Onset Of Pancreatitis Research Articles

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK.

Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions.

Effects of a peripherally acting µ-opioid receptor antagonist for the prevention of recurrent acute pancreatitis: study protocol for an investigator-initiated, randomized, placebo-controlled, double-blind clinical trial (PAMORA-RAP trial)

BackgroundAcute and chronic pancreatitis constitute a continuum of inflammatory disease of the pancreas with an increasing incidence in most high-income countries. A subset of patients with a history of pancreatitis suffer from recurrence of acute pancreatitis attacks, which accelerate disease progression towards end-stage chronic pancreatitis with loss of exocrine and endocrine function. There is currently no available prophylactic treatment for recurrent acute pancreatitis apart from removing risk factors, which is not always possible. Pain is the primary symptom of acute pancreatitis, which induces the endogenous release of opioids. This may further be potentiated by opioid administration for pain management. Increased exposure to opioids leads to potentially harmful effects on the gastrointestinal tract, including, e.g. increased sphincter tones and decreased fluid secretion, which may impair pancreatic ductal clearance and elevate the risk for new pancreatitis attacks and accelerate disease progression. Peripherally acting µ-opioid receptor antagonists (PAMORAs) have been developed to counteract the adverse effects of opioids on the gastrointestinal tract. We hypothesize that the PAMORA naldemedine will reduce the risk of new pancreatitis attacks in patients with recurrent acute pancreatitis and hence decelerate disease progression.MethodsThe study is a double-blind, randomized controlled trial with allocation of patients to either 0.2 mg naldemedine daily or matching placebo for 12 months. A total of 120 outpatients will be enrolled from five specialist centres in Denmark and Sweden. The main inclusion criteria is a history of recurrent acute pancreatitis (minimum of two confirmed pancreatitis attacks). The primary endpoint is time to acute pancreatitis recurrence after randomization. Secondary outcomes include changes in quality of life, gastrointestinal symptom scores, new-onset diabetes, exocrine pancreatic insufficiency, disease severity, health care utilization, adherence to treatment, and frequency of adverse events. Exploratory outcomes are included for mechanistic linkage and include the progression of chronic pancreatitis-related findings on magnetic resonance imaging (MRI) and changes in circulating blood markers of inflammation and fibrosis.DiscussionThis study investigates if naldemedine can change the natural course of pancreatitis in patients with recurrent acute pancreatitis and improve patient outcomes.Trial registrationEudraCT no. 2021–000069-34. ClinicalTrials.gov NCT04966559. Registered on July 8, 2021.

Comparison of early and late intervention for necrotizing pancreatitis: A systematic review and meta-analysis.

Postponed open necrosectomy or minimally invasive intervention has become the treatment option for necrotizing pancreatitis. Nevertheless, several studies point to the safety and efficacy of early intervention for necrotizing pancreatitis. Therefore, we conducted a systematic review and meta-analysis to compare clinical outcomes of acute necrotizing pancreatitis between early and late intervention. Literature search was performed in multiple databases for articles that compared the safety and clinical outcomes of early (<4 weeks from the onset of pancreatitis) versus late intervention (≥4 weeks from the onset of pancreatitis) for necrotizing pancreatitis published up to August 31, 2022. The meta-analysis was performed to determine pooled odds ratio (OR) of mortality rate and procedure-related complications. Fourteen studies were included in the final analysis. For open necrosectomy intervention, the overall pooled OR of mortality rate with the late intervention compared with early intervention was 7.09(95% confidence interval [CI] 2.33-21.60; I2 = 54%; P = 0.0006). For minimally invasive intervention, the overall pooled OR of mortality rate with the late intervention compared with early intervention was 1.56 (95% CI 1.11-2.20; I2 = 0%; P = 0.01). The overall pooled OR of pancreatic fistula with the late minimally invasive intervention compared with early intervention was 2.49 (95% CI 1.75-3.52; I2 = 0%; P < 0.00001). These results showed the benefit of late interventions in patients with necrotizing pancreatitis in both minimally invasive procedures and open necrosectomy. Late intervention is preferred in the management of necrotizing pancreatitis.

Imaging of Pancreatitis, Panniculitis, and Polyarthritis Syndrome

HomeRadiologyVol. 307, No. 4 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyImaging of Pancreatitis, Panniculitis, and Polyarthritis SyndromeLakhdeep Singh Brar , Yatin ChadhaLakhdeep Singh Brar , Yatin ChadhaAuthor AffiliationsFrom the Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, Canada N6A 3K7 (L.S.B.); and Department of Medical Imaging, North York General Hospital, Toronto, Canada (Y.C.).Address correspondence to L.S.B. (email: [email protected]).Lakhdeep Singh Brar Yatin ChadhaPublished Online:May 2 2023https://doi.org/10.1148/radiol.222426MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 64-year-old man initially presented with pancreatitis that required hospitalization. Several months later, he developed knee pain and a fluctuant soft tissue mass at the lateral aspect of the left knee. Rheumatologic and metabolic workups (serum calcium and phosphate, and parathyroid hormone) were negative. Radiography performed 10 months after the initial onset of pancreatitis (Figure, A) showed bilateral symmetric osteopenia involving the knees with a permeative appearance of the bones. Subsequent bilateral knee MRI scans (Figure, B and C) demonstrated bilateral multifocal osteonecrosis with rim enhancement in the soft tissues of the left knee, supporting panniculitis. Subsequent imaging showed improvement of all imaging findings. The patient was referred to orthopedic oncology at a tertiary care center as a precaution. The diagnosis of pancreatitis, panniculitis, and polyarthritis (PPP) syndrome was made based on the clinical and imaging findings.Images in a 64-year-old man presenting with knee pain 10 months after hospitalization for pancreatitis. (A) Anteroposterior radiograph of both knees shows a permeative appearance of the bones (arrows). (B) Coronal T1-weighted knee MRI scan shows osteonecrosis. (C) Coronal T1-weighted postgadolinium MRI scan shows bilateral multifocal osteonecrosis (arrowheads) and panniculitis (rim enhancing) in the lateral soft tissues of the left knee (arrow).Download as PowerPointOpen in Image Viewer PPP syndrome is rare and occurs in the setting of pancreatitis or an underlying pancreatic mass (1). Patients may report mild or absent abdominal symptoms, making it difficult to diagnose. It has been reported to occur in all age groups, with a mean age ± SD of 51 years ± 16, and has a higher prevalence rate in men than in women (2:1 ratio) (2). While any joint may be involved, it most commonly affects the knees, ankles, and wrists (2). The pathophysiology is thought to result from the release of pancreatic lipase into the circulation, causing lipolysis and inflammation (2). The clinical symptoms and imaging findings can be transient or persist over time (3). Treatment involves addressing the underlying pancreatitis (3).Disclosures of conflicts of interest: L.S.B. No relevant relationships. Y.C. No relevant relationships.

Intrapancreatic Fat Deposition: Cause or Consequence of First Acute Pancreatitis Attack?

Schepis, Tommaso MD1,2; Tringali, Andrea MD, PhD1,2; Spada, Cristiano MD, PhD1,2; Costamagna, Guido MD, FACG, FJGES1,2; Boškoski, Ivo MD, PhD1,2 Author Information

A case of early-onset idiopathic chronic pancreatitis associated with a loss-of-function TRPV6 p.R483Q variant successfully treated by pancreatic duct stenting.

Several pancreatitis-related genetic variants have been identified. Recently, the association of loss-of-function variants in the transient receptor potential cation channel subfamily V member 6 (TRPV6) gene and early-onset non-alcoholic chronic pancreatitis (CP) has been reported. However, detailed clinical presentation of the cases carrying TRPV6 variants remains largely unknown. We report a case of early CP carrying a TRPV6 variant in which recurrent attacks of pancreatitis were successfully managed by pancreatic duct stenting. A 12-year-old boy with CP was referred to our hospital for further investigation. He had experienced recurrent pancreatitis attacks since he was 11years old. Pancreatic ductal anomalies were not identified on magnetic resonance cholangiopancreatography. Genetic analysis revealed that the patient had a loss-of-function TRPV6 c.1448G > A (p.R483Q) variant in a heterozygous form. Conservative treatments were not effective; thus, we placed pancreatic duct stent by endoscopic intervention, and the frequency of relapses have dramatically decreased. We present the first pediatric report of early CP associated with the TRPV6 variant that was successfully treated with pancreatic duct stenting. This case suggests that pancreatic duct stenting is effective in preventing the relapse of pancreatitis related to the TRPV6 variant.

Malnutrition Imparts Worse Outcomes in Patients Admitted for Acute Pancreatitis.

Purpose Cessation of enteral nutrition is usually a part of the early stage of acute pancreatitis (AP) treatment. To our knowledge, there is no large database study that examines the effects of preexisting malnutrition on the morbidities of patients admitted for acute pancreatitis. We aimed to investigate the effects of malnutrition on patients admitted for acute pancreatitis. Methods Data between 2008 and 2014 from the National Inpatient Sample (NIS) database was extracted. Inclusion criteria included patients with a primary diagnosis of AP using the International Classification of Diseases, Ninth Revision (ICD-9) codes, and ages greater than 17. Exclusion criteria included ICD-9 codes for chronic pancreatitis. The study group consisted of patients with a primary diagnosis of AP and a concurrent diagnosis of malnutrition. In-hospital mortality was compared using univariate and multivariate analyses to generate odds ratios. Elixhauser comorbidity scores predicting mortality and readmission were calculated based on weighted scores from 29 different comorbidities and compared using univariate analysis. Results Patients with malnutrition were significantly more likely to experience in-hospital mortality, sepsis, severe sepsis, septic shock, and respiratory failure. Malnutrition was found to increase mortality. Female sex and Black or Hispanic race showed lower mortality. Conclusion We hypothesize that there are likely other preexisting comorbidities that lead to malnutrition before the onset of pancreatitis. Malnutrition can cause impaired healing and the ability to recover from acute inflammation, which may be why the study group had a higher rate of sepsis.

Sepsis and Acute Pancreatitis in Tumor-Stage Mycosis Fungoides and Treatment with Brentuximab-Vedotin

Dear Editor, we report a case of a 67-year-old male patient who was first diagnosed with tumor-stage Mycosis Fungoides (MF) (T3N0M0B0a, clinical stage IIB – current ISCL/EORTC classification) in 2017. During the course of the disease of MF the patient was treated with bexarotene, gemcitabine and chlorambucil. All these treatments helped only short-term, quickly followed by relapses of the skin lesions. In September 2018, the patient developed a rapidly progressive disease with erythematous patches, plaques and ulcerated tumors (mSWAT 20) (Fig. 1). CD30 expression was determined in several skin biopsies, each with an expression rate of 2-5% (Fig. 1). Despite this relatively low amount, the tumor board decision was made favoring the monoclonal CD30-antibody Brentuximab-Vedotin (BV) application. In October 2018, BV was first administered with the maximum dose of 180 mg (1.8mg/kg of body weight). Five days after the infusion, the patient developed abdominal pain, diarrhea, chills and fever. Blood cultures were positive for Methicillin-Resistant Staphylococcus Aureus (MRSA) and a MRSA-sepsis was diagnosed. Intensive medical care was requiredand under symptomatic treatment, the patient recovered completely. Two months later – in December 2018 – the patient presented again in our department to evaluate the skin lesions, displaying a partial response (mSWAT 12) (Fig. 1). At this time, the sepsis was not considered in direct context with the medication. The patient had several ulcerations and had been a known MRSA-patient already before the initiation of the treatment. Therefore, the patient received BV for a second time in the total dose of 180 mg. Nine days after the infusion, abdominal pain with vomiting, diarrhea and unconsciousness occurred. The patient was readmitted to the intensive care unit and an acute pancreatitis was diagnosed (lipase 1502 U/l). Under symptomatic therapy and close monitoring, pancreatitis resolved within two weeks. BV is a CD30 antibody-drug conjugate. The cytotoxic component is monomethylauristatin E, a potent inhibitor of microtubule assembly [1]. It is approved for the treatment of patients with relapsed or refractory Hodgkin’s Lymphoma (HL), systemic Anaplastic Large-T-cell Lymphoma (sALCL) and in addition, for the treatment of CD30-positive Cutaneous T-cell Lymphoma (CTCL) [2]. This case report describes two serious complications after the administration of BV in the same patient. Both belong in the spectrum of rare to infrequent side effects. Awareness of the possibility of pancreatitis as a side effect of BV is essential, especially because it seems to occur not immediately but within days or weeks after the treatment application. The literature describes pancreatitis in patients with HL, ALCL and cutaneous Gamma Delta T-cell Lymphoma (GD-TCL) [3]. The onset of pancreatitis in most cases seems to be delayed with a range of 7-33 days [1,4]. In our patient the first symptoms presented nine days after the BV-administration. Acute pancreatitis can lead to fatal outcomes. BV reinduction should be carefully discussed. However, in patients without any other treatment options, it might be possible to reinduce BV without the risk of side effect recurrence [1,3].

Establishment and validation of a predictive nomogram for the risk of premalignant lesions in children with choledochal cyst.

Choledochal cyst (CDC) increases the risk (2.5%-30%) of malignancy. Metaplasia and dysplasia have been recognized as premalignant lesions among CDCs. This study aimed to evaluate the risk factors of metaplasia and dysplasia in CDC children. Two hundred and ten CDC children who underwent cyst excision and Roux-en-Y hepaticojejunostomy at our institution between July 2020 and November 2021 were included and randomly divided into the training set andvalidation set. Univariate and multivariate logistic regression analysis were used to identify independent risk factors of premalignant lesions in the training set and build a predictive nomogram. The performance and discriminatory abilities of the nomogram were further assessed and validated in the validation set. Of the 210 CDC children, 78 (37.1%) patients developed premalignant lesions. Age (OR, 1.011, 95%CI, 1.000-1.022, P = 0.046), symptoms duration (OR, 1.021, 95%CI, 1.001-1.042, P = 0.036), cyst diameter (OR, 1.737, 95%CI, 1.328-2.273, P < 0.001), recurrent attacks of biliary pancreatitis (OR, 3.653, 95%CI, 1.205-11.076, P = 0.022), and biliary operation history (OR, 5.860, 95%CI, 1.268-27.084, P = 0.024) were identified as independent risk factors. Based on these predictors, a predictive nomogram was generated. The AUC of the nomogram was 0.873 in the training set and 0.793 in the validation set, indicating that it was robust and well calibrated. A novel nomogram to the individualized risk of premalignant lesions in CDC children was successfully built, on the basis of age, symptoms duration, cyst diameter, recurrent attacks of biliary pancreatitis, and biliary operation history. This nomogram, combined with the final pathological results, can help clinicians to develop more efficient follow-up strategies for the high-risk children with CDC.

Serum metabolomics study for acute attack of chronic pancreatitis

Background & aimsChronic pancreatitis (CP) is an inflammatory disease characterized by irreversible changes. However, acute CP attacks can lead to various complications and affect patient prognosis. Therefore, this study aimed to identify reliable candidate metabolic biomarkers for diagnosing acute CP attacks and complement candidate diagnostic markers for CP. MethodsA total of 139 serum specimens were prospectively included in three consecutive exploratory, identification, and validation studies. All samples were analyzed for candidate diagnostic biomarkers and metabolic pathways using a liquid chromatography-mass spectrometer. ResultsSerum metabolic profiles differed between patients with CP and non-pancreatic disease controls, and 239 potential metabolic biomarkers for diagnosing CP were identified. Based on identification and validation studies, Diacylglycerol(16:0/18:4), 16-F1-PhytoP, N-(hexacosanoyl)-tetradecasphing-4-enine, carnosic acid, and Auxin b were identified as biomarkers for distinguishing acute attacks from non-acute attacks in patients with CP. The area under the curve of the Diacylglycerol(16:0/18:4) was 0.969 (95% confidence interval, 0.869–1) in the validation study. ConclusionsTo the best of our knowledge, this is the first prospective cohort study to identify and validate a metabolomic signature in serum for diagnosing acute attacks of CP. In addition, our study identified 239 potential biomarkers for CP diagnosis.

High Triglyceride Variability Increases the Risk of First Attack of Acute Pancreatitis.

Hypertriglyceridemia is the third most common etiology of acute pancreatitis. Whether triglyceride variability, independent of absolute triglyceride levels, is a predictor of acute pancreatitis is unknown. We identified 98,819 patients who were diagnosed with hyperlipidemia between January 1, 2007, and December 31, 2013, and had at least 1 triglyceride measurement annually for 4 consecutive years from the Chang Gung Research Database in Taiwan. Triglyceride variability, defined as variability independent of the mean, was calculated in the 4-year run-in period. The patients were stratified according to the quartiles of triglyceride variability and were followed until December 31, 2019, for first attack of acute pancreatitis. During a mean follow-up of 5.9 years, 825 (0.83%) patients were newly diagnosed with acute pancreatitis (14.1 events per 10,000 person-years; 95% confidence interval 13.2-15.1). Triglyceride variability was significantly associated with an increased risk of acute pancreatitis, independent of baseline triglyceride and mean triglyceride levels (hazard ratio, 1.28 [95% confidence interval 1.05-1.57] for the highest vs the lowest quartiles of triglyceride variability; P for trend = 0.006 over the quartiles of triglyceride variability). Subgroup analysis showed that this association was more pronounced among the patients with a higher neutrophil-to-lymphocyte ratio ( P for trend = 0.022). In this multi-institutional cohort study, high triglyceride variability was associated with an increased risk of first attack of acute pancreatitis, independent of baseline and mean triglyceride levels. The association between triglyceride variability and acute pancreatitis may be partly mediated by subclinical inflammation.

PHPT with Pancreatitis: Atypical Presentation of PHPT.

Primary hyperparathyroidism (PHPT) is rarely associated with the occurrence of acute or chronic pancreatitis, requiring complex perioperative management. This study aimed to assess the prevalence and disease characteristics of pancreatitis in PHPT. This study is a clinicopathological analysis of the medical records of patients who were diagnosed with PHPT with pancreatitis between 1989 and 2021 in the Endocrine Surgery department, SGPGI, Lucknow. Out of 548 PHPT cases, 44 (8.03%) were found to be associated with pancreatitis. The mean age was 33.57 years (15-65 years); 5 were ≤20 years, while 26 were ≤30 years of age. There were 27 males and 17 females. Twenty-one cases were of acute (11 acute, nine recurrent acute, one acute on chronic), whereas 23 were of chronic pancreatitis (six chronic calcific pancreatitis). The major clinical presentation of PHPT with pancreatitis was abdominal pain (65.91%). The mean number of attacks per patient in recurrent acute pancreatitis was two. Mean PTH levels were 68.19 pmol/L. The mean tumor size (in the largest dimension) was 2.79 ± 1.4 cm while the mean tumor weight was 4.91 g. Nephrolithiasis was associated with 25 cases. An association with multiple endocrine neoplasia type 1 syndrome was seen in one case. The final histopathological diagnosis was parathyroid carcinoma in two, hyperplasia in three, and parathyroid adenoma in 39 cases. Normocalcemia was seen in 27.2%, hypercalcemic crisis in 15.9%, and 25% of patients required semi-emergency parathyroidectomy. The outcome was favorable in all, as none had any further attacks of pancreatitis. In our study, the prevalence of pancreatitis in PHPT cases was 8.03%. The majority of patients were young. Normocalcemia was seen in 12 patients, so even if calcium levels are normal, PHPT should be suspected in young patients with pancreatitis. Parathyroidectomy resulted in the complete resolution of symptoms of pancreatitis in all 44 patients.

ОСТРЫЙ ПАНКРЕАТИТ БИЛИАРНОЙ ЭТИОЛОГИИ. Сообщение 1. ЭПИДЕМИОЛОГИЯ И СОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О ПАТОГЕНЕЗЕ

The epidemiological data and modern ideas concerning the pathogenesis of acute biliary pancreatitis are presented. Acute pancreatitis of biliary etiology is a widespread pathology with the lethality rate of 2–7%, and at a severe course – 17–39%. The leading pathogenetic mechanism of acute pancreatitis of biliary etiology is pancreaticobiliary ductal hypertesion. During the conservative treatment the relapse rate of acute biliary pancreatitis reaches 90% with the lethality rate up to 31%. The only risk factor of the relapse development is refusal to perform cholecystectomy after the first attack of acute biliary pancreatitis to the patients whose condition permitted to survive the intervention.

Management of common bile duct stones in a tertiary care hospital

Background: Common bile duct (CBD) stone is a relatively frequent disorder in our clinical practice. Early diagnosis and prompt treatment are the most important for managing CBD stones. The various modalities of treatments in bile duct stones include open, endoscopic, and laparoscopic approaches. Aim and Objectives: CBD stones are one of the common diseases faced by both surgeons and gastroenterologists. Many patients remain asymptomatic and show mild-to-moderate dyspeptic symptoms. However, symptomatic patients are frequently associated with complications that cause a lot of suffering to the patients. At present, open, endoscopic, and laparoscopic approaches are available for the management of bile duct stones with surgical methods slowly giving a way to other two newer modalities. However, treatment modalities should be individualized. The objectives of the study are various modalities of treatments in bile duct stones and the efficacy of these modalities in terms of outcomes, morbidity, and mortality. Materials and Methods: This was a prospective study of 68 patients who were admitted to Peerless Hospital and B.K. Roy Research Center between October 2014 and December 2015. Results: In this study, CBD stones were common in females between 55 and 64 years of age group. The presentation of the disease ranged from asymptomatic to symptomatic with features of complications in the form of acute biliary pancreatitis and cholangitis. Pain was the leading symptom, followed by jaundice and fever. Transabdominal USG revealed stones in bile ducts in 41.2% of cases, and the diagnosis was suspected in 26.4% of cases by only seeing proximal dilated bile ducts. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) stone extraction procedure, and in cases where the endoscopic procedure failed, open CBD exploration was done. The success rate of open surgery is marginally high than that of endoscopic intervention. Choledochoduodenostomy was performed in one patient where the open procedure failed to extract all the stones from the bile ducts. Complications seen in ERCP are pancreatitis (4.4%), hemorrhage (2.9%), cholangitis (1.5%), and death in 1 (1.5%) patient, following a severe attack of pancreatitis. Conclusion: From the above study, it is clear that open surgery is more successful than endoscopic procedure. ERCP failed due to multiple large stones and its impaction at the lower end of CBD. Hence, the patients should be categorized properly after a pre-operative workup. Facilities for the procedure and availability of experienced doctors are also crucial in making the decision.

An In Vitro Model for Assessing Acute Lung Injury During Pancreatitis Development Using Primary Mouse Cell Co-cultures.

Acute pancreatitis is a serious inflammatory disease of the pancreas that can lead to lung injury. Despite extensive research, the mechanisms underlying this complication are ill-defined. In recent years, in vitro co-culture systems have emerged as powerful tools for studying complex interactions between different cell types in disease. In the context of pancreatitis, pancreatic acinar epithelial cells produce and secrete digestive enzymes, and their cellular damage, death, and/or dysfunction is a major contributing factor to the onset of pancreatitis. Here, in this chapter we describe a co-culture system of acinar cells and lung epithelial progenitor/stem cells to model for lung injury associated with pancreatitis.

Evolution of Rosemont’s indeterminate for chronic pancreatitis in recurrent acute pancreatitis patients with 1-year follow-up: A prospective case series

Some patients presenting with recurrent acute pancreatitis (RAP), while undergoing endoscopic ultrasound (EUS), are classified as indeterminate for chronic pancreatitis (CP) according to Rosemont criteria. We are describing the clinical and radiological evolution of 14 such patients for 1 year. All the patients were closely followed up at 3 monthly intervals and subjected to ultrasound abdomen and blood sugar profile 6 monthly and EUS after 12 months. Males were 93%. Median age was 26 years. Most common etiology of RAP was idiopathic followed by ethanol and hypertriglyceridemia. On 1-year follow-up, 35.7% remained pain free and 28.6% had acute pancreatitis attack. Endocrine and exocrine insufficiency seen in one and two patients, respectively. Follow-up EUS in eight patients revealed Rosemont “normal” in 1, “Indeterminate” in 2, suggestive of CP in 3, and consistent with CP in two patients. Therefore, Rosemont’s “Indeterminate’’ progress to suggestive/consistent with CP in majority of patients.

A Chinese prospective multicenter cohort study evaluating EUS-guided drainage of pancreatic fluid collections using the Hot AXIOS system.

The Hot AXIOS system, which features a cautery-enhanced lumen-apposing metal stent, facilitates EUS-guided transmural drainage of pancreatic fluid collection (PFC). We aimed to evaluate the safety and efficacy of stents in a multicenter Chinese cohort. Thirty patients from nine centers with a single pancreatic pseudocyst (PP) or walled-off necrosis (WON) who underwent EUS-guided transgastric or transduodenal drainage with the novel stent were prospectively enrolled. We included 15 (50%) patients with PPs and 15 (50%) with WONs. The mean diameter of the PFCs was 11.06 ± 3.56 cm. Stent placement was technically successful in all patients (100%), whereas clinical success was achieved in 93.3% of patients (28/30). Clinical success was defined as the alleviation of clinical symptoms combined with at least a 50% reduction in PFC diameter within 60 days after surgery. 73.3% (22/30) of AXIOS stents were removed after reaching clinical success in the 1st month of follow-up. A total of 14 (46.7%) PFC-associated infections occurred (4 pre- and 10 postoperation), which recovered within 1 week after treatment. Other complications included three (10%) partially or fully blocked stents and two (6.7%) stent migrations. Regarding the fully opened stent without blocking, complete remission of PFCs within 1 month was independently predicted by a previous pancreatitis attack > 6 months prior (adjusted odds ratio: 11.143; 95% confidence interval: 1.108-112.012; P = 0.041). EUS-guided drainage of PFCs using the Hot AXIOS system is safe and efficient. Regarding completely patent stents, a previous pancreatitis attack > 6 months prior predicts a greater chance of achieving 100% remission of PFCs within 1 month of AXIOS treatment.

Acute pancreatitis associated with scoliosis surgery: Could opioids be a determinant factor in its development?

Various medical complications can occur after spinal surgery in the pediatric population. Current surgical techniques have allowed a greater degree of scoliosis correction, but at the same time, unusual complications have been described that seem to be associated and have a multifactorial etiology. We present a case series of three pediatric patients who underwent scoliosis correction surgery with continuous use of full-dose opioids, and during hospitalization and post-operative surveillance developed acute pancreatitis. The association between prolonged exposure to high-dose opioids and the onset of pancreatitis in the context of major surgery suggests a potential relationship that warrants further study.

Protective Effect of Nigella Sativa on Taurocholate Induced Pancreatitis in Rats

Introduction: Acute necrotizing pancreatitis with a high mortality rate and the search for treatment continues. We investigated the protective effect of Nigella Sativa (NS), with antioxidant and anti-inflammatory effects, in experimental acute necrotizing pancreatitis. Materials and Methods: Thirty six male Wistar albino rats (weights 180-220 g) were randomised into four groups. Group 1 (Control): Rats were given standard mouse chow. No pro-drug or pancreatic intervention was performed. Group 2 (NS): In addition to their standard diet, rats were given 0.1 ml/100gr of NS orally for 3 days prior to the experiment. Group 3: Necrotizing pancreatitis was induced by retrograde administration of 3% Na-Taurocholate through the distal common bile duct of the rats on on experiment day. Group 4 (NS+ANP): Necrotizing pancreatitis was also formed in rats receiving 0.1ml/100 mg of NS for 3 days. Rats were given high-dose anesthesia 8 hours after the onset of pancreatitis. Immunohistochemical (TNF-a, MDA, MPO, Caspase), histological pancreatitis scoring and biochemical (LDH, Lipase, amylase) analyzes were performed from the blood and pancreatic tissue samples obtained. Results: There was no difference in histopathological, immunohistochemical and biochemical values between Group 1 and Group 2 (p&gt;0.05). There were significiant differences between Group 4 and Group 3 in terms of histopathological, immunohistochemical and biochemical parameters (p&lt;0.001). The pancreatitis findings of the Group 4 were found to be significantly milder than Group 3, which did not receive NS. Conclusion: NS pretreatment alleviates NaTaurocholate-induced experimental pancreatitis. NS firstly studied in experimental models of pancreatitis.

Pancreatic pseudocyst after pegaspargase treatment in six children

Objective: To investigate the clinical characteristics and treatment of pancreatic pseudocyst after pegaspargase treatment in children. Methods: The clinical data of 6 children with pancreatic pseudocyst after pegaspargase treatment in the Department of Pediatrics in Peking University Third Hospital from July 2018 to February 2021 were analyzed retrospectively. Results: There were 4 males and 2 females, and their age of onset was 9.5 (5.8, 13.0) years. The total number of pegaspargase applications was 2.5 (2.0, 3.5) times. The course from the last dose of pegaspargase to the onset of pancreatitis was 11.0 (9.0, 17.2) days, and 42.5 (35.0, 129.5) days from the onset of pancreatitis to the diagnosis of pancreatic pseudocyst. Abdominal pain was the most prominent manifestation of pancreatitis (6/6). All of the 6 children were asymptomatic when pancreatic pseudocyst was noted, and were treated conservatively at first, but one case later developed intermittent abdominal distension or nausea after eating. All the cases had pancreatic pseudocyst enlargement during the conservative treatment. Three children were treated with endoscopic ultrasound-guided transgastric drainage, and the cyst disappeared from 10 days to 4 months after the operation. The other 3 children received endoscopic retrograde cholangiopancreatography (ERCP)-guided transpapillary drainage, but one of them turned to surgery due to pancreatic duct stricture, and in the rest 2 children the cyst disappeared at 1 and 3 months after operation respectively. Regarding safety issues, 1 child who received ERCP-guided transpapillary drainage had acute postoperative pancreatitis, which were improved after treatment, and the other 5 had no complications. Conclusions: Pancreatic pseudocyst after pegaspargase chemotherapy can be asymptomatic in the early stage, and should be diagnosed with a history of pegaspargase treatment and timely imaging examination. Conservative treatment is the first choice for asymptomatic pseudocyst. When the pseudocyst enlarges, different endoscopic drainage treatments are required according to whether the pseudocyst is connected with the main pancreatic duct.