Exocrine Pancreatic Function Research Articles

Fecal glycoprotein 2 is a marker of gut microbiota dysbiosis and systemic inflammation

BackgroundAntimicrobial autoantigenic glycoprotein 2 (GP2) is an important component of the innate immune system which originates from the exocrine pancreas as well as from the small intestines. The relationship of GP2 with the intestinal microbiome as well as the systemic implications of increased fecal GP2 levels are, however, still unclear. Therefore, fecal samples from 2,812 individuals of the Study of Health in Pomerania (SHIP) were collected to determine GP2 levels (enzyme-linked immunosorbent assay) and gut microbiota profiles (16 S rRNA gene sequencing). These data were correlated and associated with highly standardised and comprehensive phenotypic data of the study participants.ResultsFecal GP2 levels were increased in individuals with higher body mass index and smokers, whereas lower levels were found in case of preserved exocrine pancreatic function, female sex or a healthier diet. Moreover, higher GP2 levels were associated with increased serum levels of high-sensitivity C-reactive protein, loss of gut microbial diversity and an increase of potentially detrimental bacteria (Streptococcus, Haemophilus, Clostridium XIVa, or Collinsella). At the same time, predicted microbial pathways for the biosynthesis of beneficial short-chain fatty acids or lactic acid were depleted in individuals with high fecal GP2. Of note, GP2 exhibited a stronger association to overall microbiome variation than calprotectin.ConclusionFecal GP2 is a biomarker of gut microbiota dysbiosis and associated with increased systemic inflammation. The intestines may be more important as origin for GP2 than pancreatic acinar cells. Future studies need to investigate the potential clinical value in disease specific patient cohorts.

Clinical Implications and Risk Factors of Dilatation of Remnant Pancreatic Duct at 1 Year after Pancreatoduodenectomy: A Prospective, Japanese, Multicenter, Observational Cohort Study (DAIMONJI Study).

To determine the precise frequency of main pancreatic duct (MPD) dilatation within the remnant pancreas at 1 year after pancreatoduodenectomy (PD) and its clinical implications, a prospective multicenter cohort study was performed in patients without MPD dilatation before PD (registry number: UMIN000029662). Between October 2017 and July 2020, patients with an MPD diameter less than 3 mm who were planned to undergo PD for periampullary lesions at 21 hospitals were enrolled. The primary endpoints were frequency of MPD dilatation at 1 year after PD, and the relationship between MPD dilatation and pancreatic endo- and exocrine function, nutritional status, and fatty liver. Secondary endpoints were risk factors for MPD dilatation at 1 year after PD and time-course change in MPD diameter. Of 200 registered patients, 161 patients were finally analyzed. Pancreatic fistula was the most frequent complication (76; 47.2%). MPD dilatation (MPD > 3 mm) at 1 year after PD was seen in 35 patients (21.7%). Pancreatic exocrine function, assessed by steatorrhea, was significantly impaired in patients with MPD dilatation. However, endocrine function, nutrition status, and fatty liver development were comparable between the 2 groups. In multivariate analysis, the serum total protein level 7.3 g/dL or more was an independent predictor for MPD dilatation at 1 year after PD (odds ratio 3.12, 95% CI 1.31 to 7.15). A mean MPD diameter significantly increased at 6 months after PD and kept plateau thereafter. MPD dilatation at 1 year after PD was seen in 21.7% of patients and significantly associated with exocrine function impairment but not with endocrine function, nutrition status, or development of fatty liver.

Impact of asprosin, interleukin-6, and adiponectin on exocrine pancreatic insufficiency in patients with type 2 diabetes mellitus and chronic pancreatitis

Exocrine pancreatic insufficiency (EPI) is a clinical condition often associated with chronic pancreatitis (CP) and type 2 diabetes mellitus (T2DM) leads to malabsorption and nutritional deficiencies, severely impacting patients’ quality of life. It has been identified that asprosin, a glucogenic protein, is a key player in carbohydrate metabolism and chronic inflammation. Elevated levels of asprosin, along with changes in interleukin‑6 (IL‑6) and adiponectin, may contribute to the pathophysiology of EPI in patients with T2DM and CP. Objective — to investigate the levels of asprosin, IL‑6, and adiponectin and their correlation with exocrine pancreatic function in patients with T2DM and CP. Materials and methods. The study included 100 patients treated at Kharkiv Regional Clinical Hospital from 2020 to 2022. Patients were divided into two groups: Group 1 (n=70) with comorbid T2DM and CP, and Group 2 (n=30) with T2DM alone. The control group included 20 healthy individuals. Blood levels of asprosin, IL‑6, and adiponectin were measured using immunoassays. Fecal elastase‑1 (FE‑1) levels were used to assess exocrine pancreatic function. Pearson’s correlation coefficient was calculated to determine the relationships between these markers. Results. Asprosin levels were significantly higher in Group 1 compared to Group 2 and the control group, with the highest levels observed in patients with comorbid T2DM and CP (10.06±3.56 ng/ml). IL‑6 levels were also elevated in Group 1 (64.44±4.35 pg/ ml), indicating heightened inflammation. Adiponectin levels were lower in Group 1 (2.80±0.38 ng/ml), correlating with worse metabolic profiles. FE‑1 levels were markedly reduced in Group 1 (142.2±6.3 mg/ g), confirming severe EPI. Significant correlations were found between asprosin levels and IL‑6 (positive correlation, r=0.49, p<0.01), as well as between asprosin levels and FE‑1 (negative correlation, r=–0.52, p<0.01). In the group of patients with isolated T2DM, significant moderate negative correlations were found between asprosin levels and adiponectin (r=–0.47, p<0.05) and FE‑1 (r=–0.44, p<0.05). The study also demonstrated a strong negative correlation between adiponectin and IL‑6 (r=–0.61, p<0.01) in patients with comorbid T2DM and CP. Conclusions. Elevated asprosin levels in patients with T2DM and CP are associated with increased inflammation and reduced exocrine pancreatic function. The significant correlations between asprosin, IL‑6, and FE‑1 suggest that asprosin could serve as a clinically valuable biomarker for assessing metabolic and inflammatory status in these patients. The findings highlight the complex interaction between metabolic and inflammatory pathways in the development of EPI.

Impaired exocrine pancreatic function is associated with sarcopenia in the asymptomatic general population without a history of pancreatic disease

Impaired exocrine pancreatic function is associated with sarcopenia in the asymptomatic general population without a history of pancreatic disease

Image J as the quantification tool in endosonography strain elastography may be reflected in the disturbance of endocrine pancreatic dysfunction.

Pancreatic fibrosis is one of the main pathological features of chronic pancreatitis (CP), suggesting a strong relationship between CP and pancreatic ductal cancer. There was no available data about pancreatic fibrosis and pancreatic dysfunction in the early CP (ECP) using endosonography (EUS). Asymptomatic patients with pancreatic enzyme abnormalities (AP-P; n = 56) and patients with ECP (n = 21) were determined by the absence of abnormal findings on upper gastrointestinal endoscopy, abdominal ultrasonography, and abdominal computed tomography. An Olympus EUS (GF-UCT 260; Olympus) was used to perform EUS. Open software "Image J", developed by NIH, was used to measure the surface area fraction of the designated elastic blue region. The maximum value among the pancreatic head, pancreatic body, and pancreatic tail was defined as the ELST-blue score. The exocrine and endocrine pancreatic functions were evaluated using the N-benzoyl-l-tyrosyl-p-aminobenzoic acid (BT-PABA) test and homeostasis model assessment of β-cell function (HOMA-β) value, respectively. EUS score, lobularity, and hyperechoic foci/strands in patients with ECP were significantly (p < 0.001) higher than those in patients with AP-P. In addition, there were no significant differences in the BT-PABA test (73.1 ± 25.5, 68.5 ± 15.6) and HOMA-β (93.1 ± 67.4, 73.5 ± 139.7) between patients with ECP and AP-P. The ELST-blue score measured by image J as the quantification tool in EUS strain elastography in patients with ECP was significantly higher (p = 0.002) than that in patients with AP-P. Interestingly, the ELST-blue score was significantly associated with HOMA-β in patients with ECP. The ELST-blue score may be a useful tool for the evaluation of endocrine pancreatic dysfunction in the ECP.

Beyond Insulin: A Deeper Dive into Pancreatic Disease

Abstract: There are several different categories into which the etiology of pancreatic disease can be subdivided, including inflammation, neoplasia, endocrine dysfunction, and genetic disorders. A comprehensive understanding of the pathogenesis of pancreatitis is necessary for the development of appropriate management methods and therapies, as the disorder has a complicated underlying pathophysiology. Complications such as reduced digestive function, the formation of pseudocysts or abscesses, and ongoing pain are likely as the illness develops. The purpose of this review is to act as a knowledge base. This study aims to examine existing approaches to treating diabetes, including both cutting-edge and tried-and-true therapies. Based on the literature review, the authors discussed how pancreatic failure affected higher animals, explored how the pancreatic exocrine function affects adult and adolescent organism development, and gave an overview of all the conditions that directly affect pancreatic health. There was also a discussion of the link between obesity, lifestyle, nutrition, and pancreatic issues.

New Insights into Chronic Pancreatitis: Potential Mechanisms Related to Probiotics.

Chronic pancreatitis is a progressive fibroinflammatory disorder with no currently satisfactory treatment. Emerging evidence suggests an association between gut microbial dysbiosis and chronic pancreatitis. Although direct causative evidence is lacking, it is hypothesized that the gut microbiota may play a pivotal role in modulating pancreatic function via the gut-pancreas axis. Thus, modulating the gut microbiota through the administration of probiotics or prebiotics may alleviate pancreatic disorders. In this review, we first propose the potential mechanisms by which specific probiotics or prebiotics may ameliorate chronic pancreatitis, including the alleviation of small intestinal bacterial overgrowth (SIBO), the facilitation of short-chain fatty acids' (SCFAs) production, and the activation of glucagon-like peptide-1 receptors (GLP-1Rs) in the pancreas. Since there are currently no probiotics or prebiotics used for the treatment of chronic pancreatitis, we discuss research in other disease models that have used probiotics or prebiotics to modulate pancreatic endocrine and exocrine functions and prevent pancreatic fibrosis. This provides indirect evidence for their potential application in the treatment of chronic pancreatitis. We anticipate that this research will stimulate further investigation into the gut-pancreas axis and the potential therapeutic value of probiotics and prebiotics in chronic pancreatitis.

Correlation between endoscopic ultrasound features and exocrine pancreatic function in chronic pancreatitis

BackgroundEndoscopic ultrasound (EUS) is the most sensitive method for diagnosing chronic pancreatitis (CP) in its early stages, and Rosemont Classification (RC) is used for its evaluation. Data on the correlation between EUS features and pancreatic exocrine insufficiency (PEI) are limited. We investigated the correlation between the EUS findings and PEI. MethodsThis was a retrospective, monocentric cohort study involving patients prospectively enrolled from 2018 to 2022, with definite or probable CP according to the M-ANNHEIM criteria. All the patients underwent EUS and exocrine function investigations within 12 months of diagnosis. PEI was diagnosed using fecal elastase (FE) or when overt steatorrhea was reversed by pancreatic enzyme replacement therapy. Logistic regression analyses, rank correlation, ROC curve, and area under the curve (AUROC) were performed to evaluate the association between EUS features and PEI, and the accuracy of RC in predicting PEI. ResultsAmong 128 patients examined (63.3 % male; mean age, 47 years), 69.5 % were diagnosed with PEI. In multivariate logistic regression among all the RC criteria, only lithiasis in the main pancreatic duct (MPD) was associated with increased risk of PEI (OR 2.92, 95 % CI 1.29–6.61; p = 0.01). Rank analysis showed a weak inverse correlation between RC and FE (Spearman's rho = −0.02; p = 0.03). The accuracy of RC was moderate (AUROC 0.62, p = 0.014). ConclusionsAmong RC EUS features, lithiasis in the MPD is helpful for predicting the risk of PEI, while other findings are of limited utility in evaluating exocrine function.

Embolization of the Pancreas Using Microspheres: A Proof-of-Safety Study in a Porcine Model

PurposeTo evaluate safety and impact of particle embolization on pancreatic function in a pig model. Materials and MethodsEmbolization of the dorsal pancreatic artery using 100–300-μm particles was performed on 14 Yorkshire pigs. Baseline and post-embolization glucose tolerance testing results and serum amylase/lipase levels were obtained. Pigs were observed for 2 weeks to assess for behavioral signs of pain/distress, bowel changes, and changes to intake/output. After 2 weeks, euthanasia and necropsy with gross and histopathologic assessment of the pancreas were performed. ResultsEmbolization was technically successful in all pigs. All animals survived the 2-week follow-up without evidence of pain/distress. There were significant increases in amylase and lipase at 24 and 48 hours (P < .001), which normalized by 2 weeks. There was minimal change in glucose tolerance testing at 2 weeks. Bowel habits were unchanged without diarrhea. At necropsy, all examined pancreases had fibrosis in the distal body and tail, without gross evidence of ongoing inflammation. On histopathologic evaluation, all pancreases demonstrated fibrosis in the embolized portions without evidence of active inflammation in treated or adjacent pancreatic tissue. ConclusionsParticle embolization of the pancreas was feasible and tolerated by all tested pigs with transient amylasemia, lipasemia, and mildly impaired glucose tolerance but without clinical or histopathologic evidence of acute pancreatitis and no evident impact on pancreatic endocrine or exocrine function.

Efficacy of the Coordinative compound of Aluminium and N-(2,3-dimethylphenyl)-anthranilic (mefenamic) acid on the Model of Chronic Alcohol-Induced Pancreatitis

The aim of the study is to determine the efficacy of the innovative coordinative compound of aluminium and N-(2,3-dimethylphenyl)-anthranilic (mefenamic) acid (CCAA, possessing hepatoprotective and antioxidative activity) on the model of chronic alcohol-induced pancreatitis in rats (Lieber–DeCarli isocaloric alcohol liquid diet for 10 weeks + LPS administration once a week for the three last weeks, 3 mg/kg intravenously). CCA was administered for 21 days at doses of 30, 60, and 120 mg/kg intragastrically. Leucocyte content in the peripheral blood and erythrocyte sedimentation rate, basal glycemia, total lipids level, α-amylase and pancreatic elastase activity in blood serum and the duodenal contents as well as histological structure of the pancreas were evaluated. In the blood serum and the homogenate of the pancreas, glutathione content, superoxide dismutase (SOD), catalase, glutathione reductase, glutathione-S-transferase, and glutathione peroxidase activities were measured. The dose-dependent normalizing effect of CCAA was registered by the influence on the non-specific inflammatory markers, pancreatic exocrine function, and cytoarchitectonics of the pancreas (the highest efficacy – at a dose of 120 mg/kg). The normalizing influence on the prooxidant-antioxidant balance markers was not dose-dependent with an especially significant normalizing influence on SOD activity. The results substantiate expanding indications for the of the studied drug.

Střevní mikrobiom u nemocných s chronickou pankreatitidou

Summary: We refer to the microfl ora inhabiting the intestine as a whole as the intestinal microbio ta, and their genomes collectively as the microbio me. Dysbio sis is a violation of the balance between the intestinal microbio ta, the immune system and the epithelial intestinal barrier. Dysbio sis is associated not only with a number of gastrointestinal diseases, including infl ammatory and cancerous diseases of the pancreas. We do not know the answer as to whether dysbio sis is a causal factor in the development of chronic pancreatitis, but it is a fact that, for example, the severity of the disease or changes in exocrine or endocrine pancreatic function are related to the intestinal microbio ta. Pancreatic enzymes, especially pancreatic elastase, are signifi cantly involved in the modulation of intestinal microfl ora. Specifi c changes in the composition of the intestinal microbio me in people with an autoimmune form of chronic pancreatitis could also become early dia gnostic markers of the disease. It is evident that systematic research is more than desirable in this area of pancreatology. Key words: intestinal microbio me – chronic pancreatitis – autoimmune pancreatitis – diabetes mellitus – exocrine pancreatic insuffi ciency – corticoids

Semi-automated software improves interrater reliability and reduces processing time of magnetic resonance imaging-based exocrine pancreatic assessments in pediatric patients

ObjectivesMagnetic resonance (MR) imaging with secretin stimulation (MR-PFTs) is a non-invasive test for pancreatic exocrine function based on assessing the volume of secreted bowel fluid in vivo. Adoption of this methodology in clinical care and research is largely limited to qualitative assessment of secretion as current methods for secretory response quantification require manual thresholding and segmentation of MR images, which can be time-consuming and prone to interrater variability. We describe novel software (PFTquant) that preprocesses and thresholds MR images, performs heuristic detection of non-bowel fluid objects, and provides the user with intuitive semi-automated tools to segment and quantify bowel fluid in a fast and robust manner. We evaluate the performance of this software on a retrospective set of clinical MRIs.MethodsTwenty MRIs performed in children (< 18 years) were processed independently by two observers using a manual technique and using PFTquant. Interrater agreement in measured secreted fluid volume was compared using intraclass correlation coefficients, Bland-Altman difference analysis, and Dice similarity coefficients.ResultsInterrater reliability of measured bowel fluid secretion using PFTquant was 0.90 (0.76–0.96 95% C.I.) with − 4.5 mL mean difference (-39.4–30.4 mL 95% limits of agreement) compared to 0.69 (0.36–0.86 95% C.I.) with − 0.9 mL mean difference (-77.3–75.5 mL 95% limits of agreement) for manual processing. Dice similarity coefficients were better using PFTquant (0.88 +/- 0.06) compared to manual processing (0.85 +/- 0.10) but not significantly (p = 0.11). Time to process was significantly (p < 0.001) faster using PFTquant (412 +/- 177 s) compared to manual processing (645 +/- 305 s).ConclusionNovel software provides fast, reliable quantification of secreted fluid volume in children undergoing MR-PFTs. Use of the novel software could facilitate wider adoption of quantitative MR-PFTs in clinical care and research.

ОСОБЕННОСТИ НУТРИТИВНОГО СТАТУСА ДЕТЕЙ С МУКОВИСЦИДОЗОМ РАЗЛИЧНЫХ ЭТНИЧЕСКИХ ГРУПП СЕВЕРНОГО КАВКАЗА

Adequate nutritional status in a patient with cystic fibrosis (CF) positively correlates with the normal function of the bronchopulmonary system. Many domestic and foreign studies have been conducted so far to assess the nutritional status of children and adults with CF. However, there is no data as yet on the phenotypic characteristics of children from different ethnic groups of the North Caucasus depending on their genotype. The purpose of this research was to study the peculiarities of nutritional status in children with CF of the following Russia’s North Caucasus ethnic groups: Chechen, Karachay-Circassian, Dagestani, Ingush and Ossetian-Alanian. Materials and methods used: a single-center open prospective study of 117 children with CF aged 2 months to 17 years old (Me 6 y/o) of various North Caucasus ethnic groups was conducted. All patients have undergone molecular diagnosis and assessment of both nutritional status and exocrine pancreatic function. Results: 50.4% of pediatric patients with CF in the Russia’s North Caucasus have had pathological mutations in c.1545_1546delTA, p.(Tyr515*) and c.3846G&gt;A, p.(Trp1282*) in homozygous state. These mutations were most often found in the Ingush (100%) and Chechen (82%) ethnic groups and somewhat less frequently in the Dagestani (57.1%) and Karachay-Circassian (54%) ethnic groups. In the Chechen and Ossetian-Alanian ethnic groups, when these mutations were detected, severe pancreatic insufficiency was established in 40.5% and 100% of cases, respectively. Pseudo-Bartter syndrome was diagnosed in 60% of cases with this genetic variant in a homozygous or compound heterozygous states during the patients’ first years of life. Indicators for the nutritional status of children with CF from different ethnic groups were significantly lower compared to those recorded officially in the 2021 Russian National Register of Patients with CF. Conclusion: it is necessary to study the course of CF and the state of nutritional status separately in each population and its connection with the identified genetic characteristics of the Russia’s North Caucasus ethnic groups. The genotype and phenotype patterns for these patients were the reason for the development of disorders of the exocrine function of the pancreas and pseudo-Bartter syndrome at an early age, which in its turn could lead to further development of nutritional deficiency.

Usefulness of pancreatic volume quantitative analysis as a predictor of development and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis

BackgroundPost-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most common and serious adverse events associated with ERCP. Thus, we aimed to investigate the usefulness of pre-ERCP pancreatic volume, which is deeply involved in exocrine pancreatic function, as a predictor of PEP development and severity. MethodsIn total, 1107 patients who underwent their first ERCP were recruited from January 2012 to December 2022 for this retrospective study. Pancreatic volume was measured by cross-sectional analysis using pre-ERCP computed tomography images. The potential risk factors for PEP were analyzed using multivariate logistic regression. ResultsOf the 745 patients included in the study, 34 (4.6 %) developed PEP: severe, moderate, or mild PEP in 1, 7, and 26 cases, respectively. Multivariate analysis revealed that only a large pancreatic volume (>70 cm3) was an independent risk factor for the development of PEP (odds ratio, 7.98; 95 % confidence interval, 11.80–67.50; P < 0.001). Additionally, the incidence of PEP was significantly higher in patients with a pancreatic volume >70 cm3 than in those with a pancreatic volume ≤70 cm3 (18.5 % [31/168] vs. 0.5 % [3/577]; P < 0.001). Also, the association between the pre-ERCP pancreatic volume and PEP severity was positively correlated (r = 0.625, P < 0.005), with a larger pancreatic volume corresponding to increased PEP severity. ConclusionsA large pancreatic volume before ERCP may be a novel risk factor for PEP incidence and severity. This finding suggests that quantitative analysis of the pre-ERCP pancreatic volume could be a useful predictor of PEP.

T1 and T2-mapping in pancreatic MRI: Current evidence and future perspectives

Conventional T1- and T2-weighted magnetic resonance imaging (MRI) of the pancreas can vary significantly due to factors such as scanner differences and pulse sequence variations. This review explores T1 and T2 mapping techniques, modern MRI methods providing quantitative information about tissue relaxation times. Various T1 and T2 mapping pulse sequences are currently under investigation. Clinical and research applications of T1 and T2 mapping in the pancreas include their correlation with fibrosis, inflammation, and neoplasms. In chronic pancreatitis, T1 mapping and extracellular volume (ECV) quantification demonstrate potential as biomarkers, aiding in early diagnosis and classification. T1 mapping also shows promise in evaluating pancreatic exocrine function and detecting glucose metabolism disorders. T2* mapping is valuable in quantifying pancreatic iron, offering insights into conditions like thalassemia major. However, challenges persist, such as the lack of consensus on optimal sequences and normal values for healthy pancreas relaxometry. Large-scale studies are needed for validation, and improvements in mapping sequences are essential for widespread clinical integration. The future holds potential for mixed qualitative and quantitative models, extending the applications of relaxometry techniques to various pancreatic lesions and enhancing routine MRI protocols for pancreatic pathology diagnosis and prognosis.

Improved Nutritional Outcomes and Gastrointestinal Symptoms in Adult Cystic Fibrosis Patients Treated with Elexacaftor/Tezacaftor/Ivacaftor

Introduction: Cystic fibrosis transmembrane conductance regulator modulator therapy improves nutritional status and quality of life. Clinical trials have shown pancreatic insufficiency conversion, mostly in pediatric patients treated with ivacaftor. Studies with elexacaftor/tezacaftor/ivacaftor (ETI) in older patients have not suggested restoration of exocrine pancreas function, but quality data in adults are lacking. Our aim was to show the effect of ETI in adults with cystic fibrosis (CF) on nutritional status and digestive function. We hypothesized improvement of nutritional parameters and gastrointestinal symptoms, reduction of pancreatic enzyme replacement therapy, but uncertain improvement in exocrine pancreatic function. Methods: We prospectively enrolled adults with CF treated with ETI from August 2021 to June 2022. We measured anthropometric parameters, laboratory nutritional markers, change of fecal elastase, pancreatic enzymes replacement therapy needs, and gastrointestinal symptoms. Results: In the cohort of 29 patients (mean age 29.1 years), 82.8% suffered exocrine pancreatic insufficiency. After ETI, mean BMI increased by 1.20 kg/m2 (p < 0.001), mean body weight by 3.51 kg (p < 0.001), albumin by 2.81 g/L, and prealbumin by 0.06 (both p < 0.001). Only 1 patient, initially pancreatic insufficient (4.5%, p < 0.001), developed pancreatic sufficiency, indicated by increased fecal elastase from 45 μg/g to 442.1 μg/g. Mean change in lipase substitution decreased by 1,969 units/kg/day (p < 0.001) and stools frequency by 1.18 per day (p < 0.001). Conclusion: Our data suggest increased nutritional parameters, lower pancreatic substitution requirements, and improved defecation in adult CF patients on ETI. Improvement in exocrine pancreatic function might be mutation-specific and needs further study.

Premalignant cystic neoplasms and neuroendocrine tumors of the pancreatic head-Is the Kausch-Whipple resection an adequate treatment?

Currently, the most frequently used surgical treatment for symptomatic, benign, premalignant cystic and neuroendocrine neoplasms of the pancreatic head is the Whipple procedure or pylorus-preserving pancreatoduodenectomy (PD). However, when performed for treatment of benign tumors, PD is amultiorgan resection involving loss of pancreatic and extrapancreatic tissue and functions. PD for benign neoplasm is associated with the risk of considerable early postoperative complications and an in-hospital mortality of up to 5%. Following the Whipple procedure anew onset of diabetes mellitus is observed in 14-20% and new exocrine insufficiency in 25-45%, leading to metabolic dysfunction and impairment of quality of life persisting after resection of benign tumors. Symptomatic neoplasms are indication for surgery. Patients with asymptomatic pancreatic tumors are treated according to the criteria of surveillance protocols. The goal of surgical treatment for asymptomatic patients is, according to the guideline criteria, interruption of the surveillance program before the development of an advanced stage cancer associated with the neoplasm. Tumor enucleation and duodenum-preserving pancreatic head resection, either total or partial, are parenchyma-sparing resections for benign neoplasms of the pancreatic head. The first choice for small tumors is enucleation; however, enucleation is associated with an increased risk of pancreatic fistula B + C following pancreatic main duct injury. Duodenum-preserving total or partial pancreatic head resection has the advantage of low postoperative surgery-related complications, amortality of < 0.5% and maintenance of the endocrine and exocrine pancreatic functions. Parenchyma-sparing pancreatic head resections should replace classical Whipple procedures for neoplasms of the pancreatic head.

The effect of steroid therapy on pancreatic exocrine function in autoimmune pancreatitis

Background/objectivesAutoimmune pancreatitis (AIP) is a steroid-responsive inflammatory disease of the pancreas. Few studies investigated pancreatic exocrine function (PEF) in patients suffering from AIP and no definitive data are available on the effect of steroids in PEF recovery. Aim of the study is the evaluation of severe pancreatic insufficiency (sPEI) prevalence in AIP at clinical onset and after steroid treatment. Methods312 Patients with diagnosis of AIP between January 1st, 2010 and December 31st, 2020 were identified in our prospectively maintained register. Patients with a pre-steroid treatment dosage of fecal elastase-1 (FE-1) were included. Changes in PEF were evaluated in patients with available pre- and post-treatment FE (between 3 and 12 months after steroid). ResultsOne-hundred-twenty-four patients were included, with a median FE-1 of 122 (Q1-Q3: 15–379) μg/g at baseline. Fifty-nine (47.6 %) had sPEI (FE-1<100 μg/g). Univariable analysis identified type 1 AIP, radiological involvement of the head of the pancreas (diffuse involvement of the pancreas or focal involvement of the head), weight loss, age and diabetes as associated with a greater risk of sPEI. However, at multivariable analysis, only the involvement of the head of the pancreas was identified as independent risk factor for sPEI. After steroids, mean FE-1 changed from 64 (15–340) to 202 (40–387) μg/g (P = 0.058) and head involvement was the only predictor of improvement of sPEI. ConclusionThe inflammatory involvement of the head of the pancreas is associated with PEF severity, as well as PEF improvement after treatment with steroids in patients with AIP.

Quantitative assessment of pancreatic exocrine function in symptomatic patients with locally advanced pancreatic cancer receiving radiation therapy

Quantitative assessment of pancreatic exocrine function in symptomatic patients with locally advanced pancreatic cancer receiving radiation therapy

Fecal elastase-1 and ultrasonography for assessment of exocrine pancreatic function in children with cystic fibrosis

Fecal elastase-1 and ultrasonography for assessment of exocrine pancreatic function in children with cystic fibrosis