This study demonstrates that NAFLD and PS are related. This relationship seems to be mediated by general obesity. Intralobular pancreatic fat is associated with nonalcoholic steatohepatitis.

There is consensus in guidelines and meta-analyses that ERCP/ES is indicated in patients with ABP and coexisting cholangitis and/or persistent cholestasis. Consensus is lacking on the role of routine early ERCP/ES in patients with predicted severe ABP.

Background and aim Stenosis of the pancreaticojejunostomy is a well-known long-term complication of pancreatoduodenectomy. Traditionally, the endoscopic approach consisted of endoscopic retrograde pancreaticography (ERP). Endoscopic ultrasound (EUS)-guided intervention has emerged as an alternative, but the success rate and adverse event rate of both treatment modalities are poorly known. We aimed to compare the outcome data of both interventions Methods We performed a systematic literature search using the Pubmed/Medline and Embase databases with the aim of summarizing the available data regarding efficacy and complications of ERP-and EUS-guided pancreatic duct (PD) drainage and compare these outcome data using uniform outcome measures in a multilevel logistic model. Results In total 13 studies were included, with 89 patients having undergone ERP-guided drainage and 113 patients EUS-guided drainage. An EUS-guided approach was significantly superior to an ERP-guided approach with regard to cannulation success (80% vs 20%, p<0.000), pancreatic duct opacification (86% vs 25%, p<0.000) and stent placement (73% vs 20%, p<0.000). An EUS-guided approach also appeared superior with regard to clinical outcomes such a pain resolution. The adverse event rate between the two treatment modalities could not be compared due to insufficient data. All included studies were found to be of low quality. Conclusion Based on limited available data, EUS-guided PD intervention appears superior to ERP-guided PD intervention.

Background and study aims  Endoscopic retrograde cholangiopancreatography (ERCP) and/or extracorporeal shock wave lithotripsy are first-line therapies for draining an obstructed pancreatic duct (PD) in painful chronic calcifying pancreatitis (CCP). Pancreaticoscopy has shown promising success rates in small series. Materials and methods  This study was a retrospective analysis of a clinical database. Included were all digital single-operator digital video (SOV) pancreaticoscopy-guided interventions (n = 23) on CCP patients (n = 20) between 2015 and 2017. Success and complication rates were collected from the database. Clinical success was determined by assessing pain level score (NRS) and quality of life (QoL) using standardized questionnaires. Results  Overall technical success rate (successful SOV-pancreaticoscopy and PD drainage) was 95 %. Adverse events occurred in 7 of 23 procedures (30 %) and included extravasation from the PD (n = 1), self-limiting post-sphincterotomy bleeding (n = 1) and post-ERCP pancreatitis (PEP) (n = 6). At 3- to 6-month follow-up, 95 % of patients reported improvement in symptoms and reduction in intake of analgesics. Mean NRS decreased from 5.4 (±1.6) to 2.8 (± 1.8) ( P  < 0.01). Clinical success was achieved in 95 % of patients. Conclusions  Digital SOV-guided lithotripsy was found to be safe and effective in this highly selected population of CCP patients. PD decompression had a beneficial effect on pain reduction and QoL.

OBJECTIVE -To investigate the relationship between duodenojejunal motor activity and glucose absorption and to evaluate the effect of modification of duodenojejunal motility on glucose absorption by using the prokinetic drug cisapride.RESEARCH DESIGN AND METHODS -We examined seven healthy males, mean age 22 years, who were treated with cisapride 10 mg t.i.d. and placebo during 3 days in a randomized order, with a 2-week time interval. Duodenojejunal manometry was performed after each treatment on the morning of day 3, using an 18-lumen catheter. A liquid nutrient (3 kcal/min) was administered intraduodenally for 30 min, followed by a bolus of the glucose analog 3-Omethylglucose (3-OMG). Plasma 3-OMG concentrations were measured to assess absorption kinetics.RESULTS -The area under the 3-OMG concentration curve in the first 30 min after infusion was related to the number of antegrade propagated pressure waves (r ϭ 0.49, P Ͻ 0.05), but not to the peak concentration, time to peak, and absorption fraction. The mean amplitude of pressure waves was higher during cisapride than placebo (P Ͻ 0.05), but the reoccurrence of interdigestive motility, numbers of pressure waves, and propagated pressure waves, as well as 3-OMG absorption characteristics, were not significantly different between the two treatments. During both treatments Ͼ60% of antegrade propagated pressure waves were propagated over a very short distance (1.5 cm).CONCLUSIONS -Glucose absorption in the human small intestine is related to shorttraveling propagated intestinal contractile activity. Cisapride increases the amplitude of pressure waves, but does not affect the organization of pressure waves or the absorption of 3-OMG. Diabetes Care 25:1857-1861, 2002D igestion and absorption of nutrients are the primary functions of the small bowel. Small intestinal motor activity serves to facilitate exposure of luminal contents to the mucosal surface. Studies demonstrating the interactions between intestinal motility and nutrient absorption are few and have yielded conflicting results (1-5). This may be due to the fact that the interaction is complex and dependent on the organization of motor activity (i.e., propagated or nonpropagated) and is also affected by neuroendocrine factors.Recent studies have provided insights into the relationships between gastrointestinal motor function and glucose absorption, showing that variation in the rate of gastric emptying accounts for ϳ35% of the variance in peak blood glucose concentrations after ingestion of glucose, and that increased small intestinalpropagated activity results in the blunting of the postprandial glycemic peak (6).In the present study we used the prokinetic drug cisapride as a tool to modify small intestinal transit. Transit studies have shown the propulsive properties of cisapride in the small intestine (7,8) and its effects on fasting and postprandial gastrointestinal motility have been well established (9 -13).Several reports have shown that the spatiotemporal organization of pressure waves (i.e., propag...