Cases Of Mild Acute Pancreatitis Research Articles

Establishing the optimal number of passes during EUS-FNB for diagnosis of pancreatic solid lesions: Prospective multicenter study.

Background and study aims The optimal number of needle passes during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is not yet established. We aimed to perform a per-pass analysis of the diagnostic accuracy of EUS-FNB of solid pancreatic lesions using a 22G Franseen needle. Patients and methods Consecutive patients with solid pancreatic lesions referred to 11 Italian centers were prospectively enrolled. Three needle passes were performed; specimens were collected after each pass and processed individually as standard histology following macroscopic on-site evaluation (MOSE) by the endoscopist. The primary endpoint was diagnostic accuracy of each sequential pass. Final diagnosis was established based on surgical pathology or a clinical course of at least 6 months. Secondary endpoints were specimen adequacy, MOSE reliability, factors impacting diagnostic accuracy, and procedure-related adverse events. Results A total of 504 samples from 168 patients were evaluated. Diagnostic accuracy was 90.5% (85.0%-94.1%) after one pass and 97.6% (94.1%-99.3%) after two passes ( P =0.01). Similarly, diagnostic sensitivity and sample adequacy were significantly higher adding the second needle pass (90.2%, 84.6%-94.3% vs 97.5%, 93.8%-99.3%, P =0.009 and 91.1%, 85.7%-94.9% vs 98.2%, 95.8%-99.3%, P =0.009, one pass vs two passes, respectively). Accuracy, sensitivity, and adequacy remained the same after the third pass. The concordance between MOSE and histological evaluation was 89.9%. The number of passes was the only factor associated with accuracy. One case of mild acute pancreatitis (0.6%) was managed conservatively. Conclusions At least two passes should be performed for the diagnosis of solid pancreatic lesions. MOSE is a reliable tool to predict the histological adequacy of specimens.

A Case of Acute Pancreatitis Following Computed-Tomography Scan

Introduction:
 Acute pancreatitis is a common cause of hospitalization among gastrointestinal disorders and its frequency has been rising in the past few years. The majority of cases are due to alcohol use, gallstones and hypertriglyceridemia. However, there still remain a significant number of cases in which no causative factor can be found and therefore called idiopathic. Contrast-induced pancreatitis is a rare cause pancreatitis and there are only a few cases reported so far. Here we present a case of mild acute pancreatitis following iodinated contrast exposure.
 
 Case Presentation:
 A 42-year-old female patient with a history of lymphoma was admitted to our clinic with severe abdominal pain and nausea. Her blood tests revealed elevated pancreatic enzyme levels and mildly elevated liver function tests. Upper abdomen magnetic resonance imaging revealed pancreatic inflammation without any sign of necrosis. Since her complaints began after a computed-tomography scan that she had earlier that day for the evaluation of lymphoma and no other cause could be found, iodinated contrast was thought to be the cause of acute pancreatitis in this patient.
 
 Conclusion:
 Contrast agents seem to be a rare cause of acute pancreatitis, however taking the increasing availability of procedures involving radiocontrast agents into consideration, it is important to keep in mind that clinicians may come across more cases of contrast-induced acute pancreatitis in the future.

The Role of Serum High Mobility Group Box 1 and Interleukin-6 Levels in Acute Pancreatitis: A Meta-Analysis.

The purpose of this meta-analysis was to comprehensively investigate the correlation between high mobility group box 1 (HMGB1) and interleukin-6 (IL-6) in relation to acute pancreatitis. A highly regulated exploration of various electronic databases, supplemented by manual searching methods, was performed in an attempt to identify pertinent articles of a useful nature. Subsequently, high-quality cohort studies that were deemed to comply with the arduous inclusion and exclusion criteria were selected for our meta-analysis. The extensive data analyses reported in our meta-analysis were conducted in connection with the Comprehensive Meta-analysis 2.0 (CMA 2.0). A total of 395 studies (135 Chinese studies and 260 English studies) were initially retrieved. 27 of those studies were selected for our meta-analysis, comprising of 896 cases of mild acute pancreatitis (MAP), 700 cases of severe acute pancreatitis (SAP) as well as 312 healthy controls. Pooled data suggested that serum HMGB1 and IL-6 levels of SAP and MAP patients were higher than in healthy controls. Moreover, serum HMGB1 and IL-6 levels of SAP patients exhibited significantly higher levels than in that of MAP patients. Based on the rigorous investigation of our meta-analysis, it was concluded that serum HMGB1 and IL-6 levels might be used as effective indicators for pancreatic lesions as well as the degree of inflammatory response, owing ultimately to the observations and data analyses, suggesting that serum HMGB1 and IL-6 levels share a close correlation with the severity of pancreatitis. J. Cell. Biochem. 119: 616-624, 2018. © 2017 Wiley Periodicals, Inc.

Prevalence, severity, and clinical features of acute and chronic pancreatitis in patients with systemic lupus erythematosus.

Pancreatitis is a rare, life-threatening complication of systemic lupus erythematosus (SLE). This study aimed to describe the clinical features of acute pancreatitis (AP) and chronic pancreatitis (CP) in patients with SLE. Data of patients who fulfilled the revised criteria of the American Rheumatism Association for diagnosis of SLE were retrospectively analyzed. SLE activity was graded according to the SLE Disease Activity Index. Logistic regression analysis was conducted to find out independent associations. Survival rates were estimated by using Kaplan-Meier plots. This study included 5665 SLE patients admitted between January 1983 and January 2014, of whom 52 patients were diagnosed with pancreatitis. Pancreatitis prevalence in SLE patients was 0.92% (52/5665). AP (0.8%, 46/5665) was more prevalent than CP (0.1%, 6/5665), presented mostly during active SLE, and affected more organs. Hypertriglyceridemia occurred in 76.9% of AP patients and in none of the CP patients. AP patients were divided into severe (n=10) or mild (n=20) cases. The average triglyceride level in severe AP cases was higher than that in mild AP cases (P=0.006), and the mortality rate of lupus-associated AP was 32.6% (15/46). Concomitant infections and thrombocytopenia were independently associated with poor prognosis (P<0.001, P=0.028, respectively). There were significant differences in the clinical manifestations of AP and CP. Patients with severe AP were found to have a higher incidence of concomitant infection and serum triglyceride levels. Concomitant infections and thrombocytopenia were independent risk factors for poor prognosis.

Meta-analysis of aetiology and the severity of acute pancreatitis about Chinese clinical trials

Objective To investigate the characteristics of common causes of acute pancreatitis (AP) in China and to evaluate the association of the aetiology with the severity of disease. Methods The relevant literature was searched from the China National Knowledge Infrastructure (CNKI) database (1989.1-2015.3), WANFANG database (1999.1-2015.3), VIP database (1994.1-2015.3), and China Academic Journal Network Publishing Database (CAJD). To collect related literature about aetiology and the severity of acute pancreatitis, Meta analysis was performed for gallstone, alcohol, hyperlipidemia and other AP from the aspects of the severity of disease in the literature which reaches the criteria. Results The Meta analysis included 24 clinical articles which were accordance with the criteria, totally 17359 patients, including 8673 cases of biliary AP [6690 cases of mild acute pancreatitis (MAP), 1983 cases of acute necrotizing pancreatitis (ANP)], 1408 cases of alcoholic AP (1022 cases of MAP, 386 cases of ANP), 1753 cases of hyperlipidemia AP (1107 cases of MAP, 646 cases of ANP), and 5525 cases of other aetiology (4179 cases of MAP, 1346 cases of ANP). The Meta analysis showed that among the common causes which was developed to AP, there was significant difference between biliary AP and alcohol AP (OR=0.65, 95% CI: 0.45~0.93, P 0.05). Conclusions There is difference in the severity of AP caused by different reasons in China. There is more likely that hyperlipidemia AP and alcohol AP easily developed into ANP than biliary AP. However, further investigation and large-scale clinical trials will be needed to confirm this conclusion. Key words: Pancreatitis/ET; Meta-analysis

The prognostic value of CD14＋HLA-DRlow/-for evaluating the severity of acute pancreatitis

Objective To investigate the prognostic value of CD 4＋CD25＋/high CD127 low/-and CD14＋HLA-DRlow/-for evaluating the severity of acute pancreatitis .Methods The percentages of CD4＋CD25＋/highCD127low/-and CD14＋HLA-DRlow/-and the CD64 index were measured by flow cytometry in pa-tients with acute pancreatitis （ including 43 cases of mild acute pancreatitis and 24 cases of severe acute pan-creatitis）.Moreover, the levels of C-reactive protein （CRP）, acute physiology and chronic health evaluationⅡ（ APACHEⅡ） score and CT severity index （ CTSI ） were detected for a correlation analysis .Results The percentages of CD4＋CD25＋/highCD127low/-and CD14＋HLA-DRlow/-and the CD64 index in patients with severe and mild acute pancreatitis were significantly higher than those in healthy subjects .Patients with se-vere acute pancreatitis showed higher percentages of CD 14＋HLA-DRlow/-than patients with mild acute pan-creatitis.With the disease progression, the CD64 index and the levels of CD4＋CD25＋/highCD127low/-, CD14＋HLA-DRlow/-and CRP were significantly dropped after an initial increase in patients with mild acute pancrea -titis, while these indexes were continuously elevated in patients with severe acute pancreatitis .The percent-age of CD14＋HLA-DRlow/-was positively correlated with CD64 index, CRP level, APACHEⅡ score and CTSI.Conclusion CD14＋HLA-DRlow/-level was closely related to the severity of acute pancreatitis , which could be used as immune parameter for the estimation of the clinical severity of acute pancreatitis . Key words: Acute pancreatitis; CT severity index; CD64 index; Flow cytometry

Comparative study of rendezvous techniques in post-liver transplant biliary stricture

To investigate the usefulness of a new rendezvous technique for placing stents using the Kumpe (KMP) catheter in angulated or twisted biliary strictures. The rendezvous technique was performed in patients with a biliary stricture after living donor liver transplantation (LDLT) who required the exchange of percutaneous transhepatic biliary drainage catheters for inside stents. The rendezvous technique was performed using a guidewire in 19 patients (guidewire group) and using a KMP catheter in another 19 (KMP catheter group). We compared the two groups retrospectively. The baseline characteristics did not differ between the groups. The success rate for placing inside stents was 100% in both groups. A KMP catheter was easier to manipulate than a guidewire. The mean procedure time in the KMP catheter group (1012 s, range: 301-2006 s) was shorter than that in the guidewire group (2037 s, range: 251-6758 s, P = 0.022). The cumulative probabilities corresponding to the procedure time of the two groups were significantly different (P = 0.008). The factors related to procedure time were the rendezvous technique method, the number of inside stents, the operator, and balloon dilation of the stricture (P < 0.05). In a multivariate analysis, the rendezvous technique method was the only significant factor related to procedure time (P = 0.010). The procedural complications observed included one case of mild acute pancreatitis and one case of acute cholangitis in the guidewire group, and two cases of mild acute pancreatitis in the KMP catheter group. The rendezvous technique involving use of the KMP catheter was a fast and safe method for placing inside stents in patients with LDLT biliary stricture that represents a viable alternative to the guidewire rendezvous technique.

Mo1470 The Results of Post-Surgical Treatment of the Intestinal Tract for Common Bile Duct Calculus by DB-ERCP

The Results of Post-Surgical Treatment of the Intestinal Tract for Common Bile Duct Calculus by DB-ERCP Shuhei Oana, Kazuyuki Suzuki, Toshimi Chiba, Masaki Endo, Shinji Saitou, Satosi Kasugai Gastroenterology and hepatrogy, Iwate Medical University, Morioka, Japan [Introduction] With the introduction of DBE, a biliary system treatment for postsurgical intestinal tract cases in which the duodenal papilla are difficult to reach with a conventional endoscope has become possible. The treatment results of common bile duct stone cases with DB-ERCPat our department are herein presented. [Subject] A total of 27 cases (33 instances), specifically, 18 males and 9 females with an average age of 75.0, who underwent treatment for common bile duct stone using DB-ERC at our department during the period from November 2004 to November 2010 were selected as subjects. Regarding the reconstructive procedures among these subjects, there were 22 cases of Roux-en Y reconstructive procedure and 5 cases of B-2 reconstructive procedure. [Results] The time taken to reach the duodenal papilla: The overall average time across all instances was 28.6 minutes (5 93 minutes). The rate at which the duodenal papilla was reached: 93.9% (31/33 instances). Success rates of cholangiography: 90.9% (30/33 instances) across all instances, and 96.3% (30/31 instances) if limited to those that reached the duodenal papilla. When observed according to the reconstructive procedure, the success rates were 96.2% (25/26 instances) for the Roux-en Y reconstructive procedure, and 100% (5/5 instances) for the B-2 reconstructive procedure, and it was possible to perform cholangiography. The success rate of crushing stones in a single attempt: Crushing stones in a single attempt was possible in 76.7% (23/30 instances) of cases, among cases in which cholangiography could be performed. The primary factors as to why stones could not be crushed in a single attempt: There were 5 cases in which the treatment tools could not be inserted because positions of the duodenal papilla were poor, or because the bile ducts were bent, and 2 cases in which insertion was stopped due to procedural time. Treatment time: On average, it took 100.3 minutes (14 164 minutes) for all procedures. Complications: Complications developed in 4 cases (13.8%), specifically 2 cases of mild acute pancreatitis, and 2 cases of retroperitoneal perforation; however, they subsided with conservative therapy. [Conclusion] Even when using DB-ERCP for the intestinal tract, it has now become possible to achieve higher rates of reaching the papilla by blind endings and higher rates of insertion into the intestinal tract. However, issues such as the presence of cases in which stones crushing treatment in a single attempt is difficult, low rates of success in single-attempt stones removal, and long treatment times have become clear, and it is believed that improvements are therefore necessary for both endoscopes and treatment instruments to provide improved emergency treatment for high risk patients and patients with severe cholangitis requiring dependable drainage.

Endoscopic papillectomy for ampullary adenomas

Objective To evaluate the endoscopic papillectomy （EP） for ampullary adenoma （AA）. Methods The resection rate, complications, local residual rate and local recurrence of EP for AA at endoscopy center of Changhai Hospital were retrospectively reviewed. Results From July 2005 to July 2009, a total of 19 patients with endoscopically diagnosed and pathologically confirmed AA underwent EP, in which 18 cases were scattered AA （94. 7%） including 1 case of multiple adenomas in duodenum, and 1 （5.3%） was familial adenomatous polyposis （FAP）. The lesion was resected en bloc in 11 cases （57.9%） , and piecemeal in 8 （42. 1%）. All patients were followed up at a mean period of 24. 5 months （range 7-48 months）. The residual rate after first EP was 21. 1% （4/19）, and the total success rate was 89.5% （17/19）. Short-term complications after EP included 3 cases of bleeding, 3 cases of mild acute pancreatitis and 2 cases of acute cholangitis. Long-term complications were 1 case of stenosis of the common bile duct （CBD） orifice accompanied with acute cholangitis, 1 case of CBD stone and 1 case of acute cholangitis after stent placement. No such severe complications as perforation or procedure-related death was observed.Conclusion EP is a safe and effective modality for ampullary adenoma. Key words: Duodenal papilla, major; Adenoma; Endoscopic surgical procedures

The implication of dynamic monitoring of α1-acid glycoprotein and high-sensitivity C-reactive protein to assess the severity of acute pancreatitis in the early stage

Objective To explore the value of dynamic monitoring of serum α1-acid glycoprotein (α1-AGP)and high-sensitivity C-reactive protein (HsCRP) to assess the severity of acute pancreatitis in the early stage.Methods Seventy-four cases of acute pancreatitis(AP)(23 cases of severe AP and 51 cases of mild AP)at post-admission were detected dynamically for serum α1-AGP,HsCRP,and received APACHE Ⅱ scoring and enhanced CT examination.The results were comparatively analyzed.Results The changes in α1-AGP and HsCRP levels at the same time between severe group and mild group during hospitalization showed statistically significant difference (P<0.01).α1-AGP concentrations detected at 24 h after admission to assess AP severity and APACHE Ⅱ score had a better goodness of fit(P<0.01).α1-AGP and HsCRP levels detected at the 3rd day after admission and APACHE Ⅱ score had an excellent goodness of fit(P<0.01).Conclusion α1-AGP and hsCRP can be used as indicators to assess the changes in the illness conditions of the AP patients,and predict the severity of AP in the early stage well. Key words: Acute pancreatitis; α1-acid glycoprotein; C-reactive protein

Simplified Early Predictors of Severe Acute Pancreatitis: A Prospective Study

BackgroundTo propose simple tests for the prediction of severe acute pancreatitis (SAP), which are accurate and could be performed at emergency departments and outpatient clinics.MethodsA prospective study was performed on 149 patients admitted with acute pancreatitis. Body mass index (BMI), plain chest radiograph, blood biochemical data were obtained at the time of admission; white cell, lymphocyte and platelet counts, hematocrit level, prothrombin time, PaO2, creatinine, calcium, blood sugar, total protein, aspartate aminotransferase, total bilirubin, amylase, lipase and C-reaction protein were determined. Patients were graded into severe and mild acute pancreatitis based on CT Balthazar grading system.ResultsTwenty-seven patients were diagnosed to have SAP and 122 patients considered mild acute pancreatitis. Comparing parameters between both groups; significant factors (P < 0.05) were blood sugar level, haematocrit level, BMI and presence of pleural effusion in chest X-ray. The hematocrit at admission and at approximately 24 hours was significantly higher among patients with SAP. Twenty-two of 27 cases of severe disease and only 10 of 122 cases of mild acute pancreatitis diagnosed to have pleural effusion (P < 0.001).ConclusionBMI, blood glucose ≥ 190 mg/dL, hematocrit level ≥ 43 % and pleural effusion detected by plain chest radiograph are simple tests and provide significant predictive power for clinical decision-making.

ERCP-induced and non-ERCP-induced acute pancreatitis: Two distinct clinical entities with different outcomes in mild and severe form?

Background Acute pancreatitis is a complication of endoscopic retrograde cholangio-pancreatography. Aim of the study was to compare endoscopic retrograde cholangio-pancreatography-related acute pancreatitis with attacks caused by other factors. Methods A series of consecutive patients with non-endoscopic retrograde cholangio-pancreatography-related acute pancreatitis referred to our hospital in 2007–2008 were examined retrospectively, and compared with the same number of patients with post-endoscopic retrograde cholangio-pancreatography acute pancreatitis done in the same institution. Both groups comprised 116 patients and were comparable for mean age, sex, and body mass index. Duration of abdominal pain, pancreatic enzyme elevation, hospital stay, and type of analgesia administered were retrieved. Results There were no differences between the groups as regards the severity of pancreatitis, mortality rate and hospitalisation, although mortality was double in severe post-endoscopic retrograde cholangio-pancreatography acute pancreatitis. In the mild acute pancreatitis cases, serum amylase fell 50% from the peak in a mean of 46.4 h (range 24–72) in group 1 and 38.9 h (range 24–72) in group 2 ( p < 0.001). The peak amylase serum level halved within 48 h in 73.6% of cases with non-endoscopic retrograde cholangio-pancreatography-related acute pancreatitis, and in 92% of patients with endoscopic retrograde cholangio-pancreatography-related acute pancreatitis ( p < 0.001). Conclusions Non-endoscopic retrograde cholangio-pancreatography- and endoscopic retrograde cholangio-pancreatography-induced pancreatitis did not differ as regards severity, hospital stay or mortality; in mild pancreatitis, serum amylase halved significantly sooner in post-endoscopic retrograde cholangio-pancreatography cases.

Clinical analysis of diagnosis and treatment of acute pancreatitis in pregnancy

Objective To explore the etiology,mechanism,clinical features,diagnosis,therapy and prevention of acute pancreatitis in pregnancy(APIP).Methods The clinical data of 63 cases of APIP treated in our hospital from January 1996 to December 2006 were retrospectively analyzed.Results Among the 63 cases of APIP,there were 43 (68.25%) cases of mild acute pancreatitis (MAP) and 20 (31.75%)cases of severe acute pancreatitis (SAP).Thirty-seven (58.73%) patients had gallstone or chronic cholecystitis and 19 (30.16%) had hyperlipidemia before the onset of APIP.Forty-nine (77.78%) patients received conservative therapy and 14 (22.22%),surgical operations.A total of 58 (92.06%) patients recovered.The mortality during pregnancy was 7.94% (5 cases) for the pregnant women,and 21.21% (14 cases) for the fetuses.In most of these cases,the major causes for death were MSOF and ARDS.Fourteen cases received termination of pregnancy and 49 continued their pregnancy.There were 5 cases (7.94%) of missed diagnosis,and misdiagnosis.Conclusion The occurrence of APIP is mainly related to gallstone and hyperlipidemia and it is prone to occur during the midterm and late stage of pregnancy.Since the clinical presentation of APIP is complex,misdiagnosis is likely and it threatens the lives of mother and fetus seriously.For the purpose of increasing the curative rate and reducing the mortality of APIP,taking hold of its features,raising the vigilance of discerning APIP,making an early correct diagnosis and proper individualized therapy principles,and the timely termination of pregnancy are of great importance. Key words: Pancreatitis; Pregnancy complication; Diagnosis; Treatment

Expression of TREM-1 mRNA in acute pancreatitis.

To explore the expression of triggering receptor expressed on myeloid cells (TREM-1) mRNA in acute pancreatitis (AP). Using the reverse transcription polymerase chain reaction (RT-PCR), we examined the expression of TREM-1 mRNA in 10 cases of mild acute pancreatitis (MAP), 8 cases of severe acute pancreatitis (SAP), and 10 cases of healthy control subjects. And we also examined the expression of TREM-1 mRNA in 14 cases of AP (including 10 MAP and 4 SAP) before treatment, after successful therapy and clinically cured. The expression of TREM-1 mRNA in the groups of MAP, SAP patients and healthy control subjects was 0.771+/-0.274, 1.092+/-0.331 and 0.459+/-0.175, respectively; there was a significant difference among the three groups (P<0.05). And there was also a significant difference between the AP patients (0.914+/-0.341) and healthy control subjects (0.459+/-0.175) (P<0.05). Moreover, in the 14 cases of AP, before treatment, after successful therapy and clinically cured, the expression of TREM-1 mRNA was 0.905+/-0.226, 0.739+/-0.169 and 0.633+/-0.140, respectively, and there was a significant difference among the three stages (P<0.05). The expression of TREM-1 mRNA in the patients with AP increases obviously, and correlates with the degree of AP. Furthermore, the expression of TREM-1 mRNA is distinctly different at the different stages of AP. It indicates TREM-1 may play an important role in the occurrence and development of AP.