Journal of the Pancreas最新文献

{"title":"An Appraisal of Current Guidelines for Managing Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasm.","authors":"Kazuki Takakura,&nbsp;Yuichi Torisu,&nbsp;Yuji Kinoshita,&nbsp;Yoichi Tomita,&nbsp;Masanori Nakano,&nbsp;Tsunekazu Oikawa,&nbsp;Shintaro Tsukinaga,&nbsp;Kazuki Sumiyama,&nbsp;Guido Eibl,&nbsp;Masayuki Saruta","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pancreatic intraductal papillary mucinous neoplasm was originally regarded as a benign mucinous cystic tumor but certainly has a marked malignant potential. With the array of high-resolution imaging modalities that are now available, more frequent incidental asymptomatic intraductal papillary mucinous neoplasm patients can be diagnosed. Until now, our clinicians have been managing intraductal papillary mucinous neoplasm patients by referring to the international consensus guidelines which have been revised twice or American Gastroenterological Association guidelines. The aim of this review is to reassess the current guidelines for the management of malignancy in intraductal papillary mucinous neoplasm. Furthermore, we specifically discuss the problems to be solved for establishing more refined guideline for the early detection, risk stratification and better management of pancreatic cancer in intraductal papillary mucinous neoplasm patients.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"19 4","pages":"178-182"},"PeriodicalIF":0.2,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327957/pdf/nihms-999835.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36857965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening of Pancreatic Cancer.","authors":"Muhammad Wasif Saif","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"19 3","pages":"109-112"},"PeriodicalIF":0.2,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063088/pdf/nihms976856.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36352366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative and Survival Outcomes Following Neoadjuvant FOLFIRINOX versus Gemcitabine Abraxane in Patients with Pancreatic Adenocarcinoma.","authors":"Brandon C Chapman,&nbsp;Ana Gleisner,&nbsp;Devin Rigg,&nbsp;Wells Messersmith,&nbsp;Alessandro Paniccia,&nbsp;Cheryl Meguid,&nbsp;Csaba Gajdos,&nbsp;Martin D McCarter,&nbsp;Richard D Schulick,&nbsp;Barish H Edil","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Context: </strong>Neoadjuvant chemotherapy is increasingly used in borderline resectable and locally advanced pancreatic cancer to facilitate surgical resection.</p><p><strong>Objective: </strong>To compare progression free survival and overall survival in patients receiving neoadjuvant FOLFIRINOX with those receiving gemcitabine/abraxane.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>University of Colorado Hospital from 2012-2016.</p><p><strong>Participants: </strong>Patients with pancreatic adenocarcinoma.</p><p><strong>Interventions: </strong>Neoadjuvant FOLFIRINOX or gemcitabine/abraxane.</p><p><strong>Outcome measures: </strong>Perioperative outcomes, progression free survival, and overall survival were compared between groups. A multivariate Cox proportional hazard model was applied to evaluate survival outcomes.</p><p><strong>Results: </strong>We identified 120 patients: 83 (69.2%) FOLFIRINOX and 37 (30.8%) gemcitabine/abraxane. The FOLIFRINOX group was younger and had a lower ECOG performance status (p<0.05). Patients in the FOLFIRINOX group were more likely to undergo surgical resection compared to gemcitabine/abraxane (66.3% <i>vs.</i> 32.4%, p=0.002). Among all patients, median follow up was 16.9 months and FOLFIRINOX was associated with improved PFS (15.3 <i>vs.</i> 8.2 months, p=0.006), but not overall survival (23.5 <i>vs.</i> 18.7 months, p=0.228). In these patients, insulin-dependent diabetes was associated with a worse progression free survival and overall survival and surgical resection was protective. Among surgically resected patients, median follow up was 21.1 months and there was no difference in progression free survival (19.5 <i>vs.</i> 15.1 months) or overall survival (27.4 <i>vs.</i> 19.8 months) between the FOLFIRINOX and gemcitabine/abraxane groups, respectively (p>0.05). Insulin-dependent diabetes and a poor-to-moderate pathologic response was associated with worse progression free survival and overall survival.</p><p><strong>Conclusion: </strong>Neoadjuvant FOLFIRINOX may improve progression free survival by increasing the proportion of patients undergoing surgical resection. Improved understanding of the role for selection bias and longer follow up are needed to better define the impact of neoadjuvant FOLFIRINOX on overall survival.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"19 2","pages":"75-85"},"PeriodicalIF":0.2,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018015/pdf/nihms970973.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36264786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Preoperative Biliary Drainage in Patients Undergoing Pancreatoduodenectomy For Suspected Pancreatic or Periampullary Cancer","authors":"M. Bakens, B. V. Rijssen, V. V. Woerden, M. Besselink, D. Boerma, O. Busch, K. DeJong, M. Gerhards, J. E. Hooft, Y. Keulemans, J. Klaase, M. Luyer, Q. Molenaar, J. Oor, E. Schoon, W. Steen, D. Tseng, D. Gouma, I. Hingh","doi":"10.18154/RWTH-2018-223495","DOIUrl":"https://doi.org/10.18154/RWTH-2018-223495","url":null,"abstract":"Introduction A Dutch randomized trial showed that patients with obstructive jaundice due to periampullary tumors and a bilirubin below 250 μmol/l have a higher rate of complications after preoperative biliary drainage as compared to early surgery. Therefore, in the Netherlands the recommended treatment is early surgery without preoperative biliary drainage. This study investigated adherence to this recommendation. Methods A retrospective multicenter cohort study was performed in patients undergoing pancreatoduodenectomy for suspected malignancy in a 2-years period in seven Dutch high-volume centers. The proportion of and reasons for preoperative biliary drainage were studied. Results Pancreatoduodenectomy was performed in 609 patients, of whom 401 (66%) presented with preoperative jaundice. Of these, 245 patients had bilirubin levels below 250 μmol/l. Preoperative biliary drainage was performed in 165 (67%) of these patients. In the majority of patients, no medical reason justifying a preoperative biliary drainage could be retrieved from the medical charts (n=102, 62%). Preoperative biliary drainage was mostly performed in the hospital of diagnosis prior to referral to a pancreatic center (53%). After referral, the rate of preoperative biliary drainage varied considerably between pancreatic centers (13% - 58%, p<0.001). Conclusion In the Netherlands, more than half of the patients with obstructive jaundice still undergo preoperative biliary drainage prior to surgery in the Netherlands without an urgent medical reason. Given the negative influence of preoperative biliary drainage on outcome, this practice should be improved.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"19 1","pages":"24-28"},"PeriodicalIF":0.2,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67703532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) in 2017.","authors":"Muhammad Wasif Saif","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"18 6","pages":"444-447"},"PeriodicalIF":0.2,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870128/pdf/nihms946832.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35961232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing Post-ERCP Pancreatitis: The Role of Prophylactic Pancreatic Duct Stenting in the Rectal NSAID Era.","authors":"Noor-L-Houda Bekkali, Tom Thomas, Margaret Geraldine Keane, Sam Murray, Deepak Joshi, Ghassan Elsayed, Gavin James Johnson, Michael Huw Chapman, Stephen Paul Pereira, George John Mitchell Webster","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Rectal non-steroidal anti-inflammatory drug at endoscopic retrograde cholangiopancreatography is now the standard of care to reduce the risk of post-ERCP pancreatitis. Pancreatic duct stenting also reduces the risk of post- ERCP pancreatitis in high-risk patients, but failed pancreatic duct stenting carries an increased PEP rate (up to 35%).</p><p><strong>Study aim: </strong>To assess the impact on post-ERCP pancreatitis of successful and unsuccessful pancreatic duct stent placement in the setting of universal rectal non-steroidal anti-inflammatory drug use.</p><p><strong>Methods: </strong>Between 2013-2015, all patients undergoing endoscopic retrograde cholangiopancreatographys in our tertiary referral centre (where rectal non-steroidal anti-inflammatory drugs are used routinely) were included. The electronic patient's records were reviewed and the following parameters were analysed: indication for pancreatic duct stenting; deployment success; and adverse events.</p><p><strong>Results: </strong>A total of 1633 endoscopic retrograde cholangiopancreatographys were performed, and pancreatic duct stenting was attempted in 324 cases (20%), with successful placement in 307 patients (95%). Contra-indications to non-steroidal anti-inflammatory drugs were found in 106 (6.5%) patients. Prophylactic stenting failed in 12 of 213 patients; of whom one patient developed post-ERCP pancreatitis (8%). Eighteen (9%) patients with prophylactic pancreatic duct stents developed post-ERCP pancreatitis compared to 1.4% without prophylactic stents (RR 8.4, p=0.04).</p><p><strong>Conclusion: </strong>A lack of difference in post-ERCP pancreatitis in those who underwent successful, and unsuccessful, pancreatic duct stent placement may reflect the protective effect of non-steroidal anti-inflammatory drugs. This data adds to evidence suggesting that pancreatic duct stenting may be less important, even in high-risk patients, with the widespread use of non-steroidal anti-inflammatory drugs.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"18 4","pages":"316-319"},"PeriodicalIF":0.1,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933872/pdf/nihms888909.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36074527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confocal Endomicroscopy Characteristics of Different Intraductal Papillary Mucinous Neoplasm Subtypes.","authors":"Amrit K Kamboj,&nbsp;John M Dewitt,&nbsp;Rohan M Modi,&nbsp;Darwin L Conwell,&nbsp;Somashekar G Krishna","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intraductal papillary mucinous neoplasms are classified into gastric, intestinal, pancreatobiliary, and oncocytic subtypes where morphology portends disease prognosis. The study aim was to demonstrate EUS-guided needle-based confocal laser endomicroscopy imaging features of intraductal papillary mucinous neoplasm subtypes. Four subjects, each with a specific intraductal papillary mucinous neoplasm subtype were enrolled. An EUS-guided needle-based confocal laser endomicroscopy miniprobe was utilized for image acquisition. The mean cyst size from the 4 subjects (2 females; mean age = 65.3±12 years) was 36.8±12 mm. All lesions demonstrated mural nodules and focal dilation of the main pancreatic duct. EUS-nCLE demonstrated characteristic finger-like papillae with inner vascular core for all subtypes. The image patterns of the papillae for the gastric, intestinal, and pancreatobiliary subtypes were similar. However, the papillae in the oncocytic subtype were thick and demonstrated a fine scale-like or honeycomb pattern with intraepithelial lumina correlating with histopathology. There was significant overlap in the needle-based confocal laser endomicroscopy findings for the different intraductal papillary mucinous neoplasm subtypes; however, the oncocytic subtype demonstrated distinct patterns. These findings need to be replicated in larger multicenter studies.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"18 Suppl 2","pages":"198-202"},"PeriodicalIF":0.2,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558896/pdf/nihms879347.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35284423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Endotherapy in the Treatment of Pain Associated With Chronic Pancreatitis: A Systematic Review and Meta-Analysis.","authors":"Mikram Jafri,&nbsp;Amit Sachdev,&nbsp;Javed Sadiq,&nbsp;David Lee,&nbsp;Ting Taur,&nbsp;Adam Goodman,&nbsp;Frank Gress","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Endotherapy is a treatment modality that can be used to manage the pain associated with chronic pancreatitis. The aim of this systematic review and meta-analysis is to evaluate the efficacy of endotherapy in the management of pain associated with chronic pancreatitis.</p><p><strong>Methods: </strong>A search of Medline, Pubmed, and Embase databases between 1988 to December 2014 was conducted to evaluate the use of endotherapy for pain relief in patients with chronic pancreatitis. We included large prospective studies, randomized controlled trials and retrospective analyses. Exclusion criteria included studies not written in the English language, small studies with less than 10 patients, case series/case reports and studies that enrolled patients treated with dual therapies including surgery or celiac plexus neurolysis. In addition, a subgroup analysis was conducted to evaluate studies that included patients with pancreatic duct strictures. A meta-analysis was performed and the data on pain relief was subsequently extracted, pooled, and analyzed. I² index estimates were calculated to test for variability and heterogeneity across the included studies.</p><p><strong>Results: </strong>Our final analysis included sixteen studies, comprising 1498 patients. Eleven studies presented data on immediate pain relief after endotherapy and twelve studies presented data on both immediate and long term pain relief (mean follow up was 47.4 months). The compiled result of the sixteen studies for immediate pain relief demonstrated 88% efficacy (95% NT CI [81.0%, 94%]) of endotherapy. Similarly, analysis of pain relief on long term follow-up showed a 67% efficacy of endotherapy (95% NT CI [58%, 76%]). The compiled complication rate for endotherapy in this review was 7.85% per ERCP/endotherapeutic procedure and the most common complications were acute pancreatitis, stent occlusion and stent migration.</p><p><strong>Conclusions: </strong>Endotherapy is beneficial for both immediate and long term management of pain associated with chronic pancreatitis. The efficacy of endotherapy decreases over time as assessed by evaluating pain relief on long term follow up. Given the considerable heterogeneity of reported data, additional prospective and standardized multicenter studies need to be conducted to evaluate the efficacy of this modality in controlling pain associated with chronic pancreatitis.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"18 2","pages":"125-132"},"PeriodicalIF":0.2,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5619873/pdf/nihms883252.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35459495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Burden of Systemic Adiposity on Pancreatic Disease: Acute Pancreatitis, Non-Alcoholic Fatty Pancreas Disease, and Pancreatic Cancer.","authors":"Ahmad Malli,&nbsp;Feng Li,&nbsp;Darwin L Conwell,&nbsp;Zobeida Cruz-Monserrate,&nbsp;Hisham Hussan,&nbsp;Somashekar G Krishna","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Obesity is a global epidemic as recognized by the World Health Organization. Obesity and its related comorbid conditions were recognized to have an important role in a multitude of acute, chronic, and critical illnesses including acute pancreatitis, nonalcoholic fatty pancreas disease, and pancreatic cancer. This review summarizes the impact of adiposity on a spectrum of pancreatic diseases.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"18 5","pages":"365-368"},"PeriodicalIF":0.2,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826578/pdf/nihms913698.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35873347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Real Time Endoscopic Ultrasound Guided Elastography for Targeting EUS-FNA of Suspicious Pancreatic Masses: A Review of the Literature and A Single Center Experience.","authors":"Mikram Jafri,&nbsp;Amit H Sachdev,&nbsp;Lauren Khanna,&nbsp;Frank G Gress","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound guided elastography is an imaging modality that can be used to evaluate tissue stiffness and to assess solid pancreatic lesions. It can also assist in optimizing the diagnostic yield of endoscopic ultrasound guided fine needle aspiration biopsies.</p><p><strong>Aims: </strong>To review the literature on solid pancreatic lesions, the use of EUS guided fine needle aspiration and endoscopic ultrasound guided elastography and to present a single center experience using elastography to direct fine needle aspiration biopsies of solid pancreatic lesions.</p><p><strong>Methods: </strong>We present a review of the literature and a single center experience describing the use of EUS guided elastography in directing fine needle aspiration biopsies of solid pancreatic lesions.</p><p><strong>Results: </strong>Thirteen male veterans with an average age of 62.3 (SD±11.8) years were enrolled in the study. The mean pancreatic mass size on EUS was 5.1×5.2 (SD±4.4×4.5) cm. A total of 13 lesions were identified during elastography. The lesions were most commonly found in the body (n=5), followed by multifocal lesions (n=4), pancreatic head (n=3) and tail (n=1). The seven concerning pancreatic lesions were stratified based on color pattern identified on EUS and EUS-elastography. Three lesions were homogenously blue, and four lesions were heterogeneously blue. The remaining six lesions which were less concerning were predominantly green. Of the three lesions, that were homogenously blue, two were diagnosed as adenocarcinoma (n=2) and chronic pancreatitis (n=1) respectively. Of the four heterogeneously blue lesions two were adenocarcinomas, while the other two represented a large B-cell lymphoma and chronic pancreatitis. Patients whose lesions were characterized as homogenous or heterogeneous green were benign and remained disease free after a median of two years of regular follow up.</p><p><strong>Limitations: </strong>Relatively small number of patients studied.</p><p><strong>Conclusions: </strong>In our single center experience we found that the use of real time endoscopic ultrasound guided elastography for targeting fine needle aspiration of suspicious pancreatic lesions may be beneficial as an adjunct modality to complement conventional EUS. Larger prospective studies need to be conducted to evaluate the utility of this modality in targeting pancreatic lesions.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"17 5","pages":"516-524"},"PeriodicalIF":0.2,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595420/pdf/nihms883249.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35514309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}