Diagnosis Of Chronic Pancreatitis Research Articles

The chronic pancreatitis (CP) Type Cambridge 2 as a cause of unclear upper abdominal pain: a radiologically underestimated diagnosis

AbstractThe time interval from symptom onset to the diagnosis of chronic pancreatitis (CP) remains disproportionately long today due to nonspecific symptoms and the absence of a definitive laboratory marker. Nevertheless, mortality is increased by 3.6 times compared to the general population. Additionally, the risk of developing pancreatic carcinoma is 16 times higher in the presence of CP. According to the current S3 guideline, the morphological staging of CP should be based on the Cambridge Classification for CT/MRCP. Most radiologists morphologically associate CP with Cambridge Stage 4, which is characterized by classic calcifications. The subtle morphologies of earlier Cambridge Stages are often unrecognized, leading to delayed diagnosis. The aim of this study was to diagnose CP at Cambridge Stage 2 as the cause of unexplained upper abdominal discomfort.A retrospective analysis was conducted on 266 patients with unexplained upper abdominal pain who underwent outpatient MRI with MRCP between January 1, 2021, and October 1, 2023. The criteria for Cambridge Stage 2 were evaluated: pancreatic duct in the corpus measuring between 2 and 4 mm, pancreatic hypertrophy, cystic changes < 10 mm, irregularities in the duct, or > 3 pathological side branches. Patients with known tumors or other leading diagnoses, which explained the discomfort, were excluded.25 patients (15 female, 10 male) met the criteria for CP Stage 2 (9%). Ductal dilation between 2 and 4 mm was visible in 21 cases. Pancreatic hypertrophy was observed in six cases. Cystic changes < 10 mm were identified in three cases. Irregularities in the duct (“wavy duct”) were diagnosed in 19 patients. Dilation of > 3 side branches was recognized in 17 cases. Lipase levels were additionally determined, with 13 patients showing pathologically elevated levels (> 60 U/l).CP at Cambridge Stage 2 is an important and underestimated diagnosis in patients with unexplained upper abdominal pain in the outpatient setting. Radiologists should pay attention not only to common signs like calcifications, large cysts, or duct strictures but also to subtle changes such as duct irregularities (“wavy duct configuration”) and pathologically dilated side branches, which could lead to a significantly earlier diagnosis of CP. Lipase determination may be an additional indication of chronic pancreatitis in this context.

Chronic pancreatitis: Pain and computed tomography/magnetic resonance imaging findings

Chronic pancreatitis (CP) is a fibroinflammatory disease characterized by irreversible destruction of pancreatic tissue. With the development of the disease, it may lead to exocrine and/or endocrine insufficiency. CP is one of the common diseases that cause abdominal pain, which will not get permanent spontaneous relief as the disease evolves. The American College of Gastroenterology clinical guidelines recommend computed tomography or magnetic resonance imaging as the first-line examination for the diagnosis of CP. CP common imaging findings include pancreatic atrophy, irregular dilatation of the pancreatic duct, calcification of pancreatic parenchyma, pancreatic duct stones, etc. In clinical practice, whether any correlations between CP-induced abdominal pain patterns (no pain/constant/intermittent pain) and corresponding imaging findings present are not well known. Therefore, this review aims to comprehensively sort out and analyze the relevant information by collecting lots of literature on this field, so as to construct a cross-bridge between the clinical manifestations and imaging manifestations of CP patients. Also, it provides an imaging basis and foundation for the classification and diagnosis of abdominal pain types in clinical CP patients.

Clinical case of delayed diagnosis of celiac enteropathy

Clinical case of delayed diagnosis of celiac enteropathy

Does Chronic Pancreatitis in Growing Pigs Lead to Articular Cartilage Degradation and Alterations in Subchondral Bone?

Chronic pancreatitis (CP), a progressive inflammatory disease, poses diagnostic challenges due to its initially asymptomatic nature. While CP's impact on exocrine and endocrine functions is well-recognized, its potential influence on other body systems, particularly in young individuals, remains underexplored. This study investigates the hypothesis that CP in growing pigs leads to alterations in articular cartilage and subchondral bone, potentially contributing to osteoarthritis (OA) development. Utilizing a pig model of cerulein-induced CP, we examined the structural and compositional changes in subchondral bone, articular cartilage, and synovial fluid. Histological analyses, including Picrosirius Red and Safranin-O staining, were employed alongside immuno-histochemistry and Western blotting techniques. Our findings reveal significant changes in the subchondral bone, including reduced bone volume and alterations in collagen fiber composition. Articular cartilage in CP pigs exhibited decreased proteoglycan content and alterations in key proteins such as MMP-13 and TGF-β1, indicative of early cartilage degradation. These changes suggest a link between CP and musculoskeletal alterations, underscoring the need for further research into CP's systemic effects. Our study provides foundational insights into the relationship between CP and skeletal health, potentially guiding future pediatric healthcare strategies for early CP diagnosis and management.

A novel early cancer detection approach for pancreatic cancer.

613 Background: Pancreatic adenocarcinoma (PDAC) is commonly diagnosed at advanced stages, leading to high mortality rates. Earlier detection of PDAC is associated with improved long-term survival, but effective population-level screening is not available. There is therefore an urgent need to improve early detection of PDAC. Wholomics has developed a PDAC-specific proprietary early detection test, using cancer-specific molecular signatures in peripheral blood. Methods: We conducted a retrospective analysis of serum samples from the Amsterdam UMC Liquid Biopsy Center. Three cohorts were included in this study: 1) A cohort of healthy control subjects, 2) patients with a histopathologically confirmed diagnosis of PDAC spanning stages I through IV, and 3) patients with a confirmed diagnosis of chronic pancreatitis. Peripheral blood samples of cancer patients were taken before treatment or surgery. Wholomics used its proprietary technology to quantitatively analyse all serum specimens. Disease-specific molecular signatures were identified and used to develop computational biomarkers specific to both pancreatic pathologies (chronic pancreatitis and pancreatic cancer) and to pancreatic cancer individually. A comparative analysis was conducted employing multiple machine learning algorithms, which were subjected to a 10-fold cross-validation procedure. The accuracy, specificity and sensitivity of the best-performing algorithm is reported. Results: This retrospective study included 50 healthy controls, 12 patients with chronic pancreatitis, and 42 patients with pancreatic cancer (12 stage I, 15 stage II, 9 stage III, 6 stage IV). Applying Wholomics´ technology, an accuracy of 99.1% in differentiating the chronic pancreatitis and pancreatic cancer patients from the healthy controls was achieved. A specificity of 98.0% and a sensitivity of 100.0% were reached. Furthermore, pancreatic cancer patients and chronic pancreatitis patients were differentiated with 95.2% accuracy. Wholomics was also capable of differentiating between early stage (stages I and II) and late-stage (stages III and IV) pancreatic cancer with an accuracy of 100%. Conclusions: Taken together, this study demonstrates that disease-specific molecular signatures in peripheral blood can distinguish patients with PDAC from healthy individuals and patients with pancreatitis with very high accuracy. If validated in additional cohorts, this method could be evaluated as a screening test for PDAC to allow for early detection and improve patient outcomes.

Multivariate analysis and mathematical modeling of the informativeness of patients cases data in chronic pancreatitis associated with concomitant pathology.

Aim: To investigate and analyze homeostatic disorders in patients with a combination of Chronic Pancreatitis(CP) and Arterial Hypertension (AH) and to develop correcting ways of the detected changes. Materials and Methods: General clinical, laboratory-instrumental examination of 121 patients, who were undergoing inpatient treatment with a diagnosis of Chronic Pancreatitis in combination with Arterial Hypertension of the II stage during 2021-2022. Results: In the majority of cases of patients signs the increasing in IL-1,6 and Cortisol levels were found. A decrease in Ca to the lower limit of the norm was observed (2.18 ± 0.26 mmol/l to the data of control group patients (2.32 ± 0.12 mmol/l, p= 0.01 ), the levels of trace elements Zn and Se were determined within the reference values. The Atherogenic Index was increased 1.8 times and was significantly different from the control group date. During the FE-1 study, a decrease in the level of this indicator was revealed by 151.71±13.91 mg/g of feces, both to the values of reference values and a significant difference to the data of the control group (241.28±29.17 mg/g of feces, p<0 .05). Conclusions: Based on the multivariate linear regression analysis of the obtained data, formulas have been developed that can be used to predict the dynamics of the dependent variable (FE-1, IL-1, Selenium level, Glutathione Peroxidase, blood pressure) according to changes in the studied influencing factors.

Secretin magnetic resonance cholangiopancreatography (s-MRCP) in the diagnosis of early chronic pancreatitis: Why not?

Chronic pancreatitis is a syndrome with several conditions, resulting in similar phenotypic manifestations. Pancreatic biopsy would be the gold standard for diagnosis, but it is often not possible to perform. If chronic pancreatitis is suspected, early diagnosis facilitates appropriate management and prevents complications. In this context, secretin-induced magnetic resonance cholangiopancreatography (s-CPRM) is one of the tests used. This study aims to determine the accuracy and efficiency of s-CPRM in the early diagnosis of chronic pancreatitis, comparing its results with those of other methods used for this purpose, as well as analyzing its cost-benefit ratio. A systematic review was carried out in accordance with PRISMA recommendations. The data from each article used was summarized in a table with the following topics: DOI; first author; year; location; type of study; target population; importance of s-CPRM; other methods and conclusions. We included articles with adults over the age of 18; in English or Spanish; talking about s-CPRM; studies from 2018 onwards; articles comparing the techniques researched. Case reports, editorials and editor's opinions, and animal studies were excluded. Articles from previous years were added to expand the scarce literature. s-CPRM is a low-invasive test that analyzes pancreatic structure and function, presenting diagnostic results that are comparable and even superior to those of other methods. It faces difficult access to specialized professionals, in addition to the high costs of equipment and secretin. However, as early diagnosis can contain the progression of the disease, avoiding future treatment costs, investing in this test is valid and necessary.

Visible Pancreatic Tail Pseudocyst on Abdominal Transplenic Scan

Chronic pancreatitis is the end result of a continuous, prolonged, inflammatory, and fibrosing process that affects the pancreas. Pseudocyst is a common sequela of acute pancreatitis or chronic pancreatitis. It is difficult to detect pancreatic disease on abdominal ultrasonography, especially when it is located in the pancreatic tail. A 56-year-old male visited with upper abdominal pain. We could visualize a pseudocyst on abdominal transplenic scan in the right oblique position. We confirmed a diagnosis of chronic pancreatitis and pseudocyst on computed tomography. Abdominal transplenic scan is useful for visualizing pancreatic tail disease.

Positive Predictive Value of Cirrhosis and Chronic Pancreatitis Diagnoses in Individuals with Alcohol Use Disorder: A Single-Center Study.

Although accuracy of diagnosis codes for cirrhosis and chronic pancreatitis (CP) has been evaluated in multiple studies, none have focused on patients with alcohol use disorders (AUD). We evaluated the positive predictive value (PPV) for a verified diagnosis of cirrhosis and CP in AUD patients treated at a tertiary care center. We performed a detailed review of electronic health records for AUD patients assigned ICD-9 or 10 codes for alcoholic cirrhosis (ALC) (n = 199), CP (n = 200), or both (n = 200). We calculated PPV for a verified diagnosis of cirrhosis and CP and performed multivariable regression analysis to assess the impact of relevant factors on PPV for a verified diagnosis. PPV of cirrhosis was 81.2% (95% CI 77.0 to 84.9%) which increased to 87.5% (95% CI 83.8 to 90.6%) if the definition was relaxed to include alcohol-related hepatitis. PPV of CP was 54.5% (95% CI 49.5 to 59.5%) which increased to 78% (95% CI 73.6 to 82.0%) when recurrent acute pancreatitis was included in the definition. In multivariable analyses, the odds of a verified diagnosis were significantly higher in individuals aged 65+ years for both cirrhosis (OR 12.23, 95% CI 2.19 to 68.42) and CP (OR 8.84, 95% CI 2.7 to 28.93) and in ever smokers for CP (OR 1.95, 95% CI 1.05 to 3.65). PPV for diagnosis codes in AUD patients is high for a verified diagnosis of cirrhosis but only modest for CP. While administrative datasets can provide reliable information for cirrhosis, future studies should focus on ways to boost the diagnostic validity of administrative datasets for CP.

Identification of a specific biomarker panel for early chronic pancreatitis diagnosis: An exploratory prospective descriptive and observational study

Identification of a specific biomarker panel for early chronic pancreatitis diagnosis: An exploratory prospective descriptive and observational study

Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study.

Chronic Pancreatitis (CP) causes morphological changes in the pancreatic tissue, leading to complications and pain, which may require endoscopic interventions. Our aim was to determine the frequency of endoscopic procedures (EP) in CP patients and to analyse pain and quality of life (QoL) in these patients after their EP. This study included 1327 CP patients from the Scandinavian Baltic Pancreatic Club (SBPC) database including four countries and eight centres. We analysed patients undergoing EPs and gathered information on the EP, pancreatic function, pain, disease and duration. The EORTC C-30 QoL questionnaire was gathered prospectively and multivariable analysis was conducted on independent parameters between the groups. The reference population had no interventions (n=870). 260 CP patients (22%) underwent EPs, median one year (range 0-39years) after CP diagnosis. 68% were males. The median age was 59 (20-90) years. Most common aetiological factors were alcohol in 65% and smoking in 71%. Extracorporeal shock wave lithotripsy (ESWL) was used in 6% of the CP population and in 21% of the EP group. Biliary duct stenting was performed on 37% and pancreatic stenting was performed on 56% of the patients. There was no difference in pain patterns between patients who had pancreatic stenting and the reference population. The EP group had slightly better QoL (p=0.047), functioning and fewer symptoms than the reference population, in the multivariable analysis there was no interaction effect analysis between the groups. The pancreatic stent group had better QoL and the same amount of pain than the reference group. The patients who needed later surgery (23%) had more pain (p=0.043) and fatigue (p=0.021). One in five of the CP patients underwent EP. These patients scored higher on QoL responses and had better symptom scores. CP patients who had pancreatic stenting performed had the same pain patterns as the reference population. Randomised prospective trials are needed to determine the effect of endoscopy procedures on CP patients.

Determination of the diagnostic potential of research methods in the differentiation of pancreatic cancer and chronic pancreatitis based on evidence-based medicine

Background. Currently, the use of the principles of evidence-based medicine is an integral part of assessing the effectiveness and safety of modern technology for the diagnosis and treatment of any disease or clinical condition. Differential diagnosis of pancreatic cancer and chronic pancreatitis is one of the most controversial issues in surgical pancreatology. The reduced number of cases of resectable pancreatic cancer indicates the need to develop programs for the differentiation of these pathologies with the wide implementation of modern diagnostic methods.&#x0D; Purpose − to compare the results of diagnostic methods (which are standardly used in accordance with clinical guidelines for the diagnosis of chronic pancreatitis) based on evidence-based medicine and quantitative assessments of their specificity, sensitivity, and general accuracy in terms of the differential diagnosis of chronic pancreatitis and pancreatic cancer in order to determine the most significant results for the differentiation of these pathologies.&#x0D; Materials and methods. The results of diagnostic methods were compared in 80 patients, among them 38 (47.5%) had pancreatic cancer, and 42 (52.5%) − chronic pancreatitis with predominant lesion of the pancreatic head. The patients underwent general clinical blood and urine tests, biochemical blood tests, and the following procedures and examinations available in the clinic: ultrasound examination of the abdominal organs, spiral computed tomography, fibrogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, magnetic resonance imaging, CA 19-9 tumor marker test, ultrasound-guided percutaneous puncture of the pancreas, aspiration of pancreatic juice, urgent intraoperative biopsy, and histological examination of surgically resected areas of the pancreas. Based on the received data, we performed a comparison of their quality, accuracy, and informativeness.&#x0D; Results. Ultrasound imaging is a screening method for suspected pancreatic cancer, however, the overall accuracy, sensitivity, and specificity of the method are quite low (82.5%, 76.32%, 88.10%, respectively). When analyzing the qualitative characteristics of endoscopic retrograde cholangiopancreatography, the overall accuracy, sensitivity, and specificity indicators for the differential diagnosis of pancreatic cancer were 71%, 78.6%, and 63.3%, respectively. The interval assessment of the accuracy of the method of transcutaneous biopsy of the pancreas aimed at determining chronic pancreatitis was (34.9; 96.8)%; for pancreatic cancer – (8.5; 75.5)%. The interval assessment of the accuracy of the method of endoscopic aspiration of pancreatic juice for chronic pancreatitis was (6.8; 93.2)%; for pancreatic cancer – (19.4; 99.4)%. An increase in the level of CA 19-9 was found in 40.5% of patients (CI95% from 27.0% to 55.5%), while the average level was significantly higher in pancreatic cancer. The level of the CA 19-9 tumor marker depended on the size of the tumor and the spread of the process, and during the dynamic observation in the settings of treatment, it had a tendency to decrease, which indicated chronic pancreatitis. The significance of intraoperative morphological verification of the diagnosis of pancreatic cancer in histological examination was 98%, in cytological examination – 95.3%, in 4.7% urgent intraoperative biopsy was questionable. In all examinations, the surrounding tumor tissue showed a morphological pattern of chronic pancreatitis, in 36 (88%) cases – with foci of metaplasia and intraductal neoplasia of the epithelium, which can be considered as a background for the development of intraductal adenocarcinoma. At the same time, cancerous occlusion of the ducts led to their expansion above the point of narrowing with pronounced fibrous changes and inflammatory reaction of the stroma that was accompanied by widespread atrophy of the parenchyma.&#x0D; Conclusions. On the basis of evidence-based medicine, it was established that spiral computed tomography is the most informative method for the differential diagnosis of pancreatic cancer with chronic pancreatitis, with an overall accuracy of 92.2%, sensitivity of 89.2%, and specificity of 95%. The low qualitative indicators of ultrasound diagnostics can be increased due to its complex combination with the CA 19-9 tumor marker test with an overall accuracy of 92.3%, with sensitivity and specificity of 95% and 91%, respectively, which is significantly different from such indicators when the method was used separately (82.5%, 76.3%, and 88.1%, respectively). In the cases when the complex combination of endoscopic retrograde cholangiopancreatography with the measurement of the level of the CA 19-9 tumor marker was used, the overall accuracy of the method was 95.2%, with sensitivity of 95% and specificity of 95.5%, which is significantly different from such indicators obtained when the method was used separately (71%, 78.6% and 63.3%, respectively). Advances in modern imaging methods cannot replace histological examination as the «gold standard» for the correct determination of the morphological substrate of these pancreatic lesions.

1191 Novel Biomarkers for the Diagnosis of Chronic Pancreatitis: An Exploratory Case-Control Study

Abstract Aim Chronic pancreatitis is a complex inflammatory syndrome with manifestations including abdominal pain, malnutrition, and diabetes. Early recognition is necessary for optimal management; however this remains clinically challenging and there are no established biomarkers for diagnosis. This exploratory study aims to determine the expression of a set of fibrosis-related serum biomarkers in patients with chronic pancreatitis relative to controls. Method Participants were recruited from specialist outpatient clinics at a single centre. Ethical approval was granted via the institutional biobank. Cases were defined as adult patients with a radiological and/or histological diagnosis of chronic pancreatitis. Controls were adult patients with no history of pancreatic disease. Blood samples were collected from each participant and the serum concentrations of candidate biomarkers measured in duplicate by enzyme-linked immunosorbent assays. Results In cases (n = 17; median age 53 years) compared to controls (n = 4; median age 54 years), the mean serum concentration of osteoactivin was 39.32 ng/ml vs. 18.70 ng/ml (2.1 fold); fibronectin was 512.33 μg/ml vs. 328.83 μg/ml (1.6 fold), osteopontin was 8.19 ng/ml vs. 7.47 ng/ml (1.1 fold), vimentin was 637.94 ng/ml vs. 562.14 ng/ml (1.1 fold), TIMP1 was 0.25 μg/ml vs. 0.23 μg/ml (1.0 fold) and osteonectin was 3.8 μg/ml vs. 4.71 μg/ml (0.8 fold). Conclusions This pilot study demonstrated differential expression of several fibrosis-related serum biomarkers in patients with chronic pancreatitis compared to controls. An expanded study will aim to establish the utility of these biomarkers for the early diagnosis of this condition.

Incidence, prevalence, and comorbidities of chronic pancreatitis: A 7-year population-based study.

Chronic pancreatitis (CP) is a fibroinflammatory syndrome leading to reduced quality of life and shortened life expectancy. Population-based estimates of the incidence, prevalence, and comorbidities of CP in China are scarce. To characterize the incidence, prevalence, and comorbidities of CP in Sichuan Province, China, with population-based data. Data on CP from 2015 to 2021 were obtained from the Health Information Center of Sichuan Province. During the study period, a total of 38090 individuals were diagnosed with CP in Sichuan Province. The yearly incidence rate and point prevalence rate (December 31, 2021) of CP were calculated. The prevalence of comorbid conditions in CP patients was estimated. The annual number of CP-related hospitalizations, hospital length of stay, and hospitalization costs for CP were evaluated. Yearly incidence rates were standardized for age by the direct method using the permanent population of Sichuan Province in the 2020 census as the standard population. An analysis of variance test for the linearity of scaled variables and the Cochran-Armitage trend test for categorical data were performed to investigate the yearly trends, and a two-sided test with P < 0.05 was considered statistically significant. The 38090 CP patients comprised 23280 males and 14810 females. The mean age of patients at CP diagnosis was 57.83 years, with male patients (55.87 years) being younger than female patients (60.11 years) (P < 0.001). The mean incidence rate of CP during the study period was 6.81 per 100000 person-years, and the incidence of CP increased each year, from 4.03 per 100000 person-years in 2015 to 8.27 per 100000 person-years in 2021 (P < 0.001). The point prevalence rate of CP in 2021 was 45.52 per 100000 individuals for the total population, with rates of 55.04 per 100000 individuals for men and 35.78 per 100000 individuals for women (P < 0.001). Individuals aged 65 years or older had the highest prevalence of CP (113.38 per 100000 individuals) (P < 0.001). Diabetes (26.32%) was the most common comorbidity in CP patients. The number of CP-related hospitalizations increased from 3739 in 2015 to 11009 in 2021. The total costs for CP-related hospitalizations for CP patients over the study period were 667.96 million yuan, with an average of 17538 yuan per patient. The yearly incidence of CP is increasing, and the overall CP hospitalization cost has increased by 1.4 times during the last 7 years, indicating that CP remains a heavy health burden.

The Impact of Chronic Pancreatitis on the Occurrences of Human Cancers: Real-World Data.

Chronic pancreatitis (CP) may induce systemic inflammation, potentially increasing cancer susceptibility. However, the link between CP and extra-pancreatic cancer remains underexplored. Employing Taiwanese National Health Insurance Database data from 2000 to 2017, we compared 5394 CP patients with 21,576 non-CP individuals through propensity score matching. CP patients exhibited a significantly higher cancer risk (adjusted hazard ratio (aHR) of 1.32 for females and 1.68 for males) and cumulative incidence (p < 0.001) compared to non-CP individuals. CP showed notable associations with pancreatic (aHR = 3.51), liver (aHR = 1.62), stomach (aHR = 2.01), and other cancers (aHR = 2.09). In terms of liver cancer, CP was significantly associated with patients without viral hepatitis, regardless of gender (aHR = 2.01 for women; aHR = 1.54 for men). No significant cancer occurrences were observed within the first year following CP diagnosis. Pancreatic or liver cancer developed in approximately half of CP patients within 2-3 years, while gastric cancer in male CP patients predominantly occurred around the fifth year after diagnosis. These findings inform potential cancer-screening plans for CP patients.

Chronic pancreatitis: prospects for early detection: A review

Over the last 10 years, the incidence of chronic pancreatitis (CP) has increased 4 times and nowadays is about 27.450 cases per 100 000 adults. In the outpatient gastroenterologist practice, patients with CP account for about 3545%, in the hospital gastroenterology department up to 2045%. CP criteria according to imaging methods fibrosis, duct dilatation and deformation, calcifications in the pancreatic parenchyma or its atrophy are formed at a late stage of the disease. Simultaneously, diagnosis at the early stage with potentially reversible changes remains difficult, due to the lack of clear instrumental and laboratory findings confirming minimal changes in the pancreas. However, some methods in combination with a detailed history taking, risk factors identification in comparison with the clinical features are of interest for the early diagnosis of chronic pancreatitis.

Diagnosis of chronic pancreatitis using semi-quantitative MRI features of the pancreatic parenchyma: results from the multi-institutional MINIMAP study.

To determine the diagnostic performance of parenchymal MRI features differentiating CP from controls. This prospective study performed abdominal MRI scans at seven institutions, using 1.5 T Siemens and GE scanners, in 50 control and 51 definite CP participants, from February 2019 to May 2021. MRI parameters included the T1-weighted signal intensity ratio of the pancreas (T1 score), arterial-to-venous enhancement ratio (AVR) during venous and delayed phases, pancreas volume, and diameter. We evaluated the diagnostic performance of these parameters individually and two semi-quantitative MRI scores derived using logistic regression: SQ-MRI Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume). When compared to controls, CP participants showed a significantly lower mean T1 score (1.11 vs. 1.29), AVR venous (0.86 vs. 1.45), AVR delayed (1.07 vs. 1.57), volume (54.97 vs. 80.00 ml), and diameter of the head (2.05 vs. 2.39 cm), body (2.25 vs. 2.58 cm), and tail (1.98 vs. 2.51 cm) (p < 0.05 for all). AUCs for these individual MR parameters ranged from 0.66 to 0.79, while AUCs for the SQ-MRI scores were 0.82 and 0.81 for Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume), respectively. After propensity-matching adjustments for covariates, AUCs for Models A and B of the SQ-MRI scores increased to 0.92 and 0.93, respectively. Semi-quantitative parameters of the pancreatic parenchyma, including T1 score, enhancement ratio, pancreas volume, diameter and multi-parametric models combining these parameters are helpful in diagnosis of CP. Longitudinal analyses including more extensive population are warranted to develop new diagnostic criteria for CP.

1117-P: Variability in Glycemia Measured by CGM in Children and Young Adults with Acute Recurrent or Chronic Pancreatitis

Post pancreatitis diabetes mellitus is an underrecognized disorder. Children with pancreatitis are at elevated risk for development of diabetes (DM) in the near term (approximately 9%), and lifetime risk of DM approaches 50%. Unfortunately, there is limited data regarding pathophysiology and disease course. This pilot study was undertaken to investigate glycemic physiology in the free-living state in children with acute recurrent (ARP) or chronic pancreatitis (CP). Methods: Children (&amp;lt;21 years of age) with an established diagnosis of CP or ARP, and participants of INSPPIRE-2 (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE) were invited to participate. Pancreatitis type, demographics and growth parameters were extracted from the INSPPIRE-2 database. HbA1c was collected. A continuous glucose monitor was placed (CGM, Dexcom Pro). Glycemic variability metrics were calculated at the participant level using EasyGV software. The relationship between HbA1c and CGM variables was evaluated via multiple linear regression. Results: 12 children were enrolled, age 10-20.8 years (mean 17.2; 66% female). One subject had known DM prior to enrollment. Participants had normal mean height (0.19+/- 0.72 SD), weight (1.1 +/- 0.98SD) and BMI (0.98 +/- 0.81 SD) z-scores. Mean A1c was 5.73% (range 5.0-8.9) with the known diabetic and 5.42% (5.0-6.1) without. Mean CGM glucose was 121.8 mg/dl +/- 21.4. Of the 11 subjects without DM, 2 had CGM glucose &amp;gt;180 mg/dl &amp;gt; 10% time and 1 had CGM glucose &amp;lt;55 mg/dl &amp;gt; 1% time. HbA1c correlated with mean CGM glucose in univariate analysis and when controlled for age and BMI (p = 0.02, r2 = 0.47). Conclusions: In this small study, A1c correlated well with average CGM glucose in children with ARP and CP, and some had abnormal glycemic excursions on CGM. More research is needed on the use of CGM in children with CP and ARP. Disclosure M.G.Parra villasmil: None. M.Bellin: Consultant; Insulet Corporation, Vertex Pharmaceuticals Incorporated, Research Support; Dexcom, Inc., ViaCyte, Inc. C.Pinnaro: None. K.L.Ode: None.

Analysis of association between vitamin D metabolite concentration in blood plasma and pancreatic cancer. Experience of one center

Introduction. An early detection of malignant neoplasms is of great practical importance for improvement of treatment results.&#x0D; Objective. To analyze the levels of dehydrocholecalciferol in patients with different forms of malignant neoplasms of the pancreas and chronic pancrestitis.&#x0D; Materials and methods. The cohort study enclosed the data from 160 patients, who were examined and treated in the Academician A.M. Granov Russian Scientific Center of Radiology and Surgical Technologies for the period from 2018 to 2022. The main group included 89 patients with morphologically confirmed diagnosis of the pancreatic cancer without metastases. The control group included 71 patient with the confirmed diagnosis of chronic pancreatitis. Vitamin D concentration was controlled prior to treatment.&#x0D; Results. The size of the tumor node with the location of pathological process in the head of the pancreas varied from 2.1 to 6.3 cm. In the subgroup of patients with tumor lesion of the head of the pancreas, decompression of biliary ducts due to mechanical jaundice was implemented in 43 (82.6 %) persons. When comparing the indicators of 25(ОН)D concentration, in 36 (69.2 %) patients of the main group, different degrees of fall of vitamin D concentration in blood plasma were found. Most often a pronounced deficit of vitamin D was diagnosed in patients with the tumor localized in the head of the pancreas (8 (15.9 % patients). Out of 37 patients with localization of the tumor node in the body/tail, 25 (67.5 %) persons demonstrated normal values of blood plasma vitamin D and 12 (13.4 %) different degrees of decrease in vitamin D concentration. A marked deficit of vitamin D was diagnosed in 2 (16.6 %) patients, deficit of vitamin D in 7 (58.3 %), insufficiency in 3 (25 %). In the control group, decrease in vitamin D level was determine in 12 (16.9 %) patients. An apparent deficit of vitamin D was diagnosed in 3 (4.2 %) patients, deficit of vitamin D in 4 (5.6 %), and insufficiency of vitamin D in 7 (9.8 %); normal values were registered in 57 (80.2 %) persons.&#x0D; Conclusions. Taking into account the obtained data regarding a reliable association between the deficit and insufficiency of vitamin D and the cancer of the head of the pancreas as well as literature data, it is worthwhile to use this indicator as a marker of early detection of pancreatic cancer in risk group patients.

Endovascular treatment of ruptured dorsal pancreatic artery pseudoaneurysm: case report

The objective of the present study is to report the technical success of the endovascular procedure in the treatment of pseudoaneurysm of the dorsal pancreatic artery. A 60-year-old white male patient came to the emergency room, complaining of the appearance of an ulcerated wound in the distal third of the left lower limb for 20 days. Alcoholic, smoker and previous diagnosis of chronic pancreatitis. On physical examination, upon admission, the abdomen was normotensive, painless on palpation and without masses or visceromegaly. During the investigation of this ulcer and 12 hours after admission, the patient developed diffuse abdominal pain and distension, more intense in the upper abdomen and associated with peritonitis. A computed tomography scan of the upper abdomen and pelvis was performed, which showed a pseudoaneurysm of the dorsal artery of the pancreas with frank extravasation of contrast into the abdominal cavity, in addition to a moderate amount of free blood around the liver. He underwent endovascular embolization treatment, in which he was selectively catheterized splenic artery and dorsal pancreas with therapeutic success.