Pancreas最新文献

{"title":"Multi-hole Versus Fully Covered Self-expandable Metal Stents for Distal Biliary Obstruction in Unresectable Pancreatic Cancer.","authors":"Takashi Ito, Tsukasa Ikeura, Ayaka Orino, Koh Nakamaru, Masataka Masuda, Shinji Nakayama, Daisuke Hashimoto, Masashi Kanai, Sohei Satoi, Makoto Naganuma","doi":"10.1097/MPA.0000000000002722","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002722","url":null,"abstract":"<p><strong>Objectives: </strong>Self-expandable metallic stents (SEMS) are commonly used to treat biliary obstruction in patients with unresectable pancreatic cancer. Fully covered SEMS (FCSEMS) prevents tumor ingrowth but is prone to migration. Multi-hole SEMS (MHSEMS) has multiple holes in the stent membrane, prevents stent migration. This study compared time to recurrent biliary obstruction (TRBO) between MHSEMS and FCSEMS.</p><p><strong>Methods: </strong>We retrospectively enrolled patients with unresectable pancreatic cancer who underwent initial SEMS placement at our institution between January 2017 and December 2025. We evaluated TRBO, causes of obstruction, and stent-related adverse events (AEs). Risk factors for TRBO were assessed using univariate and multivariate analyses.</p><p><strong>Results: </strong>A total of 116 patients were included; and MHSEMS and FCSEMS were placed in 58 and 58 patients, each. Median TRBO was longer with MHSEMS than FCSEMS (394 vs. 238 d, P<0.01). The MHSEMS group had significantly fewer RBO, including migration, than the FCSEMS group (P=0.01). Multivariate analysis identified MHSEMS use and chemotherapy after SEMS placement as being independently associated with reduced RBO. The rates of AEs, including post-endoscopic retrograde cholangiopancreatography-related pancreatitis, cholecystitis, and non-occlusive cholangitis, were similar between the groups.</p><p><strong>Conclusions: </strong>MHSEMS may be more effective than FCSEMS in patients with unresectable pancreatic cancer, offering reduced migration risk and better TRBO.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012666","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":"Commentary on \"Effect of Skeletal Muscle Mass Loss on Outcomes of Patients with Intraductal Papillary Mucinous Neoplasm\".","authors":"Minyan Zhao, Difeng Chen","doi":"10.1097/MPA.0000000000002719","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002719","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990474","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":"Pancreatitis-associated SPINK1 Variant c.-53C>T Reduces Trypsin Inhibitor Translation.","authors":"Zoltán Attila Nagy, Miklós Sahin-Tóth","doi":"10.1097/MPA.0000000000002718","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002718","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990702","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":"Possible Dynamic Changes of Cachexia Index During and After Neoadjuvant Chemotherapy Followed by Pancreatectomy.","authors":"Kanako Maeda, Haruka Kobayashi, Kenei Furukawa, Toru Ikegami","doi":"10.1097/MPA.0000000000002716","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002716","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990761","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":"The Effect of Pancreatic Exocrine Insufficiency and Pancreatic Enzyme Replacement Therapy on Gut Microbiome Composition in Pancreatic Disease: A Prospective Cohort Study.","authors":"James M Halle-Smith, Katie Fung, Elena Efstathiou, Nick Tovey, Joanne Stockton, Tariq H Iqbal, Paul Moss, Andrew D Beggs, Keith J Roberts","doi":"10.1097/MPA.0000000000002709","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002709","url":null,"abstract":"<p><strong>Objectives: </strong>Increasing evidence demonstrates that pancreatic exocrine insufficiency (PEI) is associated with harmful changes to the gut microbiome. The mainstay of PEI treatment is with pancreatic enzyme replacement therapy (PERT), which has been shown to lead to significant survival benefit in pancreatic disease. The aim of this study was to determine how treatment of PEI with PERT affects gut microbiome composition.</p><p><strong>Methods: </strong>This is a prospective observational cohort study of patients being treated for pancreatic disease at a single centre. PEI status of patients was assessed at the time of recruitment using published diagnostic criteria. Pre-PERT samples were taken before treatment was started and post-PERT samples were taken after at least 4 weeks of treatment. To profile the gut microbiome composition, shotgun metagenomic sequencing was performed with DNA extracted from stool samples.</p><p><strong>Results: </strong>25 patients with pancreatic disease were included. The abundance of pathogenic bacteria, such as Viridans group Streptococcus and Campylobacter species, was significantly increased in the gut microbiome of patients with PEI compared to those without PEI. Following PERT treatment, analysis of the gut microbiome of treated patients showed a significant reduction in the abundance of multiple pathogenic species, such as those from Viridans group Streptococci, compared to untreated PEI patients.</p><p><strong>Conclusions: </strong>Treatment with PERT leads to significant changes in the gut microbiome composition of patients with pancreatic disease. Changes include a significant reduction in potentially pathogenic bacteria and so may contribute to the survival benefits seen with PERT treatment in pancreatic disease.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930428","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":"Safety and Diagnostic Performance of Pancreatic Duct Brushings for Detecting Pancreatic Cancer.","authors":"Shuji Mitsuhashi, Chinmay Guralwar, Jad P AbiMansour, Samuel Han, Aliana Bofill-Garcia, Santhi Swaroop Vege, Motaz H Ashkar, Randall K Pearson, Bret T Petersen, John A Martin, Andrew C Storm, Ryan J Law, Barham K Abu Dayyeh, Shounak Majumder, Vinay Chandrasekhara, Eric J Vargas","doi":"10.1097/MPA.0000000000002714","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002714","url":null,"abstract":"<p><strong>Objectives: </strong>Pancreatic duct (PD) brush cytology (BC) and fluorescence in-situ hybridization (FISH) are viable techniques but underutilized due to limited data on their diagnostic accuracy for pancreatic malignancy and associated risks. This study evaluates the safety and diagnostic performance of BC, FISH, and their combination for detecting pancreatic malignancy.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on subjects undergoing endoscopic retrograde cholangiopancreatography (ERCP) PD brushings at a tertiary hospital. Data included demographics, procedural details, adverse events, and outcomes. Malignancy was confirmed by EUS-guided biopsy or surgical histology. Diagnostic metrics for BC, FISH, and their combination were calculated.</p><p><strong>Results: </strong>Of the 205 subjects who underwent ERCP PD brushings from 2004 to 2023, 35 (17.1%) were diagnosed with pancreatic malignancy. BC had a sensitivity of 31.4% and specificity of 95.9% (AUC 0.64). Abnormal FISH showed 45.7% sensitivity and 89.4% specificity (AUC 0.68), while polysomy FISH had 28.6% sensitivity and 97.1% specificity (AUC 0.63). Combined BC and abnormal FISH yielded 54.3% sensitivity and 87.7% specificity (AUC 0.71). AEs included post-ERCP pancreatitis in 16 cases (7.8%), bleeding in 2 (1.0%), and micro-perforation in 1 (0.5%).</p><p><strong>Conclusions: </strong>PD brushing for BC and FISH is generally safe with modest diagnostic accuracy for malignancy. While novel diagnostic tests such as molecular biomarkers in pancreatic fluid for detecting PC are still needed, PD brushings can assist in the detection of PC with low rates of PEP in select subjects.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930467","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":"Germline Cancer Testing in Unselected Patients With Neuroendocrine Neoplasms: A Multicenter Prospective Study.","authors":"Oluseyi Abidoye, Michael Golafshar, Katie Kunz, Cody Eslinger, Zaid Elsabbagh, Samee Z Alheraki, Abdullah Alsulaiman, Margaret Klint, Edward Esplin, Robert L Nussbaum, Jason Starr, Daniel Ahn, Tanios Bekaii-Saab, Thorvardur Halfdanarson, Niloy J Samadder, Mohamad B Sonbol","doi":"10.1097/MPA.0000000000002665","DOIUrl":"10.1097/MPA.0000000000002665","url":null,"abstract":"<p><strong>Purpose: </strong>Neuroendocrine neoplasms (NENs) are increasingly recognized to have a hereditary predilection, yet the prevalence and clinical relevance of pathogenic germline variants (PGVs) in unselected patients with NEN remain poorly defined. This prospective, multicenter study aimed to evaluate the prevalence and clinical utility of PGVs through universal multigene panel testing in a diverse cohort of patients with NENs.</p><p><strong>Patients and methods: </strong>Between 2018 and 2024, we enrolled unselected patients with NENs from 3 Mayo Clinic Cancer Centers. Germline genetic testing was performed using a next-generation sequencing panel of up to 84 cancer predisposition genes. Patients were not selected based on age, disease stage, ethnicity, or family history. Variants were classified as PGVs, variants of uncertain significance (VUS), or negative. Clinical and demographic data were analyzed descriptively.</p><p><strong>Results: </strong>Among 88 patients, PGVs were identified in 15.9% (n=14), most frequently in high- or moderate-penetrance genes including MEN1 , CHEK2 , MITF , and MUTYH . PGVs were most commonly found in pancreatic NENs [n=12/55 (21.8%)], followed by small bowel NENs [n=2/20 (10%)], with no PGVs detected in lung NENs. Mismatch repair (MMR) gene alterations were identified in 5.7% of patients, including 1 MLH1 PGV and 4 MSH2/MSH6 VUS, 2 of which demonstrated MMR deficiency by protein testing. VUS were reported in 34.1% of patients. Notably, 35.7% of PGV-positive patients did not meet current NCCN or ACMG testing criteria, and 53.9% had PGVs in genes outside of cancer-specific guideline recommendations.</p><p><strong>Conclusions: </strong>Universal germline testing in unselected patients with NEN identified clinically relevant PGVs in over 15% of cases. These findings support broader genetic testing approaches to guide treatment, enhance familial risk assessment, and inform cascade testing-regardless of traditional clinical selection criteria.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e850-e855"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157641","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":"Trends in Pancreatic Cancer Incidence, Prevalence, and Mortality in the United States and High-SDI Countries (1991-2021) and Future Projections: A Forecasting Population-Based Analysis.","authors":"Acacia N Shouse, Abdul Rafeh Awan, Muhammad Ahmad Nadeem, Arshia Jahangir, Mohammed A Quazi, Fatima Ashfaq, Mudasar Nisar, Jibran Ikram, Hassam Ali, Anna J Willingham, Abu Baker Sheikh, Asad Ullah, Amir Humza Sohail","doi":"10.1097/MPA.0000000000002660","DOIUrl":"10.1097/MPA.0000000000002660","url":null,"abstract":"<p><strong>Objectives: </strong>Pancreatic cancer has poor prognosis, and incidence is rising, particularly in high Socio-Demographic Index (SDI) countries. This study examines trends in pancreatic cancer incidence, prevalence, and mortality in the United States and high-SDI countries from 1991 to 2021 and uses modeling to project pancreatic cancer rates through 2041.</p><p><strong>Methods: </strong>This retrospective, population-based observational study analyzed pancreatic cancer trends using the Global Burden of Disease (GBD) database. Primary outcome measures included age-standardized incidence (ASIR), prevalence (ASPR), and mortality (ASMR) rates, stratified by sex and region. Joinpoint regression analysis estimated annual percentage change (APC) with 95% CIs to identify significant trends. Autoregressive Integrated Moving Average (ARIMA) models were used to forecast rates from 2022 to 2041.</p><p><strong>Results: </strong>From 1991 to 2021, pancreatic cancer ASIR, ASPR, and ASMR rose in both the United States and high-SDI countries, with a sharp rise after 2001 and a plateau after 2016. ASIR peaked at 10.46 (United States, 2016) and 10.24 (high SDI, 2018), with similar trends in ASPR and ASMR. APC analysis revealed a significant rise ( p <0.001) in most periods through 2016, although rates recently declined between 2016 and 2020. Males consistently had higher rates compared with females. Projections of ASMR to 2041 continue to rise to 9.856 in high-SDI countries and 9.813 in the United States, leading to a projected 271,310 and 72,304 deaths, respectively.</p><p><strong>Conclusions: </strong>Pancreatic cancer incidence, prevalence, and mortality have increased in the past 2 decades in both high-SDI countries and the United States. Rising incidence and prevalence are likely driven by a combination of improved diagnosis and treatment, as well as population aging, lifestyle, and environmental factors. Males have higher rates compared with females across both regions, a trend that has not yet been fully explained. Despite the recent stabilization of pancreatic cancer rates, modeling predicts a rise in all 3 metrics through 2041. Continued efforts are imperative to refine early diagnostic methods, identify modifiable risk factors, and develop effective interventions to reduce mortality.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e810-e817"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157664","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":"Endoscopic Ultrasound-Guided Transluminal Drainage of Walled-Off Necrosis Using Naso-Cystic Drain With Metal Stent Versus Metal Stent Alone: A Randomized Controlled Pilot Study.","authors":"Nilanjan Kar, Surinder S Rana, Rajesh Gupta, Vaneet Jearth, Jimil Shah, Mandeep Kang, Kamal Kishore, Arnab Pal, Vikas Gautam","doi":"10.1097/MPA.0000000000002659","DOIUrl":"10.1097/MPA.0000000000002659","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic ultrasound (EUS)-guided drainage using a lumen-apposing metal stent (LAMS) has become the standard of care in managing symptomatic walled-off necrosis (WON). However, the role of nasocystic drainage (NCD) in addition to stent placement remains uncertain. We conducted a pilot study to compare outcomes of EUS-guided drainage with and without NCD in patients with WON.</p><p><strong>Methods: </strong>In this open-label, prospective, block-randomized controlled pilot trial, 40 patients with symptomatic WON undergoing EUS-guided drainage using LAMS were randomized into 2 groups: NCD (n=20) and non-NCD (n=20). The 2 groups were compared for clinical success, defined as symptomatic improvement accompanied by a reduction in the size of the WON to ≤3 cm on cross-sectional imaging, and for the number of necrosectomy sessions required, duration of hospitalization, readmissions, procedure-related complications, and mortality.</p><p><strong>Results: </strong>Technical success was achieved in all patients. Clinical success at day 3 was observed in 55% (n=11) in the NCD arm and 45% (n=9) in the non-NCD arm ( P =0.527). Time to clinical success and the number of necrosectomy sessions were comparable between groups. The median hospital stay was significantly shorter in the non-NCD group ( P =0.038). Readmission ( P =0.093), reintervention ( P =0.495), complications ( P =0.072), and mortality rates ( P =0.147) were similar across both groups.</p><p><strong>Conclusion: </strong>The addition of nasocystic drainage to EUS-guided LAMS drainage did not improve clinical outcomes in patients with WON. However, due to the small sample size and baseline imbalance, the findings are exploratory and require confirmation in larger, adequately powered randomized trials.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e804-e809"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778003","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":"Relationship Between Number of Acute Pancreatitis Episodes and Risk of New-onset Diabetes in the U.S.: A Real-world Data Analysis.","authors":"Djibril M Ba, Yue Zhang, Kadiyatu Fofana, Tian Qiu, Douglas L Leslie, Xiang Gao, Vernon M Chinchilli, Nazia Raja-Khan, Phil A Hart","doi":"10.1097/MPA.0000000000002708","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002708","url":null,"abstract":"<p><strong>Introduction: </strong>Acute pancreatitis (AP) is a common inflammatory disorder that is associated with increased risk for diabetes mellitus (DM). It remains unclear whether recurrent acute pancreatitis (RAP) is associated with further increased risk of incident DM. This study aims to investigate the association between RAP and incident DM using real-world data.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the MerativeTM MarketScan® claims database (2016-2023), identifying patients with AP and no prior history of DM at baseline. The primary exposure of interest, RAP, was defined as one or more episodes of AP occurring ≥90 days after the index AP diagnosis, whereas one episode of AP referred to a single episode of AP (SAP) with no subsequent recurrence within 90 days following the index event. A multivariable stratified Cox proportional hazards regression models were used to determine the association between RAP and incident DM, identified using ICD-10 codes.</p><p><strong>Results: </strong>In total, 16,184 individuals with AP (mean [SD] age: 45.8 [12.3]) contributed 40,712 person-years of follow-up, during which 1,477 incident cases of DM were documented. Individuals with RAP had an increased risk of incident DM compared with those with a SAP(adjusted HR, 1.92; 95% CI, 1.61-2.29). The risk increased significantly with the frequency of RAP. In comparing the modifying effect of patient demographics and comorbidities, a stronger association between RAP and incident DM was observed in females (adjusted HR, 2.44; 95% CI, 1.87-3.19) than in males (adjusted HR, 1.64; 95% CI, 1.30-2.07; Pinteraction=0.03). Also, stronger associations were observed among younger patients (18-46 y) (adjusted HR=2.56; 95% CI, 1.97-3.31) and among non-tobacco abuse (adjusted HR=2.19; 95% CI, 1.81-2.65), with significant interactions for all comparisons (Pinteraction<0.05.</p><p><strong>Conclusions: </strong>In this real-world study, RAP was associated with an increased risk of incident DM. Our findings highlight an opportunity for glycemic monitoring and proactive management of patients with RAP to mitigate their risk of developing DM.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865669","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}