Findings from a randomized, placebo-controlled, double-blind clinical trial raise doubts about the usefulness of indomethacin for prophylaxis of pancreatitis in all patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).1 Consecutive ERCP patients randomized to receive a single dose of indomethacin (100 mg, rectal) prior to ERCP failed to exhibit any statistically significant decrease in the occurrence of post- ERCP pancreatitis (PEP) (7.9 percent), compared to patients randomized to placebo (4.4 percent). The indomethacin and placebo groups were also similarly likely to experience hospital readmission within 30 days following ERCP (Figure). Continue reading
Category Archives: Research
The majority of variants of uncertain significance (VUS) end up being normal polymorphisms that are not linked to increased cancer risk. Rarely, a VUS is later reclassified as a pathogenic variant that would then inform medical management recommendations. In these cases, patients with the reclassified VUS are contacted for follow-up consultation, sometimes years after the gene test was performed.
The presence of a newly identified pathogenic variant can also raise difficulties for advising patients. The result may be found in a gene for which we do not yet appreciate the full spectrum of cancers and the lifetime risks associated with these cancers, and screening recommendations are not necessarily developed. Continue reading
A multi-center, investigator-initiated epidemiologic study is underway [clinical trial: NCT01633489] aiming to determine the proportion of adults affected by late-onset lysosomal acid lipase deficiency (LAL-D) using definitive genetic testing.
LAL-D is an autosomal recessive disease caused by mutations in the Iipase gene that lead to decreased or absent enzyme activity. Lack of such activity causes lysosomal accumulation of cholesteryl ester in various organs, including the liver, spleen and adrenals, which leads to morbidity and mortality.1 Transplant hepatologist Karen L. Krok, M.D., Penn State Hershey Gastroenterology and Hepatology, explains, “At Penn State Hershey and other study centers in Pennsylvania, adults with cryptogenic cirrhosis or nonalcoholic steatohepatitis [NASH] who are awaiting liver transplant will have the opportunity to be tested for LAL-D. The signs and symptoms of LAL-D are similar to other common conditions; however, 10 to 15 percent of patients have no comorbid condition like hepatitis, obesity, diabetes or alcohol use to explain the disease. (Learn more about clinical features of LAL-D in adults.) Continue reading
“Surgical oncologists in the Program for Liver, Pancreas, and Foregut Tumors at Penn State Hershey Cancer Institute, Penn State Hershey Medical Center, are using a robotic-assisted approach to complex gastrointestinal surgeries. The team performed an average of four to five such cases per month during 2013- 2014. “Distal pancreatectomy with splenectomy is the most common procedure in which we use a robotic technique. Compared to laparoscopy, we’re finding that more tumors and cysts are amenable to a robotic approach, with less conversion to an open procedure compared to a laparoscopic approach,” says Niraj Gusani, M.D., director of the Program for Liver, Pancreas, and Foregut Tumors.
Gusani has partnered with Joyce Wong, M.D., director of the Robotic Surgical Oncology Program, to implement a two-attending model for all robotics procedures. Amanda Cooper, M.D., the third member of the team, will also perform robotics procedures. Gusani notes, “Visualization is much better with the robotic platform [see Figure] versus open surgery. This is really key with very complex anatomy. Resections may be more thorough.” Wong further adds, “The robot mimics your hand movements with more precision; there is less internal manipulation. It’s a shift from ‘feeling’ to ‘seeing’.” To date, the team has performed more than thirty complex oncologic cases robotically.
Two unconventional, bacteria-precise antibiotics may offer a means to gain an upper hand against Clostridium Difficile (C. diff) infection (CDI), according to findings from researchers at Penn State Hershey Colon and Rectal Surgery. In vitro investigations of phage tail-like proteins (PTLPs) have shown promising capacity to specifically eradicate C. diff, while C. diff-specific anti-sense DNA morpholinos prevent C. diff expression of toxins and transformation into active infection. Both approaches appear to leave other types of gastrointestinal bacteria unharmed.
David Stewart, M.D., associate professor of surgery, Penn State Colon and Rectal Surgery, explains, “Some strains of C. diff produce PTLPs, which are morphologically similar to bacteriophages, but lack genetic material. Other C. diff strains are susceptible to their PTLP bactericidal action. When these PTLPs bind to a bacterial surface receptor, the ‘tail’ portion inserts itself into the bacterial cell membrane, creating a hole that rapidly leads to cell death.” (Figure) Continue reading
Fecal Microbiome Transplant (FMT) for Clostridium Difficile (C. diff): Drawing Upon Wisdom of the Ancients
The successful use of fecal matter to treat severe diarrhea was first recorded more than 1,800 years ago in China. Flash forward to 2014, and the publication of controlled clinical trial evidence demonstrating the effectiveness of “fecal microbiota transplant” (FMT) to treat C. diff infection (CDI).¹ Thomas J. McGarrity, M.D., chief, Penn State Hershey Gastroenterology and Hepatology, has drawn on this evidence to treat twelve patients with recurrent or severe CDI. McGarrity explains, “We’ve administered FMT via a colonoscopic approach to patients with either three or more recurrences of CDI, or severe CDI unresponsive to conventional antibiotic treatment. Some of the patients were critically ill and faced the risk of renal failure. Within forty-eight hours of receiving FMT, clinical improvement was seen and a full recovery was eventually made in all twelve patients. None have experienced any further CDI occurrences.” Continue reading
Diverticular disease is a common gastrointestinal disorder seen in over half of all United States adults over the age of sixty years, with approximately 5 percent of the population requiring surgery. According to Walter Koltun, M.D., F.A.C.S, F.A.S.C.R.S., chief, division of colon and rectal surgery at Penn State Hershey Medical Center, “We’re beginning to understand that diverticulitis is caused by a mix of genetic and environmental factors. A strong genetic component for diverticular disease was demonstrated in twin studies done in Europe, showing that about 50 percent of diverticular disease susceptibility is genetically based. We also know genetic influence is complex, and related to multiple genes.” The overall mix of genetic and environmental factors associated with the development of diverticular disease helps to explain the wide phenotypic variation physicians observe clinically, ranging from asymptomatic to life-threatening. Continue reading