Non-calcific Chronic Pancreatitis Research Articles

Differences in Plasma Fatty Acid Composition Related to Chronic Pancreatitis: A Pilot Study.

Chronic pancreatitis (CP) is an inflammatory disease affecting the absorption of fat-soluble nutrients. Signaling in pancreatic cells that lead to inflammation may be influenced by fatty acids (FAs) through diet and de novo lipogenesis. Here, we investigated the relationship between plasma FA composition in CP with heterogeneity of etiology and complications of CP. Blood and clinical parameters were collected from subjects with CP (n = 47) and controls (n = 22). Plasma was analyzed for FA composition using gas chromatography and compared between controls and CP and within CP. Palmitic acid increased, and linoleic acid decreased in CP compared with controls. Correlations between age or body mass index and FAs are altered in CP compared with controls. Diabetes, pancreatic calcifications, and substance usage, but not exocrine pancreatic dysfunction, were associated with differences in oleic acid and linoleic acid relative abundance in CP. De novo lipogenesis index was increased in the plasma of subjects with CP compared with controls and in calcific CP compared with noncalcific CP. Fatty acids that are markers of de novo lipogenesis and linoleic acid are dysregulated in CP depending on the etiology or complication. These results enhance our understanding of CP and highlight potential pathways targeting FAs for treating CP.

Endoscopic ultrasound-guided detective flow imaging (DFI) to evaluate pancreatic microvascularization in patients with noncalcific chronic pancreatitis: A prospective, single-centre, observational study

Endoscopic ultrasound-guided detective flow imaging (DFI) to evaluate pancreatic microvascularization in patients with noncalcific chronic pancreatitis: A prospective, single-centre, observational study

Strain elastography for the diagnosis of non-calcific chronic pancreatitis (CP). Strain ratio or strain histogram?

Strain elastography for the diagnosis of non-calcific chronic pancreatitis (CP). Strain ratio or strain histogram?

Shear wave elastography for the diagnosis of non-calcific chronic pancreatitis. A prospective, single-centre, observational study

Shear wave elastography for the diagnosis of non-calcific chronic pancreatitis. A prospective, single-centre, observational study

Endoscopic ultrasound-guided detective flow imaging (DFI) to evaluate pancreatic microvascularisation in patients with non-calcific chronic pancreatitis: a prospective, single-centre, observational study

Endoscopic ultrasound-guided detective flow imaging (DFI) to evaluate pancreatic microvascularisation in patients with non-calcific chronic pancreatitis: a prospective, single-centre, observational study

Strain elastography for the diagnosis of non-calcific chronic pancreatitis (CP). Strain ratio or strain histogram?

Strain elastography for the diagnosis of non-calcific chronic pancreatitis (CP). Strain ratio or strain histogram?

Shear wave elastography for the diagnosis of non-calcific chronic pancreatitis: a prospective, single-centre, observational study

Shear wave elastography for the diagnosis of non-calcific chronic pancreatitis: a prospective, single-centre, observational study

Natural course of chronic pancreatitis and predictors of its progression

BackgroundThe natural course of chronic pancreatitis(CP) and its complications has been inadequately explored. We aimed to describe the natural history and factors affecting the progression of alcoholic(ACP), idiopathic juvenile(IJCP) and idiopathic senile(ISCP) variants of CP. MethodsThis study was a retrospective analysis from a prospectively maintained database of patients with CP following up at a tertiary care centre from 1998 to 2019. Cumulative rates of pain resolution, diabetes, steatorrhea, pseudocysts and pancreatic cancer were computed using Kaplan-Meier analysis, and the factors affecting their incidence were identified on multivariable-adjusted Cox-proportional-hazards model. ResultsA total of 1415 patients were included, with 540(38.1%) ACP, 668(47.2%) IJCP and 207(14.6%) ISCP with a median follow-up of 3.5 years(Inter-quartile range: 1.5–7.5 years). Diabetes occurred at 11.5, 28 and 5.8 years(p < 0.001) while steatorrhea occurred at 16, 24 and 18 years(p = 0.004) after onset for ACP, IJCP and ISCP respectively. Local complications including pseudocysts occurred predominantly in ACP(p < 0.001). Ten-year risk of pancreatic cancer was 0.9%, 0.2% and 5.2% in ACP, IJCP and ISCP, respectively(p < 0.001). Pain resolution occurred more frequently in patients with older age of onset[Multivariate Hazard Ratio(HR):1.7(95%CI:1.4–2.0; p < 0.001)], non-smokers[HR:0.51(95%CI:0.34–0.78); p = 0.002] and in non-calcific CP[HR:0.81(0.66–1.0); p = 0.047]. Occurrence of steatorrhea[HR:1.3(1.03–1.7); p = 0.028] and diabetes[HR:2.7(2.2–3.4); p < 0.001] depended primarily on age at onset. Occurrence of pancreatic cancer depended on age at onset[HR:12.1(4.7–31.2); p < 0.001], smoking-history[HR:6.5(2.2–19.0); p < 0.001] and non-alcoholic etiology[HR:0.14(0.05–0.4); p < 0.001]. ConclusionACP, IJCP and ISCP represent distinct entities with different natural course. Age at onset of CP plays a major prognostic role in all manifestations, with alcohol predominantly causing local inflammatory complications.

Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria.

Critical review of the indications for total pancreatectomy and highlight limitations in current diagnostic criteria for chronic pancreatitis. The diagnosis of noncalcific chronic pancreatitis remains controversial because of an overreliance on nonspecific imaging and laboratories findings. Endoscopic ultrasound, s-magnetic resonance cholangiopancreatography, and/or endoscopic pancreatic function testing are often used to diagnose noncalcific chronic pancreatitis despite the fact that there is no gold standard for this condition. Abdominal pain is not specific for chronic pancreatitis and is more likely to be encountered in patients with functional gastrointestinal disorders based on the high incidence of these conditions. The duration of pain and opioid analgesic use results in central sensitization that adversely affects pain outcomes after total pancreatectomy. An alcoholic cause is associated with poorer pain outcomes after total pancreatectomy. The lack of a gold standard for noncalcific chronic pancreatitis limits the diagnostic accuracy of imaging and laboratory tests. The pain of chronic pancreatitis is nonspecific and is affected by duration, preoperative opioid use, and cause. These factors will need to be considered in the development of future selection criteria for this morbid surgery.

Chronic pancreatitis in Eastern India: Experiencefrom a tertiary care center.

There is a wide variation in the clinical presentation of chronic pancreatitis (CP) in the different parts of India. Data regarding the clinical profile of CP from eastern India are scarce. We describe the clinical and demographic profiles of patients with CP in eastern India. Consecutive patients were evaluated for the clinical presentation, etiology and complication of CP. One hundred and thirty-nine patients with CP (mean age 39.57±14.88 years; M/F 3.48:1) were included. Idiopathic CP (50.35%) was the most common etiology followed by alcohol (33.81%); 68.34% had calcific CP and 31.65% had noncalcific CP. The median duration of symptoms was 24 (1-240) months. Pain was the most common symptom, being present in 93.52% of the patients. Diabetes, steatorrhea and pseudocyst were present in 45.32%, 14.38% and 7.19% of the cases, respectively. Moderate to severe anemia was revealed in 16.53% of the patients. Benign biliary stricture was diagnosed in 19.42% of the cases (symptomatic in 6.47%). The common radiological findings were the following: pancreatic calculi (68.34%), dilated pancreatic duct (PD) (58.99%), parenchymal atrophy (25.89%) and PD stricture (23.74%). In our center, idiopathic CP followed by alcoholic CP was the most frequent form of CP. Tropical CP was distinctly uncommon.

Evaluation of Rosemont criteria for non-calcific chronic pancreatitis (NCCP) based on histopathology – A retrospective study

BackgroundRosemont classification for chronic pancreatitis has not been evaluated specifically in non-calcific chronic pancreatitis (NCCP) patients and to this date, it has not been correlated with the gold standard namely histopathology. ObjectiveTo assess the correlation of EUS Rosemont criteria for NCCP with histopathology from surgical specimens and evaluate the impact of age, sex, BMI, smoking and alcohol on Rosemont classification. MethodsAdult patients undergoing TPIAT for NCCP between July 2009 and January 2013 were identified from our institutional database. The presence or absence of standard and Rosemont (major and minor) criteria were determined by expert endosonographers using linear endosonography. Patients were categorized into normal, indeterminate and suggestive with CP based on Rosemont classification. Histology was obtained at time of TPIAT from the resected pancreas by wedge biopsy of head, body and tail. All histopathology were re-reviewed by a GI pathologist blinded to endosonographic features and clinical outcomes. Available pancreatic tissue was graded for severity of intralobular and perilobular pancreatic fibrosis by the Ammann classification system. Results50 patients with NCCP (42 females, mean age± SD = 37.9 ± 10.8) underwent TPIAT with preoperative EUS during the study period. Univariate analysis of features such as age, sex, BMI, smoking and alcohol history showed no significant difference between patients identified as normal and those identified as indeterminate/suggestive (p > 0.05). Rosemont “Normal” was poor in excluding CP as 5/9 patients (55.5%) had CP on histopathology. 25/26 patients (96.2%) with features “suggestive” of CP had evidence of CP on histopathology. 12/15 patients (80.0%) with “indeterminate” features had CP on histopathology. ConclusionsRosemont classification can be used independent of patient characteristics (age, sex and BMI) and environmental factors (smoking and alcohol exposure). In our cohort, Rosemont classification was strongly predictive of CP in patients with features “suggestive” of CP. However, “normal” Rosemont classification had poor correlation in this study. This is maybe due to lack of true comparator “normal” pancreas which cannot be obtained reasonably. The strength of agreement for diagnosis of CP was substantial between the standard and Rosemont criteria.

Diagnostic Performance of Endoscopic Ultrasound (EUS) for Non-Calcific Chronic Pancreatitis (NCCP) Based on Histopathology.

Studies correlating endoscopic ultrasound (EUS) with histopathology for chronic pancreatitis (CP) are limited by small sample size, and/or inclusion of many patients without CP, limiting applicability to patients with painful CP. The aim of this study was to assess correlation of standard EUS features for CP with surgical histopathology in a large cohort of patients with non-calcific CP (NCCP). Adult patients undergoing total pancreatectomy and islet autotransplantation (TPIAT) for NCCP, between 2008 and 2013, with EUS <1 year before surgery. Histology from resected pancreas at the time of TPIAT (from head, body, and tail) was graded by a GI pathologist blinded to the EUS features. A fibrosis score (FS) ≥2 was abnormal, and FS≥6 was considered severe fibrosis. A multivariate regression analysis for the EUS features predicting fibrosis, after taking age, sex, smoking, and body mass index into consideration, was performed. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation co-efficient (r) was calculated. 68 patients (56 females, mean±s.d. age-38.77±10.92) underwent TPIAT for NCCP with pre-operative EUS. ROC curve showed that four or more EUS features provided the best balance of sensitivity (61%), specificity (75%), and accuracy (63%). Although significant, correlation between standard EUS features and degree of fibrosis was poor (r=0.24, P<0.05). Multivariate regression analysis showed that main pancreatic duct irregularity was the only independent EUS feature (P=0.02) which predicted CP. Correlation between standard EUS features and histopathology is poor in NCCP. MPD irregularity is an independent predictor for NCCP.

Evaluation of Rosemont Classification for Non-calcific Chronic Pancreatitis (NCCP) Based on Histopathology: A Retrospective Study

Introduction: Rosemont classification represents a consensus-based scoring system to standardize endosonographic diagnosis of chronic pancreatitis. To this date, its diagnostic accuracy has not been validated based on the gold standard, namely histopathology. The aim of this study was to assess the accuracy of Rosemont classification in NCCP patients undergoing total pancreatectomy and islet autotransplantation (TPIAT). Methods: Adult patients undergoing TPIAT for NCCP between July 2009 and January 2013 were included if they underwent endoscopic ultrasound (EUS) at our center within 1 year before surgery. The presence or absence of major and minor Rosemont criteria was determined by expert endosonographers using linear EUS. Patients were categorized into normal, indeterminate, suggestive, and consistent with CP based on the major and minor criteria as per the Rosemont classification. Histology was obtained at time of TPIAT from the resected pancreas by wedge biopsy of head, body, and tail. All histopathology was reviewed by a GI pathologist blinded to EUS features and clinical outcomes. Available pancreatic tissue was graded for severity of intralobular and perilobular pancreatic fibrosis by the Ammann classification system. A fibrosis score (FS) ≥2 was considered abnormal. Results: Fifty patients (42 females; mean age 37.9±10.8 years) underwent TPIAT with preoperative EUS during the study period. As expected, none of the patients had any major A feature as our study population consisted of only NCCP. None of our patients could be categorized into the “consistent” with CP category. Sensitivity, specificity, PPV, and NPV for “normal,” “indeterminate,” and “suggestive” of CP are shown in Table 1. A box plot is also shown.Table 1: Diagnostic Performance of Rosemont Classification Based on HistopathologyConclusion: In our study, Rosemont classification for NCCP correlated poorly with histopathology. Although Rosemont scoring adds more complexity, it may not improve the diagnostic accuracy of EUS for NCCP. Further attempts should be made to refine the EUS diagnostic criteria for CP to enhance its reliability in diagnosing NCCP.Figure 1

7 Diagnostic Performance of Contrast Enhanced MRI With Secretin-Stimulated MRCP (sMRCP) for Non-Calcific Chronic Pancreatitis (NCCP): A Comparison With Histopathology

7 Diagnostic Performance of Contrast Enhanced MRI With Secretin-Stimulated MRCP (sMRCP) for Non-Calcific Chronic Pancreatitis (NCCP): A Comparison With Histopathology

Su1827 Prediction of Islet Yield in Patients Undergoing Total Pancreatectomy With Islet Autotransplantation (TPIAT) for Non-Calcific Chronic Pancreatitis (NCCP) Using Contrast Enhanced MRI and Secretin Stimulated MRCP (sMRCP)

Su1827 Prediction of Islet Yield in Patients Undergoing Total Pancreatectomy With Islet Autotransplantation (TPIAT) for Non-Calcific Chronic Pancreatitis (NCCP) Using Contrast Enhanced MRI and Secretin Stimulated MRCP (sMRCP)

9 Accuracy of Endoscopic Ultrasonography (EUS) and Contrast Enhanced MRI/Secretin Stimulated (sMRCP) for the Diagnosis of Non-Calcific Chronic Pancreatitis (NCCP) -A Comparative Study Based on Surgical Histopathology

9 Accuracy of Endoscopic Ultrasonography (EUS) and Contrast Enhanced MRI/Secretin Stimulated (sMRCP) for the Diagnosis of Non-Calcific Chronic Pancreatitis (NCCP) -A Comparative Study Based on Surgical Histopathology

Mo1456 ‘Seeing Is Not Believing'- Histopathological Correlation of Endoscopic Ultrasound (EUS) in Non-Calcific Chronic Pancreatitis (NCCP)

Mo1456 ‘Seeing Is Not Believing'- Histopathological Correlation of Endoscopic Ultrasound (EUS) in Non-Calcific Chronic Pancreatitis (NCCP)

Ratio of Pancreatic Duct Caliber to Width of Pancreatic Gland by Endosonography Is Predictive of Pancreatic Cancer

This study aimed to determine whether (1) a pancreatic duct (PD) diameter to pancreatic gland width (G) ratio (PDG) by endoscopic ultrasonography (EUS) predicts pancreatic cancer (PC) and (2) whether this ratio better indicates PC compared to PD dilation alone. Patients presenting for EUS were classified into the following 4 categories: (1) normal, (2) noncalcific chronic pancreatitis (NCCP), (3) calcific CP (CCP), and (4) PC. There were 198 patients enrolled. Final diagnoses were PC (n = 34), CCP (n = 16), and normal/NCCP (n = 148). The median PD diameter (8, 5, and 2 mm, respectively; P = <0.001), G (16, 20, and 17 mm, respectively; P = 0.002), and PDG ratio were significantly different among groups (0.54, 0.25, and 0.12, respectively; P < 0.001). Patients with PC were more likely to have a PDG ratio of greater than or equal to 0.34 compared to CCP, and normal/NCCP groups (94%, 19%, 1.3%, respectively; P < 0.001). The positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of PDG greater than or equal to 0.34 for detecting cancer were 87%, 99%, 94%, 97%, and 97%, respectively. The accuracy and positive predictive value of PD dilation alone for diagnosing PC were 83% and 50%, respectively. A PDG ratio is a good predictor of PC and is better than PD dilation. This sign should be routinely used by endosonographers to improve EUS diagnostic capability of PC.

Clinical presentation and outcome of endoscopic therapy in patients with symptomatic chronic pancreatitis associated with pancreas divisum.

The results of endoscopic drainage in pancreas divisum with chronic pancreatitis have been debatable.To evaluate clinical presentation and long term results of endoscopic therapy in patients of calcific and non-calcific chronic pancreatitis with pancreas divisum.Between 1996 and 2011, 48 patients (32 males and 16 females) with chronic pancreatitis and pancreas divisum were treated endoscopically. Patients were considered to have clinical success if they had resolution of symptoms and did not require surgery.All patients presented with abdominal pain and symptoms were present for 36.6 ± 40.5 months. Pseudocyst, diabetes, pancreatic ascites, pancreatic pleural effusion, segmental portal hypertension and steatorrhea were seen in 13 (27.1%), 6 (12.5%), 3 (6.3%), 2 (4.2%), 2 (4.2%) and 1 (2.1%) patients, respectively. Ductal calculi and strictures were noted in 3 (6.3%) and 2 (4.2%) patients, respectively. In 47 patients, an endoprosthesis (5 or 7 Fr) was successfully placed in the dorsal duct. Following pancreatic endotherapy, 45/47 (95.7%) patients had successful outcome. The mean number of stenting sessions required to have clinical success was 2.6 ± 0.9. One patient each had mild post ERCP pancreatitis, inward migration of stent and precipitation of diabetic ketoacidosis. Over a follow up of 2-174 months (median: 67 months), 12 out of 31 patients with pain only and no local complications (38.7%) required restenting for recurrence of pain and none of these patients required surgery.Intensive pancreatic endotherapy is safe and effective both in patients with chronic calcific, as well as non-calcific, pancreatitis associated with pancreas divisum. It gives good long term response in patients having abdominal pain and/or dorsal ductal disruptions.

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Patients with dilated common bile duct (CBD) (>7mm) and/or pancreatic duct (PD) on abdominal imaging are often referred for endoscopic ultrasound (EUS). In many cases, the EUS shows no obvious etiology for the dilated ducts. Find clinical factors that may predict which patients are more likely to have positive findings on EUS to explain the etiologies for the dilated ducts. Retrospective database analysis. Tertiary-care university hospital. Patients referred for EUS for dilated CBD and/or PD from January 2004 to February 2010 were included in this study. Only patients without an obvious etiology for the dilated ducts on abdominal imaging were included. An EUS was performed by using either a radial echoendoscope or a linear endoscope to evaluate the common bile duct and/or the pancreatic duct. When appropriate fine needle aspiration of the mass or cyst was performed. The characteristics of patients who had positive findings on EUS to explain the etiology of their dilated PD and/or CBD. A total of 140 patients were included in the study with a mean age of 64 years, 51 (36%) male and 115 (82%) white. The majority of our patients had a presenting symptom of abdominal pain 105 (75%). 49 (36%) had elevated AST or ALT, 25 (8%) had an elevated bilirubin and 13 (23%) had an elevated lipase. EUS findings explained the dilated ducts in 54 (39%) of our patients, most common diagnoses included: CBD stone in 11 (8%), non-calcific chronic pancreatitis in 9 (6%), pancreatic mass in 8 (6%), IPMN in 7 (5%). On bivarate analysis patients who were older (p = 0.006), male (p = 0.001), had elevated LFTs (p = <0.001), had elevated lipase (p = 0.021) or had dilated CBD and PD (p = 0.007) were more likely to have an etiology for their dilated duct(s) discovered on EUS. A retrospective study with a small number of patients. Older patients, males and those patients presenting with concurrent elevations in the AST/ALT and/or lipase were more likely to have an underlying etiology discovered on EUS. Furthermore, EUS may detect an undiagnosed pancreatic malignancy in patients presenting with unexplained duct dilation.