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Abstract Background Many pancreatic pseudocysts spontaneously resolve, but larger or symptomatic pseudocysts may require procedural management. Though endoscopic ultrasound guided approaches are standard of care and have high success rates, complications can include bleeding, infection, and splenic perforation. This patient case report details an unusual series of complications of endoscopic cystogastrostomy that should encourage clinicians to evaluate for anatomic disruptions caused by mass effects of pancreatic pseudocysts prior to endoscopic pseudocyst drainage. Case presentation A 53-year-old African American male with a past medical history notable for alcohol use disorder, chronic pancreatitis, and insulin dependent diabetes presented with a 4-day history of left upper quadrant abdominal pain. Computed tomography imaging with contrast revealed enlargement of a known pancreatic pseudocyst to 15.9 × 10.4 cm. Due to pseudocyst size and the patient’s symptoms, endoscopic cystogastrostomy stent placement was performed. However, postprocedurally, he developed leukocytosis to 19,800 cells/m3 (from 14,100 cells/m3 preoperatively) as well as acute hypoxemic respiratory failure with a large left pleural effusion. Postprocedural computed tomography with contrast demonstrated a new large subcapsular splenic hematoma in communication with a new subdiaphragmatic fluid collection. Due to suspicion of endoscopic procedural complication, he underwent open laparotomy which revealed grade 4 splenic laceration, septic splenic hematoma, and a subdiaphragmatic abscess. Conclusions While endoscopic drainage of pancreatic pseudocyst was technically successful, this case demonstrates complications from mass effect of a large pancreatic pseudocyst which putatively tore the splenorenal ligament, leading to excessive separation of the left kidney and spleen. If anatomic disruptions caused by mass effect from a pancreatic pseudocyst are recognized through preprocedural abdominal imaging, such cases may be considered for early open repair versus cystogastrostomy.

Background. Pancreatic pseudocysts stand among current challenges in modern medicine. Their treatment uses variant instrumental techniques and implies a multispecialty approach. Trials in surgery and gastroenterology have aimed to identify an optimal strategy to tackle pancreatic pseudocysts for reducing complications and the recurrence rate, suggesting ultrasound-guided percutaneous, laparoscopic and flexible endoscopic drainage as promising treatment choices.Objectives. A summarising review of diagnostic and therapeutic methods for pancreatic pseudocyst treatment and comparison of ultrasound-guided percutaneous vs. surgical and endoscopic drainage techniques.Methods. The review examines the classification, epidemiology and methods for diagnosis and treatment of pancreatic pseudocysts. Only comparative full-text studies published within 2014–2021, as well as selected impactive publications within 2002–2013, have been included. The eLibrary, Elsevier and PubMed resources were queried for the article or journal title fields against the keywords (separate or combined) “pancreatic pseudocyst” [псевдокиста поджелудочной железы], “pseudocyst drainage” [дренирование псевдокисты], “surgical drainage” [хирургическое дренирование], “endoscopic drainage” [эндоскопическое дренирование], cystogastrostomy [цистогастростомия], gastrojejunostomy [гастроеюностомия], “duodenal-cystic anastomosis” [цистодуоденоанастомоз], “transpapillary drainage” [транспапиллярное дренирование], “transmural drainage and esophagogastroduodenoscopy” [трансмуральное дренирование и эзофагогастродуоденоскопия]. Records have been selected for topic-related scientific value.Results. The review systematically surveys 68 scientific papers in the focus area and summarises the most common surgical methods for pancreatic pseudocyst treatment. Based on the main principle, the methods are classified into three categories, ultrasound-guided percutaneous drainage, surgical drainage and flexible endoscopic drainage. The major classifications and treatment techniques are highlighted for their advantages and disadvantages.Conclusion. There exist no generally adopted strategy for pancreatic pseudocyst treatment in current clinical practice and no evidence on a particular method application in a large patient cohort. The publication survey identifies the techniques of percutaneous, surgical and endoscopic drainage with ultrasound control as highly effective overall among other surgical treatments.

Background. Splenic artery pseudoaneurysm is a rare complication of acute and chronic pancreatitis caused by an arterial wall lesion with aggressive pancreatic enzymes and followed by arrosive bleeding into pseudocyst lumen and the formation of a dense fibrous capsule prone to growth.Clinical Case Description. Patient M., 61 yo, was emergently admitted to Territorial Clinical Hospital No. 2 with a preliminary diagnosis: Chronic pancreatitis, incomplete remission. Pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting. Gastrointestinal haemorrhage. The patient complained of moderate persistent belting upper abdominal and left subcostal pain, nausea, general weakness, black liquid stool over last five days. Pancreonecrosis in history. Pseudocyst formation in two months, endoscopic papillosphincterotomy and pancreatic stenting in hospital, the aforementioned complaints appeared past three months. Moderate anaemia (haemoglobin 73 g/L, erythrocyte count 2.8 x 1012), hyperamylasaemia (amylase 170 U/L), no other pathology in general and biochemic blood panels. The patient was rendered urgent oesophagogastroduodenoscopy for large duodenal papilla, with no evident bleeding detected. Abdominal CT angiography revealed a haemorrhagic mass connected with splenic artery lumen in the projection of pancreatic tail. The patient was transferred to an interventional radiology room for coil embolisation of splenic artery. The postoperative period was benign, and the patient discharged on day 3 after surgery for outpatient surgical patronage. Definite clinical diagnosis: Chronic pancreatitis, incomplete remission. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting.Conclusion. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst is reluctant to early diagnosis due to a lacking definite clinical picture and tractable only at an interdisciplinary institution disposing with a rich diagnostic toolkit and sufficiently qualified medical personnel. Endovascular treatment is overall most effective and enables a reliable aneurysm isolation from the splenic artery basin.

A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to address the research gaps and opportunities in pancreatic EUS. The event occurred on July 26, 2017 in 4 sessions: (1) benign pancreatic diseases, (2) high-risk pancreatic diseases, (3) diagnostic and therapeutics, and (4) new technologies. The current state of knowledge was reviewed, with identification of numerous gaps in knowledge and research needs. Common themes included the need for large multicenter consortia of various pancreatic diseases to facilitate meaningful research of these entities; to standardize EUS features of different pancreatic disorders, the technique of sampling pancreatic lesions, and the performance of various therapeutic EUS procedures; and to identify high-risk disease early at the cellular level before macroscopic disease develops. The need for specialized tools and accessories to enable the safe and effective performance of therapeutic EUS procedures also was discussed.

Widespread antibiotic use in clinical medicine and the livestock industry has contributed to the global spread of multidrug-resistant (MDR) bacterial pathogens, including Acinetobacter baumannii We report on a method used to produce a personalized bacteriophage-based therapeutic treatment for a 68-year-old diabetic patient with necrotizing pancreatitis complicated by an MDR A. baumannii infection. Despite multiple antibiotic courses and efforts at percutaneous drainage of a pancreatic pseudocyst, the patient deteriorated over a 4-month period. In the absence of effective antibiotics, two laboratories identified nine different bacteriophages with lytic activity for an A. baumannii isolate from the patient. Administration of these bacteriophages intravenously and percutaneously into the abscess cavities was associated with reversal of the patient's downward clinical trajectory, clearance of the A. baumannii infection, and a return to health. The outcome of this case suggests that the methods described here for the production of bacteriophage therapeutics could be applied to similar cases and that more concerted efforts to investigate the use of therapeutic bacteriophages for MDR bacterial infections are warranted.

Purpose: Pancreatic cysts are estimated to be present in 2%-3% of the adult population. Unfortunately, current diagnostics do not accurately distinguish benign cysts from those that can progress into invasive cancer. Misregulated pericellular proteolysis is a hallmark of malignancy, and therefore, we used a global approach to discover protease activities that differentiate benign nonmucinous cysts from premalignant mucinous cysts.Experimental Design: We employed an unbiased and global protease profiling approach to discover protease activities in 23 cyst fluid samples. The distinguishing activities of select proteases was confirmed in 110 samples using specific fluorogenic substrates and required less than 5 μL of cyst fluid.Results: We determined that the activities of the aspartyl proteases gastricsin and cathepsin E are highly increased in fluid from mucinous cysts. IHC analysis revealed that gastricsin expression was associated with regions of low-grade dysplasia, whereas cathepsin E expression was independent of dysplasia grade. Gastricsin activity differentiated mucinous from nonmucinous cysts with a specificity of 100% and a sensitivity of 93%, whereas cathepsin E activity was 92% specific and 70% sensitive. Gastricsin significantly outperformed the most widely used molecular biomarker, carcinoembryonic antigen (CEA), which demonstrated 94% specificity and 65% sensitivity. Combined analysis of gastricsin and CEA resulted in a near perfect classifier with 100% specificity and 98% sensitivity.Conclusions: Quantitation of gastricsin and cathepsin E activities accurately distinguished mucinous from nonmucinous pancreatic cysts and has the potential to replace current diagnostics for analysis of these highly prevalent lesions. Clin Cancer Res; 23(16); 4865-74. ©2017 AACR.

Introduction: pancreatic pseudocyst is a rare complication of pancreatitis; when hemorrhage occurs, the prognosis becomes poorer. Clinical case: a seven-year-old female patient with recurrent pancreatitis is presented, who developed a pancreatic pseudocyst. Surgical drainage was decided, but during the procedure it was detected that the pseudocyst was hemorrhagic. The patient died from hemorrhage and shock. Conclusions: hemorrhagic pancreatic pseudocyst represents a therapeutic challenge; currently, interdisciplinary management is recommended, which includes surgery and arterial embolization. [ABSTRACT FROM AUTHOR]

Over the last one-decade, endoscopic ultrasound (EUS)-guided drainage has evolved as a preferred modality for treating pseudocyst over conventional surgical or radiological procedures among adults using plastic stents or lumen opposing stents; however, studies on EUS-guided pancreatic of pseudocyst among children are mainly in the form of case reports or small case series. Therefore, we aimed to describe four pediatric cases of the pseudo-pancreatic cyst treated successfully with EUS-guided cysto-gastrostomy using plastic stents. In all four cases, EUS-guided drainage was successful using plastic stent with no major complications, and none of them required any follow-up endoscopic or surgical intervention. EUS-guided cysto-gastrostomy offers an excellent and safe alternative to surgery for treating pancreatic pseudocysts in children.

Purpose: Pancreatic pseudocyst is a well-recognized complication of acute pancreatitis, chronic pancreatitis and pancreatic trauma. Pancreatic trauma is the most common cause among children cases. The aim of this study is to describe the clinical presentation and management of symptomatic pancreatic pseudocyst in a series of 2 children following abdominal blunt trauma treated in our institution between January 2021 to August 2021. Method: This was single-centre case series from our institution that is a tertiary referral hospital from January to August 2021. There were two patients between age 8–11 that diagnosed with pancreatic pseudocyst after blunt abdominal trauma, both of them underwent open internal drainage, specifically cystojejunostomy. Result: All of 2 patients had a history of blunt abdominal trauma due to bicycle handlebar injury. Epigastric pain and abdominal mass were the main complaints. Amylase and lipase serum level were elevated and imaging diagnostic reveal pancreatic pseudocyst. Open cystojejunostomy were performed and the patient discharged from the hospital on day 7 and day 11 post operative, respectively, without any complication. Conclusion: Pancreatic pseudocyst although rare in children, can lead to a significant morbidity if not properly diagnosed and treated. Open internal drainage is still the procedure of choice in our institution.

Pancreaticopleural fistula is one of the rarest complication of acute pancreatitis, chronic pancreatitis and pancreatic pseudocyst. Diagnosis requires a high index of clinical suspicion in alcoholic patients presenting with pancreatitis and associated recurrent pleural effusion. Diagnosis is delayed as patients usually present with predominant pulmonary symptoms of dyspnea and chest pain. Hereby authors presented a case, where a 50-year-old chronic alcoholic male presented with chief complains of shortness of breath and chest pain. Based on the chest radiograph, Computed Tomography (CT) scan and pleural fluid analysis diagnosis of pancreaticopleural fistula was made. The patient was managed with intercoastal tube drainage and symptomatic treatment for other complains. Medical management, endoscopic and surgical interventions bring out a good prognosis in pancreaticopleural fistula.

Background: Disconnected pancreatic duct syndrome (DPDS) frequently occurs in patients with acute necrotizing pancreatitis and resultant pancreatic fluid collection (PFC). We performed a systematic review and meta‐analysis to evaluate outcomes of endoscopic ultrasound‐guided treatment of PFCs according to the presence of DPDS. Methods: Using PubMed, Embase, and the Cochrane database, we identified clinical studies published until January 2021 with data comparing outcomes of endoscopic ultrasound‐guided drainage of PFCs between DPDS and non‐DPDS patients. We pooled data on technical and clinical success rates, PFC recurrence, and adverse events using the random‐effects model. Results: We identified five eligible articles including 941 PFC patients treated with endoscopic ultrasound‐guided interventions. Clinical success, defined as resolution of the PFC and symptoms, was achieved in a majority of the cases irrespective of DPDS (pooled odds ratio [OR] comparing DPDS to non‐DPDS patients, 0.77; 95% confidence interval [CI] 0.33–1.81). Compared to patients without DPDS, patients with DPDS were more likely to undergo PFC recurrence (pooled OR 6.72; 95% CI 2.72–16.6) after clinical resolution of PFC. Prolonged plastic stent placement following the clinical resolution was more frequently performed in DPDS patients than in non‐DPDS patients (pooled OR 15.9; 95% CI 2.76–91.9). No statistically significant difference was observed between the groups in terms of the rate of technical success, adverse events, or mortality. Conclusion: Disconnected pancreatic duct syndrome was associated with higher rate of PFC recurrence after successful endoscopic treatment of PFCs. Future studies should evaluate effectiveness and optimal duration of long‐term placement of transmural plastic stents for PFCs with DPDS. [ABSTRACT FROM AUTHOR]

We present a case report of a 2‐year‐old boy who presented to a local hospital to evaluate vague abdominal symptoms of one‐month duration. The patient, therefore, had an open cystogastrostomy and drainage of the free abdominal fluid with minimal complications. He was monitored for several days after his surgery. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic drainage is an established treatment modality for adult patients with pancreatic fluid collections (PFCs). Available data regarding the efficacy and safety of endoscopic drainage in pediatric patients are limited. In this systematic review and metaanalysis, we aimed to analyze the outcomes of endoscopic drainage in children with PFCs. Methods: A literature search was performed in Embase, PubMed, and Google Scholar for studies on the outcomes of endoscopic drainage with or without endoscopic ultrasonography (EUS) guidance in pediatric patients with PFCs from inception to May 2021. The study's primary objective was clinical success, defined as resolution of PFCs. The secondary outcomes included technical success, adverse events, and recurrence rates. Results: Fourteen studies (187 children, 70.3% male) were included in this review. The subtypes of fluid collection included pseudocysts (60.3%) and walled-off necrosis (39.7%). The pooled technical success rates in studies where drainage of PFCs were performed with and without EUS guidance were 95.3% (95% confidence interval [CI], 89.6-98%; I²=0) and 93.9% (95% CI, 82.6-98%; I²=0), respectively. The pooled clinical success after one and two endoscopic interventions were 88.7% (95% CI, 82.7-92.9%; I²=0) and 92.3% (95% CI, 87.4-95.4%; I²=0), respectively. The pooled rate of major adverse events was 6.3% (95% CI, 3.3-11.4%; I²=0). The pooled rate of recurrent PFCs after endoscopic drainage was 10.4% (95% CI, 6.1-17.1%; I2=0). Conclusion: Endoscopic drainage is safe and effective in children with PFCs. However, future studies are required to compare endoscopic and EUS-guided drainage of PFCs in children. [ABSTRACT FROM AUTHOR]

Introduction: The pancreatic pseudocyst is one of the late local complications of acute pancreatitis. For managing a giant pancreatic pseudocyst, there are multiple strategies. Aim: To present the case of a patient with a giant pancreatic pseudocyst managed by endoscopic cystogastrostomy. Clinical case: A 41-year-old woman developed a giant pancreatic pseudocyst as a complication of acute pancreatitis that was managed by endoscopic cystogastrostomy without endoscopic ultrasound guidance, with good evolution. Conclusions: Endoscopic cystogastrostomy, with or without the help of ultrasound endoscopy or lumen-apposing metal stent (LAMS), is a viable, safe, effective, and economical therapeutic option for selected patients with a giant pancreatic pseudocyst. [ABSTRACT FROM AUTHOR]

Background Cystogastrostomy is the most effective drainage method for large, persistent pancreatic pseudocyst (PP). There are many approaches for cystogastrostomy either open cystogastrostomy, laparoscopic cystogastrostomy (LCG), or nonsurgical techniques (endoscopic or percutaneous radiologic drainage). Patients and methods This was a prospective clinical trial single-center experience study on patients with PP who presented at our outpatient clinic at Ain Shams University hospitals during the period from January 2019 till January 2021. It included patients with symptomatic cyst of more than 6 cm with well-formed wall after 6 weeks from the last attack. The included cases underwent LCG, aiming to assess our early experience of LCG and its short-term outcome. Results A total of 20 patients with PP presented to us during the study period, and 16 (80%) patients met the inclusion criteria, and these patients underwent LCG. The mean operative time was 170.31 min, and the mean blood loss was 156.88 ml. Overall, 6.3% of our cases had open conversion. Concomitant cholecystectomy was done in 56.3% of our cases. The mean hospital stay was 6.31 days, with 12.5% of our cases had postoperative wound infection and 6.3% had postoperative hematemesis. No cases of recurrence or mortality were encountered in our study. Conclusion Laparoscopic drainage of PP has major advantages over the open approach in the form of less postoperative pain, hospital stay, and wound complications with comparable recurrence incidence. Our early experience in laparoscopic anterior cystogastrostomy approach was promising with good results and acceptable morbidity, which encouraged us to expand this approach in drainage of PP. [ABSTRACT FROM AUTHOR]

Hydatid disease (HD) is a zoonotic disease, which typically affects the liver and the lungs. Primary retroperitoneal localization of the disease is infrequent. The most common symptom is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst. A 53-year-old female patient presented to Kocaeli University General Surgery Clinic, Turkey in September 2019 with complaints of flank pain, constipation and vomiting. The MRI revealed cystic lesions in the pancreas and psoas muscle. Both cysts were excised totally during laparotomy. Histopathology reports showed that the lesion in psoas muscle was hydatid cyst whereas the lesion in pancreas was pancreatic pseudocyst. Postoperative period was uneventful and the patient was discharged with albendazole treatment. No recurrence occurred during follow-up period. Atypical localization for hydatid disease is a diagnostic dilemma for surgeons, especially in endemic countries. Hydatid disease should always be considered in the differential diagnosis of retroperitoneal lesions, inadequate management can lead to complications and fatalities. Surgery combined with antiparasitic therapy, may be an option in the presence of obstruction of gastrointestinal and/or urinary tract. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a frequent condition with a significant morbidity and mortality (approximately 20% are complicated forms). Peripancreatic collections are a very common complication. The 2012 Atlanta classification distinguishes between 4 types of peripancreatic collections. Acute peripancreatic fluid collections and pseudocysts develop after acute interstitial oedematous pancreatitis and acute necrotic collections. Walled-off necrosis develops after acute necrotizing pancreatitis. Although these collections are mostly asymptomatic, it is sometimes necessary to drain them when symptoms appear. Management by endoscopic ultrasound (EUS) is the gold standard. In this review of the literature, we will focus only on the pseudocysts' drainage. With the rapid development of therapeutic EUS, new stents have been developed: lumen apposing metal stent (LAMS). Several studies focused on their use in peripancreatic collections drainage and particularly in pseudocysts. The technical and clinical successes are very high for this type of stent, above 90% for these two criteria. However, the cost of these stents is significant. LAMS redefine the management of peripancreatic collections. However, it is necessary to manage this type of condition in a collegial manner, due to sometimes-serious complications at the time of insertion or afterwards. Their superiority seems undeniable in the management of walled-off necrosis, but as far as pseudocysts with fluid content are concerned, the debate remains open. New studies should be carried out to clarify the position of these stents and their complications, especially in the management of pseudocysts. [ABSTRACT FROM AUTHOR]

Background: Management of symptomatic pancreatic pseudocysts poses a unique challenge to minimally invasive surgeons. Despite the predominance of endoscopic management of pancreatic pseudocysts, the laparoscopic approach remains a critical skill in the armamentarium of surgeons. Methods: This report details a laparoscopic intragastric approach to create a pancreatic cystgastrostomy using intraoperative ultrasound and endoscopy. Conclusion: Laparoendoscopic techniques for pancreatic pseudocysts are still required in selective cases when endoscopic management is not available or fails. Using this technique provides patients with same clinical benefits of an endoscopic approach. [ABSTRACT FROM AUTHOR]

Pancreatobiliary disorder is a challenging clinical condition, especially when this condition is causing severe infection or biliary sepsis, and sometimes it requires intensive care unit (ICU) treatment. Biliary drainage is the mainstay of therapy; however, the choice of the drainage method is dependent on the patient’s clinical condition and the disease itself. A 79-year-old female was transferred on a ventilator to our ICU from another hospital due to biliary sepsis, a large common bile duct stone, and an infected pancreatic pseudocyst. The patient also has other comorbidities such as heart problems, hypothyroidism, and diabetes mellitus. Bedside percutaneous transhepatic biliary drainage without fluoroscopy and percutaneous cyst aspiration was successfully performed, which improved the patient’s condition; this was followed by an endoscopic approach, i.e., endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided pancreatic pseudocyst drainage. The clinical improvement showed itself in the change of the patient’s respiratory status and ventilator mode. In conclusion, the percutaneous approach has a big role in managing critically ill patients in the ICU setting. However, expertise, training experience, and a multidisciplinary team approach are very important for successful management and patient outcome.

Pancreatic pseudocyst (PP) is a known complication of pancreatitis. When a rupture occurs, patients often become haemodynamically unstable and require emergency surgery for source control. Conventionally, such a procedure is carried out through open technique due to patient, surgeon and technical factors. We present two cases of emergency laparoscopic surgery performed for ruptured PP. Our first patient was a 53-year-old male with a ruptured 17.6 cm pancreatic body pseudocyst who underwent a laparoscopic washout, adhesiolysis, necrosectomy, distal pancreatectosplenectomy and cholecystectomy. The second patient was a 66-year-old male with a ruptured 11 cm pancreatic body pseudocyst who underwent laparoscopic surgery, subsequently converted to hand-assisted surgery. We compare our cases with the existing literature and discuss pertinent management considerations. In conclusion, we demonstrated that emergency laparoscopic adhesiolysis, necrosectomy and distal pancreatosplenectomy are feasible and safe for the management of ruptured pseudocyst when performed by an experienced surgeon. However, further studies are needed to determine the advantages or limitations of the minimally invasive surgical approach for the management of these complicated cases.

Pancreatic pseudocysts are cystic cavities which are localized collection of pancreatic secretions, rich in amylase and other enzymes, present in and around pancreas, encased in a false epithelial lining of fibrous or reactive granulation tissue. Extension of a pancreatic pseudocyst into the mediastinum is rare. We are reporting a case of a 5-year-old child with mediastinal pancreatic pseudocyst which was successfully drained by cystojejunostomy.

Surgical internal drainage of pancreatic pseudocyst can be done into the stomach, duodenum or jejunum depending on the anatomic relation of pseudocyst with hollow viscera. For cystojejunostomy, a Roux-en-Y loop is preferred over loop cystojejunostomy as former is thought to avoid the reflux of jejunal contents into the cyst cavity. This study presents our experience with laparoscopic loop cystojejunostomy showing loop cystojejunostomy for the pseudocyst of the pancreas can be safely performed laparoscopically with simpler technique with no complications including reflux.

Background: Endoscopic ultrasound (EUS)-guided cystogastrostomy with a single 7-French (Fr) double-pigtail stent (DPS) is less popular due to the concern of stent patency. We aimed to assess the effectiveness, complications, and long-term outcomes of a single 7-Fr DPS in the endoscopic drainage of uncomplicated pseudocysts, containing no or minimal (

Abstract We present a case report of a 2‐year‐old boy who presented to a local hospital to evaluate vague abdominal symptoms of one‐month duration. The patient, therefore, had an open cystogastrostomy and drainage of the free abdominal fluid with minimal complications. He was monitored for several days after his surgery.

Hydatid disease (HD) is a zoonotic disease, which typically affects the liver and the lungs. Primary retroperitoneal localization of the disease is infrequent. The most common symptom is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst. A 53-year-old female patient presented to Kocaeli University General Surgery Clinic, Turkey in September 2019 with complaints of flank pain, constipation and vomiting. The MRI revealed cystic lesions in the pancreas and psoas muscle. Both cysts were excised totally during laparotomy. Histopathology reports showed that the lesion in psoas muscle was hydatid cyst whereas the lesion in pancreas was pancreatic pseudocyst. Postoperative period was uneventful and the patient was discharged with albendazole treatment. No recurrence occurred during follow-up period. Atypical localization for hydatid disease is a diagnostic dilemma for surgeons, especially in endemic countries. Hydatid disease should always be considered in the differential diagnosis of retroperitoneal lesions, inadequate management can lead to complications and fatalities. Surgery combined with antiparasitic therapy, may be an option in the presence of obstruction of gastrointestinal and/or urinary tract.

Objective: Rare disease Background: Pancreaticopleural fistula (PPF) is a rare complication of acute and chronic pancreatitis. PPF results from the release of pancreatic enzymes, either from a damaged pancreatic duct or pancreatic pseudocyst. This report is of a 58-year-old woman with a history of chronic pancreatitis associated with gallstones who had a known pancreatic pseudocyst that was being managed conservatively and who presented to the Emergency Department with pleural effusion due to a PPF. Case Report: A 58-year-old woman with past medical history of gallstone pancreatitis with subsequent development of pancreatic pseudocyst (being managed conservatively) presented with a 2-week history of progressive exertional shortness of breath. Physical examination indicated decreased breath sounds on the right lower lung fields. A chest X-ray revealed possible subphrenic free air. Laboratory test results were unremarkable except for elevated D-dimer levels. Computed tomography angiography revealed a large right-sided pleural effusion, which led to thoracentesis and the results illustrated elevated amylase levels. Magnetic resonance cholangiopancreatography was done, which showed pancreatic pseudocyst and possibly a fistula. Pancreatic enzymes were not checked in pleural fluid, as diagnosis was established with the presence of amylase and imaging findings. The patient felt better clinically after thoracentesis with volume removal and was discharged. She later underwent endoscopic ultrasound, which revealed a pancreatic duct leak requiring stent placement. Conclusions: Pleural effusions rarely occur secondary to PPF. Physicians must be wary of the presentation, especially in patients with a history of a conservatively managed pancreatitis pseudocyst. Early diagnosis and management can lead to prevention of long-term morbidity and mortality. [ABSTRACT FROM AUTHOR]

In severe acute pancreatitis, accompanied by local complications such as acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection and walled-off necrosis, the mortality rate is as high as 12-25%. In many cases, interventional procedure or surgical treatment are required at an appropriate time. Conservative treatment is considered for acute peripancreatic fluid collection. Endoscopic drainage could be considered preferentially for the treatment of pancreatic pseudocysts with clinical symptoms or complications. In the case of necrotizing pancreatitis, conservative treatment is preferred, but therapeutic intervention should be considered if infectious pancreatic necrosis with clinical deterioration is suspected. For therapeutic intervention, it is recommended to proceed with a step-up approach in which drainage is first performed and, if necessary, necrosectomy is performed. The optimal timing of intervention is considered 4 weeks after the onset of pancreatitis when necrosis become walled-off, but early drainage within 4 weeks can be considered depending on the patient's condition. This guideline provides an overview of current treatment strategies for local complications of acute pancreatitis. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic pseudocysts (PPCs) and walled-off necrosis (WON) in children following acute pancreatitis are uncommon. The various modalities of therapy possible are conservative treatment, external drainage, endoscopic stenting, and internal surgical drainage procedures. There are no existing guidelines for the management of PPC in children. We evaluate the outcomes of laparoscopic cystogastrostomy (LCG) performed at our center. Materials and Methods: Eight children (median age: 10 years) underwent LCG for large PPC (median size: 12.5 cm). There were seven patients with PPC and one with WON. Seven underwent LCG by a transgastric approach and one underwent LCG by a retrogastric approach. Results: Seven out of the eight patients had complete resolution of symptoms and the PPC. The median follow-up period was 32 months (interquartile range: 9.5–55.5 months). There were no conversions. There was one patient with a WON who developed a recurrence. Conclusion: LCG is a safe and effective treatment option for large PPC/WON in children. A posterior retrogastric approach, when indicated, is a safe approach with a comparable outcome. [ABSTRACT FROM AUTHOR]

Pancreaticopleural fistulas (PPF) are a rare etiology of pleural effusions. We describe a case of a 61-year-old man, with left chest pain with six months of progression who presented with a large volume unilateral pleural effusion. A thoracentesis was performed, which showed a dark reddish fluid (exudate) and high content of pancreatic amylase. After that an abdominal computed tomography (CT)and magnetic resonance cholangiopancreatography (MRCP) was done, revealing fistulous pathways that originated in the pancreas. The patient was admitted for conservative and endoscopic treatment by Endoscopic Retrograde Cholangiopancreatography (ERCP) and a prosthesis was placed on a fistulous path. He was discharged without complications, with the resolution of the pleural effusion and fistula. The interest of this case lies in the rarity of the event and absence of symptoms of the probable primary event (acute pancreatitis). The possible iatrogenic association with several drugs of his usual medication makes it even more complex. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP. Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP. Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups. Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson's score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005). Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis. [ABSTRACT FROM AUTHOR]

Fluid resuscitation is the keystone of treatment for acute pancreatitis. Though clinical guidelines and expert opinions agree on large volume resuscitation, debate remains on the optimal fluid type. The most commonly used fluids are Lactated Ringer's (LR) and Normal Saline (NS), but the studies published to date comparing LR vs NS yield conflicting results. We aimed to identify and quantitatively synthesize existing high quality data of the topic of fluid type or acute pancreatitis resuscitation. In collaboration with the study team, an information specialist performed a comprehensive literature review to identify reports addressing type of fluid resuscitation. Studies were screened using the Covidence system by two independent reviewers in order to identify Randomized controlled trials comparing LR versus NS. The main outcome was the development of moderately severe or severe pancreatitis and additional outcomes included local complications, ICU admission, and length of stay. Pooled odds ratios were estimated using the random effects model and standardized mean difference to compare continuous variables. We reviewed 7964 abstracts and 57 full text documents. Four randomized controlled trials were identified and included in our meta-analyses. There were a total of 122 patients resuscitated with LR versus 126 with NS. Patients resuscitated with LR were less likely to develop moderately severe/severe pancreatitis (OR 0.49; 95 % CI 0.25–0.97). There was no difference in development of SIRS at 24 or 48 h or development of organ failure between the two groups. Patients resuscitated with LR were less likely to require ICU admission (OR 0.33; 95 % CI 0.13–0.81) and local complications (OR 0.42; 95 % CI 0.2–0.88). While there was a trend towards shorter hospitalizations for LR (SMD -0.18, 99 % CI -0.44-0.07), it was not statistically significant. Resuscitation with LR reduces the development of moderately severe-severe pancreatitis relative to NS. Nevertheless, no difference in SIRS development or organ failure underscores the need for further studies to verify this finding and define its mechanism. [ABSTRACT FROM AUTHOR]

Endoscopic drainage of pancreatic fluid collections (PFCs) with fewer complications and less trauma has gradually replaced surgery or percutaneous drainage to become the first-line treatment for PFCs. In recent years, the differential efficacy of various stent techniques to drain different types of PFCs has been controversial. This review summarizes the clinical applications of endoscopic ultrasound-guided stent placement for PFCs drainage.

Pancreatic pseudocysts are a common complication of both acute and chronic pancreatitis. The complications of pancreatic pseudocysts include compression of abdominal great vessels, gastric or duodenal stenosis, cholestasis due to stenosis of common bile duct, infection, and hemorrhage into the cyst. Moreover, pancreatic pseudocysts most commonly occur around the pancreas; however, extension into the adjacent viscera including spleen, liver, transverse colon, anterior or posterior pararenal space, retroperitoneum and mediastinum does occur infrequently. Here, we report a rare case of atypical extensive pancreatic pseudocyst with hemorrhage in a hemodialysis patient.

Pancreatic and peripancreatic collections (PPC) are a known complication of acute pancreatitis. They are categorized into four types of collection: (1) acute peripancreatic fluid collection, (2) pseudocyst, (3) acute necrotic collection and (4) walled-off necrosis. Most PPC resolve spontaneously or are persistent but asymptomatic. Intervention is needed in a minority of patients with infected or symptomatic collection. Endoscopic ultrasound-guided transmural drainage is currently the first-line treatment option for PPC management. It has shown great technical and clinical success, similar to percutaneous or surgical approaches, but with lower morbidity and costs and better quality of life. In this review article, the GRUPUGE presents an updated perspective on the potential role of endoscopic ultrasound-guided drainage of peripancreatic collections, addressing the selection criteria and the technical issues of different techniques and analysing emerging data on their efficacy and safety.

A case of endovascular treatment of a patient with a large false aneurysm of the splenic artery resulting from arrosion of its wall into the cavity of a previously existing pancreatic pseudocyst is described. In addition to the rather rare occurrence of this pathology, a feature of this clinical case was the patient’s sharp tortuosity of the access vessels, including the iliac arteries, abdominal aorta, and the splenic artery. Thus, both the endovascular prosthetics of the affected splenic artery and its embolization according to the traditional method using standard angiographic catheters and Gianturco coils turned out to be technically impossible because of the inability to reach the lesion site, especially with access through the common femoral artery that typical for such interventions, which was used by us when performing diagnostic selective arteriography. The second stage was the embolization of the splenic artery by access through the left axillary artery by means of conducting of guiding catheter into the celiac trunk. Through the lumen of this catheter, we introduced a microcatheter, through which detachable microcoils (usually used in interventional neuroradiology) were introduced into the splenic artery proximal and distal to the aneurysm cavity. As a result, the affected area of ​​the splenic artery with aneurysm was completely turned off from the bloodstream and thrombosed, that allowed to avoid extremely risky open surgical intervention and eliminated the risk of rupture of the aneurysm. Medication support included hypotensive therapy to reduce the risk of rupture of the aneurysm (before and after surgery), analgesics for the relief of post-embolization pain, and antibiotics for the prevention of infectious complications associated with pancreatitis and the possible development of spleen infarction. Monitoring the effectiveness of the intervention in the postoperative period was carried out using ultrasound dopplerography.

Background/Aims Endoscopic ultrasound-guided transmural drainage and necrosectomy employing lumen-apposing metal stent (LAMS) are used for treating pancreatic fluid collections (PFCs) with excellent results from academic centers. Herein, we report the efficacy and safety of LAMS in the treatment of PFCs at a community hospital. Methods We retrospectively reviewed the etiology of pancreatitis, type and size of PFCs, length of procedure, technical success, clinical success, adverse events, and stent removal. The primary outcome was the rate of clinical success, and secondary outcomes were technical success and adverse events. Results Twenty-seven patients with a mean age of 54.1±6.5 years were included, 44% of which were men. The mean size of the PFCs was 9.7±5.0 cm (range, 3–21). The most common etiology of pancreatitis was alcohol (44%) followed by idiopathic causes (30%) and presence of gallstones (22%). The diagnosis was pseudocyst in 44.4% (12/27) and walled off necrosis in 55.6% (15/27) of patients. There was 100% technical success without any complications. Clinical success was achieved in 22 of 27 patients (81.5%) who underwent stent removal. Conclusions Our study is the first to report that endoscopic therapy of PFCs using LAMS is safe and effective even in a community hospital setting with limited resources and support compared to large academic centers.

Background/Aims Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomatic pancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs and report on its effcacy and safety. Methods Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs were classified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm. Results A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwo patients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patients achieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patients with enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was five times more likely to achieve resolution within 90 days (p=0.0069). Conclusions A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PD stenting, and early enteral feeding is adopted.

Introduction. Minimally invasive approach for the treatment of acute pancreatitis (AP) and its complications has proven to reduce morbidity and mortality rate, length of hospitalization and costs of treatment, and improve quality of life of the patients. This approach for the AP has been implemented in developed countries, but in our region lags behind. In this case report we presented the successful endoscopic transgastric drainage of the large pancreatic pseudocyst (PPC) developed as a complication of AP. Case report. A 63-years old male patient was presented with nausea and vomiting as a consequence of the compressive effects of the PPC in the body and tail of the pancreas after episode of AP. On computed tomography (CT) scan, it was shown a cystic formation in the region of the pancreatic body and tail compressing stomach which was verified on upper endoscopy. Under fluoroscopy, using lateral duodenoscope, the biliary plastic prosthesis of 12 French and 8 cm of length was placed throughout posterior stomach wall into the PPC. The intervention was finished uneventfully, without complications. On CT scan performed 7 days after procedure, the reduction of the PPC size was significant and control CT scan one month after the procedure and removal of the prosthesis showed almost complete resolution of the PPC. Conclusion. Endoscopic transgastric drainage is safe and effective procedure for PPCs especially when the PPC has propulsion effects on stomach wall.

Mediastinal pancreatic pseudocyst (PP) is a rare complication of acute alcoholic pancreatitis. Endoscopic drainage has become widely used in the management of PPs and novel lumen apposing metal stents (LAMS) could provide more effective treatment

Pancreatic injuries due to trauma in children are rare. An early diagnosis is difficult as the signs and symptoms are insidious, but delays in diagnosis can lead to significant complications. We report a case of a child who visited the emergency department with aggravating abdominal pain. The physicians first diagnosed the abdominal pain as being caused by a disease in the emergency department, but the patient was subsequently diagnosed with pancreatic injury. Clinicians should be aware of a possible trauma in children who complain of vague abdominal pain even in the absence of corresponding history.

Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP.Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP.Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups.Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson’s score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005).Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.

Background Pancreatic duct (PD) disruption can occasionally be attributed to pancreatic cancer. Therapeutic interventions for PD disruption due to pancreatic cancer and their influence on pancreatic cancer prognosis remain unclear. This study investigated the therapeutic modalities and prognostic implications of PD disruption in pancreatic cancer. Methods This retrospective study included 15 patients with PD disruption concomitant with pancreatic cancer between April 2011 and March 2023. As an endoscopic intervention for PD disruption, endoscopic pancreatic stenting (EPS) or endoscopic ultrasonography-guided pancreatic fluid collection drainage (EUS-PFD) was performed. Technical success was defined as stent placement and clinical success was defined as an improvement in PD disruption. Results Of the 15 cases of PD disruption, two involved only pancreatic juice leakage without symptoms, four involved pancreatic pseudocyst (PPC) without infection, and nine involved PPC with infection. Four patients underwent EPS, nine underwent EUS-PFD, and two underwent lumen-apposing metal stent placement. All patients achieved both technical and clinical success without complications. The clinical stage of pancreatic cancer ranged from carcinoma in situ to the metastatic phase. For the treatment of pancreatic cancer, five patients underwent surgical resection, and eight underwent chemotherapy. There was no obvious recurrence of peritoneal sowing. The median overall survival from the diagnosis of pancreatic cancer in the resected and non-resected cases was 74 and 9.6 months, respectively. Conclusion Endoscopic intervention was effective in all cases of PD disruption due to pancreatic cancer. Furthermore, even in cases of pancreatic cancer after PD disruption, survival rates were similar to those in cases without PD disruption and were achieved through surgical resection or chemotherapy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Kobe University School of Medicine Ethics Committee issued approval B232030. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Oka et al.)

A pancreatic pseudocyst is defined as an encapsulated fluid collection with a well-defined inflammatory wall with minimal or no necrosis. The diagnosis cannot be made prior to 4 wk after the onset of pancreatitis. The clinical presentation is often nonspecific, with abdominal pain being the most common symptom. If a diagnosis is suspected, contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the pseudocyst. Endoscopic ultrasound with cyst fluid analysis can be performed in cases of diagnostic uncertainty. Pseudocyst of the pancreas can lead to complications such as hemorrhage, infection, and rupture. The management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications, such as biliary or gastric outlet obstruction. Management options include endoscopic or surgical drainage. The aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions, diagnosis, and management of this condition., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: To prepare a set of practice guidelines to standardize the entire process, from diagnosis to treatment and follow-up, for pancreatic pseudocysts and walled-off necrosis., Methods: Thirty-six experts in the fields of digestive endoscopy, pancreatic surgery, interventional radiology, and others presented their opinions via discussions in online conferences by referring to the patient, intervention, comparison, and outcomes principles and then reviewed the evidence and statements using the Delphi method to reach a consensus. The consensus of >80% was finally achieved for the items., Results: The experts discussed and reached a consensus on 29 statements including 10 categories: (1) definition and classification, (2) imaging and endoscopic diagnosis, (3) therapeutic implications, (4) surgical therapy, (5) percutaneous catheter drainage, (6) endoscopic retrograde cholangiopancreatography, (7) EUS-guided drainage, (8) stent selection for EUS-guided drainage, (9) complication related to stents for cyst drainage, and (10) drug treatment and follow-up., Conclusion: This consensus based on the clinical experience of experts in various fields and international evidence-based medicine further standardizes the multidisciplinary diagnosis and treatment processes for pancreatic pseudocysts and walled-off necrosis., Competing Interests: Zhaoshen Li is an Honorary Editor-in-Chief of the journal, and Zhendong Jin is an Associate Editor-in-Chief. The article was subjected to the standard procedures of the journal, with a review process independent of the editors and their research group., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Scholar Media Publishing.)

With the introduction of endoscopic retrograde cholangiopancreatography and linear endoscopic ultrasound, interventional pancreaticobiliary (PB) endoscopy has had an enormous impact in the management of pancreatic and biliary diseases. Continuous efforts to improve various devices and techniques have revolutionized these treatment modalities as viable alternatives to surgery. In recent years, trends toward combining endoscopic techniques with other modalities, such as laparoscopic and radiological interventions, for complex PB diseases have emerged using a multidisciplinary approach. Ongoing research and clinical experience will lead to refinements in interventional PB endoscopic techniques and subsequently improve outcomes and reduce complication rates., Competing Interests: Disclosure The authors have no financial disclosures., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal (GI) tract, typically originating from the interstitial cells of Cajal. The clinical presentations are variable according to their size and shape but rarely present as a palpable abdominal mass. Pancreatic pseudocysts are common complications of chronic pancreatitis characterized by fluid collections surrounded by a non-epithelialized wall of fibrous and granulation tissue. Patients may present with non-specific symptoms like abdominal pain, nausea, and vomiting and they generally have a history of acute pancreatitis. Small pseudocysts often resolve spontaneously, but larger ones often become symptomatic and may lead to complications. It is rare to find both a GIST of the stomach and a pseudocyst of the pancreas in the same patient. We present a unique case of a giant GIST and a pancreatic pseudocyst in a 72-year-old male who was experiencing abdominal pain and distension. Imaging revealed a massive lesion originating from the posterior gastric wall, which resembled a pseudocyst, along with a distinct cystic lesion adjacent to the pancreatic body. During surgical exploration, a complex interplay of both pathologies was discovered, requiring a comprehensive resection approach. The successful outcome highlights the importance of careful evaluation and personalized management in such rare cases., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ali et al.)