Serum Lipase Levels Research Articles

Resveratrol Suppresses Severe Acute Pancreatitis-Induced Microcirculation Disturbance through Targeting SIRT1-FOXO1 Axis.

Background Resveratrol (RSV), one of the SIRT1 agonists, has the ability of alleviating severe acute pancreatitis (SAP); however, the concrete protective mechanism remains unknown. It is noteworthy that microcirculation disturbance plays a vital role in SAP, and the SIRT1/FOX1 axis can regulate microcirculation. Therefore, this study is aimed at ascertaining what is the underlying mechanism of the protective effect of RSV on SAP, and whether it is associated with alleviating microcirculation disturbance by regulating the SIRT1/FOX1 axis. Method The model of SAP was induced by retrograde injection of sodium taurodeoxycholate into the bile duct of the rats. The pancreatic wet/dry weight, ET/NO, and TXB2/6-keto-PGF1α ratios; microcirculatory function; and SIRT1 activity were examined. ELISA was used to examine the serum level of lipase, amylase, hemorheology, ET, NO, TXB2, and 6-keto-PGF1α and the content of SIRT1, VEGF, Ang I, and Ang II in the pancreas. RT-PCR was used to examine the mRNA level of VEGF, Ang I, and Ang II. Western blotting was used to detect SIRT1, FOXO1, and acetyl-FOXO1. Immunoprecipitation was used to examine the interaction of SIRT1 and FOXO1. Results Resveratrol can significantly decrease the expression of lipase, amylase, acetyl-FOXO1, VEGF, Ang II, ET, NO, TXB2, and 6-keto-PGF1α and the ratio of wet/dry weight, ET/NO, and TXB2/6-keto-PGF1α by improving microcirculatory dysfunction and blood viscosity in SAP. Moreover, resveratrol can also promote the interaction of SIRT1 and FOXO1 and increase SIRT1 activity and the expression of SIRT1 and Ang I. The SIRT1 inhibitor, Sirtinol (EX527), obliviously reversed the effects of RSV on SAP. Conclusion Resveratrol can protect rats against SAP, and its protective mechanism is associated with suppressing microcirculation disturbance through activating SIRT1-FOXO1 axis.

A Rare Case: Gall Stone Induced Acute Pancreatitis with Normal Amylase and Lipase Levels

Acute pancreatitis (AP) is most commonly diagnosed by increased values of serum amylase and lipase. Acute pancreatitis where value of serum amylase and lipase is normal is very rare. This is a case of gall stone induced AP where levels of serum amylase and lipase are normal but the clinical suspicion and imaging are strongly confirming pancreatitis.

Incidence of Polycythaemia in Pancreatitis Patients

Acute pancreatitis is the inflammation of the pancreas due to reversible parenchymal injury. It is clinically diagnosed by a characteristic abdominal pain and laboratory findings of elevated levels of serum amylase and serum lipase. In addition to this, due to the movement of the intravascular fluid into the abdominal cavity, polycythaemia has been observed in a few such patients, which can potentially predispose to thromboembolic complications such as deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), thereby posing a life-threatening risk to the patient. A study was conducted in the Department of General Surgery at Saveetha Medical College and Hospital to assess the incidence of polycythaemia in patients clinically diagnosed with acute pancreatitis by retrospectively analysing the haematology reports of 50 patients. It was found that 5 out of 50 patients (10%) had a finding of polycythaemia in their haematology reports. The identification of polycythaemia in pancreatitis patients will help the clinician with the management protocol to prevent the occurrence of thromboembolic events.

Insight into the exocrine pancreatic function (serum amylase and lipase) in type 2 diabetes mellitus

Introduction: Insulin has its effect on the basal and stimulatory secretion of exocrine pancreatic enzymes. In this context this study has been done to understand the relationship between the exocrine and endocrine entities of pancreas by analyzing two most commonly estimated exocrine enzymes; serum amylase and serum lipase in type 2 DM. Materials and Methods: The study was conducted at Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka from January 2012 to December 2012. Hundred clinically diagnosed cases of type 2 diabetes mellitus {Fifty well controlled (HbA1c < 7> Results: Serum amylase and serum lipase levels were within the reference range in all the three study groups. There was no significant difference in serum amylase among well controlled and poorly controlled type 2 DM. In contrast, significant difference in serum amylase levels was observed between diabetic group and controls (p Conclusion: The potential underlying connection between exocrine and endocrine function of pancreas in patients with type 2 DM needs further investigation with larger population; to consider the analysis of serum pancreatic enzymes especially serum lipase levels as an additional informative parameter to assess the glycemic control in type 2 DM. Keywords: Type 2 DM, Serum amylase, Serum lipase.

Systemic lupus erythematosus-related acute pancreatitis.

Systemic lupus erythematosus (SLE) is a complex autoimmune pathology that can involve any organ. Lupus-related acute pancreatitis (AP) is, together with lupus mesenteric vasculitis, an important cause of SLE-induced acute abdominal pain. A literature search was conducted using the terms "Pancreatitis" and "Lupus Erythematosus, Systemic" on PubMed/Medline and Web of Science from January 2007 to January 2020. Clinical characteristics, diagnostic approach, and treatment principles in SLE-related AP are presented in this review. Mainly retrospective reports were identified. The reported incidence of SLE-associated AP ranges from 0.9 to more than 5% of patients. A total of 264 SLE patients were found in the selected research, with a net female predominance (sex ratio 9:1) and mean age of 31.4 years. Abdominal pain was virtually present in all cases. AP occurrence was more frequent in SLE patients with short disease duration, high activity scores, and multiorgan involvement. The AP definition was based on currently available guidelines and after exclusion of any other known causes (including iatrogenic, i.e. drugs), a diagnosis of "idiopathic" SLE-related AP might be sustained. Management is difficult, as there is no standardized therapeutic approach. Of note, glucocorticoid use remains still controversial as, especially for high doses, subsequent pancreatic injury may occur. Monitoring serum lipase levels after high dose steroids might be considered. One study reported beneficial prognostic effect of plasma exchange. Moreover, AP in SLE might raise awareness about macrophage activation syndrome association. Mortality up to one third of AP cases in SLE was reported. The SLE-related AP is a rare, but severe, life-threatening complication. Corticosteroids must be used with caution. Plasma exchange could be considered in selected cases.

Effect of somatostatin combined with magnesium sulfate in treatment of severe acute pancreatitis

Objective To explore the efficacy of somatostatin combined with magnesium sulfate in the treatment of patients with severe acute pancreatitis(SAP)and its effects on the levels of serum amylase(AMS), serum lipase(LPS)and inflammatory factors. Methods A total of 76 SAP patients were randomly divided into control group(n=38, treated with somatostatin)and observation group(n=38, treated with somatostatin and magnesium sulfate). The therapeutic effect and complications were compared between the two groups, and the levels of serum AMS, LPS and inflammatory factors before and after treatment were compared between the two groups. Results The total effective rate in the observation group was 94.74%, which was significantly higher than 78.95% in the control group(P<0.05). The levels of LPS and AMS after treatment in the observation group were significantly lower than those in the control group(P<0.05). The C-reactive protein(CRP), tumor necrosis factor-α(TNF-α)and interlenkin-6(IL-6)levels after treatment in the observation group were significantly lower than those in the control group(P<0.05). The incidence of complications in the observation group was 5.26%, which was significantly lower than 21.05% in the control group(P<0.05). Conclusion Somatostatin combined with magnesium sulfate is effective in the treatment of SAP patients, which can improve the levels of serum AMS and LPS, reduce the levels of inflammatory factors, and alleviate pancreatic injury.

Soy-tomato enriched diet reduces inflammation and disease severity in a pre-clinical model of chronic pancreatitis

Chronic pancreatitis (CP) is a fibro-inflammatory syndrome in individuals who develop persistent pathological responses to parenchymal injury or stress. Novel therapeutic or dietary interventions that could lessen inflammation in this disease could significantly improve quality of life in patients with CP. Complex dietary foods like soy and tomatoes are composed of active metabolites with anti-inflammatory effects. Data from our group reports that bioactive agents in soy and tomatoes can reduce pro-inflammatory cytokines and suppressive immune populations. Additionally, our team has developed a novel soy-tomato juice currently being studied in healthy individuals with no toxicities, and good compliance and bioavailability. Thus, we hypothesize that administration of a soy-tomato enriched diet can reduce inflammation and severity of CP. C57BL/6 mice were injected intraperitoneally with 50 μg/kg caeurlein (7 hourly injections, twice weekly) for 6 weeks to induce CP. After 4 weeks of caerulein injections, mice were administered a control or a soy-tomato enriched diet for 2 weeks. Disease severity was measured via immunohistochemical analysis of pancreata measuring loss of acini, fibrosis, inflammation, and necrosis. Serum lipase and amylase levels were analyzed at the end of the study. Inflammatory factors in the serum and pancreas, and immune populations in the spleen of mice were analyzed by cytokine multiplex detection, qRT-PCR, and flow cytometry respectively. Infra-red (IR) sensing of mice was used to monitor spontaneous activity and distress of mice. Mice fed a soy-tomato enriched diet had a significantly reduced level of inflammation and severity of CP (p = 0.032) compared to mice administered a control diet with restored serum lipase and amylase levels (p < 0.05). Mice with CP fed a soy-tomato diet had a reduction in inflammatory factors (TNF-α, IL-1β, IL-5) and suppressive immune populations (myeloid-derived suppressor cells; MDSC) compared to control diet fed mice (p < 0.05). Infra-red sensing to monitor spontaneous activity of mice showed that soy-tomato enriched diet improved total activity and overall health of mice with CP (p = 0.055) and CP mice on a control diet were determined to spend more time at rest (p = 0.053). These pre-clinical results indicate that a soy-tomato enriched diet may be a novel treatment approach to reduce inflammation and pain in patients with CP.

Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis by Endoscopic Pancreatic Stenting after Insertion of Self-Expandable Metal Stent for Malignant Distal Biliary Stricture

The insertion of a self-expandable metal stent (SEMS) for nonpancreatic cancer is a factor predicting the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We evaluated the efficacy of endo-scopic pancreatic stenting (EPS) to prevent PEP after SEMS insertion in patients with malignant distal biliary stricture and without main pancreatic duct (MPD) obstruction. We performed a single-center, retrospective, historically controlled investigation to assess the outcomes of 33 consecutive patients who underwent SEMS insertion. From March 2013 to June 2015, 13 patients did not undergo EPS (Non-EPS group). The other 20 patients underwent EPS (EPS group) between July 2015 and August 2018. The background data demonstrated no significant differences. Except for one patient in the Non-EPS group, all patients underwent biliary sphinc-terotomy. The EPS group's PEP incidence was significantly lower (n = 1, 5%) than that of the Non-EPS group (n = 4, 31%) (p = 0.04). The median serum amylase and lipase levels after the procedure were significantly lower in the EPS group than in the Non-EPS group (amylase: 104 vs. 262 U/L; p < 0.01, lipase: 102 vs. 666 U/L; p = 0.01). The use of EPS decreased the incidence of PEP after SEMS insertion in individuals with malignant distal biliary stricture and without MPD obstruction.

Saikosaponin A-Induced Gut Microbiota Changes Attenuate Severe Acute Pancreatitis through the Activation of Keap1/Nrf2-ARE Antioxidant Signaling.

Objective Severe acute pancreatitis (SAP) is a serious and life-threatening disease associated with multiple organ failure and a high mortality rate and is accompanied by distinct oxidative stress and inflammatory responses. Saikosaponin A has strong antioxidant properties and can affect the composition of gut microbiota. We sought to determine the effects of Saikosaponin A interventions on SAP by investigating the changes of gut microbiota and related antioxidant signaling. Methods A SAP model was established in Sprague-Dawley (SD) rats through the injection of sodium taurocholate into the biliopancreatic duct and confirmed by elevated levels of serum lipase and amylase. The model was fed a standard diet either with saline solution or with Saikosaponin A. Fecal microbiota transplantation (FMT) from Saikosaponin A-induced rats into the rat model was performed to test the effects of gut microbiota. The composition of gut microbiota was analyzed by using 16S rRNA gene sequencing. We measured apoptotic status, inflammatory biomarkers, and Keap1-Nrf2-ARE ((Kelch-like ECH-associated protein 1) nuclear factor erythroid 2-related factor 2-antioxidant response element) antioxidant signaling. Results Saikosaponin A intervention attenuated SAP lesions and reduced the levels of serum amylase and lipase, oxidative stress, and inflammatory responses by reducing pathological scores and affecting the serum level of oxidative and inflammatory factors. Meanwhile, the expression of Keap1-Nrf2-ARE was increased. Saikosaponin A intervention improved microbiota composition by increasing the relative abundance of Lactobacillus and Prevotella species. FMT resulted in similar results as those caused by the Saikosaponin A intervention, suggesting Saikosaponin A may exert its function via the improvement of gut microbiota composition. Conclusions Saikosaponin A-induced gut microbiota changes attenuate SAP progression in the rat model and may be a potential natural drug for adjuvant treatment of SAP. Further work is needed to clear up the points.

Astaxanthin alleviates oxidative damage in acute pancreatitis via direct antioxidant mechanisms.

Astaxanthin (ATX) is a naturally occurring carotenoid and a potent antioxidant. Various anti-inflammatory effects of ATX have been examined. We aimed to investigate the protective effect of ATX and its mechanism in a cerulein-induced acute pancreatitis rat model. The rats were randomized into 2 main groups as control (C) and acute pancreatitis group (AP). AP group was subsequently divided into subgroups as AP+vehicle (AP), AP+ATX, and ATX+peroxisome proliferator-activated receptor-alpha antagonist GW6471 (ATX+GW) groups. To induce AP, the rats were administered cerulein (50 µg/kg, intraperitonally [ip]) at 1 hour intervals, whereas the C group received saline. The AP group was treated with vehicle olive oil, ATX 40 mg/kg/orally, or GW6471 and ATX (GW1 mg/kg/ip; ATX; 40 mg/kg/peroral). Treatments were administered after the 1st cerulein injection. At the 7th hour after the final injection, the rats were killed and the pancreatic tissue was used for the determination of malondialdehyde (MDA), glutathione (GSH), and myeloperoxidase (MPO) activities and luminol-lucigenin chemiluminescence levels. Serum amylase, lipase, and histopathological analyses were performed. Elevated serum lipase and amylase levels in the vehicle-treated AP group (p<0.01) decreased in the ATX and ATX+GW groups (p<0.05). In the AP groups, GSH was reduced and MDA, MPO, luminol, and lucigenin levels were increased (p<0.05-0.001). ATX reversed these changes (p<0.05-0.001). The vehicle-treated group revealed significant severe cytoplasmic degeneration and vacuolization, whereas ATX ameliorated these destructions. GW6471 did not abolish the positive effects of ATX biochemically or histologically. ATX has a potent protective effect on AP via its radical scavenging and antioxidant properties. Therefore, we believe that ATX may have therapeutic potential.

Hyperlipasemia and Potential Pancreatic Injury Patterns in COVID-19: A Marker of Severity or Innocent Bystander?

Hyperlipasemia and Potential Pancreatic Injury Patterns in COVID-19: A Marker of Severity or Innocent Bystander?

RETRACTED: Peg-Asparaginase-Associated Pancreatitis in Chemotherapy-Treated Pediatric Patients: A 5-Year Retrospective Study

BackgroundAsparaginase-associated pancreatitis (AAP) is one of the most common complications occurring in patients with asparaginase-treated acute lymphoblastic leukemia (ALL). Peg-asparaginase (peg-asp), a chemically recombined asparaginase with lower hyposensitivity and better patient tolerance, is now approved as the first line asparaginase formulation in ALL chemotherapy regimens. Due to the differences in pharmacokinetic characteristics and administration procedure between l-asp and peg-asp, this study aimed to investigate the clinical manifestations of peg-asp-associated pancreatitis.MethodPatients with peg-asp-associated pancreatitis diagnosed within a 5-year period (July 2014 to July 2019) were identified and retrospectively studied. The clinical manifestations, laboratory findings, and imaging results of patients with AAP were analyzed. AAP patients were further classified into mild/moderate and severe groups based on criteria used in previous studies. Clinical outcomes were compared between groups.ResultsA total of 38 patients were enrolled in this study. The underlying disease included ALL (n=35) and lymphoma (n=3). The majority of patients developed AAP during the first phase, called remission induction (n=26, 68.4%), after a median of 2 peg-asp doses (range: 1–11). The DVLP regimen (n=23) is the most common peg-asp regimen used in AAP patients. Abdominal pain occurred after a median of 14.5 days (range: 1–50) from the last peg-asp administration, accompanied by abdominal distension (n=14), nausea (n=17), vomiting (n=21), and fever (n=19). Serum amylase elevation was reported in all AAP patients, of whom 65.8% (n=25) exhibited an elevation in the level of this enzyme three times the upper normal level, fulfilling the Atlanta criteria. The level of serum lipase (median days of elevation=23 days, range: 4–75) was significantly elevated compared with that of serum amylase (median days of elevation=9 days, range: 2–71) and persisted at a markedly high level after the level of serum amylase returned to normal. Common local complications included abdominal ascites (n=10) and peripancreatic fluid collection (n=8). Approximately 42.1% (n=16) of patients with severe AAP experienced systemic complications (septic shock or hypovolemic shock) or severe local complications (pseudocyst), among whom 5 failed to recover. Approximately 84.8% (n=28/33) of the remaining patients resumed chemotherapy; among them, peg-asp formulation in 30.3% (n=10/33) of these patients was adjusted, while asparaginase treatment in 39.4% (n=13/33) was permanently discontinued. Five patients experienced an AAP relapse in later stages of asparaginase treatment. Comparison between mild/moderate and severe AAP patients showed a statistically significant difference in the number of pediatric intensive care unit stays (p=0.047), survival rate (p=0.009), AAP prognosis (p=0.047), and impacts on chemotherapy (p=0.024), revealing a better clinical outcome in mild/moderate AAP patients.ConclusionEarly recognition and management of AAP is essential in reversing the severity of AAP. The existing AAP criteria had a low strength in determining the severity of pediatric AAP. A well-defined AAP definition could help distinguish patients with high anticipated risk for redeveloping AAP and ALL relapse, in order to prevent unnecessary withdrawal of asparaginase. Our study could serve as a basis for conducting future large cohort studies and for establishing an accurate definition of pediatric AAP.

Fatal case of pancreatic panniculitis caused by occult neuroendocrine tumor in the corresponding organ: A case report and review of the published work

Pancreatic panniculitis (PP) is a rare clinical variant of subcutaneous fat necrosis, developing in patients with a variety of pancreatic diseases such as acute or chronic pancreatitis, tumors and cysts. The tumor-associated PP represents a noteworthy skin manifestation of underlying internal malignancies, also known as dermadrome. Among causative pancreatic tumors, acinar cell carcinoma is the most frequent malignancy; however, little is known about how the origin of tumor cells and progression stage of pancreatic tumors potentially contribute to the establishment of panniculitis. Here, we present a 69-year-old Japanese male case of clinically aggressive PP on the bilateral legs, whose skin lesions developed prior to the diagnosis of occult pancreatic tumor and liver metastasis. Moreover, the immunopathology of the pancreatic lesion revealed neuroendocrine tumor (NET), a rare pathological variant. Skin lesions immediately spread to the upper limbs with extensive ulcerations and necrosis, accompanied by high levels of serum lipase and elastase, but not with other pancreatic enzymes. He died 2months after the initial development of the skin lesion due to rapid deterioration of general condition. We reviewed 14 cases, including ours, of PP with NET in the pancreas thus far reported, to identify the clinicopathological characteristics regarding to what extent this rare complication could reflect the clinical course of pancreatic tumors and overall prognosis. Our published work review found that the disease has a significant male predominance (male:female, 13:1) and cases with occult pancreatic tumors died within 4months after the development of their skin lesions. Our case was the poorest prognostic outcome. This report emphasizes that dermatologists should recognize PP with NET, reflecting a fatal prognosis, and to make a prompt diagnosis.

Punicalagin Improved the Oxidant-antioxidant Status in Male New Zealand White Rabbits

Background: Although punicalaginis known for its strong antioxidant properties, the current literature lacks knowledge about the direct oral consumption of punicalagin in rabbits. Therefore, the present study evaluated the potential effects of this powerful antioxidant in male rabbits. Methods: The rabbits (n=24) were randomly divided into 4 treatment groups; controls (tap water) and 3 different doses of punicalagin in tap water (1, 2 and 10 mg/kg punicalagin). At the end of the experiment (9 wk), blood samples were taken and rabbits were sacrificed. The liver and kidney tissues were collected for oxidant and antioxidant parameters. Result: Punicalagin did not cause any clinical symptoms. Body weights and feed intakes were not affected by punicalagin treatments. Similarly, the hematological parameters such as red blood cells, hemoglobin, hematocrit, white blood cells and platelets did not differ among the treatments. Serum glucose, urea, creatinine, amylase, lipase, cholesterol, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase levels were within the physiological ranges. Two highest doses used in the experiment decreased malondialdehyde levels and positively affected superoxide dismutase and catalase enzyme activities (P less than 0.05). Therefore, the current study suggests a lack of harmful effects and promising antioxidant capacity of punicalagin in male New Zealand rabbits up to 10 mg/kg/day dose levels.

Hyperemesis Gravidarum-Induced Acute Tubular Necrosis: A Case with More Than Fivefold Rise in Serum Lipase Level Above the Upper Limit of Normal

Hyperemesis Gravidarum-Induced Acute Tubular Necrosis: A Case with More Than Fivefold Rise in Serum Lipase Level Above the Upper Limit of Normal

THROMBOTIC MICROANGIOPATHY: A RARE SEQUELAE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Thrombotic microangiopathy (TMA) is characterized by many etiologies, however it is not often described as a complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). Failure to identify the relationship between TMA and ERCP may result in delay of diagnosis and poor patient outcomes. We present a case of a young healthy female who developed TMA after ERCP. CASE PRESENTATION: A 26-year-old woman presented to the hospital with complaints of abdominal pain, nausea and vomiting. An abdominal CT scan showed cholelithiasis and choledocholithiasis and the patient was scheduled for ERCP. She tolerated the procedure well with no immediate complications. However, a day after procedure, labs showed elevated serum lipase and amylase levels with renewed abdominal pain. Two days after ERCP she developed fever, severe thrombocytopenia, anemia and acute kidney injury (AKI) evidenced by elevated serum creatinine. A preliminary diagnosis of thrombotic thrombocytopenic purpura (TMA) was considered. Plasma exchange therapy with platelet transfusion and high dose steroids was initiated. She also received multiple packed red cell transfusion for severe anemia. ADAMTS13 antibody testing returned low at 53% with negative anti-ADAMTS13 IgG. After 7 daily sessions of plasma exchange platelets improved, AKI and anemia resolved, and the patient was discharged from the hospital. DISCUSSION: Literature review shows only about 4 cases of ERCP induced TMA. A well-known complication of ERCP is pancreatitis and a rare unfortunate sequela of this is TMA. There is a known correlation between TMA and pancreatitis, though the mechanism by which this occurs is still not well understood. Endothelial damage, cytokine release and platelet activation are thought to be the pathophysiological links between these two conditions (1). Cytokines cause release of ultra-large von-Willebrand factor (VWf) molecules that attach to activated platelets promoting aggregation, clumping and thrombus formation. There is concomitant reduction in serum ADAMTS13, which would normally cleave the ultra-large VWf, due to pancreatic enzyme degradation. CONCLUSIONS: This case illustrates how complicated the diagnosis of TMA can be, but also points out how clinical judgment is imperative to prompt early treatment and increase favorable outcomes. TMA caused by ERCP is rare, but recognizing this link is important for immediate initiation of life saving treatment. Reference #1: 1. Malik, F., Ali, N., Ahsan, I., Ghani, A. R., & Fidler, C. (2016). Eculizumab refractory thrombotic thrombocytopenic purpura secondary to post-endoscopic retrograde cholangiopancreatography pancreatitis in a patient. Journal of community hospital internal medicine perspectives, 6(6), 32310. DISCLOSURES: No relevant relationships by Kitson Deane, source=Web Response No relevant relationships by Abidemi Idowu, source=Web Response

S1476 COVID-19-Associated Atypical Acute Pancreatitis!!

INTRODUCTION: The clinical presentation of pancreatitis in the course of novel coronavirus infection (COVID-19) is not well understood. The etiology may be a direct cytopathic effect mediated by local SARS-CoV-2 replication versus an injury caused by the cytokine release induced by the infection. We present 2 cases of COVID-19-associated pancreatitis. Both had severe multi-organ failure requiring ventilator and dialysis support. CASE DESCRIPTION/METHODS: Case 1: 57 year old man with diabetes mellitus type 2 and hypertension presented with a PCR-confirmed COVID-19 infection. Leukocytes were 14.6 K/uL and C-reactive protein was 89⋅7 g/L, AST was 98 IU/L, ALT was135 IU/L, and INR was 1⋅3. Serum amylase and lipase levels were 398 IU/L and 2726 IU/L, respectively. Triglyceride level was179 mg/dL. He had no alcohol use and viral hepatitis panel and urine drug scree were all negative. After extubation, he ate well with minimal symptoms despite lipase levels peaking at 3,369 IU/L on day 11 and declined only to peak again on day 20 to 4,620 IU/L. C-reactive protein remained under 10 g/L during the first peak and began to climb only with the second peak. He was discharged on day 23 with lipase declining to 2,856 IU/L while asymptomatic and off dialysis. Case 2: 70 year old man was admitted with PCR confirmed COVID19 systemic infection requiring mechanical ventilation. Two weeks after extubation, he developed mild abdominal pain and anorexia that promptly resolved but his lipase level was found to be 1,874 IU/L. This continued to fluctuate mildly down to 1,247 IU/L over 10 days despite lack of symptoms. DISCUSSION: Viral pancreatitis has been reported with Coxsackie virus, CMV, HIV, HSV, mumps, VZV, among others. We describe pancreatitis associated with COVID-19 that may be related to direct viral invasion. Both persons had conspicuously absent symptoms despite substantial elevations of lipase levels. In both, the amylase paralleled the lipase levels trending while but there was no correlation between these enzyme levels and those of C-reactive protein making cytokine release less probable as an etiology.

S3077 Acute Pancreatitis Without Early Imaging Changes Has Similar Outcomes to Those With Early Changes

INTRODUCTION: Increased use of abdominal computed tomography (CT) in the emergency department (ED) has led to a diagnostic dilemma where patients present with abdominal pain and lipase levels three times the upper limit of normal (ULN) while abdominal imaging may not support a diagnosis of acute pancreatitis (AP). This study seeks to determine whether early imaging findings are associated with change in clinical outcomes in AP patients. METHODS: The study is a single-center, retrospective cohort study with patients from 1/1/2016 to 12/31/2018 presenting to the ED and tested for serum lipase levels (N = 1464). Those with serum lipase of three times ULN (N = 209) and with CT imaging of the abdomen and pelvis with contrast performed in the ED were included in the cohort (N = 93). All charts were reviewed for repeat CT imaging, magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) during admission, bedside index for severity in AP (BISAP) score criteria, intensive care unit (ICU) admission, hospital length of stay (LOS), in-hospital mortality and hospital disposition. Outcome measurements consisted of RR of death, ICU admission, BISAP score >=2, BISAP >=3, inpatient ERCP and median length of hospital stay for patients with CT changes suggesting AP at ED presentation versus those patients with CT not notable for changes of AP. RESULTS: CT findings consistent with AP were associated with a RR for ICU admission of 1.47 [CI: 0.41-5.33, P = 0.55] , RR of 3.79 [CI:0.48-30.20, P = 0.21] for repeat inpatient CT imaging, RR of 0.95 [CI:0.48-2.33, P = 0.89] for MRCP, RR of 1.05 [CI:0.42-2.65, P = 0.91] for ERCP, RR of 0.32 [CI:0.03-3.36, P = 0.34] for death, RR of 0.63 [CI:0.09-4.29, P = 0.64] for non-home disposition, RR of 0.32 [CI:0.03-3.35, P = 0.34] for BISAP >=3, RR of 1.26 [CI:0.52-3.07, P = 0.61) for BISAP >=2. Difference in mean LOS for CT positive AP was 1.73 [CI:0.21-3.67, P = 0.08] 4.7 days versus 2.97 days in CT negative AP. CONCLUSION: Ninety-three out of 209 (44%) patients with lipase levels three times the ULN underwent CT imaging during ED assessment. Relative risk of ICU admission, difference in mean hospital LOS, risk of BISAP≥2 and BISAP≥3, risk of mortality and non-home disposition rate were all statically non-significant. These findings suggest that patients with early CT imaging not showing changes of AP have an unchanged clinical course. Therefore, they should be treated similarly as those with CT imaging displaying AP.

Acute Phase Response and Postprocedural Evaluation of Open and Laparoscopic Cryoablation Procedures in Porcine Pancreases.

Cryoablation is a potentially less invasive locoregional ablation modality. Although cryoablation has been used to treat malignancy in various organs, a limited application of this modality in the pancreas has been reported. Acute phase response assessments and postprocedural course evaluations of 2 experimental locoregional ablation methods were conducted. In one method, open and laparoscopic cryoablation of a porcine pancreas using an argon-helium gas-based cryoablation system and monitoring of tissue temperature during the procedure were performed. In the other method, open cryoablation of a porcine pancreas using liquid nitrogen was performed. The animals were evaluated postoperatively. The size of the cryolesion was larger in the second treatment than in the first. Laparoscopic cryoablation was associated with the formation of an iceball, which possibly affected the surrounding structures. The ablated region was adequately cooled with 10 minutes of freeze/repeat cycles. The area cooled to a temperature of less than -40°C was approximately half the size of the cryolesion in diameter. The swine used for the evaluation of the postprocedural course survived 3 weeks after the procedure with a temporal elevation of the serum lipase level. Cryoablation of the pancreas was experimentally practicable without severe complications under direct or laparoscopic vision.

Early Feeding in Acute Pancreatitis in Children: A Randomized Controlled Trial.

Studies have increasingly challenged the traditional management of acute pancreatitis (AP) with bowel rest. However, these studies used a low-fat diet or transgastric feeding and only included adults. Aiming to generate higher-quality prospective pediatric data, we compared the traditional approach of fasting and intravenous fluids and early enteral feeding with standard diet or formula. Randomized controlled trial of children (2-18 years) with mild-moderate AP. Patients were randomly assigned 1:1 to initial fasting and intravenous fluids or an immediate, unrestricted diet. Pain scores, blood measures, and cross-sectional imaging were recorded throughout admission and follow-up. The primary outcome was time to discharge, and secondary outcomes were clinical and biochemical resolution and local and systemic complication rates. Of 33 patients (17 [52%] boys, mean age of 11.5 [±4.8] years), 18 (55%) were randomly assigned to early feeding and 15 (45%) were randomly assigned to initial fasting. We recorded the median (interquartile range [IQR]) time to discharge (2.6 [IQR 2.0 to 4.0] vs 2.9 [IQR 1.8 to 5.6]; P = .95), reduction in serum lipase levels by day 2 (58% [IQR 2% to 85%] vs 48% [IQR 3% to 71%]; P = .65), and readmission rates (1 of 18 [6%] vs 2 of 15 [13%]; P = .22) between the early feeding and fasting cohorts, respectively. Immediate or delayed complication rates did not differ. Patients randomly assigned to early feeding had weight gain of 1.3 kg (IQR 0.29 to 3.6) at follow-up, compared with weight loss of 0.8 kg (IQR -2.1 to 0.7) in fasted patients (P = .028). This is the first randomized controlled trial in pediatric AP. There was no difference between early commencement of a standard oral diet and initial fast in any of the major outcome measures.