Pancreatology最新文献

{"title":"Significant projected savings with expansion of an emergency department observation protocol for mild acute pancreatitis","authors":"Nikhil Thiruvengadam ,&nbsp;Kelsey L. Anderson ,&nbsp;Sunil G. Sheth","doi":"10.1016/j.pan.2024.12.009","DOIUrl":"10.1016/j.pan.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Acute pancreatitis (AP) significantly contributes to healthcare costs, but not all patients require hospitalization. A novel, validated Emergency Department (ED) pathway for mild AP (MAP) at our tertiary care center reduced hospitalizations and resource utilization, without affecting outcomes.</div></div><div><h3>Methods</h3><div>A decision-analytic model was constructed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and methodologic recommendations by the Second Panel on Cost-Effectiveness in Health and Medicine to predict healthcare costs based on whether an ED discharge protocol for MAP was utilized.</div></div><div><h3>Results</h3><div>Average savings for one MAP discharged from the ED were $1720.5 compared to the standard of care hospitalization. Assuming that 67.7 % of cases are mild and that there are 288,820 hospitalizations for AP annually, the ED discharge pathway would result in $98.6 million direct healthcare savings.</div></div><div><h3>Conclusions</h3><div>Implementation of an evidence-based, protocoled ED pathway for MAP could result in over $100 million in direct healthcare savings.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 35-38"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896691","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}

{"title":"YKL-40 as a risk stratification marker in acute pancreatitis: A prospective study","authors":"Nina Blažević ,&nbsp;Vladimir Trkulja ,&nbsp;Dunja Rogić ,&nbsp;Stipe Pelajić ,&nbsp;Marijana Miler ,&nbsp;Goran Glavčić ,&nbsp;Zvonimir Misir ,&nbsp;Mario Živković ,&nbsp;Marko Nikolić ,&nbsp;Ivan Lerotić ,&nbsp;Neven Baršić ,&nbsp;Davor Hrabar ,&nbsp;Tajana Pavić","doi":"10.1016/j.pan.2024.11.024","DOIUrl":"10.1016/j.pan.2024.11.024","url":null,"abstract":"<div><h3>Background/objectives</h3><div>Increased systemic concentrations of YKL-40 are seen in various inflammatory conditions. We explored the relationship between the serum YKL-40 concentrations and subsequent disease severity in patients with acute pancreatitis (AP).</div></div><div><h3>Methods</h3><div>Consecutive adults with AP were prospectively enrolled, and classified as having mild, moderate or severe disease. On admission and 48 h later, C-reactive protein (CRP), YKL-40, interleukin-6 and 8 (IL-6, IL-8), and tumor necrosis factor alpha (TNF-α) concentrations were measured. Patients were also classified as those with low (&lt;50 ng/mL, in the range seen in 30 age and sex-matched non-AP subjects), high (≥190 ng/mL, seen in most of the other inflammatory conditions), and intermediate YKL-40 (50–189 ng/mL).</div></div><div><h3>Results</h3><div>Incidence of mild, moderate and severe AP among the 150 enrolled patients was 80 (53.3 %), 59 (39.3 %), and 11 (7.4 %), respectively. Both on admission and 48 h later, high YKL-40 (vs. intermediate or low) was strongly associated with higher odds of a more severe AP, independently of the concurrent IL-8 and TNF-α concentrations (OR around 3.5–4.0, or higher). On admission, the association was independent also of the concurrent CRP, whereas the association between the later concentrations and the outcome was conditional on CRP – uncertain at low, strong at high CRP. The high YKL-40 – outcome association at both time-points was conditional on concurrent IL-6: uncertain if IL-6 was low, strong if IL-6 was high.</div></div><div><h3>Conclusions</h3><div>Serum YKL-40 is a plausible candidate for further evaluation as an early biochemical indicator of subsequent AP severity, particularly if considered jointly with CRP and/or IL-6.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 48-57"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786436","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}

{"title":"Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage catheter combined with clinical findings improves diagnostic ability for malignant cases of suspected pancreatic cancer with non-identifiable tumors","authors":"Tatsunori Satoh ,&nbsp;Junichi Kaneko ,&nbsp;Eiji Nakatani ,&nbsp;Hirotoshi Ishiwatari ,&nbsp;Junya Sato ,&nbsp;Akihiko Ohata ,&nbsp;Reiko Yamada ,&nbsp;Tetsuro Miwata ,&nbsp;Kazuma Ishikawa ,&nbsp;Fumitaka Niiya ,&nbsp;Yosuke Kobayashi ,&nbsp;Yasushi Hamaya ,&nbsp;Jun Ito ,&nbsp;Kazuhito Kawata ,&nbsp;Azumi Suzuki ,&nbsp;Yasunari Sakamoto ,&nbsp;Yuya Ishiguro ,&nbsp;Haruna Takahashi ,&nbsp;Shinya Kawaguchi","doi":"10.1016/j.pan.2024.11.022","DOIUrl":"10.1016/j.pan.2024.11.022","url":null,"abstract":"<div><h3>Background/objectives</h3><div>The detection of pancreatic cancer (PC) often depends on indirect indicators such as parenchyma atrophy (PPA), main pancreatic duct stenosis, and low echoic areas, particularly when no mass is evident on imaging. While pathological evaluation is the gold standard for differentiating malignant from benign conditions, endoscopic ultrasound-guided fine-needle aspiration/biopsy is not always feasible in such cases. Serial pancreatic juice aspiration cytologic examination (SPACE) via endoscopic nasopancreatic drainage (NPD) has emerged as an alternative diagnostic method, though its accuracy remains underevaluated. This study aimed to evaluate the diagnostic performance of SPACE and explore strategies to enhance its accuracy in diagnosing PC.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective study analyzed patients who underwent SPACE between January 2015 and September 2023. The inclusion criteria focused on cases lacking a clear pancreatic mass but exhibiting indirect signs suggestive of PC. Diagnostic accuracy was determined using surgical pathology or a minimum follow-up period of 12 months as the reference standard.</div></div><div><h3>Results</h3><div>Among 164 patients, 85 (51.8 %) were diagnosed with malignancy. The sensitivity and specificity of SPACE were 74.1 % and 87.3 %, respectively, with a area under the receiver operating characteristic curve (ROC-AUC) of 0.807 (95%CI: 0.748–0.867). Incorporating patient age, CEA and PPA with SPACE results further improved diagnostic performance, yielding a ROC-AUC of 0.828 (95%CI: 0.76–0.897, p = 0.013).</div></div><div><h3>Conclusions</h3><div>Combining SPACE with clinical and imaging findings significantly enhances diagnostic accuracy in suspected PC cases where conventional imaging fails to detect tumors. This integrated approach has the potential to enhance clinical outcomes by facilitating more accurate patient management.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 125-133"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792165","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}

{"title":"Impact of islet autotransplantation on 30-day post-operative outcomes in patients undergoing total pancreatectomy: A NSQIP retrospective cohort analysis of 584 patients","authors":"Armin Rouhi,&nbsp;Kevin Verhoeff,&nbsp;Blaire Anderson,&nbsp;Khaled Dajani,&nbsp;David L. Bigam,&nbsp;A.M James Shapiro","doi":"10.1016/j.pan.2024.12.002","DOIUrl":"10.1016/j.pan.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Total pancreatectomy (TP) offers a surgical option for refractory pancreatitis, yet confers substantial long-term morbidity associated with resultant diabetes. While total pancreatectomy with islet autotransplantation (TPIAT) offers an intuitive solution, data evaluating its safety have been limited to single-center studies. The aim of this study is to evaluate whether the addition of islet autotransplantation to TP confers additional post-operative morbidity within the 30-day post-operative period.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of prospectively collected cases from the National Surgical Quality Improvement Program (NSQIP) database. Cases of TP with or without islet autotransplantation from 2016 to 2021 were included. Baseline demographics, and a comprehensive list of 30-day postoperative outcomes were evaluated. Multivariable logistic regression models were constructed to evaluate the impact of each factor on 30-day complications.</div></div><div><h3>Results</h3><div>A total of 584 cases were included with 171 (29.2 %) patients undergoing TPIAT. TPIAT patients were younger (58.8 vs. 39.5; p &lt; 0.0001), and had lower incidences of pre-existing diabetes (41.4 % vs. 19.9 %; p &lt; 0.0001) and hypertension (48.2 % vs. 24.6 %; p &lt; 0.0001). TPIAT cohort had longer length of stay (10.3 days vs.12.2 days; p = 0.0006). There was no difference in overall rates of serious complications between the two cohorts (50.1 % vs. 45.0 %; p = 0.263). After adjusting for demographic differences between cohorts using multivariable logistic regression models, TPIAT was not associated with serious complications (OR 0.71; p = 0.168) compared to TP alone.</div></div><div><h3>Conclusion</h3><div>The results from this study suggest that TPIAT does not appear to be associated with increased 30-day morbidity, and should be considered in patients to mitigate the long-term morbidity associated with diabetes mellitus post TP.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 147-152"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854756","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}

{"title":"Onset of pancreatic cancer before and after acute pancreatitis: A multicenter longitudinal cohort study","authors":"Tamás Hussein ,&nbsp;Péter Mátrai ,&nbsp;Vivien Vass ,&nbsp;Andrea Szentesi ,&nbsp;Péter Hegyi","doi":"10.1016/j.pan.2024.12.007","DOIUrl":"10.1016/j.pan.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic cancer (PC) is a leading cause of cancer mortality, often diagnosed at advanced stages. Acute pancreatitis (AP), particularly idiopathic cases, may serve as an early indicator of PC.</div></div><div><h3>Objective</h3><div>This multicenter cohort study investigated the incidence of PC before and after an AP episode, focusing on idiopathic AP and the role of pseudocysts as potential early markers for PC development.</div></div><div><h3>Methods</h3><div>We analyzed data from 2356 AP patients across 25 centers, with a median follow-up of 4.1 years (IQR: 1.6–6.8 years). Patients were categorized into 'PC before AP' and 'PC after AP' groups, and relative risk (RR) and adjusted odds ratios (OR) were calculated for idiopathic AP cases to quantify PC risk.</div></div><div><h3>Results</h3><div>Among all cases, 69 patients (2.9 %) developed PC: 1.4 % (n = 34) before and 1.5 % (n = 35) after AP. Idiopathic AP cases had a fourfold higher risk of PC (OR = 4.46, [2.25–8.85]). Notably, pseudocysts were five times more prevalent in the PC group (14 %) compared to controls (3 %) (RR = 5.66; p &lt; 0.01), often located at the tumor site. PC developed in 3 % of idiopathic AP cases versus 1.0 % in non-idiopathic cases. The median time to PC diagnosis post-AP was 373 days.</div></div><div><h3>Conclusion</h3><div>Idiopathic AP and pseudocyst formation significantly elevate the risk of PC, particularly within two years. These findings underscore the need for structured follow-up and early screening in idiopathic AP cases to improve PC detection and survival outcomes.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 29-34"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903362","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}

{"title":"Author’s reply to the Letter to Editor regarding “Exploring the Role of Neoadjuvant Therapy for Resectable Pancreatic Cancer”","authors":"S. Yamada,&nbsp;D. Hashimoto,&nbsp;S. Satoi","doi":"10.1016/j.pan.2024.11.017","DOIUrl":"10.1016/j.pan.2024.11.017","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Page 189"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771006","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}

{"title":"Letter to Editor regarding “Autoimmune pancreatitis associated with severe postoperative pneumonia”","authors":"Gyula Farkas Jr.,&nbsp;Gábor Demeter,&nbsp;György Lázár","doi":"10.1016/j.pan.2024.12.004","DOIUrl":"10.1016/j.pan.2024.12.004","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Page 190"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818883","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}

{"title":"Three-tiered critical care management of acute pancreatitis","authors":"Piroska Pázmány ,&nbsp;Anna Kanjo ,&nbsp;Zsanett Macht-Szalai ,&nbsp;Noémi Gede ,&nbsp;Nelli Farkas ,&nbsp;Bálint Erőss ,&nbsp;Andrea Szentesi ,&nbsp;Áron Vincze ,&nbsp;Roland Hagendorn ,&nbsp;Zsolt Márton ,&nbsp;Andrea Párniczky ,&nbsp;Péter Hegyi ,&nbsp;Zsolt Molnár","doi":"10.1016/j.pan.2024.11.021","DOIUrl":"10.1016/j.pan.2024.11.021","url":null,"abstract":"<div><h3>Introduction and aims</h3><div>Acute pancreatitis (AP) can rapidly progress from a stable condition to multiple organ failure with high mortality. We aimed to describe the characteristics of AP patients requiring admission to a critical care facility and to identify predictors of disease progression.</div></div><div><h3>Methods</h3><div>We conducted a post-hoc analysis using prospectively collected data from AP patients admitted to the high dependency unit (HDU) and intensive care unit (ICU) at the University of Pécs, Hungary, from 2016 to 2019. Patients were categorized according to critical care needs and severity. Daily records of organ function, organ support and laboratory parameters were kept. Descriptive analysis and predictive models were developed to forecast the need for escalated critical care and mortality.</div></div><div><h3>Results</h3><div>Analysis of 92 cases (65 % male, mean age 63 (range 19–92) years) revealed a median critical care stay of 8 days (range 1–69) and a mortality rate of 47 %. Naive Bayes prediction models using admission C-reactive protein (CRP) and amylase levels achieved 75 % accuracy in predicting mortality and a 65 % probability of requiring HDU and/or ICU admission. CRP levels increased significantly (47 vs 62 mg/l, p: 0.015) from 48 to 24 h before critical care admission, contrasting with controls, resulting in significantly higher CRP levels in critical care patients (62 vs 32 mg/l, p: 0.007) 24 h before admission.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that on-admission CRP and amylase cannot reliably predict progression of AP. However, elevated and increasing levels of CRP and amylase may indicate the need for early HDU admission to enable closer monitoring.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 39-47"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854965","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}

{"title":"No definite associations between opioid doses and severity of acute pancreatitis – Results from a multicentre international prospective study","authors":"Cecilie Siggaard Knoph ,&nbsp;Nejo Joseph ,&nbsp;James Lucocq ,&nbsp;Søren Schou Olesen ,&nbsp;Wei Huang ,&nbsp;Jahnvi Dhar ,&nbsp;Jayanta Samanta ,&nbsp;Rupjyoti Talukdar ,&nbsp;Gabriele Capurso ,&nbsp;Paoletta Preatoni ,&nbsp;Enrique de-Madaria ,&nbsp;Dhiraj Yadav ,&nbsp;John Windsor ,&nbsp;Asbjørn Mohr Drewes ,&nbsp;Manu Nayar ,&nbsp;PAINAP Collaborative ,&nbsp;Sanjay Pandanaboyana","doi":"10.1016/j.pan.2024.12.014","DOIUrl":"10.1016/j.pan.2024.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal pain is the cardinal symptom of acute pancreatitis (AP), often requiring opioid therapy. This study aimed to investigate the dose-dependent relationship between opioid therapy and moderately severe or severe AP.</div></div><div><h3>Methods</h3><div>This was a post-hoc analysis of the prospective PAINAP database, which recruited patients with first-time AP from 118 centres across 27 countries between April–June 30, 2022. Baseline demographic details, opioid treatment dose, and AP outcome characteristics were extracted. The intravenous morphine-equivalent doses (MEDs) of each opioid administered were calculated based on daily doses and duration. They were subsequently summarised into cumulative MEDs. Furthermore, mean daily intravenous MEDs were registered. Using multivariable regression analysis, associations between opioid doses and the severity of AP were explored.</div></div><div><h3>Results</h3><div>The final cohort consisted of 1,043 patients receiving various doses of opioids (51 % male; median age 54 years). Most (79 %) patients had mild, 14 % moderately severe, and 7 % severe AP. Median cumulative MED was 20 mg (IQR, 8–48), whereas median daily MED was 6 (IQR, 3–11), and median duration was 3 days (IQR, 2–5). There was a significant association between moderately severe or severe AP and cumulative intravenous MEDs per 10 mg (OR 1.02 (IQR 1.00–1.03), P = 0.01). When considering daily intravenous MEDs, this association was non-significant (P = 0.15).</div></div><div><h3>Conclusions</h3><div>The association between opioid doses and AP severity was dose-dependent with cumulative opioid doses but not with daily doses. In the absence of adequate evidence and potential reverse causation bias, future studies are warranted to assess the safety of opioids in AP.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 12-19"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915441","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}

{"title":"Obituary Martin Sarner, London 1935–2024","authors":"Markus M. Lerch","doi":"10.1016/j.pan.2024.12.019","DOIUrl":"10.1016/j.pan.2024.12.019","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 1-2"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143145753","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}