Latest Updates

ENDOSCOPIC TECHNIQUES FOR OBTAINING ENTERAL ACCESS

Marvin Ryou, MD, Sanjay Salgado, MD
    • DPEJ tubes should be considered when percutaneous endoscopic gastrostomy (PEG) tubes are not feasible or are contraindicated.
    • Postpyloric feeding (percutaneous gastrostomy with a jejunal extension or direct percutaneous jejunostomy should be considered in severely ill patients (especially those with an APACHE II score over 20).
    • In patients with dementia, PEG tube placement does not enhance mortality, prevent aspiration pneumonia, improve nutritional status, or improve quality of life.

Basic Concepts of Anesthesia

Pooja Pandya, MD, George P. Yang, MD, PhD
    • Increasing adoption of risk calculators to assess operative risks
    • Use of regional anesthesia approaches to decrease narcotic usage
    • Impact of ERAS pathways on approaches to perioperative management

Basic Concepts of Anesthesia

Pooja Pandya, MD, George P. Yang, MD, PhD
    • Increasing adoption of risk calculators to assess operative risks
    • Use of regional anesthesia approaches to decrease narcotic usage
    • Impact of ERAS pathways on approaches to perioperative management

Antiepileptic and Antidepressant Drugs Used in the Treatment of Pain

Lucia Daiana Voiculescu, MD
    • Gabapentinoids
    • Antiepileptic and antidepressant drugs used in pain therapy: approved indications and off-label use
    • Antiepileptic drugs used as adjuvant analgesics in the perioperative period

Nutritional Management of Celiac Disease

Ciarán P Kelly, MD, Satya Kurada, MD, Mariana Urquiaga, MD
    • Glutenases: Clinical trials using glutenases versus placebo have demonstrated worsening of histologic findings in the placebo group compared with glutenases on consumption of up to 2 g of gluten.
    • Tight junction regulators: Larazotide acetate demonstrated a reduction in gluten-induced immune reactivity and symptoms when celiac subjects were exposed to a 2.7 g gluten challenge when compared with placebo in a randomized, double-blind, placebo-controlled trial.
    • IgY antibodies: Animal studies using mice fed with gastric-stabilized antigliadin IgY antibodies derived from the egg yolks of gluten-immunized chickens in addition to gluten showed a reduction in gluten absorption from the diet.

Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma

Kevin K. Chang, MD, Sam S. Yoon, MD
    • The eighth edition of the AJCC Cancer Staging Manual now includes prognostic information for clinical TNM staging and post–neoadjuvant therapy staging.
    • A D2 lymphadenectomy is frequently recommended as the nodal dissection of choice for locally advanced gastric adenocarcinoma.
    • Laparoscopy-assisted operations are associated with improved overall morbidity and comparable lymph node yield.

ENDOSCOPIC TECHNIQUES FOR OBTAINING ENTERAL ACCESS

Marvin Ryou, MD, Sanjay Salgado, MD
    • DPEJ tubes should be considered when percutaneous endoscopic gastrostomy (PEG) tubes are not feasible or are contraindicated.
    • Postpyloric feeding (percutaneous gastrostomy with a jejunal extension or direct percutaneous jejunostomy should be considered in severely ill patients (especially those with an APACHE II score over 20).
    • In patients with dementia, PEG tube placement does not enhance mortality, prevent aspiration pneumonia, improve nutritional status, or improve quality of life.

Child Abuse and Nonaccidental Trauma

S Terez Malka, MD
    • Abusive injuries account for over 1% of pediatric emergency department visits.
    • Skeletal survey should now be obtained in any child under age 3 with concern for abusive injury.
    • Cardiopulmonary resuscitation does not lead to significant rib fractures or retinal hemorrhages, and these conditions should be considered highly concerning for abusive injury.
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