Pancreas最新文献

{"title":"Pediatric Pancreatitis Nutritional Practice Variations amongst Clinical Providers- A Cross-Sectional Survey.","authors":"Chinenye R Dike, Bridget Dowd Kiernan, Joanna Stanisz, Zachary M Sellers, Maisam Abu-El-Haija, Michael J Wilsey","doi":"10.1097/MPA.0000000000002711","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002711","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865687","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":"Pancreatic Fluid Enzymes as a Functional Chronic Pancreatitis Biomarker: A Pilot Endoscopic Study.","authors":"Rachel L Hill, Bassam Abomoelak, Alice Hinton, Alexander T Tran, Chirajyoti Deb, Zobeida Cruz-Monserrate, Jami L Saloman, Hanno Steen, Peter A Banks, Linda S Lee, Phil A Hart, Devendra I Mehta, Darwin L Conwell","doi":"10.1097/MPA.0000000000002703","DOIUrl":"10.1097/MPA.0000000000002703","url":null,"abstract":"<p><strong>Objective: </strong>We previously validated a short endoscopic test with pancreas fluid enzyme activity in pediatrics and young adults. We assessed the role of pancreatic fluid enzyme activity as a candidate to address the lack of a diagnostic biomarker for chronic pancreatitis (CP).</p><p><strong>Methods: </strong>In this pilot study, we assessed pancreatic fluid samples collected endoscopically 30-minute post-secretin injection from adult controls (n=10) and CP subjects (n=20). Protein-normalized enzymatic activity for amylase, lipase, trypsin, chymotrypsin, and elastase was compared between CP and control groups using logistic regression, and diagnostic performance was evaluated by ROC analysis.</p><p><strong>Results: </strong>Acinar cell enzyme levels were decreased in pancreatic fluid from CP subjects compared with controls, with significant differences observed for lipase and trypsin activity (AUC≥0.82; p's=0.01). Eighty-six percent of controls had normal enzymatic activity across all five analytes, compared with only 43% of CP subjects, who more frequently exhibited multi-enzyme abnormalities. A graded pattern of reduction was observed from controls to equivocal (Eq) CP to definitive (Def) CP, indicating that enzyme activity generally shifts with advancing CP disease, although Eq and Def CP did not differ significantly from one another.</p><p><strong>Conclusions: </strong>This pilot study explored the potential of pancreatic fluid enzymatic activity as a functional assessment of exocrine activity in CP, with potential correlation to disease severity. Pancreatic fluid represents a promising, proximal biomarker source; however, larger prospective studies are needed to validate pancreas fluid biomarkers and define their relationship to disease stage, EPD, and other CP-related clinical outcomes.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831281","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":"Prognostic Utility of the Cachexia Index in Resectable and Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy.","authors":"Satoru Tsuruta, Keinosuke Ishido, Hayato Nagase, Yusuke Wakasa, Hiroaki Fujita, Kenichi Hakamada","doi":"10.1097/MPA.0000000000002706","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002706","url":null,"abstract":"<p><strong>Objectives: </strong>The cachexia index (CXI), integrating skeletal muscle mass, serum albumin, and the neutrophil-to-lymphocyte ratio, has been proposed as a marker of cancer-related cachexia. The objective of this study was to assess the prognostic significance of pre-treatment CXI in patients with resectable or borderline resectable pancreatic ductal adenocarcinoma (PDAC) undergoing neoadjuvant chemotherapy (NAC) followed by resection.</p><p><strong>Methods: </strong>We retrospectively analyzed 75 patients with resectable or borderline resectable PDAC who underwent NAC followed by curative resection (2012-2023). CXI was calculated using total skeletal muscle area (S-CXI) and psoas muscle area (P-CXI). Patients were stratified into low and normal groups using sex-specific tertiles.</p><p><strong>Results: </strong>Baseline and pathological characteristics were comparable between groups. Low S-CXI was significantly associated with shorter recurrence-free survival (P=0.02) and overall survival (P=0.013). Multivariate analysis demonstrated that low S-CXI remained independently associated with both recurrence (HR 1.81, P=0.045) and mortality (HR 2.16, P=0.033); lymph-node metastasis was also associated with mortality. P-CXI was not associated with outcomes.</p><p><strong>Conclusions: </strong>Pre-treatment S-CXI showed potential prognostic value for survival in patients with PDAC undergoing NAC followed by resection. This simple index may help identify high-risk patients who could benefit from perioperative multidisciplinary interventions. Prospective validation is warranted.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796245","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":"Comparative Study of Pathological and Imaging Findings in High-Grade Pancreatic Intraepithelial Neoplasia: A Multicenter Analysis by the Japan Study Group on Early Detection of Pancreatic Cancer (JEDPAC).","authors":"Keiji Hanada, Akinori Shimizu, Shujiro Yazumi, Akira Kurita, Toshifumi Kin, Yukiko Takayama, Koji Yoshida, Masayuki Kitano, Reiko Ashida, Mamoru Takenaka, Masahiro Serikawa, Tamito Sasaki, Yasutaka Ishii, Noboru Ideno, Satoru Yasukawa, Akio Yanagisawa, Toru Furukawa, Atsushi Kanno, Takao Ohtsuka, Hiroyuki Maguchi, Masao Tanaka","doi":"10.1097/MPA.0000000000002710","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002710","url":null,"abstract":"<p><strong>Background: </strong>High-grade pancreatic intraepithelial neoplasia (HG-PanIN) is a non-invasive precursor of pancreatic ductal adenocarcinoma (PDAC) that is notoriously difficult to detect preoperatively because it lacks a discrete mass. Comprehensive imaging-pathology correlation studies focusing exclusively on HG-PanIN remain limited.</p><p><strong>Methods: </strong>We retrospectively analyzed 50 patients with surgically resected, pathologically confirmed HG-PanIN without invasive carcinoma from 11 institutions participating in the Japan Study Group on Early Detection of Pancreatic Cancer (JEDPAC). Central pathological review classified lesions by ductal involvement pattern: Group A (main pancreatic duct [MPD] only), Group B (MPD plus branch ducts), and Group C (branch ducts only). Imaging findings on CT, MRI/MRCP, and endoscopic ultrasound (EUS) were correlated with pathological intraductal spread length. Diagnostic sensitivity of serial pancreatic-juice aspiration cytologic examination (SPACE) and EUS-guided fine-needle aspiration (EUS-FNA) was compared.</p><p><strong>Results: </strong>The median follow-up was 63 months. Five-year overall survival was 92%, with remnant pancreas recurrence observed in 12%. MPD stenosis was consistently observed in MPD-involved lesions, even with minimal intraductal spread. Periductal hypoechoic areas and focal pancreatic atrophy increased with greater intraductal extension. Group C lesions frequently presented as cystic changes without MPD stenosis. SPACE showed a higher diagnostic yield than EUS-FNA in this cohort (77.1% vs. 25.0%), although this comparison was limited by the small number of EUS-FNA cases.</p><p><strong>Conclusions: </strong>HG-PanIN exhibits distinct imaging patterns that correlate closely with ductal involvement and pathological extent. Localized MPD stenosis is the earliest imaging hallmark, and SPACE may be a useful diagnostic tool for non-mass-forming lesions. Integration of imaging, cytology, and pathology is essential for early detection of pancreatic cancer.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819146","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":"Association Between Serum Uric Acid and Intrapancreatic Fat Deposition in a General Health Check-up Population: A Cross-sectional Study.","authors":"Yu Wang, Yiping Zhang, Dingzhe Zhang, Rui Yu, Xin Chen, Rongzhou Wang, Jianhua Wang, Xiao Chen","doi":"10.1097/MPA.0000000000002705","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002705","url":null,"abstract":"<p><strong>Objectives: </strong>While the health risks associated with intrapancreatic fat deposition (IPFD) have attracted considerable attention, its contributing or risk factors remain poorly understood. Elevated uric acid (UA) levels are associated with multiple metabolic diseases. This study aimed to reveal the association between UA and IPFD.</p><p><strong>Methods: </strong>A total of 9200 subjects who underwent computed tomography (CT) examinations for lung cancer screening were included. Data, including basic information (age, sex, BMI), laboratory tests, and medical history, were collected from the healthcare system. IPFD was defined based on three markers: pancreatic fat CT attenuation (PanCT) <40 HU, pancreas-to-spleen CT attenuation ratio (P/S) <0.8, and pancreatic CT attenuation value minus spleen CT attenuation value (P-S) <-5 HU. Logistic regression analysis and stratified analysis were employed to explore the association between uric acid and IPFD.</p><p><strong>Results: </strong>Across all three pancreatic fat indicators, continuous UA was positively correlated with an elevated risk of IPFD (PanCT, odds ratio = 1.001, 95%confidence interval:1.000-1.002; P/S, OR=1.002, 95%CI:1.001-1.003; P-S, OR=1.002, 95%CI:1.001-1.003). A clear dose-response relationship was observed when UA was analyzed in quartiles. Participants in the highest UA quartile (Q4) had significantly elevated risks (PanCT, OR=1.534, 95%CI:1.220-1.930; P/S, OR=1.756, 95%CI:1.385-2.227; P-S, OR=1.747, 95%CI:1.482-2.059). Subgroup analysis revealed that this positive association was more pronounced in females.</p><p><strong>Conclusion: </strong>UA levels are positively associated with IPFD and is a valuable marker for IPFD management.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796298","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":"Chemotherapy for Unresectable Pancreatic Cancer Complicated by Disseminated Intravascular Coagulation: A Retrospective Cohort Study.","authors":"Kohei Nagata, Takayuki Ando, Hiroki Kawanaka, Jun Sakamoto, Banri Ogino, Toshiki Entani, Iori Motoo, Yuko Ueda, Nobuhiko Hayashi, Shinya Kajiura, Kazuto Tajiri, Ichiro Yasuda","doi":"10.1097/MPA.0000000000002707","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002707","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to characterize the clinical features and prognosis of advanced pancreatic cancer (APC) complicated by disseminated intravascular coagulation (DIC), with a particular focus on distinguishing between tumor-related and infection-related DIC and evaluating the feasibility of chemotherapy in this high-risk population.</p><p><strong>Methods: </strong>This single-center retrospective study analyzed 284 patients with APC. Clinicopathological features and prognosis were compared between patients with and without DIC. Outcomes were further stratified according to DIC etiology, specifically distinguishing between tumor-related and infection-related DIC.</p><p><strong>Results: </strong>Of 284 patients, 19 (6.7%) developed DIC, including 10 (52.6%) with tumor-related DIC and 9 (47.4%) with infection-related DIC. Overall survival (OS) and time to treatment failure (TTF) differed significantly among the three groups (P<0.001). Patients with tumor-related DIC had the shortest survival, (median OS: 1.3 mo; TTF: 0.85 mo, whereas the non-DIC group showed longest survival (median OS: 10.4 mo; TTF 5.2 mo). In multivariable Cox regression analysis, DIC remained independently associated with poor OS (HR 3.6, 95% CI 2.2-5.8; P<0.001). Among 8 patients with tumor-related DIC who received chemotherapy with concomitant anticoagulant or antifibrinolytic therapy, 4 (50%) achieved resolution of DIC. Notably, DIC recurred upon tumor progression, suggesting that DIC control was temporary and closely tied to tumor response.</p><p><strong>Conclusion: </strong>APC with DIC carries a dismal prognosis, particularly when tumor-related. Chemotherapy may be feasible in carefully selected patients with tumor-related DIC when administered with appropriate supportive and anticoagulant or antifibrinolytic therapy; however, its independent contribution to DIC resolution requires cautious interpretation.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796326","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":"DNA Hypomethylation in Pancreatic Cancer Tissues Before Treatment, Defined by KRAS -mutated Circulating Tumor DNA, is Associated With Poor Prognosis.","authors":"Fumiaki Watanabe, Koichi Suzuki, Ryuji Hasebe, Yuki Mizusawa, Hidetoshi Aizawa, Iku Abe, Yuhei Endo, Kosuke Ichida, Koetsu Inoue, Hiroshi Noda, Toshiki Rikiyama","doi":"10.1097/MPA.0000000000002650","DOIUrl":"10.1097/MPA.0000000000002650","url":null,"abstract":"<p><strong>Objectives: </strong>Aberrant hypomethylation of long interspersed nucleotide element-1 (LINE-1) and satellite alpha (SATa) in pancreatic cancer cells increases malignant potential. In addition, circulating tumor DNA (ctDNA) is likely to be associated with micrometastasis and appears more frequently in advanced pancreatic ductal adenocarcinoma (PDAC) patients. In this study, we elucidated the relationship between these factors.</p><p><strong>Materials and methods: </strong>A total of 37 patients with PDAC who underwent surgery or first-line chemotherapy were selected in 2014-2017. DNA extracted from surgical or biopsy specimens was used to calculate the relative demethylation levels (RDLs) of the LINE-1 and SATa using methylation-specific quantitative PCR. KRAS -mutated ctDNA was monitored using droplet digital PCR. Receiver operating characteristic curve analysis was performed to determine the cut-off values of LINE-1 and SATa RDLs before and after surgery or during first-line chemotherapy based on ctDNA status (presence or absence).</p><p><strong>Results: </strong>Median LINE-1 RDL before treatment was higher in patients with ctDNA than in those without, but these cut-off values (LINE-1 ≥0.058 and 0.055) peritreatments did not link to prognosis ( P =0.762 and 0.933). Conversely, the cut-off value of SATa RDL (SATa ≥0.150) based on ctDNA status after treatments showed a significant association with poor prognosis ( P =0.038). On the other hand, the cut-off value of SATa RDL (SATa ≥0.155) before treatment was found to have no association with prognosis ( P =0.408).</p><p><strong>Conclusions: </strong>Evaluating pretreatment tumor DNA hypomethylation together with KRAS -mutated ctDNA status after surgery or initiation of first-line chemotherapy is associated with poor prognosis in PDAC.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e747-e757"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144272","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":"Intrapancreatic Fat Deposition and Risk of Post-ERCP Pancreatitis: A Systematic Review and Meta-Analysis.","authors":"Bruna Cerbino, Leonardo C Süffert, Amanda Monteiro, Luisa M Visentini, Hosanna S D S Melo","doi":"10.1097/MPA.0000000000002624","DOIUrl":"10.1097/MPA.0000000000002624","url":null,"abstract":"<p><strong>Objectives: </strong>Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of this procedure. Emerging evidence suggests that intrapancreatic fat deposition (IPFD) may influence susceptibility to PEP, and its impact on clinical severity remains unclear. This meta-analysis aimed to evaluate whether IPFD is associated with an increased risk and severity of PEP.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and Cochrane Central databases to identify studies that compared patients who underwent ERCP with and without radiologically defined IPFD to investigate the incidence of PEP. Adjusted pooled odds ratios (ORs) with 95% CI were calculated to reduce confounding factors. Heterogeneity was assessed using the I2 statistic.</p><p><strong>Results: </strong>Three studies involving 1950 patients were included. A significantly higher incidence of PEP was observed in patients with IPFD than in those without IPFD (OR: 3.07; 95% CI: 2.00-4.73; P <0.001; I2 =4%). In the multivariable analysis, this association remained statistically significant, indicating that IPFD was an independent risk factor for PEP (OR: 2.50; 95% CI: 1.57-3.96; P <0.001; I2 =19.1%). Importantly, IPFD was also associated with an increased risk of severe PEP (OR: 5.01; 95% CI: 1.47-17.04; P =0.010; I2 =0%).</p><p><strong>Conclusion: </strong>IPFD was a significant contributor to the overall risk of PEP and its severe form. These findings highlight pancreatic fat as a potentially modifiable preprocedural risk factor, indicating the need for further validation and consideration of targeted prophylactic strategies to prevent post-ERCP pancreatitis.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e679-e685"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158002","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":"Dietary Patterns Following an Episode of Acute Pancreatitis: A Post Hoc Analysis From the PAPPEI Multicenter, Prospective Study.","authors":"Kristen M Roberts, Sasathorn Thongkhao-On, Stacey Culp, Djibril M Ba, Joseph Bejjani, Shanlin Ke, Melica Nikahd, Anna Evans Phillips, Peter J Lee, Vikesh K Singh, Mitchell L Ramsey, Georgios I Papachristou, Phil A Hart","doi":"10.1097/MPA.0000000000002644","DOIUrl":"10.1097/MPA.0000000000002644","url":null,"abstract":"<p><strong>Background: </strong>Acute pancreatitis (AP) is a common disease resulting in local and systemic inflammation. It is now recognized that long-term complications can develop after an AP episode, including persistent GI symptoms, exocrine pancreatic dysfunction (EPD), and recurrence of AP. Although nutrition plays a key role in recovery, the impact of diet patterns on gastrointestinal (GI) symptoms and recurrent AP remains unclear.</p><p><strong>Methods: </strong>A secondary analysis of participants from the multicenter, post-acute pancreatic exocrine insufficiency (PAPPEI) study who completed a standardized dietary questionnaire was performed to assess dietary patterns after AP. A dietary pattern score was developed to compare dietary changes over time, where a higher score reflects a more favorable dietary pattern.</p><p><strong>Results: </strong>Significant changes in dietary pattern scores were observed over time with average scores peaking at 3 months (10.3 ± 3.0) then declining at one year (9.2 ± 3.0) ( P =0.024). Lower baseline dietary pattern scores were linked to recurrent AP ( P = 0.035), >10% weight loss ( P =0.016), and persistent GI symptoms ( P =0.030) at 12 months.</p><p><strong>Conclusions: </strong>Dietary patterns may contribute to the development of GI symptoms, weight loss, and recurrent AP. Further research validating our observations and investigations into dietary interventions to reduce GI symptoms and disease recurrence is warranted.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e716-e721"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778009","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":"Rectal Nonsteroidal Anti-Inflammatory Drugs, Aggressive Hydration With Lactated Ringer's Solution, Somatostatin or Combinations for Prophylaxis Post-ERCP Acute Pancreatitis: A Network Meta-Analysis.","authors":"Yunzhi Shen, Yu Bai","doi":"10.1097/MPA.0000000000002648","DOIUrl":"10.1097/MPA.0000000000002648","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the clinical efficacy of Rectal nonsteroidal anti-inflammatory drugs (NSAIDs), Aggressive hydration with Lactated Ringer's solution (ALRS), somatostatin, or combinations in preventing pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography (ERCP).</p><p><strong>Methods: </strong>A systematic review was conducted following PRISMA guidelines, searching all studies from the PubMed, Embase, Ovid, Cochrane library and Google Scholar. Stata software 14.0 and RevMan 5.4 were used for statistical analysis. Outcomes assessed included the incidence of post-ERCP pancreatitis (PEP), post-ERCP hyperamylasemia (PEHA), bleeding, and perforation.</p><p><strong>Results: </strong>Forty-one trials were identified and included in the network meta-analysis, involving 15,627 patients. Somatostatin (OR=0.49, 95% CI= 0.34-0.71), rectal indomethacin (OR=0.63, 95% CI= 0.44-0.9), and rectal indomethacin + somatostatin (OR=0.31, 95% CI= 0.14-0.69) were all more efficacious than placebo in preventing PEP. The combination of rectal indomethacin and somatostatin was the best preventive strategy for PEP, with a surface under the cumulative ranking curves (SUCRA) probability of 80.9%. In terms of PEHA, somatostatin (OR=0.18, 95% CI= 0.1-0.33), rectal indomethacin (OR=0.68, 95% CI= 0.55-0.84), and rectal indomethacin + somatostatin (OR=0.45, 95% CI= 0.28-0.73) were all more efficacious than placebo in preventing PEHA. On the basis of the SUCRA, rectal indomethacin + somatostatin (100%) was found to be the most efficacious modality for the prevention of PEHA. In addition, rectal indomethacin + somatostatin showed the lowest risk of bleeding (77.5%) and perforation (93.8%).</p><p><strong>Conclusions: </strong>The combination of rectal indomethacin and somatostatin was most effective for preventing PEP and PEHA, which has the lowest risk of bleeding and perforation. Given the limited number of studies directly assessing this combination, SUCRA rankings do not always imply clinically meaningful superiority, more large-scale clinical RCTs need to be included in the future to confirm this conclusion.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e736-e746"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157580","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}