Complication Of Chronic Pancreatitis Research Articles

An intensified trans-sectoral nutritional intervention in malnourished patients with chronic pancreatitis improves diseases prognosis and identifies potential biomarkers of nutritional status.

Malnutrition is a common complication in chronic pancreatitis and associated with reduced quality of life and life expectancy. Nutritional support is considered mandatory in malnourished patients with chronic pancreatitis but there is only scarce evidence on optimal treatment modalities and the efficacy of nutrition therapy. Here, we investigated the feasibility and efficacy of an intensified nutritional intervention in malnourished patients with chronic pancreatitis and aimed to identify suitable indicators for monitoring nutritional status. We performed a single-arm feasibility study, in which malnourished patients with chronic pancreatitis received an intensified trans-sectoral nutritional intervention for 6 months. Multimodal treatment comprised face-to-face dietary counseling, oral nutritional supplementation, and a complementary telephone-based nutrition and exercise coaching. Patients underwent follow-up examinations after 28, 90, and 180 days, when we assessed changes in anthropometric and body composition measures, muscle function, Chronic Pancreatitis Prognosis Score (COPPS), as well as blood parameters and intestinal microbiota composition. Eleven out of 73 patients initially screened for study participation were enrolled in the trial of which 9 subjects (age (mean ± SD): 56.2 (±14.8) years; male: 67%; alcoholic etiology: 44%) underwent the complete intervention. Patients gained a median of 5.3 kg (8.6%) body weight, including 1.6 kg skeletal muscle mass, and significantly increased gait speed (p < 0.001). Ameliorated nutritional status and muscle function were associated with increased blood levels of IGF-1 and cholinesterase as well as altered gut microbiota composition on the phyla and genera level. Moreover, significant improvements in COPPS indicated reduced disease severity after 90 and 180 days. Malnourished patients with chronic pancreatitis benefit from intensified nutritional therapy. Besides ameliorated nutritional status, a multimodal intervention can improve muscle function as well disease prognosis. Future studies are needed to prove superiority to standard-of-care and to validate potential biomarkers for prospective monitoring of nutritional status. https://clinicaltrials.gov/study/NCT04476056, NCT04476056.

Current status and future perspectives for endoscopic treatment of local complications in chronic pancreatitis.

Chronic pancreatitis is a progressive disease characterized by irregular fibrosis, cellular infiltration, and parenchymal loss within the pancreas. Chronic pancreatitis treatment includes lifestyle modifications based on disease etiology, dietary adjustments appropriate for each stage and condition, drug therapy, endoscopic treatments, and surgical treatments. Although surgical treatments of symptomatic chronic pancreatitis provide good pain relief, endoscopic therapies are recommended as the first-line treatment because they are minimally invasive. In recent years, endoscopic therapy has emerged as an alternative treatment method to surgery for managing local complications in patients with chronic pancreatitis. For pancreatic stone removal, a combination of extracorporeal shock wave lithotripsy and endoscopic extraction is used. For refractory pancreatic duct stones, intracorporeal fragmentation techniques, such as pancreatoscopy-guided electrohydraulic lithotripsy and laser lithotripsy, offer additional options. Interventional endoscopic ultrasound has become the primary treatment modality for pancreatic pseudocysts, except in the absence of disconnected pancreatic duct syndrome. This review focuses on the current status of endoscopic therapies for common local complications of chronic pancreatitis, including updated information in the past few years.

Individualized Pain Treatment in Chronic Pancreatitis (INPAIN): An International, Multicenter, Investigator-initiated, Prospective, Cohort Study.

Pain is the foremost complication of chronic pancreatitis (CP), affecting about 70% of patients. However, the pathophysiological understanding and management of CP-related pain is complex, likely as patients have diverse "pain phenotypes" responding differently to treatment. This study aims to develop a bedside test panel to identify distinct pain phenotypes, investigate the temporal evolution, and determine whether they can be used to predict treatment response. The INPAIN study is an international, multi-center, observational, longitudinal cohort study comprised of 4 sub-studies. The studies will prospectively enroll 400 CP patients (50 without pain and 350 with pain) and 50 control subjects, conducting biannual observations for four years. The test panel is comprised of comprehensive subjective and objective assessment parameters. Statistical analysis strategies differ across the sub-studies. A model to predict treatment efficacy will be developed using various machine learning techniques, including an artificial intelligence approach, with internal cross-validation. Trajectories in pain parameters will be characterized by graphical analysis and mixed effect models. The INPAIN study aims to comprehensively understand pain in CP through a test panel developed for routine clinical use. This tool has the potential to personalize treatments, improve clinical practice, enhance patient care, improve quality of life, and minimize treatment side effects.

Extraportal venous thrombosis as an unusual complication of Chronic Pancreatitis

Extraportal venous thrombosis as an unusual complication of Chronic Pancreatitis

ЛАПАРОСКОПИЧЕСКАЯ ПАНКРЕАТОЦИСТОЕЮНОСТОМИЯ

Background. Pancreatic pseudocyst formation is known to be one of the most common complications of chronic pancreatitis. Despite the widespread use of the laparoscopy, it is still relatively rarely employed in pancreatic surgery. Objective. To analyze the outcomes of laparoscopic Roux-en-Y pancreatocytojejunostomy as well as to present a brief literature review. Material and methods. Data from diagnostic examinations, laboratory tests, as well as the outcomes of surgical treatment of a female patient for a pancreatic cyst are presented. It is worth noting that a laparoscopic Roux-en-Y pancreatocystojejunostomy was used for pancreatic cyst treatment in this case. Results. Successfully performed laparoscopic surgery enabled to preserve as much of the pancreas as possible and to avoid postoperative complications. Conclusions. The described case, along with the reviewed publications, indicate that laparoscopic internal drainage may be regarded as a feasible method for the treatment of encapsulated cysts of the body and tail of the pancreas in chronic pancreatitis. This is due to the fact that this surgical option doesn’t involve pancreatic parenchyma volume reduction and has a lower risk of relapse as compared with external drainage methods. Based on the above mentioned, the choice of this method is associated with relatively minimal surgical trauma, fewer complications and a short-term postoperative period. To perform such operations successfully, special tools and skills are required. The presence of domestically produced endoscopic staplers contributes to the further implementation of this type of intervention into practice.

A Case of Pancreatic Pseudoaneurysm

Pancreatic pseudoaneurysm (PSA) is a rare complication of chronic pancreatitis. Diagnosis requires high index of suspicion and urgent intervention is required once diagnosed as delayed treatment leads to poor outcomes and mortality. In this report, we discuss the case of a 30 year old male with a history of chronic pancreatitis who presented with upper gastrointestinal bleed (UGIB). Physical exam was elevated blood pressure, tachycardia and epigastric tenderness. A CT angiogram of abdomen done revealed pseudoaneurysm of pancreas. Patient emergently underwent endovascular embolization and coiling with resolution of GI bleed post procedure.

The detours of pancreatic ducts, internal pancreatic fistulas: a rare complication of chronic pancreatitis

Internal pancreatic fistula occurs due to the disruption of the pancreatic duct, resulting in communication with it and another epithelial surface. A rare variant is the pancreaticopleural and pancreaticogastric fistula, typically associated with chronic necrotising pancreatitis, resulting from posterior disruption of the pancreatic duct. It is a complex disease with different aetiologies, varied clinical presentations and multiple management options. Unlike postoperative pancreatic fistula, internal pancreatic fistula lacks guidelines for classification and management. Once an internal fistula is suspected, further imaging work-up and biochemical analysis needs to be performed. Here, we present an unprecedented case of pancreaticopleural fistula on a background of chronic necrotising pancreatitis, and an asymptomatic pancreatico-gastric fistula. To our knowledge, no such case has been previously reported.

Use of pancreatic endotherapy in patients with chronic pancreatitis: results from a multicenter cohort study in the United States

Background and AimsAlthough commonly used for treating complications of chronic pancreatitis (CP), data on the frequency and factors associated with the use of pancreatic endotherapy (PET) are limited. Our aim was to define the utilization and factors predictive for receiving PET in a well-characterized CP cohort. MethodsThis is a cross-sectional analysis of data from PROCEED, a multicenter US cohort study of CP. PET modalities primarily consisted of ERCP. A treatment course was defined as the number of sessions performed for a specific indication. A repeat course was defined as PET >1 year after completion of the last course. Multivariable logistic regression identified predictive factors for receiving PET, and proportional rates model assessed risk factors for repeat PET. ResultsOf a total of 681 subjects, 238 (34.9%) received PET. Factors associated with receiving PET included female sex (OR: 1.26, 95% CI: 1.03-1.53), lower education (OR: 1.30, 95% CI: 1.04-1.62), income ≤ $50,000 per year (OR: 1.35, 95% CI: 1.07-1.71) and prior acute pancreatitis (AP) (OR: 1.74, 95% CI: 1.31, 2.32). 103/238 subjects (43.3%) underwent repeat PET at a median duration of 2 years with 23.1% receiving 2 courses, 9.7% receiving 3 courses, and 10.4% receiving 4+ courses. ConclusionsNearly half of patients with CP who undergo PET received one or more repeat courses within 2-3 years. In addition to a prior history of AP, demographic and socioeconomic factors were associated with receiving PET.

Nutritional status in patients with chronic pancreatitis and liver cirrhosis is related to disease conditions and not dietary habits

Malnutrition is a common complication of chronic pancreatitis (CP) and liver cirrhosis (LC). Inadequate food intake is considered a relevant driver of malnutrition in both entities. However, the contribution of habitual diet to impaired nutritional status is unclear. In a prospective, multicenter cross-sectional study, we recruited patients with confirmed CP or LC and healthy volunteers as a control group. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria. We comprehensively investigated habitual dietary intake on nutrient, food group, and dietary pattern level applying two validated food frequency questionnaires. We included 144 patients (CP: n = 66; LC: n = 78) and 94 control subjects. Malnutrition was prevalent in 64% and 62% of patients with CP or LC, respectively. In both CP and LC, despite slightly altered food group consumption in malnourished and non-malnourished patients there were no differences in energy or nutrient intake as well as dietary quality. Compared to controls patients showed distinct dietary food group habits. Patients consumed less alcohol but also lower quantities of fruits and vegetables as well as whole grain products (p < 0.001, respectively). Nevertheless, overall dietary quality was comparable between patients and healthy controls. Nutritional status in CP and LC patients is rather related to disease than habitual dietary intake supporting the relevance of other etiologic factors for malnutrition such as malassimilation or chronic inflammation. Despite distinct disease-related differences, overall dietary quality in patients with CP or LC was comparable to healthy subjects, which suggests susceptibility to dietary counselling and the benefits of nutrition therapy in these entities.

Pancreatic-pleural fistula as a complication of chronic pancreatitis: a rare case

Pancreatic-pleural fistula as a complication of chronic pancreatitis: a rare case

Ruptura pankreasne pseudoaneurizme kao posledice hroničnog pankreatitisa - prikaz slučaja

Abstract: Introduction: Pseudoaneurysms of the pancreaticoduodenal arcade are rare, accounting for approximately 2% of all visceral artery aneurysms. They typically arise as complications of chronic pancreatitis, peptic ulcer disease, trauma, pancreatic and biliary surgery, or pancreas transplantation. Diagnosis often occurs only after rupture, leading to life-threatening internal bleeding. Bleeding may occur within a pseudocyst, with blood passing through the Vater's papilla into the digestive tract, or may result in the formation of a retroperitoneal hematoma that can rupture into the abdominal cavity, causing hemoperitoneum. The cell-saver is a tool that can be utilized for intraoperative blood cell salvage and autologous transfusions. Case Report: Our patient, a 54-year-old male, an untreated alcoholic with no prior medical history or documented treatment, presented to the Clinic for Emergency Surgery at the University Clinical Center of Serbia with a sudden onset of upper abdominal pain. A quick ultrasound of the abdomen was performed, followed by an urgent CT scan of the chest and abdomen, revealing a hematoma extending from the right retroperitoneum and mesentery of the intestine, measuring 150x109x180mm in diameter, with signs of active bleeding in the region beneath the pancreas, indicative of hemoperitoneum. Due to hemodynamic instability, accompanied by a drop in arterial blood pressure and hemoglobin levels, an urgent laparotomy was performed. Active bleeding was identified from a ruptured pseudoaneurysm originating from the pancreaticoduodenal arcade. Hemostasis was achieved followed by tamponade, and the tampons were removed 30 hours post-surgery. The patient remained hemodynamically stable thereafter, recovered well from the surgery, and was discharged home in good general condition. Intraoperatively, we utilized the Cell-saver to collect the patient's blood and subsequently administered autologous transfusion. Conclusion: In patients with chronic pancreatitis presenting with sudden abdominal pain and hemodynamic instability accompanied by a drop in arterial pressure, hemoglobin, and hematocrit levels, the possibility of a ruptured pseudoaneurysm in the pancreatic or peripancreatic region should be considered. Timely diagnosis and prompt surgical intervention are crucial for a successful outcome. Effective collaboration among radiologists, anesthesiologists, and surgeons is essential. The utilization of the Cell-saver system significantly aids in maintaining cardiac output and hemodynamic stability in these patients.

Rare Complication of Chronic Pancreatitis: Chronic Portal Vein Thrombosis and Splenic vein thrombosis causing non cirrhotic portal hypertension

Splenic vein thrombosis is a well-established complication of chronic pancreatitis, while portal vein thrombosis is a rare complication. In this case, we present an interesting instance of chronic pancreatitis associated with both portal and splenic vein thrombosis, causing non-cirrhotic portal hypertension. A fortysix-year-old male patient presented to us with clinical features of chronic pancreatitis. He underwent a CECT abdomen, which showed chronic pancreatitis with portal vein and splenic vein thrombosis. Screening for thrombophilic conditions and malignancies were negative. An upper gastrointestinal endoscopy showed fundal varices. Chronic portal vein thrombosis and splenic vein thrombosis are rare complications of chronic pancreatitis, which can cause non-cirrhotic portal hypertension.

Surgical Drainage of Pancreatic Pseudocyst

• A pancreatic pseudocyst is an encapsulated collection of homogenous fluid with little or no necrotic tissue within it. It is usually well circumscribed and located outside of the pancreas, often in the lesser sac. • Regardless of the cause, the overall incidence of pseudocysts is low; 0.5 to 1 per 100,000 adults per year. • Pancreatic pseudocysts are often seen as a complication of chronic pancreatitis and less commonly from acute pancreatitis • The incidence of pseudocysts is higher in males as it follows the incidence of pancreatitis, which is slightly male predominant. • In acute pancreatitis, the incidence of pseudocysts ranges from 5% to 16%. • Pseudocysts tend to be more common in the setting of chronic pancreatitis, with incidence rates between 20% to 40%. • The majority of the cases were alcohol-induced (70%) followed by biliary tract disease (8%), trauma (6%), and the remaining attributed to the idiopathic cause. • Symptoms of pseudocysts are typically non-specific and may present only with vague abdominal pain, nausea, or vomiting. • A contrast-enhanced CT scan of the abdomen is the diagnostic modality of choice. • Most pseudocysts resolve spontaneously, and treatment is usually conservative with supportive care. • In general, larger cysts are more likely to become symptomatic or cause complications. • Potential complications include infection, hemorrhage, pseudocyst rupture, and disruptions of the pancreatic duct system.

Pancreatic pseudoaneurysm mimicking pancreatic tumor: A case report and review of literature

BACKGROUND Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis (CP) or necrotizing pancreatitis with an incidence of 4% to 17%, but it is potentially life-threatening. It is well known that most pancreatic pseudoaneurysms are clinically associated with pancreatic pseudocysts and are usually in the peripancreatic body-tail. A minority of intrapancreatic pseudoaneurysms occur in the absence of pseudocyst formation. Noninvasive computed tomography (CT) and magnetic resonance imaging (MRI) are most commonly used examinations for screening pancreatic pseudoaneurysms. Notably, the rare intrapancreatic pseudoaneurysm in the pancreatic head can mimic a hypervascular solid mass and be misdiagnosed as a pancreatic tumor. CASE SUMMARY We report the case of a 67-year-old man who had been admitted to our hospital due to recurrent abdominal pain for 1 mo that was aggravated for 5 d. CT and MRI revealed a mass in the pancreatic head with significant expansion of the main pancreatic duct and mild atrophy of the pancreatic body-tail. He was admitted to the department of hepatobiliary and pancreatic surgery due to the possibility of a pancreatic tumor. The patient was then referred for endoscopic ultrasonography (EUS) with possible EUS-FNA. However, EUS showed a cystic lesion in the pancreatic head with wall thickness and enhancing nodules, which was doubtful because it was inconsistent with the imaging findings. Subsequently, color doppler flow imaging demonstrated turbulent arterial blood flow in the cystic lesion and connection with the surrounding vessel. Therefore, we highly suspected the possibility of CP complicated with intrapancreatic pseudoaneurysm, combined with the patient's long-term drinking history and the sonographic features of CP. Indeed, angiography revealed an oval area of contrast medium extravasation (size: 1.0 cm × 1.5 cm) at the far-end branch of the superior pancreaticoduodenal artery, and angiographic embolization was given immediately at the same time. CONCLUSION EUS is an important differential diagnostic tool when pancreatic pseudoaneurysm mimics the imaging appearance of a hypervascular pancreatic tumor.

Vascular complications of chronic pancreatitis and its management.

Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to various other complications such as pseudocyst formation, benign biliary stricture, gastric outlet obstruction; and vascular complications like venous thrombosis, variceal and pseudoaneurysmal bleed. Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy. Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration, or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations. Procedure-related bleed is usually venous and mostly managed conservatively. Procedure-related arterial bleed, however, may require radiological interventions.

Spontaneous Pancreatic Pseudocyst-Superior Mesenteric Vein Fistula

ABSTRACT Pancreatic pseudocyst formation is a common complication of chronic pancreatitis. Rarely, a fistula develops between the pseudocyst and the portal venous system. We present a case of a 50-year-old man who was found to have a pancreatic pseudocyst-superior mesenteric vein fistula after being evaluated for several months of abdominal pain and weight loss. The patient was treated with endoscopic stenting of the pancreatic duct along with early enteral nutrition and suppressive antibiotics, which resulted in improvement in his condition. This case report highlights clinical presentation and the complexity of treatment of this rare diagnosis.

Consequences of chronic pancreatitis and exocrine pancreatic insufficiency, or When leaves fall from trees

Aim. To analyze current literature data on the complications of chronic pancreatitis (CP) with exocrine pancreatic insufficiency (EPI).&#x0D; Main statements. According to statistical evidence, the presence of CP is associated with an increased risk of death, while the concomitant EPI significantly increases the risk of death. EPI is a big independent risk factor for death in patients with CP, which emphasizes the need for adequate correction of EPI in order to reduce mortality in this group.&#x0D; EPI is associated not only with an increase in mortality in CP patients but also with the development of various trophological defects. It has been stated that CP course is accompanied by a decrease in the level of albumin, malabsorption of fat-soluble vitamins (A, E, and D), carotenoids (beta-carotene, lycopene, cryptotaxin, and zeaxanthin), and the development of osteopenia and osteoporosis. CP course is linked to anxiety, depression, tumor pathology (pancreatic ductal adenocarcinoma, esophageal cancer, and stomach cancer), damage to the cardiovascular system, an increase in cardiovascular risk, and a high chance of myocardial infarction, stroke, and pancreatitis-induced thrombosis of the splenic vein. Modern enzyme replacement therapy makes it possible to compensate for some of the consequences of chronic EPI, reduce numerous signs of malnutrition, normalize the body mass index, and improve the quality of life of CP patients with EPI.

An Invading Stent: Conservative Management of a Penetrating Splenic Injury by a Migrated Pancreatic Duct Stent

Pancreatic duct (PD) stenting is a common treatment modality for PD calculi or strictures, which are common complications of chronic pancreatitis. PD stent migration is a described complication of the procedure. Penetrating splenic injury may result in life-threatening hemorrhage, often requiring splenic artery embolization or splenectomy. Herein, we describe a unique case of a 49- year-old female with chronic pancreatitis and PD stent who presented with abdominal pain. A computed tomography of her abdomen revealed the distal end of her PD stent to have migrated internally through her spleen with an associated perisplenic fluid collection. After initial clinical stabilization she underwent an endoscopic retrograde cholangiopancreatography which revealed the proximal end of the migrated stent in the duodenum and the stent was successfully with improvement in clinical status.

Left-sided portal hypertension as a complication of chronic pancreatitis in a young patient. A case report

Left-sided portal hypertension as a complication of chronic pancreatitis in a young patient. A case report

Chronic pancreatitis: about some complications and features of their pathogenesis and course

The review article provides up-to-date information on the complications of pancreatitis that are important for the tactics and strategy of patient management both at the inpatient and outpatient stages of observation. The purpose of the review was to emphasize the importance of complications for the course and life of patients with chronic pancreatitis. The authors draw the attention of internists to the course of such complications as pseudocysts, cysts, fistulas, thrombohemorrhagic, cholestatic syndromes, compression syndrome of adjacent organs, pancreatic encephalopathy (acute and chronic). The symptomatology of complications of chronic pancreatitis is discussed in detail, which is very important for differential diagnosis with the corresponding diseases. Such complications include the formation of erosive and ulcerative lesions, varicose veins of the esophagus and bleeding from varicose veins of the esophagus and stomach, portal hypertension syndrome with pancreatic ascites and chronic pancreatic encephalopathy, idiopathic non-cirrhotic portal hypertension, pancreatic cancer. The authors emphasize the need to analyze the corresponding symptoms, indicating the possibility of complications, negative consequences with each recurrence or exacerbation of chronic pancreatitis, since it concerns the prognosis and life of the patient.