Incidence Of Chronic Pancreatitis Research Articles

Citric Acid Loaded Hydrogel-Coated Stent for Dissolving Pancreatic Duct Calculi.

In recent years, the incidence of chronic pancreatitis has increased significantly. Pancreatic calculi obstruct the pancreatic duct and induce abdominal pain in the patients. Pancreatic duct stenting is the major treatment option for chronic pancreatitis with calculi. In this study, a new kind of drug-eluting stent, a pancreatic stent coated by methacrylated gelatin (GelMA) hydrogel loaded with citric acid (CA), was designed for the interventional treatment of pancreatic duct calculi. The CA loading capacity reached up to 0.7 g CA/g hydrogel-coated stent. The GelMA hydrogel coating has higher mechanical strength and lower swelling performance after loading with CA. The in vitro experiments of stents exhibited good performance in CA sustained release and the calculi can be dissolved in almost 3 days. The stents also showed good blood compatibility and cell compatibility. This research has important clinical value in the treatment of chronic pancreatitis with pancreatic calculi.

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.

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.

Smoking as the most important risk factor for chronic pancreatitis in the general population.

We tested the hypothesis that six toxic risk factors from the TIGAR-O classification system are equally important for risk of chronic pancreatitis, at the level of the individual patient and in the general population. 108,438 women and men aged 20-100years participating in the Copenhagen General Population Study from 2003 to 2015 were included. Associations of smoking, alcohol intake, waist/hip ratio, kidney function, plasma triglycerides, plasma Ca2+, and diseases within the causal pathway with risk of chronic pancreatitis, and corresponding population attributable risks were estimated. Information on chronic pancreatitis was from national Danish health registries. During median 9years (range: 0-15) of follow-up, 313 individuals had a first diagnosis of chronic pancreatitis; the incidence of chronic pancreatitis per 10,000 person-years were 3.1 overall, 2.8 in women, and 3.5 in men. Of the six toxic risk factors and relative to individuals with low values, individuals in the top 5% had hazard ratios for chronic pancreatitis of 3.1(95% CI 2.1-4.5) for pack-years smoked, 2.5(1.5-4.0) for alcohol intake, and 1.6(1.1-2.6) for plasma triglycerides. Corresponding values versus those without the baseline disease were 12.6 (7.9-20.2) for acute pancreatitis, 1.9 (1.2-2.8) for gallstone disease, and 1.9 (1.3-2.7) for diabetes mellitus. The highest population attributable fractions were for women (1) ever smoking (31%), (2) gallstone disease (5%), and (3) diabetes mellitus (4%), and for men (1) ever smoking (38%), (2) acute pancreatitis (7%)/high alcohol intake (7%), and (3) high plasma triglycerides (5%). Smoking is the most important risk factor for chronic pancreatitis in the general population.

Pancreatic Stones in Children with Chronic Pancreatitis: A Case Report

Background: Chronic pancreatitis is a continuous progressive inflammation of the pancreas that can cause recurrent abdominal pain. The incidence of chronic pancreatitis in children is on an upward trend in recent years. The purpose of this case report is to enhance clinician's insight in considering chronic pancreatitis as a differential diagnosis in cases of recurrent abdominal pain in children. Case: We reported a case of chronic pancreatitis with pancreatic stones in a 12-year-old child. The patient came with complaints of recurrent upper left abdominal and heartburn accompanied by nausea and vomiting. Epigastric and left hypochondriac tenderness were found. Laboratory examination showed an increase in pancreatic enzymes up to 6x the normal value. The results of abdominal CT-scan and MRCP showed multiple pancreatic stones with pseudocysts. The patient then underwent the Puestow procedure. Postoperatively, the complaints of abdominal pain resolved and the pancreatic enzymes improved significantly. Discussion: The diagnosis of pancreatitis must meet 2 out of the 3 criteria that have been determined. Primary management includes fluids, analgesics, early nutrition, and surgery in cases of chronic pancreatitis accompanied by complications such as pseudocysts or pancreatic stones. Conclusion: This case teaches the need for a careful clinical approach and consideration of chronic pancreatitis as a differential diagnosis in a child with recurrent abdominal pain.

Surveillance for Pancreatic Cancer in Chronic Pancreatitis

Pancreatic cancer can arise in the background of chronic pancreatitis (CP). The relative risks for pancreatic cancer in CP vary considerably according to other contributing factors such as disease duration, excess alcohol consumption, tobacco consumption, eating habits, physical activity, and late-onset diabetes. The incidence of pancreatic cancer is estimated to be about 10 per 105 per year, and the incidence and prevalence of CP are estimated to be 5-12 per 105 and 50 per 105 per year, respectively. The pooled relative risk estimates for pancreatic cancer in CP patients range from 2.7 to 13.3. Subsets of CP subjects with a family history of pancreatic cancer or those with newly developed diabetes over the age of 50 have a higher risk for pancreatic cancer. However, the prevalence of pancreatic cancer is not high enough to justify general screening of the adult CP population. Thus, it is necessary to select subsets of CP cohorts with a significantly high risk of pancreatic cancer. We need a better overall disease model that can define the interaction of multiple risk factors and their cumulative or potential effects on pancreatic cancer.

Clinical and translational markers of severity and prognosis in chronic pancreatitis.

The incidence of chronic pancreatitis as a progressive inflammation and fibrosis syndrome is on the rise due to increasing awareness and improved imaging modalities. Numerous classification systems have been suggested in recent years to describe the disease, but only few of them have been used to classify the severity and prognostic significance of the disease. Biomarkers for severity and (early) chronic pancreatitis diagnosis are not yet ready for clinical application. In using the M-ANNHEIM and Chronic Pancreatitis Prognosis Score (COPPS) classification system, the severity assessment and short- and medium-term disease progression is available. A prospectively validated biomarker for early chronic pancreatitis diagnosis is not yet available, metabolome-based approaches seem to have the greatest potential for clinical translation. Currently, due to the lack of universal definition for the early disease stage of chronic pancreatitis, it is difficult to accurately classify these patient cohorts in existing scoring systems. In principle, setting up a suitable scoring system would allow surveillance and establish a therapy approaches flanked by corresponding biomarker panel development. Therapy management of chronic pancreatitis and monitoring by means of scoring systems (such as the COPPS) would make a decisive contribution to improving patient treatment.

Vitamin D: A Potential Star for Treating Chronic Pancreatitis

Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas. The incidence of CP is increasing worldwide but the effective therapies are lacking. Hence, it is necessary to identify economical and effective agents for the treatment of CP patients. Vitamin D (VD) and its analogues have been confirmed as pleiotropic regulators of cell proliferation, apoptosis, differentiation and autophagy. Clinical studies show that VD deficiency is prevalent in CP patients. However, the correlation between VD level and the risk of CP remains controversial. VD and its analogues have been demonstrated to inhibit pancreatic fibrosis by suppressing the activation of pancreatic stellate cells and the production of extracellular matrix. Limited clinical trials have shown that the supplement of VD can improve VD deficiency in patients with CP, suggesting a potential therapeutic value of VD in CP. However, the mechanisms by which VD and its analogues inhibit pancreatic fibrosis have not been fully elucidated. We are reviewing the current literature concerning the risk factors for developing CP, prevalence of VD deficiency in CP, mechanisms of VD action in PSC-mediated fibrogenesis during the development of CP and potential therapeutic applications of VD and its analogues in the treatment of CP.

Chronic pancreatitis - an update

Chronic pancreatitis (CP) is a progressive inflammatory process that causes irreversible damage to the pancreas due to fibrosis and scarring. The incidence of CP varies among regions. Alcohol consumption and smoking are the main aetiologicalfactors of CP. In addition, autoimmune diseases, hereditary and genetic factors, and tropical CP also contribute to this condition. Though no single mechanism has been shown to initiate CP pathogenesis, this disease ultimately results in fibrosis, scarring, and insufficiency in the pancreas. Chronic upper abdominal pain, steatorrhea, malnutrition, and diabetes mellitus are the main clinical features of CP. Detecting this disease at an early stage is difficult unless it is explicitly checked for due to strong suspicions. Nevertheless, pancreatic function tests, imaging, and endoscopy are used to diagnose CP . Pain management, exocrine supplementation, diabetic management, and endoscopic or surgical drainage and resection procedures are essential for managing CP. Early surgical intervention can improve the remaining pancreatic reserve, delay pancreatic failure, and improve the quality of life of patients with this disease.

Pharmacological potential strengthening of drug therapy in treating patients with chronic pancreatitis by using therapeutic physical factors

Background. The steady increase in the incidence of chronic pancreatitis, its aggressive course in recent years, as well as the insufficient therapeutic effect of standard techniques determine the relevance of the search for new approaches to the treatment and medical rehabilitation of this category of patients.&#x0D; Aims. To improve rehabilitation treatment of patients with chronic pancreatitis (CP) at inpatient stage by strengthening pharmacological potential of drug therapy due to inclusion of therapeutic physical factors (TPF) in therapeutic programs.&#x0D; Materials and methods. 159 patients with acute CP were observed. By simple randomization, 4 groups were formed: the control group (MG; n=39) received standard drug therapy; 1st comparison group (GC1; n=38) additionally received TPF; (GC2, n=40) in addition to treatment in GC1 had drinking mineral water "Slavyanovskaya"; in main group (n=42) in addition to the treatment in GC2 got preformed peloidotherapy on the cervical-collar zone. All the patients underwent the evaluation of clinical score and quality of life before and after medical rehabilitation.&#x0D; Results. In MG, clinical symptomatology leveling was by 78.2% (р 0.01), in GC1 by 71.5% (р 0.01), GC2 by 62.3% (р 0.01), CG by 57.2% (р 0.01) on average immediately after the treatment, which was in a clear correlation with indicators of quality of life. In the long term (in 6 and 12 months), the advantage of combination therapy was noted with the same validity, the preservation of the achieved positive result was mostly noted in the MG: after 6 months the improvement in physical health compared to the initial values was noted by 34.4% (р 0.01), after 12 months by 24.0% (р 0.05); mental by 32.3% (р 0.01) and 22.5% (р 0.05), respectively. In both comparison groups, positive dynamics was 1012% lower, and in the control group, after 6 months, there was only a tendency to improve quality of life indicators.&#x0D; Conclusion. The inclusion of TPF in the programs of the inpatient stage of medical rehabilitation of patients with chronic pancreatitis by strengthening the pharmacological potential of drug therapy contributes to the leveling of clinical manifestations (abdominal pain, dyspepsia and diarrhea), the result of which is an improvement in the quality of life of this category of patients.

12382 Circadian Disruption in Pancreatic Cancer Carcinogenesis

ABSTRACT IMPACT: Circadian disruption is known to cause significant human pathology but has not been evaluated in pancreas cancer carcinogenesis; through understanding how disruption of circadian rhythms can lead to pancreas cancer development and spread, preventive and therapeutic strategies can be devised. OBJECTIVES/GOALS: Pancreatic ductal adenocarcinoma (PDAC) is a lethal cancer due to early spread and poor response to therapy. Identifying factors driving PDAC growth could lead to new therapeutic strategies. Thus, we evaluated the extent to which circadian rhythm disruption, a factor strongly associated with cancer formation, contributes to PDAC pathogenesis. METHODS/STUDY POPULATION: To achieve the objective, we evaluated mice with pancreas lineage Kras-mutation (KC mice), which are predisposed to develop the full spectrum of pancreas cancer precursor lesions (pancreatic intra-epithelial neoplasia or PANIN-1, 2, 3) and PDAC. We subjected KC mice to a light-dark phase shift protocol known to induce circadian disruption (KCCD, n = 18), and another group to standard lighting conditions (KCNC, n = 31), with equal numbers of males and females in each group. The mice were allowed access to food and water ad libitum until sacrifice at age 9 months. Histopathologic evaluation of the pancreas was then performed to assess for pancreatic inflammation, pancreatic precursor lesions (PANIN) and PDAC. Fisher’s Exact Test was used to evaluate differences in incidence. RESULTS/ANTICIPATED RESULTS: As expected, both groups of mice demonstrated 100% incidence of chronic pancreatitis and PANIN-1 (low-grade precursor lesion) at age 9 months. This is consistent with the KC phenotype. However, the KCCD mice demonstrated a significant increase in acute pancreatic inflammation (61.1% vs 19.4%, p = 0.005) compared to KCNC mice. Furthermore, intermediate grade precursor lesions (PANIN-2) were also significantly increase in the KCCD mice (38.9% vs 6.5%, p = 0.006). Incidence of high-grade precursor lesions (PANIN-3, or carcinoma in situ: 22.2% vs 9.7%) and PDAC (27% vs 19%) were also increased, but these were not statistically significant. These results are notable given the established progression from higher grade premalignant PANIN lesions (PANIN-2, PANIN-3) to PDAC. DISCUSSION/SIGNIFICANCE OF FINDINGS: Insight into how circadian disruption leads to increased PANIN-2 formation and increase in acute inflammation may be advantageous for understanding circadian disruption in PDAC carcinogenesis. The circadian clock is present in immune cells and disruption can induce immune dysregulation. This mechanism will be evaluated in follow up studies.

Значення васпіну у зовнішній та внутрішній секреторній діяльності підшлункової залози

To analyze the data of the scientific literature on the importance of vaspin as a pathogenetic link in the development of insufficiency of exocrine function of the pancreas in type 2 diabetes patients in combination with chronic pancreatitis and. Literary sources were searched in the scientometric databases Scopus and Web of Science, using the electronic search system Pubmed, mainly for the last 5 years. The search terms were: “type 2 diabetes”, “chronic pancreatitis”, “pancreas”, “exocrine function of the pancreas”, “obesity”, “vaspin”, “type 2 diabetes mellitus”, “pancreas », « obesity »,« vaspin ». An increase in the incidence of chronic pancreatitis and type 2 diabetes mellitus, as well as its severe complications, which are often associated with insulin resistance, hyperinsulinemia. Comorbid conditions can contribute to dysfunction of the pancreas. The existing relationships between vaspin level, insulin resistance, type 2 diabetes mellitus and chronic pancreatitis are not well understood. Many authors see the value and information content of vaspin as a biomarker for diagnosing these diseases and predicting treatment outcomes. The study of the effects and mechanisms of action of vaspin is the basis for determining new targets for the treatment of diabetes mellitus and chronic pancreatitis, both in isolated pathology and in combination.

On the peculiarities of nutrition of patients with chronic pancreatitis in remission

The review contains modern statistical data on the prevalence and incidence of chronic pancreatitis, the role of nutrition in the development of the chronic inflammatory process in the pancreas, the influence of nutritional culture on the formation of the disease. The pathophysiological changes occurring in the pancreas upon alcohol abuse are revealed. The components of food and beverages that can disrupt the metabolism of nutrients, activate specific enzymes, initiate lipid peroxidation processes and provoke an inflammatory process in the gland tissue are listed. The objective signs of chronic pancreatitis and the dominant clinical syndromes are described in detail. A brief historical excursion into the peculiarities of dietary nutrition in patients with chronic pancreatitis is presented, modern ideas on the rational nutrition of patients with chronic pancreatitis are described. Emphasis is made on the dietary habits of patients in remission; the importance of adaptation to adequate ration during the period of attenuation of exacerbation of chronic pancreatitis is underlined. The recommendations for the prevention of diabetes mellitus are set, nutritional measures that can improve the processes of absorption and digestion are listed. The feasibility of an individual approach to the development of an optimal diet, taking into account the peculiarities of the course of chronic pancreatitis, the patient’s condition, which helps prevent the progression of exo- and endocrine pancreatic insufficiency, is considered. The importance of diet in the rehabilitation of patients with chronic pancreatitis is discussed.

Endoscopic methods of internal drainage of pancreatic pseudocysts.

Background: A steady increase in the incidence of chronic pancreatitis and its complications has been registered over the decade. Application of EUS-guided drainage has improved the results of treatment of this group of patients. Methods: In the period from 2007 to December 2016, 263 patients were treated for chronic pancreatitis at Botkin Clinical hospital, 211 of which were operated in the HPB department of the hospital. All the patients underwent ultrasound examination, CT with oral and intravenous contrasting, MRCP, tumor marker analysis. In questionable tumor cases an EUS examination was conducted with fine needle biopsy. The patients’ age averaged 51 (20 to 70 years old), with 211 male (80.2%) and 52 female patients (19.8%). Internal EUS-guided drainage of pseudocysts was performed in 28 cases. The average size of the cysts was 55 ± 65 mm. In 18 cases (8.5%) a nitinol stenting was performed, in 10 cases (4.7%) – a double-pigtail stenting was performed. Stents were removed 4-6 weeks after the introduction depending on the control CT results. Results: The clinical effect was obtained in 100% of the cases. Complications were diagnosed in 2 patients who had plastic stents (cyst recurrence, abscess) and in one patient with a nitinol stent (stent dislocation). No cases of mortality were registered. Conclusion: The employment of EUS-guided drainage of the pancreatic pseudocysts can improve treatment results and helps avoid major surgical procedures in such cases.

Endoscopic methods of internal drainage of pancreatic pseudocysts.

Background: A steady increase in the incidence of chronic pancreatitis and its complications has been registered over the decade. Application of EUS-guided drainage has improved the results of treatment of this group of patients. Methods: In the period from 2007 to December 2016, 263 patients were treated for chronic pancreatitis at Botkin Clinical hospital, 211 of which were operated in the HPB department of the hospital. All the patients underwent ultrasound examination, CT with oral and intravenous contrasting, MRCP, tumor marker analysis. In questionable tumor cases an EUS examination was conducted with fine needle biopsy. The patients’ age averaged 51 (20 to 70 years old), with 211 male (80.2%) and 52 female patients (19.8%). Internal EUS-guided drainage of pseudocysts was performed in 28 cases. The average size of the cysts was 55 ± 65 mm. In 18 cases (8.5%) a nitinol stenting was performed, in 10 cases (4.7%) – a double-pigtail stenting was performed. Stents were removed 4-6 weeks after the introduction depending on the control CT results. Results: The clinical effect was obtained in 100% of the cases. Complications were diagnosed in 2 patients who had plastic stents (cyst recurrence, abscess) and in one patient with a nitinol stent (stent dislocation). No cases of mortality were registered. Conclusion: The employment of EUS-guided drainage of the pancreatic pseudocysts can improve treatment results and helps avoid major surgical procedures in such cases.

Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer: From Concept to Reality.

Research progress in diseases of the exocrine pancreas [chronic pancreatitis (CP), pancreatogenic diabetes mellitus, and pancreatic cancer] has been hampered by the disorders' heterogeneity, the limitations of previous small cross-sectional studies, the inability to safely obtain pancreatic tissue for study, and the lack of structured epidemiology tools, genetic testing, and biomarker development. Mechanism-based research of these diseases has suffered from the lack of systematically collected clinical measures in longitudinal cohort studies linked with biospecimens. Given the increasing incidence and prevalence of CP and its association to the development of pancreatic cancer, its complications, high mortality rate, and associated health care cost, the National Institute for Diabetes and Digestive and Kidney Diseases and the National Cancer Institute funded the Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer to identify research gaps and foster multidisciplinary collaborations to better diagnose, characterize, and manage CP and its sequelae. The CPDPC structure, governance, and research objectives are described in this article. Studies undertaken by the CPDPC are described in other articles in this journal's issue.

Nationwide Trends in Acute and Chronic Pancreatitis Among Privately Insured Children and Non-Elderly Adults in the United States, 2007–2014

Epidemiologic analyses of acute pancreatitis (AP) and chronic pancreatitis (CP) provide insight into causes and strategies for prevention and affect allocation of resources to its study and treatment. We sought to determine current and accurate incidences of AP and CP, along withtheprevalence of CP, in children and adults in the United States. We collected data from the Truven MarketScan Research Databases of commercial inpatient and outpatient insurance claims in the United States from 2007 through 2014 (patients 0-64 years old). We calculated the incidences of AP and CP and prevalence of CP based on International Classification of Diseases, 9th Revision diagnosis codes. Children were defined as 18 years or younger and adults as 19 to 64 years old. The incidence of pediatric AP was stable from 2007 through 2014, remaining at 12.3/100,000 persons in 2014. Meanwhile, the incidence for adult AP decreased from 123.7/100,000 persons in 2007 to 111.2/100,000 persons in 2014. The incidence of CP decreased over time in children (2.2/100,000 persons in 2007 to 1.9/100,000 persons in 2014) and adults (31.7/100,000 persons in 2007 to 24.7/100,000 persons in 2014). The prevalences of pediatric and adult CP were 5.8/100,000 persons and 91.9/100,000 persons, respectively, in 2014. Incidences of AP and CP increased with age. We found little change in incidence during the first decade of life but linear increases starting in the second decade. We performed a comprehensive epidemiologic analysis of privately insured, non-elderly adults and children with AP and CP in the United States. Changes in gallstone formation, smoking, and alcohol consumption, along with advances in pancreatitis management, may be responsible for the stabilization and even decrease in the incidences of AP and CP.

Laparoscopic Lateral Pancreaticojejunostomy—the Technique and Early Experience

Laparoscopic lateral pancreaticojejunostomy (LLPJ) in patients with chronic pancreatitis is scarcely reported. This study aimed to describe a technique of LLPJ and to report an early experience. The described technique of LLPJ was used in 24 patients with chronic pancreatitis (CP) starting from January 2012 to April 2017. Clinical characteristics, technical success and post-operative outcome were analysed. Out of 24 patients, 13 patients (54%) were male and mean age was 30.9 years. Incidence of tropical CP was 87.5% and of alcoholic CP was 12.5%. Incidence of exocrine and endocrine deficiency was 25 and 16.6%, respectively. Median diameter of pancreatic duct (PD) was 10 mm (range, 7–20 mm). Conversion rate was 29.2% and reasons for conversion were technical difficulty in intra-corporeal suturing, failure to localise PD and bulky head requiring Frey’s procedure. In addition to LLPJ, four patients required other procedures like pseudocyst drainage, choledochal cyst excision and hepaticojejunostomy. Intra-operative and post-operative complications occurred in 4.2 and 8.4% patients, respectively. Overall outcome was excellent in 70.8%, good in 25% and fair in 4.2%. Mean follow-up was 26 months and during that period one patient (4.2%) died due to myocardial infarction. The described technique of laparoscopic lateral pancreaticojejunostomy is safe and feasible in selected group of patients with chronic pancreatitis.

Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies

There is a lack of robust estimates of the worldwide incidence and mortality of acute pancreatitis, chronic pancreatitis, pancreatic cysts, and pancreatic cancer in the general population. Our aim was to quantitate and compare the incidence and mortality of major pancreatic diseases in high-quality population-based cohort studies. Three databases (PubMed, Embase, and Scopus) were searched independently by two reviewers. Data from eligible studies were subject to meta-analysis to obtain global estimates. A number of prespecified subgroup analyses and meta-regression analyses were also done. 48 population-based cohort studies (35 on pancreatic cancer, ten on acute pancreatitis, three on chronic pancreatitis, and none on pancreatic cysts) were identified, with a total study population of 296 million individuals and 119 000 patients with pancreatic diseases. Global estimates of incidence and mortality were 8·14 cases (95% CI 6·63-9·98) per 100 000 person-years and 6·92 deaths (95% CI 3·72-12·89) per 100 000 person-years for pancreatic cancer, 33·74 cases (95% CI 23·33-48·81) per 100 000 person-years and 1·60 deaths (95% CI 0·85-1·58) per 100 000 person-years for acute pancreatitis, and 9·62 cases (95% CI 7·86-11·78) per 100 000 person-years and 0·09 deaths (95% CI 0·02-0·47) per 100 000 person-years for chronic pancreatitis. Subgroup analysis based on the WHO regions showed that the incidences of both pancreatic cancer and acute pancreatitis, and mortality from pancreatic cancer, were significantly higher in the American region than in the European and Western Pacific regions, while the incidence of chronic pancreatitis was significantly higher in the European region than in the American region. Mortality from pancreatic cancer was lowest in the Southeast Asian region. The incidence of chronic pancreatitis was twice as high in men as in women, although there was no difference between sexes for pancreatic cancer or acute pancreatitis. Globally, acute pancreatitis is the most common pancreatic disease whilst pancreatic cancer is the most lethal. However, their burden is not equal across the globe. The epidemiological estimates reported in this study could inform future high-quality studies. None.

The Risk of Chronic Pancreatitis in Patients with Psoriasis: A Population-Based Cohort Study

BackgroundPsoriasis is a chronic systemic inflammatory disorder, and studies have revealed its association with a variety of comorbidities. However, the risk of chronic pancreatitis (CP) in psoriasis has not been studied. This study aimed to investigate the risk of CP among patients with psoriasis.MethodsUsing the Taiwan National Health Insurance Research Database, this population-based cohort study enrolled 48430 patients with psoriasis and 193720 subjects without psoriasis. Stratified Cox proportional hazards models were used to compare the risks of CP between the patients with and without psoriasis.ResultsThe incidence of CP was 0.61 per 1000 person-years in patients with psoriasis and 0.34 per 1000 person-years in controls during a mean 6.6-year follow-up period. Before adjustment, patients with psoriasis had a significantly higher risk of CP (crude hazard ratio (HR) = 1.81; 95% confidence interval (CI) = 1.53–2.15), and the risk remained significantly higher after adjustments for gender, age group, medications, and comorbidities (adjusted HR (aHR) = 1.76; 95% CI = 1.47–2.10). All psoriasis patient subgroups other than those with arthritis, including those with mild and severe psoriasis and those without arthritis, had significantly increased aHRs for CP, and the risk increased with increasing psoriasis severity. Psoriasis patients taking nonsteroidal anti-inflammatory drugs (aHR = 0.33; 95% CI = 0.22–0.49) and methotrexate (aHR = 0.28; 95% CI = 0.12–0.64) had a lower risk of developing CP after adjustments.ConclusionsPsoriasis is associated with a significantly increased risk of CP. The results of our study call for more research to provide additional insight into the relationship between psoriasis and CP.