Pancreatology最新文献

{"title":"Critical appraisal of postpancreatectomy hemorrhage after pancreatoduodenectomy: an analysis of risk factors, treatment and outcomes in 860 consecutive cases","authors":"Chun Yuet Khoo ,&nbsp;Hwee Leong Tan ,&nbsp;Titus Q.W. Tan ,&nbsp;Delphina B.X. Yeo ,&nbsp;Ye Xin Koh ,&nbsp;Jin Yao Teo ,&nbsp;Pierce K.H. Chow ,&nbsp;Peng Chung Cheow ,&nbsp;Alexander Y.F. Chung ,&nbsp;London L.P.J. Ooi ,&nbsp;Brian K.P. Goh","doi":"10.1016/j.pan.2025.05.015","DOIUrl":"10.1016/j.pan.2025.05.015","url":null,"abstract":"<div><h3>Background</h3><div>Postpancreatectomy haemorrhage (PPH) is an important and potentially life-threatening complication after pancreatoduodenectomy (PD). The aim of this study is to characterize PPH in a single institutional cohort of patients who underwent PD and analyse the incidence, risk factors, treatment and outcomes of PPH.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of 860 consecutive patients who underwent PD between January 1997 and July 2021 at a tertiary referral centre. Key perioperative data and outcome measures were analysed for all patients who developed PPH.</div></div><div><h3>Results</h3><div><span>A total of 108 patients (12.6 %) developed PPH, of which 95 patients (88.0 %) had late PPH with the median onset on postoperative day 8. Multivariate analysis<span><span> revealed that pancreatogastrostomy (PG) anastomosis, intraoperative blood loss &gt;1000 mL and postoperative </span>pancreatic fistula<span> (POPF) grades B and C were independent predictors of late PPH. The majority of patients with intraluminal PPH (42.6 %) underwent endoscopy as first-line intervention while most patients with extraluminal PPH underwent initial </span></span></span>surgical haemostasis<span><span> (40.7 %) and initial angiography (16.7 %). </span>Pancreatojejunostomy anastomosis was associated with a higher rate of POPF compared to PG, although PG was associated with a higher incidence of PPH.</span></div></div><div><h3>Conclusion</h3><div>The optimal approach to treatment of PPH takes into account location, timing and severity of the bleeding as well as the type of pancreatoenteric anastomosis. Appropriate treatment strategies for both early and late PPH include angiography, endoscopy, reoperation and conservative management or a combination of them.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 743-751"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554107","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":"A Mendelian randomization study investigating the causal effect of simvastatin consumption on pancreatitis risk","authors":"Wenfeng Lin ,&nbsp;Qiqi Zheng ,&nbsp;Maddalena Zippi ,&nbsp;Sirio Fiorino ,&nbsp;Vincent Zimmer ,&nbsp;Jiayi Zhang ,&nbsp;Alfonso Grottesi ,&nbsp;Wandong Hong","doi":"10.1016/j.pan.2025.06.007","DOIUrl":"10.1016/j.pan.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Simvastatin<span><span> has been inconsistently linked to pancreatitis. We employed </span>Mendelian Randomization<span> (MR) as a pathway to ascertain this potential causal connection among simvastatin consumption and likelihood of pancreatitis onset.</span></span></div></div><div><h3>Methods</h3><div>UK Biobank was employed to pinpoint genetic variations. Related to simvastatin. Information on acute (AP) and chronic (CP) pancreatitis has been obtained from the European ancestry, FinnGen consortium, and East Asian people. Univariate and multivariate MR analyses have been performed.</div></div><div><h3>Results</h3><div>In European populations, inverse variance weighted (IVW) analysis revealed no significant causal association between simvastatin use and acute pancreatitis (AP, <em>P</em> = 0.129) or chronic pancreatitis (CP, <em>P</em><span> = 0.430). Consistent null effects were observed across sensitivity analyses using MR-Egger, weighted median, and leave-one-out (LOO) methods. Multivariable MR adjusted for alcohol use and cholelithiasis similarly showed no direct effects (AP: </span><em>P</em><span> = 0.744; CP: </span><em>P</em><span> = 0.183). Replication analyses using GWAS<span> data from FinnGen Consortium (IVW: AP </span></span><em>P</em><span> = 0.070; CP </span><em>P</em> = 0.939) and East Asian cohorts (IVW: AP <em>P</em> = 0.325; CP <em>P</em> = 0.907) confirmed these patterns. All sensitivity methods (MR-Egger/weighted median/LOO) yielded concordant results across cohorts. Multivariable MR outcomes remained aligned with primary findings after confounder adjustment.</div></div><div><h3>Conclusions</h3><div>Genetic evidence has not proven a causality between simvastatin and pancreatitis, suggesting that routine monitoring may be unnecessary.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 614-623"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333696","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":"Associations between MRI and endoscopic ultrasound findings in the pancreas in children and young adults with suspected chronic pancreatitis","authors":"Pradipta Debnath ,&nbsp;Nadeen Abu Ata ,&nbsp;Christopher G. Anton ,&nbsp;Murat Kocaoglu ,&nbsp;Yuan Zhou ,&nbsp;Bin Zhang ,&nbsp;David S. Vitale ,&nbsp;Andrew T. Trout","doi":"10.1016/j.pan.2025.07.002","DOIUrl":"10.1016/j.pan.2025.07.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) are both used to diagnose pancreatitis but how findings relate <u>across modalities</u> has not been defined in children. Our aim is to characterize associations between pancreas imaging findings on EUS and MRI in children.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed pediatric patients (age &lt;21-years) who underwent EUS January 2019 to December 2023 and had an MRI of the abdomen within 90 days of EUS. MRIs were independently reviewed by three radiologists and EUS reports were reviewed to extract Rosemont Criteria <u>findings</u>. The association between MRI findings, Rosemont Criteria classification, and individual EUS findings was calculated using Pearson correlation coefficients, Pearson contingency test and F-test.</div></div><div><h3>Results</h3><div>Ninety-nine patients, 18 with ARP, 16 with CP as indications for EUS were included. Mean age was 13.5 ± 4.1 years. Rosemont Criteria classifications were: normal = 64 (64.7 %), indeterminate = 19 (19.2 %), suggestive = 3 (3.0 %), and consistent = 13 (13.1 %). Imaging was consistent with CP in 4/18 (EUS) and 4/18 (MRI) patients with an indication of ARP and 9/16 (EUS) and 7/16 (MRI) patients with an indication of CP. Rosemont Criteria classification was moderately associated with MRI pancreatic duct abnormalities (coefficients = 0.57 to 0.60) and subjective pancreatic atrophy (coefficient = 0.57). Associations between individual EUS and MRI features were very weak to moderate and were highest for main duct findings (coefficient ≤ 0.63).</div></div><div><h3>Conclusion</h3><div>MRI findings related to the pancreatic duct and of parenchymal atrophy were moderately associated with EUS Rosemont Criteria classification. Correlations between individual EUS and MRI findings generally ranged from weak to moderate and were highest (coefficient ≤ 0.63) for main duct findings.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 641-647"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650108","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":"Glucagon-like peptide-1 receptor agonists (GLP-1RA) and acute pancreatitis","authors":"David C. Whitcomb MD PhD","doi":"10.1016/j.pan.2025.07.005","DOIUrl":"10.1016/j.pan.2025.07.005","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 605-606"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691212","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":"Clinicopathological features for clinically resectable peripherally located pancreatic ductal adenocarcinoma","authors":"Yoshinori Ohno ,&nbsp;Ichinosuke Hyodo ,&nbsp;Toru Otsuru ,&nbsp;Akinori Asagi ,&nbsp;Yoshihiro Mikuriya ,&nbsp;Koji Ohta ,&nbsp;Sho Ishikawa ,&nbsp;Mitsuhito Koizumi ,&nbsp;Teruki Miyake ,&nbsp;Yoichi Hiasa","doi":"10.1016/j.pan.2025.06.010","DOIUrl":"10.1016/j.pan.2025.06.010","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 758-760"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340351","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":"Long-term survival and quality of life improvement in patients with large unresectable malignant main-duct IPMN treated with EUS-guided RFA (with video)","authors":"Pradermchai Kongkam ,&nbsp;Margaret Li Peng Teng ,&nbsp;Arlyn Cañones ,&nbsp;Kittithat Tantitanawat ,&nbsp;Kasenee Tiankanon ,&nbsp;Phonthep Angsuwatcharakon ,&nbsp;Wiriyaporn Ridtitid ,&nbsp;Rungsun Rerknimitr ,&nbsp;Thanawat Luangsukrerk","doi":"10.1016/j.pan.2025.06.011","DOIUrl":"10.1016/j.pan.2025.06.011","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 761-763"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529196","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":"Reply to Comment on ‘The duodenum-preserving head resections for chronic pancreatitis’","authors":"Biju Pottakkat,&nbsp;S. Harilal,&nbsp;R. Kalayarasan,&nbsp;P. Sai Krishna","doi":"10.1016/j.pan.2025.06.014","DOIUrl":"10.1016/j.pan.2025.06.014","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 764-765"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668180","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":"Bone loss, osteoporosis, and fractures in patients with resected pancreatic head cancer","authors":"Tsuyoshi Takeda ,&nbsp;Takashi Sasaki ,&nbsp;Yosuke Inoue ,&nbsp;Takeshi Okamoto ,&nbsp;Tatsuki Hirai ,&nbsp;Takafumi Mie ,&nbsp;Takaaki Furukawa ,&nbsp;Yukari Suzuki ,&nbsp;Masato Ozaka ,&nbsp;Yu Takahashi ,&nbsp;Akio Saiura ,&nbsp;Naoki Sasahira","doi":"10.1016/j.pan.2025.05.014","DOIUrl":"10.1016/j.pan.2025.05.014","url":null,"abstract":"<div><h3>Background</h3><div>Major pancreatic resections are considered to have a high risk of developing osteoporosis. This study aimed to examine factors associated with bone mineral density (BMD) loss, osteoporosis, and fractures among pancreatic head cancer patients who underwent resection.</div></div><div><h3>Methods</h3><div>We retrospectively investigated consecutive pancreatic head cancer patients who underwent resection and had evaluable computed tomography<span> (CT) before surgery and at one-year follow-up. BMD was measured using CT images at the L1 vertebra. Osteoporosis was defined as BMD &lt;135 Hounsfield units. The prevalence and risk factors for BMD loss, osteoporosis, and fractures were examined.</span></div></div><div><h3>Results</h3><div>A total of 364 patients were included. Osteoporosis was associated with older age, higher rate of severe complications, and lower rate of receiving adjuvant chemotherapy. BMD consistently decreased over time regardless of age, sex, or cancer stage, leading to accelerating increase in the prevalence of osteoporosis over time (50.8 % at baseline and 73.1 % at one year). BMD loss was greater in young patients, males, patients with late-stage cancer, and patients who developed postoperative recurrence. Incident fractures developed in 47 patients (12.9 %) during follow-up, which were associated with older age, osteoporosis at the time of surgery, and postoperative recurrence.</div></div><div><h3>Conclusions</h3><div>Pancreatic head cancer patients who underwent resection showed an increased risk of BMD loss, osteoporosis and fractures. Screening for osteoporosis should be considered in pancreatic head cancer patients who underwent resection.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 685-693"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187601","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":"Pediatric pancreas segmentation from MRI scans with deep learning","authors":"Elif Keles ,&nbsp;Merve Yazol ,&nbsp;Gorkem Durak ,&nbsp;Ziliang Hong ,&nbsp;Halil Ertugrul Aktas ,&nbsp;Zheyuan Zhang ,&nbsp;Linkai Peng ,&nbsp;Onkar Susladkar ,&nbsp;Necati Guzelyel ,&nbsp;Oznur Leman Boyunaga ,&nbsp;Cemal Yazici ,&nbsp;Mark Lowe ,&nbsp;Aliye Uc ,&nbsp;Ulas Bagci","doi":"10.1016/j.pan.2025.06.006","DOIUrl":"10.1016/j.pan.2025.06.006","url":null,"abstract":"<div><h3>Objective</h3><div>Our study aimed to evaluate and validate <em>PanSegNet</em><span>, a deep learning (DL) algorithm for pediatric<span> pancreas segmentation on MRI in children with acute pancreatitis (AP), chronic pancreatitis (CP), and healthy controls.</span></span></div></div><div><h3>Methods</h3><div>With IRB approval, we retrospectively collected 84 MRI scans (1.5T/3T Siemens Aera/Verio) from children aged 2–19 years at Gazi University (2015–2024). The dataset includes healthy children as well as patients diagnosed with AP or CP based on clinical criteria. Pediatric and general radiologists manually segmented the pancreas, then confirmed by a senior pediatric radiologist. <em>PanSegNet</em>-generated segmentations were assessed using Dice Similarity Coefficient (DSC) and 95th percentile Hausdorff distance (HD95). Cohen's kappa measured observer agreement.</div></div><div><h3>Results</h3><div>Pancreas MRI T2W scans were obtained from 42 children with AP/CP (mean age: 11.73 ± 3.9 years) and 42 healthy children (mean age: 11.19 ± 4.88 years). <em>PanSegNet</em> achieved DSC scores of 88 % (controls), 81 % (AP), and 80 % (CP), with HD95 values of 3.98 mm (controls), 9.85 mm (AP), and 15.67 mm (CP). Inter-observer kappa was 0.86 (controls), 0.82 (pancreatitis), and intra-observer agreement reached 0.88 and 0.81. Strong agreement was observed between automated and manual volumes (R² = 0.85 in controls, 0.77 in diseased), demonstrating clinical reliability.</div></div><div><h3>Conclusion</h3><div><em>PanSegNet</em> represents the first validated deep learning solution for pancreatic MRI segmentation, achieving expert-level performance across healthy and diseased states. This tool, algorithm, along with our annotated dataset, are freely available on <span><span>GitHub</span><svg><path></path></svg></span> and <span><span>OSF</span><svg><path></path></svg></span>, advancing accessible, radiation-free pediatric pancreatic imaging and fostering collaborative research in this underserved domain.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 648-657"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144619689","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":"Prediction of metastatic potential of heterogeneous pancreatic ductal adenocarcinoma through gradient-based algorithms","authors":"Parvathy Rema ,&nbsp;Aravind Ramesh ,&nbsp;Murali Appukuttan ,&nbsp;Manju B.R","doi":"10.1016/j.pan.2025.06.017","DOIUrl":"10.1016/j.pan.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic ductal adenocarcinoma carries a dismal prognosis, with five-year survival below 10 % due to late presentation, aggressive nature, and profound intratumor heterogeneity. Existing prognostic models fail to account for the dynamic interplay between subclonal evolution and the tumor microenvironment, limiting their clinical utility for risk stratification and therapy guidance.</div></div><div><h3>Methods</h3><div><span>An in silico, multiscale framework was developed, combining an agent-based model of subclone proliferation, migration, quiescence, and apoptosis with continuum reaction–diffusion equations for oxygen, nutrients, extracellular matrix, and </span>chemoattractants. Four clinically relevant microenvironmental scenarios were simulated to generate spatiogenetic signatures of subclonal adaptation. These signatures were then sequentially input into three gradient-boosting classifiers—CatBoost, LightGBM, and XGBoost—to predict each subclone's metastatic potential.</div></div><div><h3>Results</h3><div>All hybrid pipelines demonstrated robust discrimination of high-risk subclones, with XGBoost achieving the highest sensitivity (92 %) and specificity (89 %) in cross-validation. The model accurately recapitulated PDAC's known clinical features, such as hypoxia-driven invasive fronts and desmoplastic stroma–associated resistance. Importantly, it uncovered novel biomarker signatures—combinations of genetic mutations and microenvironmental factors—that correlated with early metastatic seeding in simulated cohorts.</div></div><div><h3>Conclusion</h3><div>This work introduces a novel multiscale hybrid framework that is original both in its formulation integrating agent-based, continuum, and immune dynamics and in its application, where simulated biological signatures are used to train gradient boosting models for accurate prediction of metastatic potential.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 5","pages":"Pages 694-708"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560770","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}