History Of Chronic Pancreatitis Research Articles

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.

Abstract 1074: Plasma EV profiling facilitates low abundance biomarker discovery in pancreatic cancer

Abstract The lack of reliable biomarkers for early detection of pancreatic ductal adenocarcinoma (PDAC) results in poor prognosis due to advanced disease at diagnosis. Biopsies for pancreatic cancer are known to be particularly difficult to perform because of the location of the pancreas and low volume of primary tumors that metastasize aggressively. Currently, there is no blood test or other screening modality in use, for stratification of individuals with higher-than-average risk (5-8-fold) of developing PDAC in their lifetime. Given this existing void in the US and worldwide, an FDA-compliant, minimally invasive, quantitative biomarker test for the early detection of PDAC would be critical for screening subpopulations with, a) inherent genetic or familial predisposition; history of chronic pancreatitis; c) precursor lesions of pancreas; and d) older patients (>50 years) with new onset diabetes or sudden weight loss. Extracellular vesicles (EVs) are shed by normal and cancer cells and carry a rich molecular cargo that can be leveraged for biomarker discovery. Whereas molecular profiling of bio-fluids poses intrinsic limitations for detection of low abundant, disease-specific biomarkers due to matrix effects; EVs, on the other hand, offer promise as a robust and minimally invasive biomarker resource. Mass spectrometry data were developed in our laboratory, based on multi-omics (proteomics, lipidomics and metabolomics) analyses of plasma EVs derived from patients diagnosed with early-stage PC (N=60), pancreatitis (N=39), precursor lesions of pancreas (N=45) as well as normal controls (N=50). These clinically annotated samples were made available by the Georgetown University Medical Center (GUMC) repository. Feature selection using a training-validation design allowed the development of a multiplexed biomarker panel comprising of 12-analytes (5-lipids, 2-metabolites and 5-proteins) that can robustly stratify early-stage PC from normal controls with high accuracy (AUC>95%). Availability of a FDA compliant, multi-analyte-based classification algorithm that can stratify patients with precursor lesions of the pancreas that are at potential risk of progression to PC with > 90% specificity and sensitivity is a critical clinical need. Refinement of panel to improve positive predictive value as well as identification of markers predictive of progression of precursor lesions to malignant transformation is ongoing. Citation Format: Shivani Bansal, Shu Wang, Yaoxiang Li, Sunil Bansal, Jill Smith, John B. Tyburski, Keith Unger, Amrita Cheema. Plasma EV profiling facilitates low abundance biomarker discovery in pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1074.

Advanced pancreatic cancer outcomes and the impact of COVID-19 pandemic: The experience of an academic cancer center.

626 Background: The COVID-19 pandemic increased all-cause mortality and disrupted healthcare delivery in the United States. Interruptions in cancer screening and surveillance because of the pandemic resulted in delayed diagnosis, diagnosis at later stages, and worse cancer-related outcomes. However, the effect of COVID-19 on pancreatic cancer outcomes has not been reported. This study aimed to investigate this question. Methods: We studied consecutive patients with unresectable and metastatic pancreatic cancer treated at the University of Cincinnati Cancer Center. Patients were divided into 2 cohorts: from January 2018 to December 2019 (pre-COVID) and from January of 2020 to December of 2021 (during-COVID). Descriptive data on patient characteristics, ECOG performance status (PS), laboratory values, therapies, and mortality were obtained by pre- and during-COVID. The categorical variables were compared using the Pearson Chi-square test for contingency tables (or Fisher’s exact test when the expected frequency within any cell was less than 5 in the contingency table), and the t-test or ANOVA was used for continuous variables. For overall survival time, the Kaplan-Meier curves were compared between pre- and during-COVID using log rank test. We fitted univariable Cox proportional-hazards model for each interest variable, and the multivariable Cox models, which includes only significant variables. Results: There were 81 and 64 patients in the pre- and during-COVID cohorts, respectively. Patients diagnosed during COVID were more likely to be female, have better PS, have higher proportion of alcohol use, and were more likely to receive 5-FU-based (compared with gemcitabine-based) chemotherapy upfront. There was no overall survival difference between the two cohorts. A Cox proportional hazards model showed that PS at diagnosis, history of chronic pancreatitis, any chemotherapy compared to no chemotherapy, serum albumin prior to initial chemotherapy, and body mass index at time of diagnosis were associated with survival. Conclusions: We observed no difference in overall survival in patients diagnosed with advanced stage pancreatic cancer during the first two years of the COVID-19 pandemic compared with the two prior years. While some differences were observed between patient groups and treatment selection before and during the pandemic, a concerted effort to maintain cancer care appears to have minimized the impact of the pandemic. Further analyses on patients undergoing treatment are being conducted.

Giant Pseudocyst of the Pancreas: A Rare Case Report

A Pancreatic Pseudocyst (PP) is a fluid-filled collection often found near the pancreas. It is characterised by its contained structure and homogeneous fluid composition, with little to no necrotic tissue. Individuals with a history of chronic pancreatitis, and to a lesser extent acute pancreatitis, may exhibit non specific symptoms. To minimise related morbidity and mortality, any potential complications must be identified. The authors present a case of a rare giant PP in a 28-year-old man who presented with abdominal pain and distention, severe backache, fever, frequent vomiting, loss of appetite, weight loss, and firm, sticky stools. Initially measuring 25×19.2×11.2 cm on a Computed Tomography (CT) scan, this PP was unusually large for its type. Due to the patient’s condition not being suitable, a direct cystojejunostomy was performed. Three drains were placed: an anastomotic drain near the anastomosis site, a Morrison’s drain in the Morrison pouch, and a pelvic drain. Later, a complication arose in the form of a faecal fistula, which was managed conservatively with a suction drain. The patient’s only primary complaint was non specific stomach pain, despite the size of the pseudocyst. Therefore, individuals with a history of chronic alcoholism and symptoms such as abdominal pain and distension should be evaluated for PP. A CT scan is recommended to investigate this condition, despite its rarity.

Endobiliary radiofrequency ablation of an intraductal vessel in a patient with surgically altered anatomy.

A 49-year-old man with a history of chronic pancreatitis following Whipple procedure presented with hematemesis and hematochezia. Enteroscopy revealed blood throughout the afferent and efferent limbs, with a clot at the hepaticojejunostomy anastomosis ([Fig. 1]). Two subsequent endoscopic retrograde cholangiopancreatography (ERCP) procedures were performed to remove the blood clots ([Fig. 2]) and place biliary stents to manage the hemobilia. Owing to ongoing bleeding, the patient underwent empiric embolization of the left and right hepatic arteries. Despite these efforts, the patient’s bleeding persisted, with associated hemodynamic instability. After a multidisciplinary discussion, the patient was offered salvage endobiliary radiofrequency ablation (RFA).

Abstract OT3-09-01: Clinical Trial of Alpelisib and Tucatinib in Patients with PIK3CA-Mutant HER2-Positive Metastatic Breast Cancer

Abstract Phosphatidylinositol 3-kinase (PI3K) pathway plays a key role in resistance to the drugs targeting human epidermal growth factor receptor 2 (HER2). Activating mutations in the gene encoding alpha catalytic subunit of PI3K (PIK3CA) are present in approximately 30% of HER2+ tumors. PIK3CA mutations are linked to drug resistance and decreased survival in patients with HER2+ breast cancer. To overcome this resistance mechanism, we designed a phase IB/II clinical trial to evaluate the combination of HER2 small molecule inhibitor tucatinib with PI3K inhibitor alpelisib in patients with HER2+ metastatic breast cancer (NCT05230810). This multicenter clinical trial is conducted through the Academic Breast Cancer Consortium (ABRCC), with the University of Colorado Cancer Center as the lead site. Target enrollment: 40 patients. This is a run-in phase IB/roll-over phase II study. Phase IB will follow Time-to-Event Bayesian Optimal Interval design and enroll from 9 to 19 patients to find the maximum tolerated doses (MTDs) of tucatinib and alpelisib. From 21 to 31 patients will be enrolled in phase II part, for a total of 40 patients in the final efficacy analysis. Main inclusion criteria: 1. Women and men ≥ 18 years old 2. Eastern Cooperative Oncology Group (ECOG) performance status 0-1 3. Presence of activating PIK3CA mutation in the tumor 4. Patients with HR-/HER2+ or HR+/HER2+ breast cancer may enroll; ovarian suppression is mandatory for premenopausal patients with HR+/HER2+ disease 5. HR+/HER2+ patients should be agreeable to concomitant treatment with fulvestrant 6. Prior treatment with at least two FDA-approved HER2-targeted agents 7. Measurable or evaluable disease. Bone only disease is allowed. 8. Subjects with untreated central nervous system (CNS) metastases not needing immediate local therapy, and subjects with previously treated stable or progressive brain metastases may enroll, provided that there is no indication for immediate re-treatment. For patients with treated CNS metastases: time from treatment of CNS disease until the first dose of study drugs should be as follows: WBRT ≥ 21 days, surgical resection ≥ 14 days, SRS ≥ 7 days. 9. Adequate organ and marrow function Main exclusion criteria: 1. Contraindications to undergo contrast brain MRI 2. Leptomeningeal disease 3. Poorly controlled seizures 4. Diabetes mellitus type I, or uncontrolled diabetes mellitus type II 5. Acute pancreatitis within 1 year of screening, or history of chronic pancreatitis 6. History of severe cutaneous hypersensitivity reactions 7. Toxicities of prior cancer therapies that have not resolved to grade 1 or less, except peripheral neuropathy, which must have resolved to grade 2 or less, and alopecia 8. Previous treatment with EGFR or HER2 tyrosine kinase inhibitors, or PI3K/mTOR/AKT inhibitors. 9. Systemic anti-cancer therapy, palliative radiation to extracranial sites, or surgery within 2 weeks of the first dose of study drugs 10. Active bacterial, fungal, or viral infections, hepatitis B, C, or HIV 11. Clinically significant cardio-vascular disease Primary objectives: • Phase IB: safety and tolerability of combination therapy • Phase II: efficacy by progression free survival Exploratory assessment of biomarkers will be performed in the liquid biopsy samples. Study contact: Elena Shagisultanova, MD, PhD, elena.shagisultanova@cuanschutz.edu Citation Format: Elena Shagisultanova, Kari B. Wisinski, Chelsea D. Gawryletz, Farrah M. Datko, Diana Medgyesy, Jennifer R. Diamond, Virginia F. Borges, Peter Kabos. Clinical Trial of Alpelisib and Tucatinib in Patients with PIK3CA-Mutant HER2-Positive Metastatic Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-09-01.

Dihydropyridine Calcium Channel Blockers and Risk of Pancreatic Cancer: A Population-Based Cohort Study.

Background Recent studies have reported that dihydropyridine calcium channel blockers (dCCBs) may increase the risk of pancreatic cancer, but these studies had methodological limitations. We thus aimed to determine whether dCCBs are associated with an increased risk of pancreatic cancer compared with thiazide diuretics, a clinically relevant comparator. Methods and Results We conducted a new user, active comparator, population-based cohort study using the UK Clinical Practice Research Datalink. We identified new users of dCCBs and new users of thiazide diuretics between 1990 and 2018, with follow-up until 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% CIs for pancreatic cancer, comparing dCCBs with thiazide diuretics. Models were weighted using standardized morbidity ratio weights based on calendar time-specific propensity scores. We also conducted secondary analyses by cumulative duration of use, time since initiation, and individual drugs and assessed for the presence of effect modification by age, sex, smoking status, body mass index, history of chronic pancreatitis, and diabetes. The cohort included 344 480 initiators of dCCBs and 357 968 initiators of thiazide diuretics, generating 3 360 745 person-years of follow-up. After a median follow-up of 4.5 years, the weighted incidence rate per 100 000 person-years was 37.2 (95% CI, 34.1-40.4) for dCCBs and 39.4 (95% CI, 36.1-42.9) for thiazide diuretics. Overall, dCCBs were not associated with an increased risk of pancreatic cancer (weighted HR, 0.93; 95% CI, 0.80-1.09). Similar results were observed in secondary analyses. Conclusions In this large, population-based cohort study, dCCBs were not associated with an increased risk of pancreatic cancer compared with thiazide diuretics. These findings provide reassurance regarding the long-term pancreatic cancer safety of these drugs.

Pancreatic fluorescence using continuous indocyanine greeninfusion.

Pancreatic fluorescence using continuous indocyanine greeninfusion.

Lipase elevation on admission predicts worse clinical outcomes in patients with COVID-19

Background and objectivesHyperlipasemia is highly prevalent among coronavirus disease 2019 (COVID-19) patients. The aim of this study was to assess the effect of lipase activity, measured at the time of admission, on the clinical course and mortality in COVID-19 patients. MethodsThe population of this study comprised 12,139 patients who were hospitalized due to COVID-19 between June 2020 and June 2021 in a pandemic hospital. Of these, 8819 patients were excluded from the study due to missing data, four patients were excluded due to a diagnosis of acute pancreatitis (according to the revised Atlanta criteria), and 72 patients were excluded due to alcohol use or having a history of chronic pancreatitis. The final study sample consisted of the remaining 3244 COVID-19 patients. Laboratory results, intensive care unit (ICU) follow-up periods, the need for mechanical ventilation, and mortality rates were compared between the normal lipase activity and high lipase activity groups. ResultsThere were 968 (29.8%) patients with high lipase activity at the time of admission. The rate of ICU admission was 36.1% vs. 9.9% (p < 0.001), mechanical ventilation requirement rates were 33.7% vs. 8.3% (p < 0.001), and mortality rates were as 24.6% vs. 6.4% (p < 0.001) in the high lipase activity group compared to the normal lipase activity group. Multivariate regression analysis revealed that high lipase activity was an independent factor in predicting mortality in hospitalized COVID-19 patients (odds ratio [OR]: 3.191, p < 0.001). ConclusionElevated lipase activity without acute pancreatitis at the time of admission in COVID-19 patients was determined as an independent predictor of poor prognosis.

Diagnostic Accuracy of BISAP Score for Detecting Acute Pancreatitis Keeping Computed Tomography Severity Index as GS

Objective: To establish the diagnostic accuracy of BISAP in detecting the severe acute pancreatitis keeping computed tomography severity index as gold standard. Study Design: Cross-sectional study Place and Duration of Study: Department of Gastroenterology, Hayatabad Medical Complex, Peshawar from April 16th 2018 to 16th October 2018. Methodology: One hundred and twenty nine patients of age range of 18-60, of either gender having severe acute pancreatitis were included. While patients already diagnosed as severe acute pancreatitis and having known history of chronic pancreatitis were excluded. Patients were subjected to CT scan to confirm whether the severe acute pancreatitis is present or not. All CT scans were reported by single experiences radiologist. Results: There were 30.3% were males and 69.7% were females with mean age 42±11.03 years. BISAP had sensitivity 92.74%, specificity 80%, positive predictive value 99.13%, negative predictive value 20.76% and the overall diagnostic accuracy was 92.24%. Conclusion: BISAP had sensitivity 93.61%, specificity 100%, positive predictive value 100%, negative predictive value 40% and the overall diagnostic accuracy was 93.87% in severe acute pancreatitis keeping CT severity index as gold standard. Keywords: Accuracy, Severe acute pancreatitis, Computed tomography

S1689 Anomalous Biliary-pancreatic Junction: A Case of Recurrent Pancreatitis and Implicit Bias

Introduction: Implicit bias is defined as the attitudes or stereotypes that unconsciously affect our understanding, actions, and decisions. Physicians must make a concerted attempt not to fall prey to implicit bias as this can lead to differences in the quality of care between patients. We describe a case of implicit bias secondary to a diagnosis of anomalous biliary pancreatic junction (ABPJ). Case Description/Methods: A 50-year-old Hispanic woman with an extensive psychiatric history, polysubstance abuse, and recurrent pancreatitis presented with abdominal pain. Given her history, the etiology of recurrent pancreatitis was deemed to be due to polysubstance abuse. CT abdomen showed a dilated common bile duct, dilated pancreatic duct, and pancreatic calcifications consistent with a history of chronic pancreatitis. Review of previous medical records showed that a prior MRCP had revealed duplication of the biliary ductal system. The medial duct draining the right lobe of the liver, anastomosed with the pancreatic duct to form a common channel that opened into the duodenum. The lateral duct drained the left lobe of the liver and opened it into the duodenum through a separate papilla. Gastroenterology was consulted and a diagnosis of ABPJ was made. Consequently, the patient's episodes of pancreatitis were thought to be secondary to ABPJ. Patient then underwent an ERCP with pancreatic sphincterotomy and stent placement, leading to significant symptom resolution. Discussion: ABPJ is a congenital malformation where the biliary and the pancreatic ducts join outside the wall of the duodenum. Incidence is estimated to be 1.5 – 3.2 % among all patients that undergo an ERCP. Since the function of the duodenal papilla does not traverse the length of the common duct, regurgitation of pancreatic and biliary secretions occurs. In most cases, the pressure in the pancreatic duct is higher, resulting in the reflux of pancreatic juice into the biliary tract and subsequent development of biliary tract malignancy. In a rare minority of cases, bile can reflux into the pancreatic ductal system, causing recurrent pancreatitis. ABPJ is a rare and under-recognized cause of recurrent pancreatitis in the adult population. Often, the diagnosis of ABPJ is overshadowed by the treating physician’s implicit bias due to patient factors such as ethnicity, age, past medical history, etc. A high index of suspicion is required to make an accurate diagnosis leading to prompt intervention, thus avoiding delay in care and associated morbidity.Figure 1.: CT scan showing collection in Gall Bladder fossa.

Identification of G-protein signaling modulator 2 as a diagnostic and prognostic biomarker of pancreatic adenocarcinoma: an exploration of its regulatory mechanisms.

Pancreatic adenocarcinoma (PAAD) has a high rate of mortality. Unfortunately, it is difficult to diagnosis. This study aimed to develop a more in-depth understanding of the disease. A total of 177 patients with PAAD were recruited from The Cancer Genome Atlas (TCGA) database. Microarray analysis was performed to identify differentially expressed genes (DEGs) in PAAD. The microarray data were adapted to the ingenuity pathway analysis (IPA) for annotation and visualization, followed by protein-protein interaction (PPI) network analysis. In vitro transwell migration assays were conducted to explore the molecular and functional characteristics of pancreatic adenocarcinoma cells (PANC-1) with stable low expression of G-protein signaling modulator 2 (GPSM2). Expression of GPSM2 and the associated hub genes were detected by reverse transcription-quantitative polymerase chain reaction (qPCR). The overexpression of GPSM2 was proved in PAAD, as compared with the healthy tissues, as well as its correlation with history of chronic pancreatitis, T stage, TNM stage and tumor grade. We described it as an independent prognostic factor and found that it could influence the infiltration of immune cells in the tumor microenvironment. Silencing of GPSM2 restrained the and migration of the cells. Microarray analysis identified 1,631 DEGs in PAAD cells. The PPI network analysis identified hub genes including CD44, ITGB1, ITGB5, ITGA2, ITGA5, AKT1, EGFR, NRAS and MAP2K1, and their relationship with GPSM2 was confirmed by qPCR. GPSM2 is a novel prognostic factor and therapeutic target for PAAD. GPSM2 promoted the migration of pancreatic adenocarcinoma cells .Targeting GPSM2 and its downstream genes may prolong the survival time of patients with PAAD.

Spectrum of vascular complications in acute pancreatitis - challenges in management

Background: Vascular complication of pancreatitis is a rare entity. Due to its rarity, the diagnostic and therapeutic strategy for the management of this potentially life threatening problem remains undefined. The objective of our study is to highlight the spectrum of manifestations, challenges in the diagnosis and management of vascular complications of acute pancreatitis. Methods: Patients who were managed for vascular complication of acute / chronic pancreatitis were retrospectively analysed from the year 2000 to 2019. Results: There were a total of 79 patients ( 71 Male:8 Female) with a mean age of 34.8 years . 27 patients had chronic alcoholic pancreatitis 27- Tropical pancreatitis , 18- acute pancreatitis , 3- idiopathic and 1 had post traumatic pancreatitis. 8 patients were managed conservatively. Selective arterial embolization was attempted in 55 of 70 (78.5%) patients and was successful in 44 of the 55 (80 %). 27 of 76 (31.5%) patients required surgery. Overall mortality was 7.8 %. Conclusion: Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. All hemodynamically stable patients with HP should undergo prompt initial angiographic evaluation, and if possible, embolization. Hemodynamically unstable patients and those following unsuccessful embolization should undergo emergency haemostatic surgery. Centralization of GI bleed services along with a multidisciplinary team approach and a well-defined management protocol is essential to reduce the mortality and morbidity of this condition.Tabled 1Table showing the statistics of the patient managed

РЕНТГЕНЭНДОВАСКУЛЯРНАЯ ЭМБОЛИЗАЦИЯ СОСУДОВ ПАРАПАНКРЕАТИЧЕСКОЙ ЗОНЫ В ЛЕЧЕНИИ ОСЛОЖНЕНИЙ ХРОНИЧЕСКОГО ПАНКРЕАТИТА

Goal. To improve the results of surgical treatment of chronic pancreatitis complicated by vascular pathology of the parapancreatic zone. Materials and methods. On the basis of the "Grodno University Clinic" in the department of X-ray Endovascular Surgery of the period 2010 to April 2020, were performed 16 embolizations of the arteries of the parapancreatic zone due to complications of chronic pancreatitis. Among the patients there were 13 (81.25%) men and 3 (18.75%) women. They had a history of chronic pancreatitis, which was confirmed using instrumental and laboratory research methods. One of the patients (6.25%) had a stationary aneurysm.15 (93.75%) patients had a bleeding clinic, which required urgent surgical interventions. Results. Angioembolization of the parapancreatic arteries was effective in 15 (93.75%) patients, which was confirmed by the results of control angiograms. Conclusions. The use of intraluminal embolization for vascular pathology of the parapancreatic zone in treatment of chronic pancreatitis complications is a minimally invasive and effective method.

Acquired Acrodermatitis Enteropathica

A 34-year-old woman with a history of chronic pancreatitis, untreated hepatitis C, depression, intravenous drug use, alcohol abuse, gastritis, and upper gastrointestinal bleed presented with a 2-month history of intractable rash, watery diarrhea, hair loss, poor oral intake, lethargy, and peripheral edema. On examination, she was noted to be cachectic, had pitting pedal edema, and had a thin, dull, erythematous plaque with a rim of desquamation located over both thighs and buttocks (extending to the gluteal cleft, sparing the anal orifice) (Figure, A and B).

S3072 In-hospital Outcomes of Acute Pancreatitis in Patients With Liver Cirrhosis

INTRODUCTION: Acute pancreatitis (AP) is the most common disease of the gastrointestinal (GI) tract. Acute pancreatitis was noted to be the most common GI discharge with reported increased incidence in hospitalized patients. The estimated cost of hospitalization for AP was estimated at a cost of 2.6 billion dollars in 2009. A recent study of the NIS database revealed worse outcomes of AP in patients with liver cirrhosis between 2003 and 2013. We conducted this study to evaluate any changes in the outcomes of AP in hospitalized patients with liver cirrhosis between 2012 and 2015. METHODS: The study was derived from the National Inpatient Sample (NIS) database. We queried the database for hospitalization with a primary diagnosis of acute pancreatitis using the International Classification of Diseases, 9th revision, Clinical Modification code 577.0. The primary outcomes were in-hospital mortality and length of stay. We compared the outcomes between patients with and without history of liver cirrhosis/obesity. RESULTS: A total of 1,402,750 were included in the study after exclusion of patients under 18 years of age and those with a history of chronic pancreatitis. 62,110 (4.4%) had a documented history of liver cirrhosis. Overall, patients with liver cirrhosis had significant multiple co-morbidities as compared to those without liver cirrhosis. The in-hospital mortality (adjusted odds ratio: 3.1, 95% confidence interval 2.85 – 3.37, P < 0.001), length of stay and cost of hospitalization were significantly higher in patients with liver cirrhosis. CONCLUSION: Patients with AP and liver cirrhosis have significantly higher mortality, prolonged hospitalization, and healthcare expenditure. The study findings remain similar to a recently published study looking at mortality for patients admitted between 2003 and 2013. It is unclear if the increased mortality is related to complications related to severe forms of acute pancreatitis or liver cirrhosis.Table 1.: Baseline Characteristics of AP index hospitalizationsTable 2.: Adjusted Outcomes of AP admissions with liver cirrhosis (adjusted for age, gender and co-morbidities; obesity, congestive heart failure, hypertension, diabetes mellitus, metastatic cancer, immunodeficiency, alcohol abuse, renal failure and chronic lung disease)

BAP1 is a haploinsufficient tumor suppressor linking chronic pancreatitis to pancreatic cancer in mice

Chronic pancreatitis represents a risk factor for the development of pancreatic cancer. We find that heterozygous loss of histone H2A lysine 119 deubiquitinase BAP1 (BRCA1 Associated Protein-1) associates with a history of chronic pancreatitis and occurs in 25% of pancreatic ductal adenocarcinomas and 40% of acinar cell carcinomas. Deletion or heterozygous loss of Bap1 in murine pancreata causes genomic instability, tissue damage, and pancreatitis with full penetrance. Concomitant expression of KrasG12D leads to predominantly intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, while pancreatic intraepithelial neoplasias are rarely detected. These lesions progress to metastatic pancreatic cancer with high frequency. Lesions with histological features mimicking Acinar Cell Carcinomas are also observed in some tumors. Heterozygous mice also develop pancreatic cancer suggesting a haploinsufficient tumor suppressor role for BAP1. Mechanistically, BAP1 regulates genomic stability, in a catalytic independent manner, and its loss confers sensitivity to irradiation and platinum-based chemotherapy in pancreatic cancer.

Prevalence and Factors Associated with Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Children.

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). To assess the prevalence and factors associated with post-ERCP pancreatitis (PEP) in a Chinese pediatric population. Sixty-six children who underwent ERCP between March 2018 and March 2019 at Shanghai Children's Medical Center were retrospectively recruited for the study. Clinical data, including demographics, indications, comorbidities, and procedural data, were reviewed to identify the prevalence and factors associated with PEP. Ninety-two ERCPs were performed on 66 pediatric patients aged from 8months to 14years. The indications for ERCP were chronic pancreatitis (49, 53.2%), pancreaticobiliary maljunction (19, 20.7%), pancreas divisum (19, 20.7%), and pancreatic pseudocyst (5, 5.4%). All ERCPs were performed for therapeutic purposes. PEP was identified in 19 (20.7%) patients; there were ten mild cases, eight moderate cases, and one severe case. The univariate analysis revealed that a history of chronic pancreatitis was negatively associated with PEP (P = 0.033), and sphincterotomy was positively associated with PEP (P = 0.01). The multivariate analysis showed that sphincterotomy was a risk factor for PEP (P = 0.017, OR 4.17; 95% CI, 1.29, 13.54). Our data revealed a high prevalence of PEP in a Chinese pediatric population. Chronic pancreatitis was a protective factor, and sphincterotomy was a risk factor for PEP development.

Serum Immunoglobulin G Is Associated With Decreased Risk of Pancreatic Cancer in the Swedish AMORIS Study.

Background: Emerging evidence points to potential roles of the humoral immune responses in the development of pancreatic cancer. Epidemiological studies have suggested involvement of viral and bacterial infections in pancreatic carcinogenesis. Experimental studies have reported high expression levels of antigens in pancreatic cancer cells. Therefore, we aimed to investigate the role of different components of humoral immunity in the context of pancreatic cancer. We evaluated associations between pre-diagnostic serum markers of the overall humoral immune system [immunoglobulin A (IgA), immunoglobulin G (IgG) and immunoglobulin M (IgM)], and the risk of pancreatic cancer in the Swedish Apolipoprotein-related MORtality RISk (AMORIS) study.Methods: We selected all participants (≥20 years old) with baseline measurements of IgA, IgG or IgM (n = 41,900, 136,221, and 29,919, respectively). Participants were excluded if they had a history of chronic pancreatitis and individuals were free from pancreatic cancer at baseline. Multivariate Cox proportional hazards regression was used to estimate risk of pancreatic cancer for medical cut-offs of IgA, IgG, and IgM.Results: Compared to the reference level of 6.10–14.99 g/L, risk of pancreatic cancer was elevated among those with IgG levels <6.10 g/L [HR: 1.69 (95% CI 0.99–2.87)], and an inverse association was observed among those with IgG levels ≥15.00 g/L [0.82 (95% CI 0.64–1.05); Ptrend = 0.027]. The association appeared to be stronger for women than men [HR: 0.64 (95% CI 0.43–0.97) and 0.95 (95% CI 0.69–1.29), respectively]. No associations were observed with IgA or IgM.Conclusion: An inverse association was observed between pre-diagnostic serum levels of IgG and risk of pancreatic cancer. Our findings highlight the need to further investigate the role of immune response in pancreatic cancer etiology.

Bridging the Divisum: A Rare Case of Pancreaticopleural Fistula in the Setting of Complete Pancreatic Divisum Treated Endoscopically

A pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis that occurs either due to a pancreatic duct disruption or a pseudocyst extension. A pancreatic divisum, on the other hand, is a common anatomic variant of the pancreas that is rarely symptomatic. We describe a case of recurrent pleural effusion in a patient with a history of chronic pancreatitis. Investigations revealed the presence of a PPF and a concomitant complete pancreatic divisum. There was resolution of the pleural effusion on endoscopic therapy. This is the fourth reported case of a PPF in the setting of complete pancreatic divisum and the first reported case in a middle-aged female.