Endocrine Pancreatic Insufficiency Research Articles

The Role of Pancreatitis Risk Genes in Endocrine Insufficiency Development After Acute Pancreatitis in Children

Acute pancreatitis (AP) is increasingly recognized as a risk factor for diabetes mellitus (DM). We aimed to study the association of pancreatitis genes with pancreatic endocrine insufficiency (pre-DM and DM) development post AP in children. This was an observational cohort study that enrolled subjects ≤21 years with their first episode of AP and followed them for 12 months for the development of pancreatic endocrine insufficiency. Pancreatitis risk genes (CASR, CEL, CFTR, CLDN2, CPA1, CTRC, PRSS1, SBDS, SPINK1, and UBR1) were sequenced. A genetic risk score was derived from all genes with univariable p<0.15 RESULTS: A total 120 subjects with AP were genotyped. Sixty-three subjects (52.5%) had at least 1 reportable variant identified. For modeling the development of pancreatic endocrine insufficiency at one year, 6 were excluded (2 with DM at baseline, 3 with total pancreatectomy, and 1 death).. From this group of 114, 95 remained normoglycemic and 19 (17%) developed endocrine insufficiency (4 DM, 15 pre-DM). Severe AP (58% vs 20%; p=0.001) and at least one gene affected (79% vs 47%, p=0.01) were enriched among the endocrine insufficient group. Those with versus without endocrine insufficiency were similar in age, sex, race, ethnicity, body mass index, and AP recurrence. A model for pre-DM/DM development included AP severity (OR=5.17 [1.66, 16.15], p=0.005) and genetic risk score (OR=4.89 [1.83, 13.08], p=0.002) and had an AUC of 0.74. In this cohort of children with AP, pancreatitis risk genes and AP disease severity were associated with pre-DM or DM development post AP.

Comparative Investigation of pH-Dependent Availability of Pancreatic Enzyme Preparations In Vitro.

This study aimed to compare different pancreatic enzyme preparations (PEPs) available in Germany regarding particle geometry and size, and to evaluate enzyme activity under physiologically relevant conditions in vitro. Pancreatic endocrine insufficiency is characterized by deficiency of pancreatic enzymes resulting in maldigestion. It is orally treated by pancreatic enzyme replacement therapy. The formulations differ in their physical properties and enzyme release behavior, potentially resulting in inconsistent dosages and poor interchangeability of products. A total of 25 products were analyzed for particle size and number of particles per capsule. Enzyme activities of lipase, amylase, and protease were measured by digestion of olive oil emulsion, starch, and casein, respectively. To analyze enzyme release, gastric environments were simulated by incubating PEPs at pH 1, 4, or 5. Duodenal conditions were simulated by subsequent incubation at pH 6. Regarding physical properties and enzyme release kinetics, considerable differences between different PEPs were found. Furthermore, compared to the label claim, excess lipase activity was observed for most products, reaching up to 148%. These in vitro results suggest poor interchangeability of PEPs, potentially explained by physical and release characteristics. Physicians and patients should be aware of the potential gap between label claims and the real-life performance of different PEPs.

Pancreatitis crónica

Chronic pancreatitis (CP) is a disease in which, due to different causes, the pancreatic tissue is replaced by fibrous tissue. This results in loss of both endocrine and exocrine function. This may happen due to different causes, often involving various risk factors. Investigating these causes is important due to their different therapeutic and prognostic implications, which are listed in the TIGAR-O classification. The clinical manifestations of CP occur when most of the organ's function has been lost. They include chronic abdominal pain, exocrine pancreatic insufficiency, and endocrine pancreatic insufficiency. There is no gold standard test for diagnosing CP that can provide a definitive diagnosis, but epidemiological, clinical, radiological (mainly endoscopic ultrasound and magnetic resonance cholangiopancreatography), and analytical tests (stool elastase test, complete nutritional study, and, if available, a 13C-labeled mixed triglyceride breath test) must be jointly evaluated. It is not necessary to obtain a histological specimen. Treatment is focused on pain management with medical, endoscopic, or surgical treatment in the most refractory cases; management of exocrine pancreatic insufficiency with lipase enzyme supplementation if available; management of endocrine pancreatic insufficiency (antidiabetics and insulin); and control of risk factors (tobacco use and alcohol use disorder).

Abstract 5096: Clinical feature of immune checkpoint inhibitor-induced pancreatic injury

Abstract Immune checkpoint inhibitors(ICIs) cause multiple adverse inflammatory reactions known as immune-related adverse events(irAEs), but ICI-related pancreatic injury(ICI-PI) is rare. ICI-PI ranges from asymptomatic hyperamylasemia to acute pancreatitis(ICI-AP), and its clinical features are not fully understood. We investigated the frequency and clinical features of ICI-PI and ICI-AP as well as their possible risk factors. Of the 186 consecutive cases who received ICI for GI cancers in our hospital from January 2020 to May 2022, 185 could be evaluated for serum amylase(AMY) levels pre- and post- ICI treatment. We retrospectively examined the clinical features and predictors of ICI-PI. Hyperamylasemia of grade 2 or higher according to CTCAE(v.5.0) was considered ICI-PI, and cases with other obvious factors were excluded. In the case of ICI-AP, we analyzed the pathological features of the tissues collected by EUS-FNA as well as the clinical features. The median of ICI doses was 6.0(range, 1-64), and the median duration of observation was 236 days(range, 17-1162). There were 25 cases of hyperamylasemia (higher than ULN) before starting ICI treatment. After starting ICI treatment, 14 patients(7.6%) developed ICI-PI, in all cases grade 2. The median time to onset of ICI-PI was 37.5 days(7-715). No cases discontinued ICI dosing due to ICI-PI, and no cases developed obvious pancreatic endocrine or exocrine insufficiency during the observation period. Overall survival was significantly longer in cases with ICI-PI than in those without ICI-PI(MST; 855 vs. 347days, p=0.029) and there was a trend toward longer PFS(MST; 160 vs. 96 days, p=0.057). Multivariate analysis revealed that only pretreatment serum AMY level(≥80 U/L) was a significant independent predictor of developing ICI-PI(HR: 5.00, 95% CI: 1.057-23.668, p=0.04). ICI-AP occurred in 2 cases(1.1%), both of them discontinued ICI treatment. Both cases showed enlarged pancreas on CT scan, negative serum IgG4 level, and responded well to steroid therapy. Pathological findings showed lymphoplasma cell infiltration, flower-like fibrosis, and obstructive phlebitis, which were similar to type 1 autoimmune pancreatitis(AIP) in one case. In the other case, neutrophil infiltration was observed in the stroma and epithelium, similar to type 2 AIP. The best overall response was PR in both cases with ICI-AP. The findings of this study indicate that higher pretreatment serum AMY levels may increase the probability of ICI-PI. ICI-PI cases without pancreatitis did not show any pancreatic endocrine or exocrine insufficiency during the observation period without interruption of ICI treatment and had favorable prognosis, but a more long-term evaluation of the impact on pancreatic function is needed. The clinical implications of ICI-related hyperamylasemia and its differences from ICI-AP remain uncertain and need to be explored in the future. Citation Format: Junichiro Itani, Takeshi Ishikawa, Toshifumi Doi, Daiki Sone, Ryuichi Morita, Naoto Iwai, Ryohei Hirose, Ken Inoue, Osamu Dohi, Naohisa Yoshida, Kazuhiko Uchiyama, Tomohisa Takagi, Hideyuki Konishi, Yoshito Itoh. Clinical feature of immune checkpoint inhibitor-induced pancreatic injury [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5096.

Pancreatitis in cystic fibrosis: Presentation, medical and surgical management, and the impact of modulator therapies.

Patients with Cystic Fibrosis (CF) are at increased risk of acute (AP) and chronic (CP) pancreatitis, and their complications. The extent of remaining healthy pancreatic parenchyma determines the risk of developing future episodes of pancreatitis, as well as pancreatic exocrine or endocrine insufficiency. Pancreatitis may be the presenting symptom of CF, and genetic testing is especially important in pediatrics. AP and recurrent AP are managed with intravenous fluid hydration and pain control, in addition to early refeeding and treatment of complications. With the use of modulator therapy in CF, pancreatic function may be restored to some extent. CP related pain is managed with analgesics and neuromodulators, with surgery if indicated in specific situations including TPIAT as a possible type of surgical intervention. Long-term sequelae of CP in patients with CF include exocrine pancreatic insufficiency treated with pancreatic enzyme replacement therapy, fat-soluble vitamin deficiencies and associated metabolic complications such as bone disease/osteoporosis, pancreatogenic diabetes, and less commonly, pancreatic cancer. We review the presentation and etiologies of pancreatitis in CF patients as well as the management of AP and CP primarily in children.

Pancreatic Endocrine Insufficiency

Pancreatic Endocrine Insufficiency

Exocrine and endocrine pancreatic insufficiency in patients with a history of acute pancreatitis and it’s correlation with severity of pancreatitis

Exocrine and endocrine pancreatic insufficiency in patients with a history of acute pancreatitis and it’s correlation with severity of pancreatitis

A single centre observational study of clinical profile of patients with chronic pancreatitis with special reference to pancreatic endocrine insufficiency and pancreatic exocrine insufficiency.

A single centre observational study of clinical profile of patients with chronic pancreatitis with special reference to pancreatic endocrine insufficiency and pancreatic exocrine insufficiency.

SAT079 A Novel Variant In The Carboxyl Ester Lipase (CEL) Gene Causing MODY

Abstract Disclosure: C.R. Medavarapu: None. M. McNutt: None. Introduction: Maturity-onset diabetes of the young (MODY) is a group of autosomal dominantly inherited disorders of non-autoimmune diabetes mellitus. Here, we report a patient initially diagnosed with type 2 DM and later found to have carboxyl ester lipase (CEL)-MODY. Case: A 51 year-old female was diagnosed with DM at the age of 44 and initially categorized as having type 2 DM based on normal GAD-65 antibodies. The patient’s DM was well controlled on semaglutide. The patient, however, reported chronic diarrhea/steatorrhea and intermittent dull abdominal pain which was not associated with semaglutide. The patient continued to have GI symptoms despite stopping the semaglutide. Abdominal imaging was unremarkable with a normal-appearing pancreas. Interestingly, the patient's daughter had similar gastric inflammatory symptoms and multiple members of the family have early-onset DM. Due to this symptom complex and similar presentation in the family, an inflammatory pathologic syndrome was suspected. A monogenetic auto-inflammatory syndrome was also considered in differential and the whole exome was analyzed. Genetic testing identified a novel, likely pathogenic heterozygous variant in CEL(NM_001807.5): c.1875del. Pathogenic variants in CEL are associated with MODY, type VIII. Discussion: Single-base deletions in the CEL gene can cause exocrine and endocrine pancreatic dysfunction. Our patient presented with a novel c.1875del variant in CEL that has not been reported in the literature as causative of disease nor as a variant in the general population. This variant lies in the variable number of tandem repeats (VNTR)-containing exon 11 of CEL. Two other single nucleotide deletions in this exon were described in the original report of CEL-MODY. The c.1875del variant results in the deletion of one nucleotide at position c.1875 of the CEL gene, causing a frameshift in the protein reading frame. Loss of normal protein function either through protein truncation or nonsense-mediated mRNA decay is expected. The c.1875del CEL variant is classified as likely pathogenic, and it correlated with our patient's clinical and biochemical findings. Typically, patients with CEL-MODY develop pancreatic exocrine dysfunction in early childhood and later develop DM in their 40s. A genetic diagnosis helps in determining the choice of treatment, managing associated complications, and the need for further genetic counseling for the family. Insulin is the most appropriate treatment in CEL-MODY; however, other anti-DM drugs can also be used as seen in our patient. The risk of DM complications from CEL-MODY is unknown but patients can develop pancreatic cysts and clinicians should watch for these complications. Our case highlights the need for high suspicion for possible CEL-MODY and considering genetic testing in the setting of coexistent endocrine and exocrine pancreatic insufficiency. Presentation: Saturday, June 17, 2023

Metabolic and surgical factors affecting postoperative quality of life in patients with total pancreatectomy with or without splenectomy: Single center results.

Pancreatic resection may be required in the treatment of patients with pathologies of the pancreas. Total pancreatectomy is a major surgical procedure with serious risk of mortality and morbidity, and patient selection is important for prognosis. The endocrine and exocrine pancreatic insufficiency that develops in patients after total pancreatectomy can lead to a serious decrease in the quality of life of the patients due to pain, diarrhea, vomiting etc. Our aim was to evaluate the effect of total pancreatectomy with spleen preservation as well as splenectomy on the quality of life of the patients. In our study, we retrospectively analyzed the data of patients diagnosed with pancreatic cancer, intrapapillary mucinous neoplasia, pancreatic neuroendocrine tumors, and chronic pancreatitis undergoing from partial to total pancreatic resections in our clinic between 12/2017 and 12/2022. Quality of life was compared using the EORTC QLQ-C30 scale. A total of 47 total pancreatectomy patients, 30 (63.8%) males and 17 (36.2%) females, were included in the study. Mean age of the patients was 61.38 (39-83) years. Five (35.7%) patients underwent perioperative total pancreatectomy because of high risk of pancreatic fistula development due to hard parenchyma and narrow pancreatic duct. Patients had a perioperative blood loss of 500 mL or more, and there was a statistically significant increase in perioperative blood loss compared to patients without vascular resection (p <0.001). Forty (85.1%) patients used enzyme preparations to replace pancreatic enzymes. After total pancreatectomy, quality of life of the patients is reduced both by surgical factors and by metabolic factors due to endocrine and exocrine insufficiency in the postoperative period.

Optimization of the complex treatment of chronic pancreatitis in elderly patients using systemic enzyme therapy

In the last few years, the number of young people with pancreatic pathology has increased. However, exacerbation of chronic pancreatitis (CP) in “favorable conditions” occurs at any age, leading to extremely unfavorable consequences.&#x0D; The aim is to study clinical and etiological factors of CP in elderly patients and optimize the complex treatment of this category of patients by including a systemic enzyme therapy agent.&#x0D; Materials and methods. The study included 98 CP patients, with a mean age of 71.3±1.4 years, who were randomized into two groups. All patients received the standard conventional treatment complex (CTC): pantoprazole 40 mg on an empty stomach on demand; prolonged enzyme replacement therapy with pure pancreatin at an adequate dose with each meal; prokinetics and/or antispasmodics as needed for 6 weeks. The study group was randomized into two groups: group I (CTC) — 20 patients got only CTC; group II (CTC+W) — 78 patients received Wobenzym in addition to CTC, 5 tablets three times per day.&#x0D; Results and discussion. It has been proven that CP in elderly patients occurs against the background of mixed etiopathogenetic factors: ischemic (87.7%), gastroduodenal (84.7%), and dyslipid (70.4%). Clinically, asthenic and dyspeptic syndromes predominate (92.8% and 77.5%, respectively). According to the anthropometric examination, body weight deficiency is observed in 64.3% of the examined, with endocrine pancreatic insufficiency in 29.6% in terms of fasting glucose and exocrine pancreatic insufficiency in 70.4% in terms of FαE. The use of CTC contributed to the reduction of dyspeptic and painful abdominal syndromes (p˂0.05), a decrease in body weight deficit by 4.3% in terms of body mass index, and a tendency to normalize pancreatic function.&#x0D; Conclusions. The addition of CTC with Wobenzym resulted in a decrease in the clinical manifestations of the disease (p&lt;0.03–p&lt;0.05), an improvement in carbohydrate imbalance in terms of postprandial glycemia (p&lt;0.05), and a trend towards a decrease in the level of glycated hemoglobin by an average of 0.2%. The administration of Wobenzym in the complex treatment of CP in elderly patients contributed to an increase in the level of FαE by 42.6% compared to this index before treatment (p&lt;0.001) and a decrease in nutrient deficiency due to the elevated body mass index of this category of patients by 7.0%.

376-OR: Chronic Pancreatitis Does Not Induce Specific Alterations in Beta-Cell Function

Chronic pancreatitis (CP) is the most frequent cause of diabetes due to pancreatic diseases, known as type 3c diabetes mellitus (T3cDM). Although the specific alterations of T3cDM are not completely understood, individuals with T3cDM are considered affected by pancreatic endocrine insufficiency and often treated with insulin. To investigate the functional alterations of T3cDM, we evaluated differences in beta-cell function in patients with and without CP, classified according to their glucose tolerance (NGT, IGT, DM). We recruited 50 patients with CP and 96 individuals without CP (NCP). All participants underwent OGTT, hyperglycemic clamp (HC), hyperinsulinemic euglycemic clamp and mixed meal test (MMT) with measurement of GLP-1 and glucagon. Basal insulin secretion rate (ISR), total ISR, rate secretion and β-cell glucose sensitivity (RS and GS) were estimated by mathematical models from OGTT, MMT and HC. Comparing individuals classified into NGT, IGT or DM based on OGTT-derived glucose tolerance, we did not find any difference in beta-cell function derived by OGTT and MMT within the same category (e.g.: NGT-CP vs. NGT-NCP). GLP-1 and glucagon secretion during MMT was not significantly different between CP vs. NCP. Of note, we found that insulin secretion after arginine stimulus in HC, an indirect measure of beta-cell mass, was reduced only in DM-CP vs. DM-NCP (ARG CP 397 (132; 662) pmol/l vs NCP 795 (604; 1134) pmol/l; p= 0.023). No difference was found in insulin sensitivity evaluated as glucose uptake during euglycemic clamp. At equivalent levels of glucose tolerance, patients with CP had similar beta-cell function, GLP-1 and glucagon secretion to individuals without CP. People with T3cDM have less beta-cell mass than patients with DM without CP, but analogous residual beta-cell function, so they could benefit from other therapies apart from insulin. Future studies are warranted to investigate differences in beta-cell function decline between type 2 diabetes mellitus and T3cDM. Disclosure G.Ciccarelli: None. G.Di giuseppe: None. F.Cinti: None. A.Mari: Consultant; Eli Lilly and Company. T.Mezza: None. A.Giaccari: Speaker's Bureau; Abbott, AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novo Nordisk, Sanofi.

1493-P: Immune-Mediated Diabetes Mellitus—A Rare Complication of Nivolumab Therapy

Background: Immune mediated diabetes mellitus (DM) is a rare complication of immune checkpoint inhibitor (ICI) therapy, with an incidence of less than 1%. We present a case of immune-mediated DM with nivolumab therapy presenting as diabetic ketoacidosis (DKA). Case: A 74-year-old Caucasian male with no history of DM or autoimmune disease was diagnosed with stage III metastatic melanoma and started on treatment with nivolumab, an ICI. He tolerated treatment well and had no evidence of endocrine dysfunction on routine laboratory monitoring. Shortly after completing his 14th cycle of nivolumab therapy, he presented to the emergency department with a one-week history of fatigue, poor appetite, polydipsia, and polyuria. He was found to have DKA with serum blood glucose 446 mg/dL, anion gap 20 mEq/L, serum bicarbonate 14 mEq/L, arterial pH 7.23, and 4+ urine ketones. His hemoglobin A1c was 7.3%, increased from 5.4% one year earlier. He was treated with intravenous insulin then transitioned to basal-bolus subcutaneous insulin therapy, which was continued at discharge. Evaluation in the outpatient setting revealed no measurable GAD65 antibodies or anti-insulin antibodies, but his serum c-peptide was found to be &amp;lt;0.10 ng/mL with corresponding serum blood glucose level 214 mg/dl. This supported a diagnosis of endocrine pancreatic insufficiency, in his case likely immune mediated due to nivolumab therapy. He completed an additional 6 cycles of nivolumab with no further complications. Meanwhile his DM became well-controlled with subcutaneous insulin injections, and he was eventually transitioned to insulin pump therapy. Discussion: ICIs such as nivolumab are known to cause multiple autoimmune complications that can appear at any point during treatment. The underlying mechanisms of beta cell immunotoxicity are incompletely understood, but progression to insulin-dependency appears to be rapid. It is important to recognize new or worsening DM early to avoid life-threatening complications such as DKA. Disclosure S.M.Iqbal: None. C.Houston: None.

Clinical characteristics and long-term outcomes following pancreatic injury – An international multicenter cohort study

BackgroundTrauma to the pancreas is rare but associated with significant morbidity. Currently available management guidelines are based on low-quality evidence and data on long-term outcomes is lacking. This study aimed to evaluate clinical characteristics and patient-reported long-term outcomes for pancreatic injury. MethodsA retrospective cohort study evaluating treatment for pancreatic injury in 11 centers across 5 European nations over >10 years was performed. Data relating to pancreatic injury and treatment were collected from hospital records. Patients reported quality of life (QoL), changes to employment and new or ongoing therapy due to index injury. ResultsIn all, 165 patients were included. The majority were male (70.9%), median age was 27 years (range: 6–93) and mechanism of injury predominantly blunt (87.9%). A quarter of cases were treated conservatively; higher injury severity score (ISS) and American Association for the Surgery of Trauma (AAST) pancreatic injury scores increased the likelihood for surgical, endoscopic and/or radiologic intervention. Isolated, blunt pancreatic injury was associated with younger age and pancreatic duct involvement; this cohort appeared to benefit from non-operative management. In the long term (median follow-up 93; range 8–214 months), exocrine and endocrine pancreatic insufficiency were reported by 9.3% of respondents. Long-term analgesic use also affected 9.3% of respondents, with many reported quality of life problems (QoL) potentially attributable to side-effects of opiate therapy. Overall, impaired QoL correlated with higher ISS scores, surgical therapy and opioid analgesia on discharge. ConclusionsPancreatic trauma is rare but can lead to substantial short- and long-term morbidity. Near complete recovery of QoL indicators and pancreatic function can occur despite significant injury, especially in isolated, blunt pancreatic injury managed conservatively and when early weaning off opiate analgesia is achieved.

Challenges in managing upper gastrointestinal bleeding secondary to primary squamous cell carcinoma of the pancreas: a case report and literature review

BackgroundPrimary pancreatic squamous cell carcinoma (SCC) is a rare type of pancreatic cancer, with an incidence of 5% of all pancreatic cancers. This condition is associated with a poor prognosis, and no optimal treatment has been established (Zhang et al. in Medicine (Baltim). 97:e12253, 2018).Case presentationA 56-year-old man presented to our hospital with upper gastrointestinal bleeding and new-onset diabetes mellitus. He had no other medical comorbidities, episodes of pancreatitis and symptoms secondary to pancreatic insufficiency. A computed tomography (CT) scan showed a 94 × 72 × 83 mm necrotic pancreatic body mass with gastric invasion and multiple liver metastases. Gastroscopy revealed deep ulcerations at the posterior wall of the stomach with an active slow ooze. Endoscopic ultrasound was performed with EUS guided biopsy, which confirmed poorly differentiated squamous carcinoma of the pancreas. The patient underwent palliative radiotherapy for recurrent upper gastrointestinal bleeding followed by palliative chemotherapy with gemcitabine and nab-paclitaxel. He was referred to dietitians and diabetes educators for the management of pancreatic exocrine and endocrine insufficiency before being referred to community palliative care upon discharge.ConclusionsThis is the first reported Australian case of pancreatic SCC presenting with upper gastrointestinal bleeding and new-onset diabetes mellitus. Patients with unresectable disease require a multidisciplinary approach to manage complications and improve symptom control. However, there are no standard treatment guidelines and future research is needed in this regard.

Image or scope: Magnetic resonance imaging and endoscopic testing for exocrine and endocrine pancreatic insufficiency in children

ObjectivesWe sought to evaluate associations between Magnetic Resonance Imaging (MRI) findings, exocrine pancreatic insufficiency (EPI) and endocrine insufficiency (prediabetes or diabetes) in children. MethodsThis was a retrospective study that included patients<21 years of age who underwent MRI and endoscopic pancreatic function testing (ePFT; reference standard for pancreatic exocrine function) within 3 months. MRI variables included pancreas parenchymal volume, secreted fluid volume in response to secretin, and T1 relaxation time. Data were analyzed for the full sample as well as the subset without acute pancreatitis (AP) at the time of imaging. ResultsOf 72 patients, 56% (40/72) were female with median age 11.4 years. A 5 mL decrease in pancreas parenchymal volume was associated with increased odds of exocrine pancreatic dysfunction by both ePFT (OR = 1.16, p = 0.02 full sample; OR = 1.29, p = 0.01 no-AP subset), and fecal elastase (OR = 1.16, p = 0.04 full sample; OR = 1.23, p = 0.02 no-AP subset). Pancreas parenchymal volume had an AUC 0.71 (95% CI: 0.59, 0.83) for predicting exocrine pancreatic dysfunction by ePFT and when combined with sex and presence of AP had an AUC of 0.82 (95% CI: 0.72, 0.92).Regarding endocrine function, decreased pancreas parenchymal volume was associated with increased odds of diabetes (OR = 1.16, p = 0.03), and T1 relaxation time predicted glycemic outcomes with an AUC 0.78 (95% CI: 0.55–1), 91% specificity and 73% sensitivity. ConclusionsPancreas parenchymal volume is an MRI marker of exocrine and endocrine pancreatic dysfunction in children. A model including sex, AP, and pancreas volume best predicted exocrine status. T1 relaxation time is also an MRI marker of endocrine insufficiency.

The Cause and Effect Relationship of Diabetes after Acute Pancreatitis.

Acute pancreatitis (AP) is an acute inflammation of the pancreas associated with high morbidity and mortality. Endocrine pancreatic insufficiency secondary to AP has drawn increasing attention in recent years. The aim of this paper is to analyze the available clinical and experimental literature to determine the cause and effect relationship of diabetes type 3c (T3cDM; pancreatogenic diabetes) after acute pancreatitis. The clinico-pathological features and management challenges of pancreatogenic diabetes overlap with other secondary causes of diabetes. A complex pathogenesis involving pancreatic exocrine insufficiency, dysfunction of insulin secretion, and insulin resistance is likely the cause of T3cDM after AP. To obtain an improved understanding of the pathophysiology of diabetes after AP, more research is now needed to understand the risk of complications related to the pancreas and diabetes in these patients.

Early versus Delayed Minimally Invasive Intervention for Acute Necrotizing Pancreatitis: An Updated Systematic Review and Meta-Analysis

Background: Nowadays, minimally invasive intervention (MII) has largely replaced delayed open surgery in acute necrotizing pancreatitis (ANP). However, the timing of MII remains unclear. The present study investigated the effect of early versus delayed MII on complications in ANP. Methods: Studies evaluating the impact of the timing of MII on complications in ANP patients were thoroughly searched on PubMed, Embase, Cochrane Library, and Web of Science from inception to June 2022. The primary outcome of interest was mortality. Secondary outcomes were the incidence of complications. Results: Nine studies reporting 870 patients undergoing MII for ANP were included. No significant difference was found in mortality between the early and delayed intervention groups. In addition, the timing of MII was not associated with the incidence of new-onset respiratory failure, new-onset cardiovascular failure, new-onset renal failure, new-onset multiple organ failure, gastrointestinal fistula or perforation, pancreatic fistula, stent migration, bleeding, venous thrombosis, and new-onset pancreatic endocrine insufficiency. Notably, in the subgroup analysis of biliary and Asian ANP patients, early intervention was associated with a significantly higher risk of new-onset renal failure than delayed intervention. Conclusions: Early intervention is safe and recommended only for patients with indications for intervention, such as infection.

Experiencia en la resección del proceso uncinado del páncreas: indicaciones y resultados. Revisión de la literatura

IntroductionThe aim of our study is to assess the accumulated experience in the use of uncinatectomy (UC) as a parenchymal-sparing pancreatectomy technique. MethodWe have carried out a observational and descriptive study including restrospectively all the patients undergoing UC at Hospital Universitary de Bellvitge (HUB) and an exhaustive review of the cases described in the english literature. ResultsFrom 2003 to 2019, seven patients have been operated by UC in the HUB with a diagnostic orientation of pancreatic lesion considered premalignant. All patients have presented morbidity, mainly in the form of postoperative pancreatic fistula, and none of them have presented endocrine or exocrine pancreatic insufficiency. Currently, all patients are alive and without recurrence of neoplastic disease. Another 29 cases have been described in the literature. Of all the cases (36 patients), the approach was minimally invasive (laparoscopic or robotic) in 6 patients (16.7%), leading to a shorter hospital stay. The global incidence of pancreatic fistula is 50%, with a re-admission rate of less than 10%, but without requiring re-intervention. ConclusionUC is an infrequent and poorly standardized technique for the resection of benign lesions or those with low potential for malignancy located in the uncinate process of the pancreas. Although it is associated with equal or greater morbidity than standardized resection techniques, it offers excellent preservation of endocrine and exocrine pancreatic function, with the consequent long-term benefit in the patients life quality.

Necrotizing Pancreatitis: A comprehensive review of the presentation, management, and complications

Necrotizing pancreatitis (NP) is a life-threatening complication of acute pancreatitis. It requires an extended hospital stay, aggressive management, and has a higher risk of mortality. Risk factors such as comorbidities in the patient’s history including history of coronary artery disease and cerebrovascular disease can increase the risk of developing necrotizing pancreatitis. The presentation of necrotizing pancreatitis is similar to acute pancreatitis, but specific labs such as hematocrit level can be monitored to anticipate the development of necrotizing pancreatitis. In addition, diagnostic imaging must be obtained to classify necrotizing pancreatitis and aid in management choice. Fluid hydration, adequate pain management, and nutritional support are the principles of treating necrotizing pancreatitis. Deciding whether to drain the necrotic collection or not is usually determined based on the type of necrosis present and whether it is infected. Infected necrotizing pancreatitis can also occur, and patients usually need to be monitored closely with appropriate antibiotics for a long duration. Patients affected by necrotizing pancreatitis can potentially develop complications that can lead to devastating outcomes. Necrotizing pancreatitis complications can occur due to an inflammatory reaction on the adjacent structure such as splanchnic vein thrombosis, gastrointestinal fistula or inflammatory reaction within the pancreas leading to an exocrine and an endocrine pancreatic insufficiency. We present here a literature review of necrotizing pancreatitis and the complications that can arise from it.