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Early prediction of post-pancreatectomy acute pancreatitis after pancreaticoduodenectomy based on serum C-reactive protein 基于血清c反应蛋白的胰十二指肠切除术后急性胰腺炎早期预测。
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-03-01 DOI: 10.1016/j.pan.2025.01.002
Haoda Chen , Chao Wang , Wentao Xia , Ningzhen Fu , Yiran Zhou, Rui Ding, Weishen Wang, Zhiwei Xu, Xiaxing Deng, Yuanchi Weng, Baiyong Shen
{"title":"Early prediction of post-pancreatectomy acute pancreatitis after pancreaticoduodenectomy based on serum C-reactive protein","authors":"Haoda Chen ,&nbsp;Chao Wang ,&nbsp;Wentao Xia ,&nbsp;Ningzhen Fu ,&nbsp;Yiran Zhou,&nbsp;Rui Ding,&nbsp;Weishen Wang,&nbsp;Zhiwei Xu,&nbsp;Xiaxing Deng,&nbsp;Yuanchi Weng,&nbsp;Baiyong Shen","doi":"10.1016/j.pan.2025.01.002","DOIUrl":"10.1016/j.pan.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Post-pancreatectomy acute pancreatitis (PPAP) is an early acute inflammatory process of the pancreatic remnant that is associated with a series of downstream pancreas-specific complications. This study aimed to investigate the relationship between postoperative serum C-reactive protein (CRP) levels and the occurrence of PPAP after pancreaticoduodenectomy (PD).</div></div><div><h3>Methods</h3><div>Consecutive patients who underwent PD between January 1, 2020, and May 31, 2022, were retrospectively analyzed. PPAP was defined according to the International Study Group for Pancreatic Surgery (ISGPS) definitions. A Sankey diagram incorporating Fistula Risk Score (FRS), serum amylase levels, and serum CRP levels was further performed for the early iterative risk stratification of PPAP.</div></div><div><h3>Results</h3><div>A total of 601 patients were included in the analysis. Postoperative serum hyperamylasemia (POH) was observed in 268 patients (44.6 %), of whom 136 (16.7 %) developed PPAP after PD. Patients with serum CRP &gt;100 mg/L on postoperative day (POD) 2 had a significantly higher incidence of PPAP (27.2 % vs. 2.3 %, p &lt; 0.001). The highest Youden index was achieved with the cut-off value of 100 mg/L, with the area under the curve (AUC) value of 0.754 for predicting PPAP (sensitivity 91.8 %, specificity 59.0 %). Multivariate analysis revealed that body mass index (BMI) ≥24 (OR 2.09), estimated blood loss &gt;200 mL (OR 1.70), and elevated serum CRP levels (OR 13.01) were independent risk factors for PPAP. Notably, patients with both POH and elevated serum CRP levels on POD 2 were classified as the high-risk group, exhibiting a remarkably high PPAP rate of 41.8 %.</div></div><div><h3>Conclusions</h3><div>Serum CRP levels on POD 2 are strongly associated with the development of PPAP after PD. This finding has the potential to enable tailored postoperative management and pave the way for the anti-inflammation strategies targeting the early postoperative period.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 2","pages":"Pages 208-213"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pancreatectomies with vein resection: Two large institutions’ experience of East and West
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-03-01 DOI: 10.1016/j.pan.2025.01.007
Atsushi Oba , Kimitaka Tanaka , Yosuke Inoue , Roberto Valente , Elena Rangelova , Urban Arnelo , Yoshihiro Ono , Takafumi Sato , Robert J. Torphy , Hiromichi Ito , Matthias Löhr , Yu Takahashi , Richard D. Schulick , Akio Saiura , Ernesto Sparrelid , Marco Del Chiaro
{"title":"Pancreatectomies with vein resection: Two large institutions’ experience of East and West","authors":"Atsushi Oba ,&nbsp;Kimitaka Tanaka ,&nbsp;Yosuke Inoue ,&nbsp;Roberto Valente ,&nbsp;Elena Rangelova ,&nbsp;Urban Arnelo ,&nbsp;Yoshihiro Ono ,&nbsp;Takafumi Sato ,&nbsp;Robert J. Torphy ,&nbsp;Hiromichi Ito ,&nbsp;Matthias Löhr ,&nbsp;Yu Takahashi ,&nbsp;Richard D. Schulick ,&nbsp;Akio Saiura ,&nbsp;Ernesto Sparrelid ,&nbsp;Marco Del Chiaro","doi":"10.1016/j.pan.2025.01.007","DOIUrl":"10.1016/j.pan.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>The effectiveness and preferred reconstruction methods of pancreatectomy associated with vein resection (PAVR) for pancreatic cancer, especially for the extensive portal vein/superior mesenteric vein (PV/SMV) resections (more than 4 cm), are still subjects of debate. The aim of this study is to evaluate the safety and feasibility of PAVR by analyzing data from two large institutions from different regions.</div></div><div><h3>Methods</h3><div>From 2008 to 2018, we identified consecutive series of patients with pancreatic cancer who underwent PAVR at Karolinska University Hospital (KUH), Sweden, and Cancer Institute Hospital, Japanese Foundation of Cancer Research (JFCR), Japan. Both institutions adopted the artery-first approach to enhance surgical precision. This study compared the short- and long-term outcomes, vein resection types, and reconstruction methods between the two centers.</div></div><div><h3>Results</h3><div>A total of 506 patients who underwent PAVR were identified, 211 patients were from KUH and 295 patients were from JFCR. A higher incidence of total pancreatectomy was identified at KUH (24.6 % vs 0.3 %). There were no significant differences in intraoperative estimated blood loss (KUH: 630 ml, JFCR: 600 ml), severe complications rate (8.5 %, 5.1 %), and mortality (2.4 %, 0.7 %). Primary end-to-end anastomosis was primarily performed even if the length of PV/SMV resection was 5 cm or more and achieved successfully with acceptable patency (No thrombus rate: overall cases, 98.0 %; 5 cm or more, 93.5 %).</div></div><div><h3>Conclusions</h3><div>We report favorable outcomes of PAVR for pancreatic cancer from two high-volume centers in the east and west. Primary end-to-end anastomosis was safe and feasible even if the length of PV/SMV resection was 5 cm or more.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 2","pages":"Pages 250-257"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
From Misdiagnosis to Management of Pancreatic Cystic Tumors Initially Identified as Pseudocysts and Treated with Cystogastrostomy: Experience from a Tertiary Care Center
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-03-01 DOI: 10.1016/j.pan.2025.02.001
Oğuzhan Şal , Beslen Göksoy , Görkem Uzunyolcu , Celal Caner Ercan , Neslihan Berker , Feza Ekiz , Kürşat Rahmi Serin
{"title":"From Misdiagnosis to Management of Pancreatic Cystic Tumors Initially Identified as Pseudocysts and Treated with Cystogastrostomy: Experience from a Tertiary Care Center","authors":"Oğuzhan Şal ,&nbsp;Beslen Göksoy ,&nbsp;Görkem Uzunyolcu ,&nbsp;Celal Caner Ercan ,&nbsp;Neslihan Berker ,&nbsp;Feza Ekiz ,&nbsp;Kürşat Rahmi Serin","doi":"10.1016/j.pan.2025.02.001","DOIUrl":"10.1016/j.pan.2025.02.001","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 2","pages":"Pages 286-288"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When does delay in treatment impact survival from pancreatic cancer?
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-03-01 DOI: 10.1016/j.pan.2025.01.006
Bettina M. Rau , John A. Windsor
{"title":"When does delay in treatment impact survival from pancreatic cancer?","authors":"Bettina M. Rau ,&nbsp;John A. Windsor","doi":"10.1016/j.pan.2025.01.006","DOIUrl":"10.1016/j.pan.2025.01.006","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 2","pages":"Pages 191-192"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Subclinical pancreatic exocrine insufficiency is associated with osteopathy in patients with chronic pancreatitis: Implications for management 慢性胰腺炎患者的亚临床胰腺外分泌功能不全与骨病相关:对管理的影响。
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-03-01 DOI: 10.1016/j.pan.2024.12.017
Mehul Gupta , Shallu Midha , Vikas Sachdeva , Jairam Singh , Shivam Pandey , Chetanya Mittal , Varun Teja , Tanmay Vajpai , Anugrah Dhooria , Nikhil Tandon , Soumya Jagannath , Pramod Kumar Garg
{"title":"Subclinical pancreatic exocrine insufficiency is associated with osteopathy in patients with chronic pancreatitis: Implications for management","authors":"Mehul Gupta ,&nbsp;Shallu Midha ,&nbsp;Vikas Sachdeva ,&nbsp;Jairam Singh ,&nbsp;Shivam Pandey ,&nbsp;Chetanya Mittal ,&nbsp;Varun Teja ,&nbsp;Tanmay Vajpai ,&nbsp;Anugrah Dhooria ,&nbsp;Nikhil Tandon ,&nbsp;Soumya Jagannath ,&nbsp;Pramod Kumar Garg","doi":"10.1016/j.pan.2024.12.017","DOIUrl":"10.1016/j.pan.2024.12.017","url":null,"abstract":"<div><h3>Background and aims</h3><div>Patients with chronic pancreatitis (CP) may develop pancreatic exocrine insufficiency (PEI) but data regarding subclinical PEI are scarce. Our objective was to detect subclinical PEI in patients with CP and its functional consequences.</div></div><div><h3>Methods</h3><div>We prospectively included patients with CP from April 2018–December 2021. Mild PEI and severe PEI were diagnosed if fecal elastase (FE) was 100–200 μg/g and &lt;100 μg/g stool respectively. Vitamin levels and DEXA scan were done to assess functional consequences of PEI. Presence of subclinical PEI in CP (low FE-1 but without steatorrhea) with consequent osteopathy was the primary outcome.</div></div><div><h3>Results</h3><div>Of 120 patients with CP, subclinical PEI (low FE-1 but no steatorrhea) was present in 84/120(70%) patients: 6/8(75%) in early CP, 41/53(77%) in definite CP and 37/55(67.2%) in advanced CP. Overall, 72.1% patients had osteopathy including 53(62%) among patients with subclinical PEI. There was no difference in osteopathy between subclinical and severe PEI. Patients with severe PEI had lower vitamin A levels as compared to mild PEI and no PEI patients [1.3 ± 0.5 mg/ml vs. 1.7 ± 0.6 mg/ml vs. 1.8 ± 0.5 mg/ml; p = 0.04]. There was no difference in vitamin D levels. Osteopathy was present in 40/56 (71.4%) in advanced, 26/56 (46.4%) in definite and 2/8 (25%) in early CP patients (p = 0.09). On multivariable analysis, patients with advanced CP had the higher risk of osteopathy (odds ratio 7.6, 95% CI 1.9–29.7).</div></div><div><h3>Conclusions</h3><div>Subclinical PEI was present even in early CP with increased risk of osteopathy and fat-soluble vitamin deficiency.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 2","pages":"Pages 193-199"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the editor regarding “Early detection of pancreatic cancer: Study design and analytical considerations in biomarker discovery and early phase validation studies”
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-03-01 DOI: 10.1016/j.pan.2025.01.009
Stuart G. Baker, Ruth Etzioni
{"title":"Letter to the editor regarding “Early detection of pancreatic cancer: Study design and analytical considerations in biomarker discovery and early phase validation studies”","authors":"Stuart G. Baker,&nbsp;Ruth Etzioni","doi":"10.1016/j.pan.2025.01.009","DOIUrl":"10.1016/j.pan.2025.01.009","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 2","pages":"Pages 284-285"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Depth of response in patients with locally advanced pancreatic cancer treated with first-line chemotherapy: A supplementary analysis of JCOG1407
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-03-01 DOI: 10.1016/j.pan.2025.02.005
Taro Shibuki , Masafumi Ikeda , Masayuki Yokoyama , Yusuke Sano , Junji Furuse , Satoshi Kobayashi , Akihiro Ohba , Akiko Todaka , Yoshiki Horie , Kazuhiko Shioji , Masashi Kanai , Tomohiro Nishina , Yusuke Kumamoto , Nao Fujimori , Akio Katanuma , Yukiko Takayama , Hidetaka Tsumura , Haruo Miwa , Masato Ozaka , Makoto Ueno
{"title":"Depth of response in patients with locally advanced pancreatic cancer treated with first-line chemotherapy: A supplementary analysis of JCOG1407","authors":"Taro Shibuki ,&nbsp;Masafumi Ikeda ,&nbsp;Masayuki Yokoyama ,&nbsp;Yusuke Sano ,&nbsp;Junji Furuse ,&nbsp;Satoshi Kobayashi ,&nbsp;Akihiro Ohba ,&nbsp;Akiko Todaka ,&nbsp;Yoshiki Horie ,&nbsp;Kazuhiko Shioji ,&nbsp;Masashi Kanai ,&nbsp;Tomohiro Nishina ,&nbsp;Yusuke Kumamoto ,&nbsp;Nao Fujimori ,&nbsp;Akio Katanuma ,&nbsp;Yukiko Takayama ,&nbsp;Hidetaka Tsumura ,&nbsp;Haruo Miwa ,&nbsp;Masato Ozaka ,&nbsp;Makoto Ueno","doi":"10.1016/j.pan.2025.02.005","DOIUrl":"10.1016/j.pan.2025.02.005","url":null,"abstract":"<div><h3>Background/objectives</h3><div>Depth of response (DpR; maximum % reduction from baseline in sum of the target lesion diameters) has demonstrated potential in predicting prognosis in several malignancies. However, its role in locally advanced pancreatic cancer (LAPC) is still unclear. In JCOG1407, modified FOLFIRINOX (mFOLFIRINOX) and gemcitabine plus nab-paclitaxel (GnP) exhibited comparable efficacy for LAPC. In this exploratory analysis using the data of JCOG1407, we focused on the association between DpR and prognosis.</div></div><div><h3>Methods</h3><div>DpR was classified into three groups at the tertile point and patients’ backgrounds and survival were compared. The impact of DpR on survival outcomes was evaluated using the multivariable Cox proportional hazard model.</div></div><div><h3>Results</h3><div>Of the 126 patients enrolled in JCOG1407, 109 patients were included, categorized into three DpR groups: T1 (&lt;−37.2 %), T2 (−37.2 to −13.6 %), and T3 (&gt;−13.6 %). The median DpR was significantly greater in the GnP arm than in the mFOLFIRINOX arm (−28.9 vs. −22.7 %, P = 0.041). Median duration of response tended to be shorter in the GnP arm than in the mFOLFIRINOX arm, although the difference was not significant (5.3 vs. 8.2 months, P = 0.132). Greater DpR (T1) had a significantly larger impact on better progression-free survival (PFS) and overall survival (OS) than T3, with the hazard ratio of 0.469 (95 % confidence interval [CI] 0.268–0.821, P = 0.008), and 0.398 (95 % CI 0.217–0.728, P = 0.003), respectively.</div></div><div><h3>Conclusions</h3><div>mFOLFIRINOX and GnP had similar OS, it is noteworthy that the regimens exhibited differences in DpR, with GnP leading to greater DpR. Greater DpR are associated with improved survival in patients with LAPC.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 2","pages":"Pages 275-283"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evolving trends in interventions and outcomes for acute biliary pancreatitis during pregnancy: A two-decade analysis
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-03-01 DOI: 10.1016/j.pan.2025.02.006
Ayushi Jain , Yevgeniya Gokun , Phil A. Hart , Mitchell L. Ramsey , Georgios I. Papachristou , Samuel Han , Peter J. Lee , Hamza Shah , Jordan Burlen , Raj Shah , Erica Park , Somashekar G. Krishna
{"title":"Evolving trends in interventions and outcomes for acute biliary pancreatitis during pregnancy: A two-decade analysis","authors":"Ayushi Jain ,&nbsp;Yevgeniya Gokun ,&nbsp;Phil A. Hart ,&nbsp;Mitchell L. Ramsey ,&nbsp;Georgios I. Papachristou ,&nbsp;Samuel Han ,&nbsp;Peter J. Lee ,&nbsp;Hamza Shah ,&nbsp;Jordan Burlen ,&nbsp;Raj Shah ,&nbsp;Erica Park ,&nbsp;Somashekar G. Krishna","doi":"10.1016/j.pan.2025.02.006","DOIUrl":"10.1016/j.pan.2025.02.006","url":null,"abstract":"<div><h3>Background/objectives</h3><div>Cholelithiasis is the most common cause of acute pancreatitis in pregnancy. We analyzed trends in acute biliary pancreatitis (ABP) among pregnant women over the past two decades to evaluate changes in outcomes, including the incidence of severe acute pancreatitis, mortality rates, and hospital length of stay.</div></div><div><h3>Methods</h3><div>Using the National Inpatient Sample, we identified adult women of childbearing age (age 18–50 years) with hospitalization for ABP from 2002 to 2020. Trends were analyzed using Cochran-Armitage and F-tests. Multivariable binary logistic regression was used to evaluate the outcome of severe acute pancreatitis (SAP).</div></div><div><h3>Results</h3><div>45,064 pregnant and 212,009 non-pregnant women were hospitalized for ABP (2002–2020), with a significant increase in ABP during pregnancy (14.1 %→17.8 %; p &lt; 0.001). Trend analyses in the pregnant cohort revealed increasing age (mean 27  →  28.1 years; p &lt; 0.001), Class-III obesity (0.7 %→7.8 %; p &lt; 0.001), comorbidities (Elixhauser index ≥3) (2.9 %→11.2 %; p &lt; 0.001), and SAP (2.2 %→5.0 %; p &lt; 0.001). Mortality remained very low (&lt;0.01 %). Performance of ERCP (22.2 %→26.5 %; p &lt; 0.001) and cholecystectomy (41.0 %→54.1 %; p &lt; 0.001) increased while duration of hospitalization decreased (Mean 4.9  →  3.6 days; p &lt; 0.001).</div><div>Multivariable analysis revealed that the development of SAP was associated with Black race (OR 1.70, 95 % CI: 1.10–2.63) and comorbidities (OR 5.10, 95 % CI 3.64–7.14).</div></div><div><h3>Conclusions</h3><div>Pregnant women represent a significant portion of hospitalized ABP cases, paralleling increases in age, comorbidities, and obesity rates. Racial disparities are linked to higher odds of SAP, though comorbidities have a dominant effect. There has been an increase in guideline-recommended procedures (ERCP and cholecystectomy); however, further research is needed to address the implementation gap, considering the increased complexity of pregnant women with ABP.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 2","pages":"Pages 200-207"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Recommendations from the European guidelines for the diagnosis and therapy of pancreatic exocrine insufficiency.
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-02-28 DOI: 10.1016/j.pan.2025.02.015
Miroslav Vujasinovic, Daniel de la Iglesia, J Enrique Dominguez-Muñoz, J Matthias Löhr
{"title":"Recommendations from the European guidelines for the diagnosis and therapy of pancreatic exocrine insufficiency.","authors":"Miroslav Vujasinovic, Daniel de la Iglesia, J Enrique Dominguez-Muñoz, J Matthias Löhr","doi":"10.1016/j.pan.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.pan.2025.02.015","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below a level that allows normal digestion of nutrients. Pancreatic disease and pancreatic surgery are the main causes of PEI, but other conditions can affect the digestive function of the pancreas.</p><p><strong>Methods: </strong>In collaboration with European Digestive Surgery (EDS), European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), European Society for Clinical Nutrition and Metabolism (ESPEN), European Society of Digestive Oncology (ESDO), and European Society of Primary Care Gastroenterology (ESPCG) the working group developed European guidelines for the diagnosis and therapy of PEI. United European Gastroenterology (UEG) provided both endorsement and financial support for the development of the guidelines.</p><p><strong>Results: </strong>Recommendations covered topics related to the clinical management of PEI: concept, pathogenesis, clinical relevance, general diagnostic approach, general therapeutic approach, PEI secondary to chronic pancreatitis, PEI after acute pancreatitis, PEI associated with pancreatic cancer, PEI secondary to cystic fibrosis, PEI after pancreatic surgery, PEI after esophageal, gastric, and bariatric surgery, PEI in patients with type 1 and type 2 diabetes, and PEI in other conditions.</p><p><strong>Conclusions: </strong>The European guidelines for the diagnosis and therapy of PEI provide evidence-based recommendations concerning key aspects of the etiology, diagnosis, therapy, and follow-up, based on current available evidence. These recommendations should serve as a reference standard for existing management of PEI and as a guide for future clinical research. This article summarizes the recommendations and statements.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early response evaluation using CT and CA 19-9 in patients with pancreatic cancer of all stages undergoing first-line FOLFIRINOX treatment.
IF 2.8 2区 医学
Pancreatology Pub Date : 2025-02-27 DOI: 10.1016/j.pan.2025.02.007
Seung-Seob Kim, Seokho Kim, Jung Hyun Jo, Hee Seung Lee, Jae-Joon Chung, Seungmin Bang, Mi-Suk Park
{"title":"Early response evaluation using CT and CA 19-9 in patients with pancreatic cancer of all stages undergoing first-line FOLFIRINOX treatment.","authors":"Seung-Seob Kim, Seokho Kim, Jung Hyun Jo, Hee Seung Lee, Jae-Joon Chung, Seungmin Bang, Mi-Suk Park","doi":"10.1016/j.pan.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.pan.2025.02.007","url":null,"abstract":"<p><strong>Objectives: </strong>To propose an effective integration method for CT and carbohydrate antigen (CA) 19-9 responses applicable to patients with all stages of pancreatic ductal adenocarcinoma (PDAC) treated with first-line FOLFIRINOX.</p><p><strong>Methods: </strong>We retrospectively identified patients with PDAC who underwent first-line FOLFIRINOX treatment at a single tertiary hospital between 2017 and 2020. Those with baseline and 8-week follow-up CT scans were included in the CT response dataset. Patients with both CT and CA 19-9 information comprised the CT/CA 19-9 response dataset. CT reports and CA 19-9 levels at baseline and 8-week follow-up were collected. CT response was based on Response Evaluation Criteria in Solid Tumors. CA 19-9 changes were determined as CA 19-9 levels normalized (<37 U/mL), decreased (>37 U/mL), or increased. Overall survival (OS) was compared.</p><p><strong>Results: </strong>In the CT response dataset (n = 392), patients with progressive disease (PD; n = 44) exhibited shorter OS than stable disease (SD; n = 228; P = .01) or partial response (PR; n = 120; P = .001). OS did not significantly differ between PR and SD (P = .40). In the CT/CA 19-9 response dataset (n = 242), integrated CT and CA 19-9 responses revealed the shortest OS in patients with either PD or increased CA 19-9 (n = 74; median OS, 14.3 months), followed by PR/SD with decreased CA 19-9 (n = 113; median OS, 19.8 months; P = .003), and PR/SD with normalized CA 19-9 (n = 55; median OS, 23.6 months; P = .04).</p><p><strong>Conclusion: </strong>Our combined evaluation of CT and CA 19-9 responses successfully stratified the survival of patients with PDAC treated with FOLFIRINOX, irrespective of disease stage.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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