A pancreaticoduodenectomy (PD) remains the operation of choice for the majority of malignant and benign neoplasms of the head of the pancreas and periampullary region. Despite the centralization of PD to high‐volume tertiary centres resulting in a reduction in mortality from 14% to 2%,^1. x 1. Pratt, W.B., Maithel, S.K., Vanounou, T., Huang, Z.S., Callery, M.P., and Vollmer, C.M. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg. 2007; 245: 443–451 Crossref | PubMed | Scopus (226) | Google Scholar See all References ^{, 2.} x 2. Greenblatt, D., Kelly, K., Rajamanickam, V., Wan, Y., Hanson, T., and Rettammel, R. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol. 2011; 18: 2126–2135 Crossref | PubMed | Scopus (132) | Google Scholar See all References ^{, 3.} x 3. Kneuertz, P., Pitt, H., Bilimoria, K., Smiley, J., Cohen, M., and Ko, C. Risk of morbidity and mortality following hepato‐pancreato‐biliary surgery. J Gastrointest Surg. 2012; 16: 1727–1735 Crossref | PubMed | Scopus (72) | Google Scholar See all References ^{, 4.} x 4. Begg, C.B., Cramer, L.D., Hoskins, W.J., and Brennan, M.F. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998; 280: 1747–1751 Crossref | PubMed | Scopus (1196) | Google Scholar See all References post‐operative morbidity remains significant at 30–50%.⁵ x 5. Bassi, C., Dervenis, C., Butturini, G., Fingerhut, A., Yeo, C., and Izbicki, J. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138: 8–13 Abstract | Full Text | Full Text PDF | PubMed | Scopus (2668) | Google Scholar See all References

We present a 1620 A image of the nearby globular cluster NGC 6752 obtained with the Ultraviolet Imaging Telescope (UIT) during the Astro-2 mission of the Space Shuttle Endeavour in 1995 March. An ultraviolet-visible color-magnitude diagram (CMD) is derived for 216 stars matched with the visible photometry of Buonanno et al. (1986). This CMD provides a nearly complete census of the hot horizontal branch (HB) population with good temperature and luminosity discrimination for comparison with theoretical tracks. The observed data show good agreement with the theoretical zero-age horizontal branch (ZAHB) of Sweigart (1996) for an assumed reddening of E(B-V) = 0.05 and a distance modulus of 13.05. The observed HB luminosity width is in excellent agreement with the theoretical models and supports the single star scenario for the origin of extreme horizontal branch (EHB) stars. However, only four stars can be identified as post-EHB stars, whereas almost three times this many are expected from the HB number counts. If this effect is not a statistical anomaly, then some non-canonical effect may be decreasing the post-EHB lifetime. The recent non-canonical models of Sweigart (1996), which have helium-enriched envelopes due to mixing along the red giant branch, cannot explain the deficit of post-EHB stars, but might be better able to explain their luminosity distribution.Comment: 14 pages, AASTeX, includes 4 EPS figures ApJ Letters accepte

Background: Endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) with lumen apposing metal stents has recently emerged as a viable option, as an alternative to surgical gastrojejunostomy and endoscopic enteral stenting, for managing gastric outlet obstruction (GOO). We aim to perform a retrospective analysis of the efficacy, safety and outcomes of EUS-GJ performed at three tertiary institutions in the United Kingdom. Methods: Consecutive patients who underwent EUS-GJ between August 2018 and March 2021 were identified from a prospectively maintained database. Data were obtained from interrogation of electronic health records. Results: Twenty five patients (15 males) with a median age of 63 years old (range 29–80) were included for analysis. 88% (22/25) of patients had GOO due to underlying malignant disease. All patients were deemed surgically inoperable or at high surgical risk. Both technical and clinical success were achieved in 92% (23/25) of patients. There was an improvement in the mean Gastric Outlet Obstruction Scoring System scores following a technically successful EUS-GJ (2.52 vs 0.68, p < 0.01). Adverse events occurred in 2/25 patients (8%), both due to stent maldeployment necessitating endoscopic closure of the gastric defect with clips. Long-term follow-up data were available for 21 of 23 patients and the re-intervention rate was 4.8% (1/21) over a median follow-up period of 162 (range 5–474) days. Conclusion: EUS-GJ in carefully selected patients is an effective and safe procedure when performed by experienced endoscopists.

Background: Surgical resection for pancreatic ductal adenocarcinoma (PDAC) entails the excision of the primary tumour and regional lymphadenectomy. This traditional strategy is challenged by the high rate of early recurrence, suggesting inadequate disease staging. Novel methods of intra-operative staging are needed to allow surgical resection to be tailored to the disease’s biology. Methods: A search of published articles on the PubMed and Embase databases was performed using the terms ‘pancreas’ OR ‘pancreatic’ AND ‘intra-operative staging/detection’ OR ‘guided surgery’. Articles published between January 2000 and June 2023 were included. Technologies that offered intra-operative staging and tailored treatment were curated and summarised in the following integrative review. Results: lymph node (LN) mapping and radioimmunoguided surgery have shown promising results but lacked practicality to facilitate real-time intra-operative staging for PDAC. Fluorescence-guided surgery (FGS) offers high contrast and sensitivity, enabling the identification of cancerous tissue and positive LNs with improved precision following intravenous administration of a fluorescent agent. The unique properties of optical coherence tomography and ultrasound elastography lend themselves to be platforms for virtual biopsy intra-operatively. Conclusions: Accurate intra-operative staging of PDAC, localisation of metastatic LNs, and identification of extra-pancreatic disease remain clinically unmet needs under current detection methods and staging standards. Tumour-specific FGS combined with other diagnostic and therapeutic modalities could improve tumour detection and staging in patients with PDAC.