review of literature on clinical pancreatology - The Pancreapedia

Glucos metabolism after pancreatectomyThe aim <strong>of</strong> this study was to investigate the mechanisms <strong>of</strong> the change in glucosemetabolism after a pancreatoduodenectomy (PD). Oral glucose tolerance tests wereperformed in 17 patients before and 1 month after a PD. The changes in plasma glucose andinsulin concentrations, homeostasis model <strong>of</strong> insulin resistance, and insulinogenic index(beta-cell function) were analyzed. Two additional factors, gastric emptying function andplasma glucagon-like peptide-1 (GLP-1) concentration that possibly affect perioperativeglucose metabolism were also assessed. The plasma glucose and insulin concentrationswere significantly lower after the operation, especially in preoperative diabetic patients. beta-Cell function did not change after the operation. On the other hand, insulin resistancebecame normal 1 month after the operation. The value <strong>of</strong> gastric emptying function after theoperation was not statistically different in comparison with that before the operation.Postoperative plasma GLP-1 concentration was significantly higher than the preoperativevalue. It was concluded that beta-cell function is maintained after a pancreatoduodenectomy,whereas the improvement <strong>of</strong> insulin resistance may cause a short-term transientimprovement <strong>of</strong> the glucose metabolism after the operation. The significance <strong>of</strong> increasedpostoperative GLP-1 concentration remains an unsolved issue [515].PalliationInadequate nutrient intake is common in cancer patients and is associated with pooroutcomes. Social factors may contribute to inadequate nutrient intake, although they havenot been studied. The purpose <strong>of</strong> one study was to investigate social factors that maycontribute to undereating in older adults with cancer. Participants included 30 patients, 17women and 13 men, aged 70-99 years, who were diagnosed with pancreatic, colon, breast,lymphoma, skin, and head and neck cancers. Both participants and caregivers interpretedweight loss as a positive health outcome <strong>of</strong> cancer. Furthermore, some patients who had lostweight worked to keep the weight <strong>of</strong>f by going on special diets. Patients and caregiversimbued certain foods with health-promoting qualities without corroborating scientificevidence. Cancer- and treatment-related alterations in self-identity due to changes in theirbodies, in taste, and in the manner in which they must eat caused cancer patients toexperience frustration and embarrassment, which led to reduced nutritional intake. Despitetheir compromised nutritional status, patients did not discuss food and eating habits with theirphysicians. Behaviors and attitudes <strong>of</strong> patients and caregivers may lead to negative changesin eating behaviors beyond the cancer itself or its treatment or sequelae. Many <strong>of</strong> thesebehaviors are potentially modifiable with appropriate education, communication, andintervention [516].Palliative stentingIn the endoscopic management <strong>of</strong> unresectable malignant biliary obstructions by placement<strong>of</strong> a metallic stent, longer patency and a lower incidence <strong>of</strong> stent occlusion are desirablegoals. With its mesh structure, the uncovered metallic stent is occluded mainly by tumor ortissue ingrowth, making it impossible to remove. The covered metallic stent was developedto overcome these disadvantages, and was shown to maintain patency longer than theuncovered in one randomized study. The most important characteristic <strong>of</strong> the covered stentis that it is removable, allowing it to be used in patients with resectable malignancies andbenign strictures. In addition, the drug-eluting covered metallic stent provides an additionalapproach to the treatment <strong>of</strong> biliary malignancies. The covered stent may also change thetreatment paradigm for biliary strictures and strictures due to chronic pancreatitis. Thecovered metallic stent is analogous to a large-bore, expandable plastic stent and is effectiveboth as an endoprosthesis and a dilating or anti-cancer device. However, to better