrossRef
24.
Mariani A, Arcidiacono PG, Curioni S, Giussani A, Testoni PA. Diagnostic yield of ERCP and secretin-enhanced MRCP and EUS in patients with acute recurrent pancreatitis of unknown etiology. Dig Liver Dis. 2009;41(10):753–8.PubMedCrossRef
25.
26.
Roberts JR, Romagnuolo J. Endoscopic therapy for acute recurrent pancreatitis. Gastrointest Endosc Clin N Am. 2013;23(4):803–19.PubMedCrossRef
27.•
Yusoff IF, Raymond G, Sahai AV. A prospective comparison of the yield of EUS in primary vs. recurrent idiopathic acute pancreatitis. Gastrointest Endosc. 2004;60(5):673–8. One of the the largest population based studies on the natural history of patients following a sentinel attack of acute pancreatitis.PubMedCrossRef
28.
Leung WD, Sherman S. Endoscopic approach to the patient with motility disorders of the bile duct and sphincter of Oddi. Gastrointest Endosc Clin N Am. 2013;23(2):405–34.PubMedCrossRef
29.
Small AJ, Kozarek RA. Sphincter of Oddi dysfunction. Gastrointest Endosc Clin N Am. 2015;25(4):749–63.PubMedCrossRef
30.
Cicala M, Habib FI, Fiocca F, Pallotta N, Corazziari E. Increased sphincter of Oddi basal pressure in patients affected by gall stone disease: a role for biliary stasis and colicky pain? Gut. 2001;48(3):414–7.PubMedPubMedCentralCrossRef
31.
Coyle WJ, Pineau BC, Tarnasky PR, Knapple WL, Aabakken L, Hoffman BJ, et al. Evaluation of unexplained acute and acute recurrent pancreatitis using endoscopic retrograde cholangiopancreatography, sphincter of Oddi manometry and endoscopic ultrasound. Endoscopy. 2002;34(8):617–23.PubMedCrossRef
32.
Testoni PA, Caporuscio S, Bagnolo F, Lella F. Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment. Am J Gastroenterol. 2000;95(7):1702–7.PubMedCrossRef
33.
34.
Hogan WJ, Geenen JE, Dodds WJ. Dysmotility disturbances of the biliary tract: classification, diagnosis, and treatment. Semin Liver Dis. 1987;7(4):302–10.PubMedCrossRef
35.
Small AJ, Kozarek RA. Sphincter of Oddi dysfunction. Gastrointest Endosc Clin N Am. 2015;25(4):749–63.PubMedCrossRef
36.
Arguedas MR, Linder JD, Wilcox CM. Suspected sphincter of Oddi dysfunction type II: empirical biliary sphincterotomy or manometry-guided therapy? Endoscopy. 2004;36(2):174–8.PubMedCrossRef
37.•
Cotton PB, Durkalski V, Romagnuolo J, Pauls Q, Fogel E, Tarnasky P, et al. Effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial. JAMA. 2014;311(20):2101–9. One of the the largest population based studies on the natural history of patients following a sentinel attack of acute pancreatitis.PubMedPubMedCentralCrossRef
38.
Dawwas MF, Bruno MJ, Lee JG. Endoscopic sphincterotomy for sphincter of Oddi dysfunction: inefficacious therapy for a fictitious disease. Gastroenterology. 2015;148(2):440–3. discussion 443–4.PubMedCrossRef
39.
Guda NM, Freeman ML. True culprit or guilt by association? Is sphincter of Oddi manometry the cause of post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction, or is it the patients’ susceptibility? Rev Gastroenterol Disord. 2004;4(4):211–3.PubMed
40.
Singh P, Gurudu SR, Davidoff S, Sivak MV, Indaram A, Kasmin FE, et al. Sphincter of Oddi manometry does not predispose to post-ERCP acute pancreatitis. Gastrointest Endosc. 2004;59(4):499–505.PubMedCrossRef
41.
Sherman S, Troiano FP, Hawes RH, Lehman GA. Sphincter of Oddi manometry: decreased risk of clinical pancreatitis with use of a modified aspirating catheter. Gastrointest Endosc. 1990;36(5):462–6.PubMedCrossRef
42.
Elmunzer BJ, Scheiman JM, Lehman GA, Chak A, Mosler P, Higgins PDR, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med. 2012;366(15):1414–22.PubMedPubMedCentralCrossRef
43.
Wehrmann T, Stergiou N, Schmitt T, Dietrich CF, Seifert H. Reduced risk for pancreatitis after endoscopic microtransducer manometry of the sphincter of Oddi: a randomized comparison with the perfusion manometry technique. Endoscopy. 2003;35(6):472–7.PubMedCrossRef
44.•
Coté GA, Imperiale TF, Schmidt SE, Fogel E, Lehman G, McHenry L, et al. Similar efficacies of biliary, with or without pancreatic, sphincterotomy in treatment of idiopathic recurrent acute pancreatitis. Gastroenterology. 2012;143(6):1502–9.e1. One of the the largest population based studies on the natural history of patients following a sentinel attack of acute pancreatitis.PubMedCrossRef
45.
Eversman D, Fogel EL, Rusche M, Sherman S, Lehman GA. Frequency of abnormal pancreatic and biliary sphincter manometry compared with clinical suspicion of sphincter of Oddi dysfunction. Gastrointest Endosc. 1999;50(5):637–41.PubMedCrossRef
46.
Varadarajulu S, Wilcox CM. Randomized trial comparing needle-knife and pull-sphincterotome techniques for pancreatic sphincterotomy in high-risk patients. Gastrointest Endosc. 2006;64(5):716–22.PubMedCrossRef
47.
Lee SP, Nicholls JF. Nature and composition of biliary sludge. Gastroenterology. 1986;90(3):677–86.PubMed
48.
Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis. N Engl J Med. 1992;326(9):589–93.PubMedCrossRef
49.
Buscail L, Escourrou J, Delvaux M, Guimbaud R, Nicolet T, Frexinos J, et al. Microscopic examination of bile directly collected during endoscopic cannulation of the papilla. Utility in patients with suspected microlithiasis. Dig Dis Sci. 1992;37(1):116–20.PubMedCrossRef
50.
Levy MJ, Geenen JE, et al. Idiopathic acute recurrent pancreatitis. Am J Gastroenterol. 2001;96(9):2540–55.PubMedCrossRef
51.
Hernández CA, Lerch MM. Sphincter stenosis and gallstone migration through the biliary tract. Lancet Lond Engl. 1993;341(8857):1371–3.CrossRef
52.
Ros E, Navarro S, Bru C, Garcia-Pugés A, Valderrama R. Occult microlithiasis in “idiopathic” acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology. 1991;101(6):1701–9.PubMedCrossRef
53.
Buxbaum J. The role of endoscopic retrograde cholangiopancreatography in patients with pancreatic disease. Gastroenterol Clin North Am. 2012;41(1):23–45.PubMedCrossRef
54.
Levy MJ. The hunt for microlithiasis in idiopathic acute recurrent pancreatitis: should we abandon the search or intensify our efforts? Gastrointest Endosc. 2002;55(2):286–93.PubMedCrossRef
55.
Neoptolemos JP, Davidson BR, Winder AF, Vallance D. Role of duodenal bile crystal analysis in the investigation of “idiopathic” pancreatitis. Br J Surg. 1988;75(5):450–3.PubMedCrossRef
56.
Marks JW, Bonorris G. Intermittency of cholesterol crystals in duodenal bile from gallstone patients. Gastroenterology. 1984;87(3):622–7.PubMed
57.
Dahan P, Andant C, Lévy P, Amouyal P, Amouyal G, Dumont M, et al. Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography. Gut. 1996;38(2):277–81.PubMedPubMedCentralCrossRef
58.
Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P. EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc. 2008;67(2):235–44.PubMedCrossRef
59.
Siegel JH, Veerappan A, Cohen SA, Kasmin FE. Endoscopic sphincterotomy for biliary pancreatitis: an alternative to cholecystectomy in high-risk patients. Gastrointest Endosc. 1994;40(5):573–5.PubMedCrossRef
60.
61.
Saltzman JR. Endoscopic treatment of pancreas divisum: why, when, and how? Gastrointest Endosc. 2006;64(5):712–5.PubMedCrossRef
62.
Kozu T, Suda K, Toki F. Pancreatic development and anatomical variation. Gastrointest Endosc Clin N Am. 1995;5(1):1–30.PubMed
63.
Kushnir VM, Wani SB, Fowler K, Menias C, Varma R, Narra V, et al. Sensitivity of endoscopic ultrasound, multidetector computed tomography, and magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum: a tertiary center experience. Pancreas. 2013;42(3):436–41.PubMedPubMedCentralCrossRef
64.
Gonoi W, Akai H, Hagiwara K, Akahane M, Hayashi N, Maeda E, et al. Pancreas divisum as a predisposing factor for chronic and recurrent idiopathic pancreatitis: initial in vivo survey. Gut. 2011;60(8):1103–8.PubMedCrossRef
65.
66.
Bertin C, Pelletier A-L, Vullierme MP, Bienvenu T, Rebours V, Hentic O, et al. Pancreas divisum is not a cause of pancreatitis by itself but acts as a partner of genetic mutations. Am J Gastroenterol. 2012;107(2):311–7.PubMedCrossRef
67.
Garg PK, Khajuria R, Kabra M, Shastri SS. Association of SPINK1 gene mutation and CFTR gene polymorphisms in patients with pancreas divisum presenting with idiopathic pancreatitis. J Clin Gastroenterol. 2009;43(9):848–52.PubMedCrossRef
68.
Kanth R, Samji NS, Inaganti A, Komanapalli SD, Rivera R, Antillon MR, et al. Endotherapy in symptomatic pancreas divisum: a systematic review. Pancreatology. 2014;14(4):244–50.PubMedCrossRef
69.
70.
Sahel J, Cros RC, Bourry J, Sarles H. Clinico-pathological conditions associated with pancreas divisum. Digestion. 1982;23(1):1–8.PubMedCrossRef
71.
Richter JM, Schapiro RH, Mulley AG, Warshaw AL. Association of pancreas divisum and pancreatitis, and its treatment by sphincteroplasty of the accessory ampulla. Gastroenterology. 1981;81(6):1104–10.PubMed
72.
Burtin P, Person B, Charneau J, Boyer J. Pancreas divisum and pancreatitis: a coincidental association? Endoscopy. 1991;23(2):55–8.PubMedCrossRef
73.
Delhaye M, Engelholm L, Cremer M. Pancreas divisum: congenital anatomic variant or anomaly? Contribution of endoscopic retrograde dorsal pancreatography. Gastroenterology. 1985;89(5):951–8.PubMedCrossRef
74.
Sugawa C, Walt AJ, Nunez DC, Masuyama H. Pancreas divisum: is it a normal anatomic variant? Am J Surg. 1987;153(1):62–7.PubMedCrossRef
75.
Fogel EL, Toth TG, Lehman GA, DiMagno MJ, DiMagno EP. Does endoscopic therapy favorably affect the outcome of patients who have recurrent acute pancreatitis and pancreas divisum? Pancreas. 2007;34(1):21–45.PubMedCrossRef
76.
Liao Z, Gao R, Wang W, Ye Z, Lai X-W, Wang X-T, et al. A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum. Endoscopy. 2009;41(5):439–44.PubMedCrossRef
77.
Chacko LN, Chen YK, Shah RJ. Clinical outcomes and nonendoscopic interventions after minor papilla endotherapy in patients with symptomatic pancreas divisum. Gastrointest Endosc. 2008;68(4):667–73.PubMedCrossRef
78.
Lehman GA, Sherman S, Nisi R, Hawes RH. Pancreas divisum: results of minor papilla sphincterotomy. Gastrointest Endosc. 1993;39(1):1–8.PubMedCrossRef
79.•
Lans JI, Geenen JE, Johanson JF, Hogan WJ. Endoscopic therapy in patients with pancreas divisum and acute pancreatitis: a prospective, randomized, controlled clinical trial. Gastrointest Endosc. 1992;38(4):430–4. One of the the largest population based studies on the natural history of patients following a sentinel attack of acute pancreatitis.PubMedCrossRef
80.
Ertan A. Long-term results after endoscopic pancreatic stent placement without pancreatic papillotomy in acute recurrent pancreatitis due to pancreas divisum. Gastrointest Endosc. 2000;52(1):9–14.PubMedCrossRef
81.
82.
Borak GD, Romagnuolo J, Alsolaiman M, Holt EW, Cotton PB. Long-term clinical outcomes after endoscopic minor papilla therapy in symptomatic patients with pancreas divisum. Pancreas. 2009;38(8):903–6.PubMedCrossRef
83.
Kwan V, Loh SM, Walsh PR, Williams SJ, Bourke MJ. Minor papilla sphincterotomy for pancreatitis due to pancreas divisum. ANZ J Surg. 2008;78(4):257–61.PubMedCrossRef
84.
Gerke H, Byrne MF, Stiffler HL, Obando JV, Mitchell RM, Jowell PS, et al. Outcome of endoscopic minor papillotomy in patients with symptomatic pancreas divisum. JOP J Pancreas. 2004;5(3):122–31.
85.
Heyries L, Barthet M, Delvasto C, Zamora C, Bernard J-P, Sahel J. Long-term results of endoscopic management of pancreas divisum with recurrent acute pancreatitis. Gastrointest Endosc. 2002;55(3):376–81.PubMedCrossRef
86.
Devereaux BM, Lehman GA, Fein S, Phillips S, Fogel EL, Sherman S. Facilitation of pancreatic duct cannulation using a new synthetic porcine secretin. Am J Gastroenterol. 2002;97(9):2279–81.PubMedCrossRef
87.
Devereaux BM, Fein S, Purich E, Trout JR, Lehman GA, Fogel EL, et al. A new synthetic porcine secretin for facilitation of cannulation of the dorsal pancreatic duct at ERCP in patients with pancreas divisum: a multicenter, randomized, double-blind comparative study. Gastrointest Endosc. 2003;57(6):643–7.PubMedCrossRef
88.
Park S-H, de Bellis M, McHenry L, Fogel EL, Lazzell L, Bucksot L, et al. Use of methylene blue to identify the minor papilla or its orifice in patients with pancreas divisum. Gastrointest Endosc. 2003;57(3):358–63.PubMedCrossRef
89.
Attwell A, Borak G, Hawes R, Cotton P, Romagnuolo J. Endoscopic pancreatic sphincterotomy for pancreas divisum by using a needle-knife or standard pull-type technique: safety and reintervention rates. Gastrointest Endosc. 2006;64(5):705–11.PubMedCrossRef
90.
Chandrasekhara V, Chathadi KV, Acosta RD, Decker GA, Early DS, Eloubeidi MA, et al. The role of endoscopy in benign pancreatic disease. Gastrointest Endosc. 2015;82(2):203–14.PubMedCrossRef
91.
Kozarek RA. Pancreatic stents can induce ductal changes consistent with chronic pancreatitis. Gastrointest Endosc. 1990;36(2):93–5.PubMedCrossRef
92.
Guelrud M, Morera C, Rodriguez M, Jaen D, Pierre R. Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept. Gastrointest Endosc. 1999;50(2):194–9.PubMedCrossRef
93.
Gress F, Yiengpruksawan A, Sherman S, Ikenberry S, Kaster S, Ng RY, et al. Diagnosis of annular pancreas by endoscopic ultrasound. Gastrointest Endosc. 1996;44(4):485–9.PubMedCrossRef
94.
Hwang SS, Paik CN, Lee K-M, Chung WC, Jang U-I, Yang J-M. Recurrent acute pancreatitis caused by an annular pancreas in a child. Gastrointest Endosc. 2010;72(4):848–9.PubMedCrossRef
Metadata
Title
Role of ERCP in Patients With Idiopathic Recurrent Acute Pancreatitis
Authors
Piyush Somani MD
Udayakumar Navaneethan MD
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Treatment Options in Gastroenterology / Issue 3/2016
Print ISSN: 1092-8472
Electronic ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-016-0096-9

Other articles of this Issue 3/2016

Current Treatment Options in Gastroenterology 3/2016 Go to the issue

Intractable Disease in the Elderly: When Conventional Therapy Fails (S Katz, Section Editor)

Endoscopy in the Elderly: a Cautionary Approach, When to Stop

Intractable Disease in the Elderly: When Conventional Therapy Fails (S Katz, Section Editor)

Managing Esophageal Dysphagia in the Elderly

Intractable Disease in the Elderly: When Conventional Therapy Fails (S Katz, Section Editor)

Management of Inflammatory Bowel Disease in the Elderly

Pancreas (T Stevens, Section Editor)

Preventing Post-ERCP Pancreatitis: Update 2016

Pancreas (T Stevens, Section Editor)

Interventional Pain Management Approaches for Control of Chronic Pancreatic Pain

Pancreas (T Stevens, Section Editor)

Management of Disconnected Pancreatic Duct Syndrome
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits