Dudley Hahn (ramiefront7)

Pancreatic cancer is one of the most aggressive malignancies and represents the seventh leading cause of cancer deaths in industrialized countries; in the United States, it is the third leading cause of death from cancer while in Italy it is the fourth. It is expected to become the second cancer death by 2030. The five-year survival rate is 9%, as patients with pancreatic cancer rarely exhibit symptoms until they reach an advanced stage of the disease. Therefore, despite advances in imaging techniques, over 80% of patients receive a diagnosis in the advanced stage of the disease and survival is not high at 5 years from the diagnosis despite the progress of chemotherapy and supportive therapies. An early diagnosis in people at risk is the main objective of clinical research on pancreatic cancer. The purpose of this review is to evaluate the current literature on the possibility and presence of screening programs to prevent, diagnose and treat this silent killer neoplasm.Endoscopic ultrasound (EUS) is rapidly evolving from a diagnostic into a mainly therapeutic procedure, similarly to what previously occurred to endoscopic retrograde cholangio-pancreatography (ERCP). The capability to easily access adjacent organs and structures with a minimally invasive approach as well as the availability of dedicated devices are driving this process. Several therapeutic procedures can be performed under EUS-guidance, such as drainage of pancreatic fluid collections, of the biliary system after ERCP failure, of the gallbladder for acute cholecystitis in high-risk surgical patients, as well as endoscopic gastroenteral-anastomosis creation. The introduction of dedicated lumen-apposing metal stents in the latest years has made these procedures technically easier. learn more However, further improvements of stent design will be required in the next future. Moreover, data on long-term efficacy and safety coming from well-designed randomized multicenter controlled trials are still needed to bring EUS-guided procedures to the next level.Videocapsule endoscopy is, by far, one of the most important milestones in the technological development of endoscopy in the last twenty years. The introduction and spread of videocapsule endoscopy in clinical practice revolutionized the management of small bowel's diseases, allowing a high-quality, extensive examination of its whole mucosal surface. Because of its technical features, videocapsule endoscopy does not allow any direct therapeutic interventions but, compared to other techniques, it is minimally invasive, radiation-free and has an excellent safety profile. The most common indication for videocapsule endoscopy is suspected small bowel bleeding, although other conditions (such as coeliac disease, hereditary polyposis syndromes and, above all, Crohn's disease) may benefit from its use, as highlighted by several studies in recent years. The aim of this paper is to provide a wide overview on indications, limitations and future perspectives of videocapsule endoscopy by 2020, this technique has become a valuable and irreplaceable tool for the study of the small bowel, changing the patients' management in many clinical scenarios. An Enhanced Recovery After Surgery (ERAS) program in colorectal surgery is able to significantly reduce the morbidity rates and postoperative hospital stay (LOS) related to the intervention. However, it is not clear what modalities and levels of implementation are necessary to achieve these results. The purpose of this work is to analyze the methods and results of the first year of implementation of the program in two centers of the Agenzia Sanitaria Unica Regionale (ASUR) Marche. After a structured implementation pathway, characterized by the creation of a core team, field training, internal courses and coaching, the details of 196 consecutive cases of patients submitted to colorectal resection over a one-year period in two surgical units of the ASUR Marche were pr