Volume 84 - 2021 - Fasc.4 - Reviews
The role of extracorporeal shock wave lithotripsy in the treatment of chronic pancreatitis
Pain is the most frequent symptom in chronic pancreatitis (CP) and has an important impact on quality of life. One of its major pathophysiological mechanisms is ductal hypertension, caused by main pancreatic duct stones and/or strictures. In this article, we focus on extracorporeal shock wave lithotripsy (ESWL) as a treatment for main pancreatic duct stones, which have been reported in >50% of CP patients. ESWL uses acoustic pulses to generate compressive stress on the stones, resulting in their gradual fragmentation. In patients with radiopaque obstructive main pancreatic duct (MPD) stones larger than 5 mm, located in the pancreas head or body, ESWL improves ductal clearance, thereby relieving pain and improving quality of life. In case of insufficient ductal clearance or the presence of an MPD stricture, ESWL can be followed by endoscopic retrograde cholangiopancreatography (ERCP) to increase success rate. Alternatively, direct pancreaticoscopy with intracorporeal lithotripsy or surgery can be performed
Covid-19: exploring the “new normal” in gastroenterology training
The coronavirus disease 2019 (COVID-19) pandemic has led
to unprecedented disruptions in fellowship training programs
worldwide. In gastroenterology, the strain in healthcare service
provision and the emphasis on preventing viral transmission has
adversely impacted hands-on training opportunities, with trainees
facing the constant pressure to meet training requirements under
the continuous threat of viral transmission. Emerging evidence
highlight the scale of the problem, specifically with regard to
endoscopy competence due to cancellation of elective endoscopic
procedures, provision of inpatient and outpatient consultative
care as well as academic education and the mental well-being of
trainees. As such, it has been necessary for trainees, trainers and
training programs collectively to adapt to these challenges and
incorporate novel and adaptive solutions to circumvent these
training barriers. This review aims to summarise data on the global
impact of COVID-19 on gastroenterology training and the practical
interventions that could be implemented.
Worldwide prevalence, genotype distribution and management of hepatitis C
Hepatitis C virus (HCV) is one of the leading causes of chronic
liver disease, cirrhosis, and hepatocellular carcinoma, resulting
in major global public health concerns. The HCV infection is
unevenly distributed worldwide, with variations in prevalence
across and within countries. The studies on molecular epidemiology
conducted in several countries provide an essential supplement
for a comprehensive knowledge of HCV epidemiology, genotypes,
and subtypes, along with providing information on the impact
of current and earlier migratory flows. HCV is phylogenetically
classified into 8 major genotypes and 57 subtypes. HCV genotype
and subtype distribution differ according to geographic origin
and transmission risk category. Unless people with HCV infection
are detected and treated appropriately, the number of deaths due
to the disease will continue to increase. In 2015, 1.75 million new
viral infections were mostly due to unsafe healthcare procedures
and drug use injections. In the same year, access to direct-acting
antivirals was challenging and varied in developing and developed
countries, affecting HCV cure rates based on their availability.
The World Health Assembly, in 2016, approved a global strategy
to achieve the elimination of the HCV public health threat by 2030
(by reducing new infections by 90% and deaths by 65%). Globally,
countries are implementing policies and measures to eliminate
HCV risk based on their distribution of genotypes and prevalence.
