Pancreas最新文献

{"title":"The Utility of 24/7 Interventional Radiology Service Post-pancreaticoduodennectomy.","authors":"Siddharth Darbhamulla, Hiro Masuda, Robert Ng, Timothy Shore, Ben Reidy, Lucian Roseverne, Richard Maher, Albert Goh, Jaswinder S Samra, Anubhav Mittal","doi":"10.1097/MPA.0000000000002589","DOIUrl":"10.1097/MPA.0000000000002589","url":null,"abstract":"<p><strong>Background: </strong>We investigated the utility and outcomes of interventional radiology procedures in postpancreaticoduodenectomy patients at a high-volume tertiary center with 24/7 access to an interventional radiology service.</p><p><strong>Methods: </strong>Retrospective review of all patients who underwent pancreaticoduodenectomy between January 2019 and December 2023 and analysis performed on patients who underwent interventional radiology procedures within the first 90 days postoperatively, assessing the indication, outcome, and timing of procedures. Out-of-hours intervention was defined as any procedure undertaken outside of the institution's regular hours of Monday-Friday, 8 am -4:30 pm .</p><p><strong>Results: </strong>A total of 293 pancreaticoduodenectomies were performed during the study period. A total of 212 postoperative interventional radiology procedures were performed on a total of 112 (38%) patients. A total of 152 (71.7%) procedures were completed in-hours, while 60 (28.3%) procedures performed out-of-hours. The immediate technical and overall success rates were 98.1% and 85.4%, respectively.</p><p><strong>Conclusion: </strong>Almost 30% of patients required out-of-hours emergency interventional radiology procedures. Given this finding, the propensity of pancreaticoduodenectomy patients to deteriorate rapidly, and the significant impact of failure to rescue in the morbidity and mortality associated with this operation, we believe that centers performing pancreaticoduodenectomy should have adequate access to interventional radiology services with 24-hour availability.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e311-e315"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Glucocorticoid Therapy for Acute Pancreatitis: A Review.","authors":"Xiaotian Feng, Jiyan Lin","doi":"10.1097/MPA.0000000000002563","DOIUrl":"10.1097/MPA.0000000000002563","url":null,"abstract":"<p><strong>Background: </strong>Acute pancreatitis (AP) is a prevalent gastrointestinal emergency with a substantial risk of severe complications. Evidence indicates that glucocorticoids (GCs) may attenuate organ failure and reduce mortality in AP through their anti-inflammatory and immunomodulatory properties. However, the therapeutic application of GCs in AP remains contentious due to potential adverse effects, such as heightened infection risk and exacerbation of pancreatic injury.</p><p><strong>Objective: </strong>This review evaluates recent developments in GC therapy for AP, with an emphasis on their mechanisms of action, therapeutic efficacy, and associated risks.</p><p><strong>Methods: </strong>A review investigates the role of GCs in AP pathophysiology, their impact on inflammatory markers, organ function, survival outcomes, and the ongoing controversies regarding their clinical efficacy and safety.</p><p><strong>Results: </strong>Current evidence suggests that GCs may attenuate inflammation and enhance survival in animal models and select clinical studies on AP. Yet, findings regarding their impact on disease progression and patient outcomes remain inconclusive. In addition, combination therapies incorporating GCs may be most effective within a multimodal therapeutic approach.</p><p><strong>Conclusion: </strong>GCs exhibit potential in the management of AP by modulating inflammatory pathways and immune responses. Their use necessitates thorough risk assessment. Large-scale clinical trials are essential to establish standardized protocols, optimal dosing regimens, and patient selection criteria for GCs therapy in AP.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":"55 3","pages":"e325-e333"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12893132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty in Chronic Pancreatitis and Its Impact on Health Care Utilization and Inpatient Outcomes: A Nationwide Analysis.","authors":"Waqas Rasheed, Kshitij Thakur, Kristen McQuerry, Kelsey Karnik, Darwin L Conwell, Radmila Choate","doi":"10.1097/MPA.0000000000002545","DOIUrl":"10.1097/MPA.0000000000002545","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e204-e205"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Prophylaxis: Does the Choice of Crystalloid Fluid Matter? A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Tareq Alsaleh, Saurabh Chandan, Abdul Mohammed, Nihal Khan, Mohamad Khaled Almujarkesh, Abdullah Abbasi, Sagar Pathak, Maham Hayat, Deepanshu Jain, Natalie Cosgrove, Kambiz Kadkhodayan, Dennis Yang, Muhammad Hasan, John George, Mustafa Arain","doi":"10.1097/MPA.0000000000002611","DOIUrl":"10.1097/MPA.0000000000002611","url":null,"abstract":"<p><strong>Objectives: </strong>The optimal crystalloid choice for post-ERCP pancreatitis (PEP) prophylaxis is not clear. To evaluate the published literature further, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing intravenous (IV) hydration with lactated Ringer (LR) and normal saline (NS) for PEP prevention.</p><p><strong>Materials and methods: </strong>A random-effects model was used. The primary outcome was the risk of PEP. Effect estimates were expressed as risk difference (RD) and 95% CI.</p><p><strong>Results: </strong>Pooling analysis of published RCTs with 594 patients (41.1% males, mean age: 57.6) showed statistically significant risk reduction of PEP in the LR group compared with the NS group [RD: -0.04; 95% CI (-0.08, -0.00), P = 0.03, I 2 = 0]. There was no significant risk difference in other adverse events.</p><p><strong>Conclusion: </strong>At equivalent fluid administration rates, using LR compared with NS showed a significant risk reduction in PEP of 4% with a number needed to treat (NNT) of 25. LR may be the better crystalloid for ERCP. Further studies are needed to validate these results.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e157-e161"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internet-delivered Cognitive-Behavioral Intervention for Pain in Pediatric Acute Recurrent and Chronic Pancreatitis: A Multicenter Randomized Controlled Trial.","authors":"Tonya M Palermo, Rui Li, Chuan Zhou, Homer Aalfs, Gretchen Cress, Mark Lowe, Maisam Abu-El-Haija, Ankur Chugh, Elissa M Downs, Douglas S Fishman, Alvin Jay Freeman, Matthew J Giefer, Tanja Y Gonska, Sohail Z Husain, Douglas Lindblad, Quin Y Liu, Asim Maqbool, Jacob A Mark, Brian A McFerron, Megha S Mehta, Robert Adam Noel, Emily R Perito, Fuchenchu Wang, Ying Yuan, Yuhua Zheng, Aliye Uc","doi":"10.1097/MPA.0000000000002558","DOIUrl":"10.1097/MPA.0000000000002558","url":null,"abstract":"<p><strong>Objectives: </strong>Abdominal pain is common and associated with high disease burden and health care costs in pediatric acute recurrent (ARP) and chronic pancreatitis (CP). Despite the effectiveness of psychological interventions in other abdominal pain populations, studies have not evaluated these interventions for pediatric pancreatitis pain. We evaluated the feasibility, acceptability, and preliminary efficacy of internet-delivered cognitive-behavioral therapy (CBT) for reducing pancreatitis-related abdominal pain and improving pain interference, anxiety, depression, activity limitations, and health-related quality of life.</p><p><strong>Methods: </strong>We enrolled 90 adolescents (ages 10-19, 63% female) with ARP or CP and their parents into this randomized placebo-controlled multicenter trial from 15 INSPPIRE ( IN ternational S tudy Group of P ediatric P ancreatitis: I n search for a cu RE) centers or from the community. Participants were randomly assigned to internet-delivered CBT (WebMAP-CP; n=46) or internet-delivered pain education (WebED; n=44). Assessments were completed pretreatment, at 3 months, and 6 months posttreatment.</p><p><strong>Results: </strong>High feasibility of intervention delivery was demonstrated by strong treatment engagement (>6 of 8 modules completed) in both groups. Treatment acceptability was higher in the WebMAP-CP group compared with WebED. There were no statistically significant between-group differences in pain or health outcomes.</p><p><strong>Conclusions: </strong>This is the first trial to evaluate the feasibility, acceptability, and preliminary efficacy of internet-delivered CBT for pediatric pancreatitis pain, demonstrating strong feasibility and treatment acceptability. Due to under-enrollment, the trial had reduced statistical power. Future research with a larger sample may build on these findings.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e137-e146"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bariatric Surgery in Chronic Pancreatitis: Increased Exocrine Risk Without Reduced Cancer Incidence.","authors":"Khalid Ahmed, Zachary Leslie, Yasmin Ali, Eric Wise, Martin Freeman, Stuart K Amateau, Ahmed Dirweesh","doi":"10.1097/MPA.0000000000002541","DOIUrl":"10.1097/MPA.0000000000002541","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e135-e136"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Fluid Overload in a Cohort of Patients With Acute Pancreatitis: Results From a Retrospective Tertiary Single-Center Study.","authors":"Nora Schneider, Maximilian Scharpf, Benjamin Mayer, Thomas Seufferlein, Alexander Kleger, Martin Müller, Viktoria Hentschel","doi":"10.1097/MPA.0000000000002534","DOIUrl":"10.1097/MPA.0000000000002534","url":null,"abstract":"<p><strong>Objectives: </strong>Aggressive fluid expansion has been an undisputed aspect of navigating the early stages of acute pancreatitis. Evidence produced by the WATERFALL trial supports a more conservative approach to fluid resuscitation as patients face higher odds of fluid overload while experiencing no benefit of their underlying condition. This retrospective monocentric observational study seeks to identify fluid-related complications in patients with acute pancreatitis of any grade of severity.</p><p><strong>Methods: </strong>One hundred twenty-nine patients with acute pancreatitis including moderately severe and severe courses were divided into groups based on their cumulative fluid administration within the first 24 hours (restrictive: <3 L; moderate: 3-6 L; aggressive: >6 L). Vital signs and laboratory values were reported at defined time points.</p><p><strong>Results: </strong>Most patients were allocated to the group of moderate fluid resuscitation. At baseline, patients did not differ in systemic disease severity indicated by critical illness scores. A higher proportion of patients with moderately severe or severe pancreatitis associated with an acute peripancreatic fluid collection had previously been administered >6 L fluids. C-reactive protein levels were significantly higher in patients with >6 L, whereas albumin levels were decreased.Patients receiving >6 L fluids were more likely to show radiologic features of pulmonary fluid overload and be transferred to intensive care unit. In addition, oxygenation markedly deteriorated in aggressively hydrated patients versus restrictive and moderate fluid regimes.</p><p><strong>Conclusions: </strong>The extent of fluid resuscitation was found to be strongly associated with the prevalence of clinical and radiologic signs of pulmonary fluid overload. Furthermore, moderately severe and severe courses of pancreatitis were more frequently observed in excessively hydrated patients.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e212-e219"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12788752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty as a Predictor of Outcomes in Patients With Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.","authors":"Camilo J Acosta, Sunil Amin, Jodie A Barkin","doi":"10.1097/MPA.0000000000002549","DOIUrl":"10.1097/MPA.0000000000002549","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to determine the association between frailty status and outcomes in patients with post-ERCP pancreatitis (PEP).</p><p><strong>Materials and methods: </strong>Appended data were obtained from the 2016-2017 National Inpatient Sample (NIS) database. We performed a nationwide cohort study utilizing International Classification of Diseases (ICD) diagnostic codes to identify adult patients with PEP. The Hospital Frailty Risk Score (HFRS) was used to classify patients as frail or non-frail. The primary outcome was composite complications related to PEP including all-cause mortality. Secondary outcomes were length of stay and total hospitalization costs.</p><p><strong>Results: </strong>There were 41,615 patients represented in the data, with 34.6% (14,382) characterized as frail and 65.4% (27,233) as non-frail. Of frail patients, 60.7% suffered composite complications related to PEP compared with 29.3% of non-frail patients ( P < 0.001). Frail patients had more cardiovascular, pulmonary, gastrointestinal, renal and endocrine, neurological, and infectious complications compared with non-frail patients. Frail patients also had higher all-cause mortality rates during inpatient admission (4.6% vs under 0.1%, P < 0.001) and increased length of stay (11.6 vs 0.8 d, P < 0.001) as well as total hospitalization charges ($140,855 vs $73,539, P < 0.001). On multivariable analysis, positive frailty status was associated with 2.94 times increased odds of having composite complications.</p><p><strong>Conclusion: </strong>Frailty assessments can be utilized as a predictor of outcomes and serve to guide clinical decision-making when determining prophylactic measures in patients undergoing ERCP who may be at risk for PEP.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e220-e226"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Pancreatectomy With Islet Autotransplantation for Chronic Pancreatitis in Adults: A Systematic Review.","authors":"Ramy Khalil, Muhammad Karabala, Jimmy Wen, Mouhamad Shehabat, Soham Kondle, Nabeal Dean, Yousef Karabala, Bhagvat Maheta, Eldo E Frezza","doi":"10.1097/MPA.0000000000002543","DOIUrl":"10.1097/MPA.0000000000002543","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic pancreatitis (CP) is a painful disease that can be refractory to multiple medical, endoscopic, and surgical interventions. Total pancreatectomy with islet autotransplantation (TPIAT) is a procedure that may be used to manage CP while potentially preserving endocrine pancreatic function. This study aims to ascertain the quality of life (QoL) and pain outcomes among CP patients after TPIAT through a systematic review of published literature.</p><p><strong>Materials and methods: </strong>A total of 22,691 studies published before May 2024 investigating TPIAT were collected from Scopus, Embase, Central, and PubMed databases. Title/abstract screening and full-text extraction were performed through a blinded, double review using Covidence; study quality was assessed using the MINORS criteria. Studies assessing adult patients undergoing TPIAT that reported pain or QoL outcomes using a validated scale were included. This study protocol has been registered to PROSPERO: CRD42024567887.</p><p><strong>Results: </strong>Twelve studies matched our criteria, with 1333 patients receiving TPIAT for CP. MINORS scoring indicated a low risk of bias. In all, 80% (8/10) of studies reported a significant increase in at least one QoL outcome after TPIAT and 83% (5/6) reported a significant decrease in pain.</p><p><strong>Conclusion: </strong>TPIAT improves QoL and pain outcomes in CP patients. Future studies should focus on identifying predictors of successful outcomes and exploring the impact of TPIAT on specific patient subgroups.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e183-e192"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Pancreatitis Hits Hard: High Health Care Demands in Appalachian Kentucky.","authors":"Brooks Richardson, Kshitij Thakur, Rachel Hill, Kristen McQuerry, Darwin L Conwell, Radmila Choate","doi":"10.1097/MPA.0000000000002554","DOIUrl":"10.1097/MPA.0000000000002554","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e207-e209"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}