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1
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Thierens NDE, Verdonk RC, Löhr JM, van Santvoort HC, Bouwense SA, van Hooft JE. Chronic pancreatitis. Lancet 2025; 404:2605-2618. [PMID: 39647500 DOI: 10.1016/s0140-6736(24)02187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 09/20/2024] [Accepted: 10/01/2024] [Indexed: 12/10/2024]
Abstract
Chronic pancreatitis is a progressive fibroinflammatory disease primarily caused by a complex interplay of environmental and genetic risk factors. It might result in pancreatic exocrine and endocrine insufficiency, chronic pain, reduced quality of life, and increased mortality. The diagnosis is based on the presence of typical symptoms and multiple morphological manifestations of the pancreas, including pancreatic duct stones and strictures, parenchymal calcifications, and pseudocysts. Management of chronic pancreatitis consists of prevention and treatment of complications, requiring a multidisciplinary approach focusing on lifestyle modifications, exocrine insufficiency, nutritional status, bone health, endocrine insufficiency, pain management, and psychological care. To optimise clinical outcomes, screening for complications and evaluation of treatment efficacy are indicated in all patients with chronic pancreatitis.
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Affiliation(s)
- Naomi DE Thierens
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Research and Development, St Antonius Hospital, Nieuwegein, Netherlands.
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - J Matthias Löhr
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Stefan Aw Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
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2
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Xu X, Liu S, Shao M, Wu L, Ouyang Q, Yi Q, Huang Y, Wang J, Tan C. Early diagnosis of the Need for surgical drainage in chronic pancreatitis patients based on serum metabolomics. Clin Chim Acta 2025:120369. [PMID: 40383362 DOI: 10.1016/j.cca.2025.120369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2025] [Revised: 05/15/2025] [Accepted: 05/15/2025] [Indexed: 05/20/2025]
Abstract
PURPOSE Chronic pancreatitis (CP) is a chronic inflammatory disease caused by multiple factors. Numerous studies have found that implementing surgical drainage in the early stages of CP can help alleviate pain and improve prognosis in patients. However, there is currently no consensus on clinical indications for surgical drainage in the early stages of CP, making it difficult to determine whether surgical drainage is necessary. This study aims to use metabolomics methods to identify potential biomarkers that can differentiate whether CP patients require surgical drainage. METHODS This study included two cohorts. The training cohort consisted of 32 serum samples from CP patients and 31 serum samples from healthy controls. The validation cohort comprised 73 serum samples from CP patients and 27 serum samples from healthy controls. All serum samples from CP patients were collected within 24 h of hospital admission. Liquid chromatography-tandem mass spectrometry (LC-MS) was used to perform metabolomic analysis on all collected serum samples. RESULTS Based on the validation cohort, 24 differential metabolites, including 1-(6-[3]-ladderane-hexanyl)-2-(8-[3]-ladderane-octanyl)-sn-glycerophosphocholine, PE(18:1(9Z)/20:4(5Z,8Z,11Z,14Z)), and PGP(16:0/20:4(5Z,8Z,11Z,14Z)), were identified as potential biomarkers for distinguishing whether CP patients require surgical drainage. Among these, the combination of 1-(6-[3]-ladderane-hexanyl)-2-(8-[3]-ladderane-octanyl)-sn-glycerophosphocholine and PE(18:1(9Z)/20:4(5Z,8Z,11Z,14Z)) demonstrated improved diagnostic value in joint ROC analysis, with an AUC value of 0.819 (95% CI: 0.691-0.924). CONCLUSION This study represents the first prospective cohort research to identify 24 differential metabolites in serum through metabolomic profiling, which can be used for the early diagnosis of whether CP patients require surgical drainage.
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Affiliation(s)
- Xu Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan 410005, China; School of Medicine, Hunan Normal University, Changsha, Hunan 410013, China
| | - Sixiang Liu
- Department of Emergency, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha Hunan 410005, China
| | - Min Shao
- Department of Clinical Laboratory, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan 410005, China
| | - Ling Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan 410005, China
| | - Qianhui Ouyang
- Department of Clinical Laboratory, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan 410005, China
| | - Qi Yi
- Department of Emergency, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha Hunan 410005, China
| | - Ying Huang
- Department of Emergency, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha Hunan 410005, China
| | - Jia Wang
- Department of Research, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha Hunan 410005, China.
| | - Chaochao Tan
- Department of Clinical Laboratory, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan 410005, China.
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3
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Das K. Extracorporeal Shock-Wave Lithotripsy and Endoscopy for the Treatment of Pain in Chronic Pancreatitis. Ann Intern Med 2025; 178:759-760. [PMID: 40388817 DOI: 10.7326/annals-25-00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2025] Open
Affiliation(s)
- Kshaunish Das
- Division of Gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India
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4
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van Veldhuisen CL, Leseman CA, De Rijk FEM, Marques-Antunes J, Ausania F, Belyaev O, Berrevoet F, Boermeester MA, Boggi U, Bouwense SA, Bruno MJ, Busch OR, Conlon KC, Dokmak S, Falconi M, Ghorbani P, Gryspeerdt F, Haen R, Ibrahimli A, Izbicki JR, Krikke C, Kokkola A, Marique L, Mieog JSD, Nappo G, Pavulans J, Plaudis H, Roeyen G, Scognamiglio P, Tamburrino D, Tholfsen T, Toschka M, Uzunoglu FG, van Dieren S, Van Eijck CHJ, van Hooft JE, van Santvoort HC, Verdonk RC, Voermans RP, Waage A, Besselink MG. Surgery for chronic pancreatitis across Europe (ESCOPA): prospective multicentre study. Br J Surg 2025; 112:znaf068. [PMID: 40296656 PMCID: PMC12038157 DOI: 10.1093/bjs/znaf068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 02/27/2025] [Accepted: 03/07/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND Randomized trials have demonstrated the superiority of surgery over endoscopy in patients with symptomatic chronic pancreatitis. However, large international studies quantifying the impact of surgery on chronic pancreatitis are lacking. The aim of this study was to evaluate current practice across Europe regarding indications, surgical techniques, and outcomes of surgery for chronic pancreatitis. METHODS A prospective multicentre study of consecutive patients undergoing surgery for symptomatic chronic pancreatitis from 22 centres in 13 countries from 1 June 2021 to 30 November 2022 was conducted. The outcome of interest in patients with pain as an indication was the Izbicki pain score at 6-month follow-up, with complete pain relief defined as an Izbicki pain score ≤10 and partial pain relief defined as an Izbicki pain score >10, but with a >50% decrease compared with the baseline score. Quality of life was assessed using Pancreatitis Quality of Life Instrument (PANQOLI) and 12-Item Short-Form (SF-12) surveys. Predictors of pain relief were analysed using multivariable analysis. RESULTS Overall, 207 patients underwent surgery (24.6% underwent surgical drainage procedures, 29.5% underwent duodenum-preserving head resections, and 45.9% underwent formal pancreatic resections). Before surgery, 48.8% used opioids and 51.2% had undergone prior endoscopic treatment. Major morbidity occurred in 14.0% and the 90-day mortality rate was 1.4%. Among 113 patients operated on for pain, the median Izbicki pain score decreased from 61.3 to 19.0 at 6 months (P < 0.001). Pain relief was achieved in 72.6% (43 patients reported complete pain relief and 39 patients reported partial pain relief). PANQOLI and SF-12 Physical Component Summary scores improved significantly (P < 0.001). Longer symptom duration (OR 0.95 (95% c.i. 0.90 to 1.00), P = 0.045) and use of opioids before surgery (OR 3.16 (95% c.i. 1.04 to 9.64), P = 0.043) predicted less pain relief. CONCLUSION Surgery for chronic pancreatitis across Europe was performed with low morbidity. Patients reported good pain relief and improvements in quality-of-life scores. Multidisciplinary consultation is recommended for all patients with chronic pancreatitis before undergoing any intervention.
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Affiliation(s)
- Charlotte L van Veldhuisen
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Research and Development, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Charlotte A Leseman
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fleur E M De Rijk
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Fabio Ausania
- Department of Hepatic, Pancreatic, Biliary, and Transplant Surgery, Clinic Hospital, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Orlin Belyaev
- Department of Surgery, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Frederik Berrevoet
- General and HPB Surgery and Liver Transplantations, Ghent University Hospital, Ghent, Belgium
| | - Marja A Boermeester
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Stefan A Bouwense
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kevin C Conlon
- Department of Surgery, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, University of Paris Cité, Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy, France
| | - Massimo Falconi
- Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy
| | - Poya Ghorbani
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Filip Gryspeerdt
- General and HPB Surgery and Liver Transplantations, Ghent University Hospital, Ghent, Belgium
| | - Roel Haen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Jakob R Izbicki
- Department for General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Christina Krikke
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Arto Kokkola
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lancelot Marique
- Department of HPB Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, University of Paris Cité, Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy, France
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gennaro Nappo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Pancreatic Surgery Unit, Humanitas Clinical and Research Centre, IRCCS, Milan, Italy
| | - Janis Pavulans
- Department of Surgery, Riga East Clinical University Hospital, Riga, Latvia
| | - Haralds Plaudis
- Department of Surgery, Riga East Clinical University Hospital, Riga, Latvia
| | - Geert Roeyen
- Department of Hepatobiliary Transplantation and Endocrine Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Pasquale Scognamiglio
- Department for General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Domenico Tamburrino
- Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy
| | - Tore Tholfsen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marie Toschka
- Department of Surgery, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Faik G Uzunoglu
- Department for General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Rogier P Voermans
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anne Waage
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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5
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Gadiyaram S, Nachiappan M. 'Head-first Approach' for small duct chronic pancreatitis. Updates Surg 2025:10.1007/s13304-025-02137-w. [PMID: 40032803 DOI: 10.1007/s13304-025-02137-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 02/24/2025] [Indexed: 03/05/2025]
Abstract
Small duct pancreatitis is a rare variant of chronic pancreatitis characterized by a main pancreatic duct (MPD) measuring less than 5 mm. Traditionally, resectional procedures have been advocated as a treatment for small duct pancreatitis. However, these procedures are associated with worse post-operative results and a gradual functional decline over the long term. Parenchyma-preserving hybrid extended drainage procedures have been shown to provide more comprehensive pain relief, improved functional outcomes, and enhanced quality of life (QOL). However, the identification of the MPD in these patients presents a technical challenge. We describe the 'head-first approach' for the identification of the MPD in patients with small duct pancreatitis undergoing extended drainage procedures. The study includes patients of small duct pancreatitis who underwent the extended drainage procedure during a 6-year period from April 2017 to March 2023. During the study period, 41 patients underwent surgical management for chronic pancreatitis. Thirty-two patients underwent an extended drainage procedure, with pain being the indication for surgery in all cases. Twelve of these patients had small duct disease. The 'head-first approach' for identification of the MPD was successfully employed in all 12 patients. The median blood loss during surgery was 180 mL, and the median duration from the beginning of head coring to the identification of the duct was 45 min. Of the 32 patients, post-operative bleeding was seen in 4, external pancreatic fistula was observed in 2, and superficial surgical site infection was seen in 2 patients. All four patients with bleeding were managed conservatively with blood transfusions, and no re-explorations or re-interventions were required. There were no mortalities in this cohort. The 'head-first approach' for pancreatic duct identification is a safe and feasible technique to enable an extended drainage procedure with all the advantages of a parenchyma-preserving procedure for surgical palliation of pain in small duct chronic pancreatitis.
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Affiliation(s)
- Srikanth Gadiyaram
- Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospital, New No 30, 39th Cross, Jayanagar 8th, Block, Bangalore, 560082, India.
| | - Murugappan Nachiappan
- Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospital, New No 30, 39th Cross, Jayanagar 8th, Block, Bangalore, 560082, India
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6
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Vanek P, Freeman ML. Updates in the Management of Chronic Pancreatitis: Navigating Through Recent Advances. Gastroenterol Clin North Am 2025; 54:157-174. [PMID: 39880525 DOI: 10.1016/j.gtc.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
This article provides an up-to-date review of the management of chronic pancreatitis, highlighting advancements in medical therapy, nutritional support, endoscopic and surgical approaches, and emerging treatments. Nutritional management accentuates addressing malabsorption and nutrient deficiencies. Advances in endoscopy and parenchyma-sparing surgical techniques have opened new avenues for improved patient outcomes, with total pancreatectomy and islet autotransplantation offering the only definitive solution for selected patients. Additionally, emerging therapies, including anti-inflammatory and immune-modulating agents, show promise for future treatment options. Emphasizing a multidisciplinary approach, this review aims to equip health care professionals with a comprehensive overview of current management strategies and future directions.
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Affiliation(s)
- Petr Vanek
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 77900 Olomouc, Czech Republic; Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Zluty Kopec 7, 65653 Brno, Czech Republic
| | - Martin L Freeman
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
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Sallinen V, Kokkola A, Puolakkainen P. Surgery-First for Painful Chronic Pancreatitis. JAMA Surg 2025; 160:133-134. [PMID: 39565618 DOI: 10.1001/jamasurg.2024.5181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2024]
Affiliation(s)
- Ville Sallinen
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arto Kokkola
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pauli Puolakkainen
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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8
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van Veldhuisen CL, Kempeneers MA, de Rijk FEM, Bouwense SA, Bruno MJ, Fockens P, Poley JW, Ali UA, Bollen TL, Busch OR, van Duijvendijk P, van Dullemen HM, van Eijck CH, Van Goor H, Hadithi M, Haveman JW, Keulemans Y, Nieuwenhuijs VB, Poen AC, Voermans RP, Tan AC, Thijs W, Verdonk RC, Witteman BJ, van Hooft JE, van Santvoort HC, Dijkgraaf MG, Besselink MG, Boermeester MA, Issa Y. Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis: Follow-Up Analysis of the ESCAPE Randomized Clinical Trial. JAMA Surg 2025; 160:126-133. [PMID: 39565607 PMCID: PMC11579886 DOI: 10.1001/jamasurg.2024.5182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Collaborators] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 09/08/2024] [Indexed: 11/21/2024]
Abstract
Importance Patients with painful chronic pancreatitis and a dilated pancreatic duct can be treated by early surgery or an endoscopy-first approach. Objective To compare long-term clinical outcomes of early surgery vs an endoscopy-first approach using follow-up data from the ESCAPE randomized clinical trial. Design, Setting, and Participants Between April 2011 and September 2018, 88 patients with painful chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach in 30 hospitals in the Netherlands collaborating in the Dutch Pancreatitis Study Group as part of the ESCAPE randomized clinical trial. For the present cohort study, long-term clinical data were collected after the initial 18-month follow-up. Follow-up was completed in June 2022, and data analysis was performed in June 2023. Exposure Patients with chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach. Main Outcomes and Measures The primary end point was pain, assessed by the Izbicki pain score; secondary end points included patient-reported complete pain relief and satisfaction. Predefined subgroups included patients who progressed from endoscopy to surgery and those with ductal clearance obtained by endoscopy. Analysis was performed according to the intention-to-treat principle. Results In this cohort study, 86 of 88 overall patients could be evaluated, with a mean (SD) follow-up period of 98 (16) months. Of 88 initial patients, 21 patients (24%) were female, and mean (SD) patient age was 61 (10) years. At the end of long-term follow-up, the mean (SD) Izbicki pain score was significant lower (33 [31] vs 51 [31]) in the early surgery group, as was the rate of patient-reported complete pain relief (14 of 31 patients [45%] vs 6 of 30 patients [20%]), compared to the endoscopy-first group. After the initial 18-month follow-up, 11 of 43 patients in the early surgery group (26%) underwent reinterventions vs 19 of 43 patients in the endoscopy-first group (44%). At the end of follow-up, more patients in the early surgery group were "very satisfied" with their treatment (22 of 31 patients [71%] vs 10 of 30 patients [33%]). Patients who progressed from endoscopy to surgery (22 of 43 patients [51%]) had significantly worse mean (SD) Izbicki pain scores (33 [31] vs 52 [24]) compared to the early surgery group and had a lower rate of complete pain relief (55% for early surgery vs 12% for endoscopy first). In the endoscopy-first group, patients with endoscopic ductal clearance had similar mean (SD) Izbicki pain scores as the remaining patients (49 [34] vs 53 [28]). Conclusions and Relevance In this cohort study evaluating long-term outcomes of the ESCAPE randomized clinical trial, after approximately 8 years of follow-up, early surgery was superior to an endoscopy-first approach in patients with painful chronic pancreatitis and a dilated main pancreatic duct in pain scores and patient satisfaction. Notably, patients who progressed from endoscopy to surgery had worse outcomes compared to patients undergoing early surgery, and obtaining endoscopic ductal clearance did not improve outcomes.
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Affiliation(s)
- Charlotte L. van Veldhuisen
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Marinus A. Kempeneers
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Florence E. M. de Rijk
- Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Stefan A. Bouwense
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Paul Fockens
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan W. Poley
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Usama Ahmed Ali
- Division of Colorectal Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York
| | - Thomas L. Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Olivier R. Busch
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Hendrik M. van Dullemen
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Casper H. van Eijck
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Harry Van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Muhammed Hadithi
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Jan-Willem Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yolande Keulemans
- Department of Gastroenterology and Hepatology, Zuyderland Hospital, Sittard, the Netherlands
| | | | - Alexander C. Poen
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, the Netherlands
| | - Rogier P. Voermans
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Adriaan C. Tan
- Department of Gastroenterology and Hepatology, Canisius-Wilhemina Hospital, Nijmegen, the Netherlands
| | - Willem Thijs
- Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, the Netherlands
| | - Robert C. Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Ben J. Witteman
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hjalmar C. van Santvoort
- Department of Research and Development, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Marcel G. Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Marc G. Besselink
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Yama Issa
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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Collaborators
Pieter Honkoop, Annemieke Y Thijssen, Tessa Kooistra, Sebastiaan Balkema, Noor Bekkali, Karam S Boparai, Liesbeth M Kager, Jaap J Kloek, Erik A Rauws, R Bart Takkenberg, Dirk J Gouma, Thomas M van Gulik, Willem A Bemelman, A H Koos Zwinderman, Alexander G L Bodelier, Tom C J Seerden, Conny van Enckevort, Nienke van Gils, Erik Schoon, Lauran Vogelaar, Roland S de Vries, Annet M Voorburg, Joos Heisterkamp, Geert Bezemer, Henri Braat, Paul Didden, Neda Farahani, Hajo J Flink, Arjun D Koch, Cindy Postma, Paul G van Putten, Jurriën G P Reijnders, Robert Roomer, Ubbo Wiersema, G Lieneke Homans, Wout G N Mares, Ruby Meiland, G Willemien Erkelens, Hans van Maanen, Gudrun Muller, Erwin van Geenen, Lars E Perk, Johan de Raaf, Karin Fransen, Reinier Hoedemaker, Maarten A C Meijssen, Dorien Oude Hergelink, Ivo P van Munster, Tessa E H Römkes, Anries E Braat, A F M Sandro Schaapherder, Frank J G M Kubben, Chantal Hoge, M de Maat, Ad Masclee, Laurents P S Stassen, Menno A Brink, Lotte van Vlerken, Jeroen J Kolkman, Niels G Venneman, A P J Lex Houdijk, Bas van der Spek, Jeroen M Jansen, Olle The, Michael F Gehards, Hein G Gooszen, Oliver Wilder-Smith, Jildou Hoekstra, Daniëlle F G M Josemanders, B W Marcel Spanier, Sybrand Y de Boer, Edith de Vries, Abdulbaqi Al-Toma, Bert van Ramshorst, Bas L A M Weusten, Djamila Boerma, A Rina Bijlsma, Eleonora A M Festen, Ilona P Kerkhof, Jan H Kleibeuker, Eva Kouw, H Sijbrand Hofker, R Ploeg, Ulrich Beese, Peter D Siersema, Frank P Vleggaar, I Quintus Molenaar, Huseyin Aktas, Iris van Guchelaar,
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9
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Dankha R, Sparrelid E, Gilg S, Löhr J, Ghorbani P. Surgical management of chronic pancreatitis: A narrative review. United European Gastroenterol J 2025; 13:44-54. [PMID: 39439227 PMCID: PMC11866319 DOI: 10.1002/ueg2.12694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 09/17/2024] [Indexed: 10/25/2024] Open
Abstract
Chronic pancreatitis is a severe disabling disease with persistent pain as the most prominent symptom often leading to significant quality of life (QoL) reduction. Current international guidelines propagate a step-up approach in which surgery should only be considered as a last resort in patients with failure of both medical and endoscopic interventions. Accumulating evidence, however, suggests that surgery is superior to endoscopic therapy and that early surgical intervention is beneficial in terms of pain relief, pancreatic function and QoL. Several surgical procedures are available with low morbidity and mortality rates, providing excellent long-term results. The purpose of this review was to present an overview of the surgical treatment options for chronic pancreatitis with a focus on the timing of surgery.
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Affiliation(s)
- Rimon Dankha
- Division of Surgery and OncologyDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Ernesto Sparrelid
- Division of Surgery and OncologyDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Stefan Gilg
- Division of Surgery and OncologyDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetKarolinska University HospitalStockholmSweden
| | - J.‐Matthias Löhr
- Division of Surgery and OncologyDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Poya Ghorbani
- Division of Surgery and OncologyDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetKarolinska University HospitalStockholmSweden
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10
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Montorsi RM, Francken MFG, Boermeester MA, Busch OR, Daams F, Hackert T, Haen R, Hollmann MW, van Santvoort HC, Besselink MG. Minimally invasive versus open lateral pancreaticojejunostomy in patients with painful chronic pancreatitis: systematic review. BJS Open 2024; 9:zrae135. [PMID: 39835446 PMCID: PMC11747668 DOI: 10.1093/bjsopen/zrae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 09/11/2024] [Accepted: 10/08/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Patients with painful chronic pancreatitis combined with a dilated main pancreatic duct and a normal size pancreatic head are treated according to guidelines by lateral pancreaticojejunostomy (LPJ). This systematic review compared outcomes of minimally invasive LPJ and open LPJ. METHODS From 1 January 2000 until 13 November 2023, series reporting on minimally invasive LPJ and open LPJ in patients with symptomatic chronic pancreatitis were included. This study was structured in accordance with the PRISMA guidelines. The primary outcome was intraoperative and postoperative complications. Secondary outcomes included long-term clinical outcomes. RESULTS Overall, 19 retrospective studies were included. Morbidity rate ranged from 0% to 57% after minimally invasive LPJ versus 4% to 68% after open LPJ (median: 25, i.q.r.: 23). Length of hospital stay ranged from 5 to 7 days after minimally invasive LPJ and from 6 to 16 days after open LPJ. The rate of pain relief ranged from 62% to 91% after open LPJ (median: 78.5, i.q.r.: 23) and from 71% to 100% (median: 82.5, i.q.r.: 12.5) after minimally invasive LPJ respectively. New-onset endocrine insufficiency ranged from 21% to 22% in minimally invasive LPJ and 19% to 26% after open LPJ. New-onset exocrine insufficiency was shown in 11% to 27% in minimally invasive LPJ versus 8% to 26% after open LPJ. Weight gain ranged from 60% to 100% (median: 97, i.q.r.: 23) after minimally invasive LPJ. DISCUSSION This systematic review suggested that minimally invasive LPJ can be performed safely in selected patients with symptomatic chronic pancreatitis. Phase 2 randomized trials should assess potential short-term benefits such as postoperative pain and length of hospital stay after minimally invasive LPJ.
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Affiliation(s)
- Roberto M Montorsi
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Michiel F G Francken
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of Research and Development, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roel Haen
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
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11
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Rousek M, Záruba P, Pudil J, Kšírová E, Pohnán R. Surgical treatment of chronic pancreatitis with an inflammatory pancreatic head mass: a retrospective study. BMC Gastroenterol 2024; 24:345. [PMID: 39358718 PMCID: PMC11448026 DOI: 10.1186/s12876-024-03338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/24/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Conservative treatment of chronic pancreatitis has only a limited effect in most patients. Surgery offers very good long-term results, even in the early stages of the disease. Unfortunately, only a minority of patients undergo surgical treatment. The aim of this work was to summarise the current treatment options for patients with an inflammatory mass of the pancreatic head. Data from patients in our study demonstrates that the surgery is a safe method, and here we compare the perioperative and early postoperative outcomes of patients who underwent a pancreatoduodenectomy and duodenum-preserving pancreatic head resection for chronic pancreatitis. METHODS All patients who underwent a pancreaticoduodenectomy or a duodenum-preserving pancreatic head resection in our department between 2014 and 2022 were included in this study. Perioperative and early postoperative results were statistically analysed and compared. RESULTS Thirty-eight pancreaticoduodenectomies and 23 duodenum-preserving pancreatic head resections were performed. The overall mortality was 3%, whereas the in-hospital mortality after pancreaticoduodenectomy was 5%. The mortality after duodenum-preserving pancreatic head resection was 0%. No statistically significant differences in the hospital stay, blood loss, and serious morbidity were found in either surgery. Operative time was significantly shorter in the duodenum-preserving pancreatic head resection group. CONCLUSIONS Both pancreatoduodenectomy and duodenum-preserving pancreatic head resection are safe treatment options. Duodenum-preserving pancreatic head resection showed a statistically significant superiority in the operative time compared to pancreaticoduodenectomy. Although other monitored parameters did not show a statistically significant difference, the high risk of complications after pancreaticoduodenectomy with a mortality of 5%; maintenance of the duodenum and upper loop of jejunum, and lower risk of metabolic dysfunctions after duodenum-preserving pancreatic head resection may favour duodenum-preserving pancreatic head resection in recommended diagnoses. Attending physicians should be more encouraged to use a multidisciplinary approach to assess the suitability of surgical treatment in patients with chronic pancreatitis.
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Affiliation(s)
- Michael Rousek
- Department of Surgery, Second Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic.
| | - Pavel Záruba
- Department of Surgery, Second Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic
| | - Jiří Pudil
- Department of Surgery, Second Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic
| | - Eliška Kšírová
- Department of Bioinformatics, Second Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Radek Pohnán
- Department of Surgery, Second Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic
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12
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Jiang LY, Han C, Hu LH. Progress in treatment of chronic pancreatitis: A review based on the ClinicalTrials.gov database. Shijie Huaren Xiaohua Zazhi 2024; 32:635-644. [DOI: 10.11569/wcjd.v32.i9.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/23/2024] [Accepted: 09/03/2024] [Indexed: 09/28/2024] Open
Abstract
Chronic pancreatitis (CP) is a chronic progressive fibro-inflammatory disease of the pancreas caused by various etiologies, characterized by recurrent upper abdominal pain and pancreatic exocrine dysfunction. ClinicalTrials.gov is the most commonly used clinical trial database, including information of clinical trials which have been completed or are ongoing, or upcoming. Based on the ClinicalTrials.gov database, we retrieved all clinical studies registered before June 30, 2024, screened out recent clinical studies related to CP, and summarized and integrated highlights and directions of these studies from the perspectives of nutritional support, medication, endoscopy, etc., aiming to provide new ideas for the design of CP clinical studies in the future.
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Affiliation(s)
- Ling-Ying Jiang
- School of Basic Medicine, Naval Medical University, Shanghai 200433, China
| | - Chao Han
- Hospital of 91876 Troops of Chinese People's Liberation Army, Qinhuangdao 066203, Hebei Province, China
- Department of Gastroenterology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Liang-Hao Hu
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
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13
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Riviere D, van den Boezem PB, Besselink MG, van Laarhoven CJ, Kooby DA, Vollmer CM, Davidson BR, Gurusamy KS. Minimally invasive versus open pancreatoduodenectomy in benign, premalignant, and malignant disease. Cochrane Database Syst Rev 2024; 7:CD014017. [PMID: 39056402 PMCID: PMC11274036 DOI: 10.1002/14651858.cd014017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of laparoscopic or robot-assisted pancreatoduodenectomy versus open pancreatoduodenectomy for people with benign, premalignant, and malignant disease.
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Affiliation(s)
- Deniece Riviere
- Department of Medical Imaging, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | | | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - David A Kooby
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles M Vollmer
- Department of Gastrointestinal Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian R Davidson
- Division of Surgery and Interventional Science, University College London, London, UK
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14
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Yang JP, Xie H, Zhou YF, Yuan H. Construction of risk prediction model for hypothermia during pancreaticoduodenectomy. Heliyon 2024; 10:e32490. [PMID: 38994096 PMCID: PMC11237838 DOI: 10.1016/j.heliyon.2024.e32490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 07/13/2024] Open
Abstract
Purpose To investigate the factors influencing hypothermia during pancreaticoduodenectomy and establish and verify a prediction model. Method The clinical data of patients undergoing pancreaticoduodenectomy in Hunan People's Hospital between January 1, 2022 and October 15, 2022 were analysed. The patients were divided into a hypothermia group (n = 302) and a non-hypothermia group (n = 164) according to whether hypothermia occurred during surgery. A binary logistic regression model was used to analyse the independent risk factors for hypothermia in patients undergoing pancreaticoduodenectomy. A risk prediction model was established, and R software was used to plot a column graph. The predictive value of the model was evaluated using the receiver operating characteristic (ROC) curve. Results Among the 466 patients undergoing pancreaticoduodenectomy, 302 (64.81 %) had hypothermia, including 154 men and 148 women, with a median age of 58.6 (38-86) years. The binary logistic regression analysis showed that low body mass index (BMI), room temperature at the time of entry, intraoperative flushing fluid volume and peritoneal flushing fluid temperature were independent risk factors for intraoperative hypothermia in patients undergoing pancreaticoduodenal surgery (P < 0.05). A multivariate logistic regression analysis (backward logistic regression) was used to establish the prediction model. The area under the ROC curve was 0.927, P ≤ 0.001, the sensitivity was 0.921 and the specificity was 0.848, indicating good differentiation by the prediction model. Conclusion The nomogram constructed using four independent risk factors: BMI, room temperature at the time of entry, intraoperative peritoneal flushing fluid volume and intraoperative peritoneal flushing fluid temperature, has good predictive efficacy and good clinical application value for predicting intraoperative hypothermia in patients undergoing pancreaticoduodenectomy.
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Affiliation(s)
- Ji-Ping Yang
- Department of Operating, Hunan Provincial People's Hospital(The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, China
| | - Hua Xie
- Department of Clinical Laboratory, Hunan Provincial People's Hospital(The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, China
| | - Yi-Feng Zhou
- Department of Operating, Hunan Provincial People's Hospital(The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, China
| | - Hao Yuan
- Department of Operating, Hunan Provincial People's Hospital(The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, China
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15
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Li JS, Zheng KL, Lv SL, Su XJ, Wang KX, Li ZS, Chen J, Chen Y. Endoscopic ultrasound-guided versus surgical pancreatic duct drainage after failed endoscopic retrograde pancreatography: a pilot comparative study. Surg Endosc 2024:10.1007/s00464-024-10978-6. [PMID: 38898340 DOI: 10.1007/s00464-024-10978-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Endoscopic ultrasound-guided pancreatic duct (PD) drainage (EUS-PDD) is being increasingly performed as an alternative method to surgical drainage to achieve PD decompression after failed endoscopic retrograde pancreatography (ERP). However, no directly study has compared EUS-PDD with surgical PD drainage after failed ERP in patients with chronic pancreatitis. METHODS Consecutive patients who underwent EUS-PDD or longitudinal pancreaticojejunostomy after failed ERP were retrospectively identified from our endoscopy and medical information systems. The primary end point was the Izbicki pain score. The secondary end points were pain relief at the end of follow-up, procedure outcomes, adverse events, readmission, and reintervention. RESULTS A total of 21 patients (11 EUS-PDD, 10 surgical drainages) were analyzed. There were no significant differences in mean Izbicki pain score (EUS-PDD, 13.6 ± 10.1 vs. surgical drainage 10.7 ± 7.9, p = 0.483) or complete/partial pain relief (60%/30% vs. 70%/30%, p = 0.752) at the end of follow-up of the two groups. The rates of overall adverse events (27.3% vs. 30.0%, p = 0.893) and readmission (63.6% vs. 40.0%, p = 0.290) were similar in the two treatment groups, while patients in EUS-PDD group required more reinterventions (45.5% vs. 0%, p = 0.039) compared with patients in the surgery group. CONCLUSION EUS-PDD showed comparable pain relief and safety to surgical PD drainage after failed ERP, with a higher rate of reintervention. The selection of EUS-PDD or surgical drainage may be appropriate based on an individualized strategy.
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Affiliation(s)
- Jia-Su Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Kai-Lian Zheng
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Shun-Li Lv
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xiao-Ju Su
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Kai-Xuan Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Jie Chen
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Yan Chen
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
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16
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Molero X, Ayuso JR, Balsells J, Boadas J, Busquets J, Casteràs A, Concepción M, Cuatrecasas M, Fernàndez Esparrach G, Fort E, Garcia Borobia F, Ginès À, Ilzarbe L, Loras C, Masachs M, Merino X, Olsina JJ, Puig-Diví V, Salord S, Serrano T, Vaquero EC. Chronic pancreatitis for the clinician: complications and special forms of the disease. Interdisciplinary position paper of the Catalan Society of Digestology (SCD) and the Catalan Pancreatic Society (SCPanc). Minerva Gastroenterol (Torino) 2024; 70:208-224. [PMID: 35262306 DOI: 10.23736/s2724-5985.22.03127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic pancreatitis tends to develop a number of complications that may constitute the form of presentation of the disease. Some societies have issued guidelines for diagnosis and treatment of chronic pancreatitis complications, but the level of evidence for any topic is usually low and recommendations tend to be weak. We aimed to provide defined position statements for the clinician based on updated review of published literature and on multidisciplinary expert agreement. The goal was to propose defined terminology and rational diagnostic/therapeutic circuits based on current knowledge. To this end 14 sections related to complications and special forms of chronic pancreatitis (early chronic, groove and autoimmune pancreatitis) were reviewed by 21 specialists from 6 different fields to generate 32 statements. Featured statements assert common bile duct stenosis does not require invasive treatment (endoscopic or surgical) unless cholestasis, cholangitis, lithiasis or other symptoms develop. Pancreatic duct strictures and calculi should be approached (after ruling out malignancy) if causing pain, pancreatitis, pseudocysts or other complications. Treatment of symptomatic pseudocysts must be individualized, considering associated main duct stenosis, vascular and pericystic complications. Higher risk conditions for pancreatic cancer are advance age, smoking, genetic background, recent diagnosis of chronic pancreatitis or diabetes, and appearance of new symptoms. Groove pancreatitis can initially be treated with conservative measures. Both prednisolone or rituximab can induce remission and maintenance of autoimmune pancreatitis. Internal fistula, vascular complications, bacterial overgrowth, osteoporosis and renal lithiasis require specific therapeutic approaches.
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Affiliation(s)
- Xavier Molero
- Unit of Exocrine Pancreas Research, Department of Gastroenterology, VHIR, CIBERehd, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain -
| | - Juan R Ayuso
- Department of Radiology, CDI, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Joaquim Balsells
- Department of Hepato-Pancreato-Biliary and Transplantation Surgery, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Jaume Boadas
- Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Juli Busquets
- Department of Hepatobiliary and Pancreatic Surgery, IDIBELL, Bellvitge University Hospital, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Anna Casteràs
- Unit of Diabetes and Metabolism Research, VHIR, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Mar Concepción
- Department of Gastroenterology, Santa Creu i Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Míriam Cuatrecasas
- Department of Pathology, CIBEREHD, IDIBAPS, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Gloria Fernàndez Esparrach
- Unit of Endoscopy, Department of Gastroenterology, CIBEREHD IDIBAPS, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Esther Fort
- Department of Gastroenterology, Doctor Josep Trueta University Hospital, Girona, Spain
| | | | - Àngels Ginès
- Unit of Endoscopy, Department of Gastroenterology, CIBEREHD IDIBAPS, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Lucas Ilzarbe
- Department of Gastroenterology, Hospital del Mar Parc Salut Mar, Barcelona, Spain
| | - Carme Loras
- Department of Gastroenterology, CIBERehd, University of Barcelona, Terrassa, Spain
| | - Miquel Masachs
- Department of Endocopy, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Terrassa, Spain
| | - Xavier Merino
- Department of Radiodiagnostic, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jorge J Olsina
- Department of General Surgery, Institute for Research in Biomedicine of Lleida (IRBLleida), University Hospital Arnau de Vilanova, Lleida, Spain
| | - Valentí Puig-Diví
- Department of Gastroenterology, Parc Taulí Research and Innovation Institute I3PT, Parc Taulí University Hospital, Sabadell, Spain
| | - Sílvia Salord
- Unit of Hepato-Bilio-Pancreatic, Department of Digestive Diseases, IDIBELL, Bellvitge University Hospital, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Teresa Serrano
- Department of Pathology, IDIBELL, CIBERehd, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Eva C Vaquero
- Department of Gastroenterology, CIBEREHD IDIBAPS, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
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17
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Mai DN, Nguyen QV, Phan MT, Doan TM. Surgical Treatment for Chronic Pancreatitis With a Normal-Sized Pancreatic Head and a Dilated Duct: Frey or Extended Partington Procedure? Cureus 2024; 16:e61881. [PMID: 38855486 PMCID: PMC11162353 DOI: 10.7759/cureus.61881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Surgical drainage for chronic pancreatitis patients with a normal-sized pancreatic head remains controversial. Both Frey and extended Partington procedures could be used, but the level of evidence is weak. METHOD The object of this prospective cohort study was to assess the mid-term results concerning pain, quality of life, and pancreatic function of surgical drainage (Frey or extended Partington procedure) in patients with painful chronic pancreatitis and a normal-sized pancreatic head. RESULTS Fifty-nine patients (Frey procedure: 14 cases; extended Partington procedure: 45 cases) were enrolled in the study with a median length of follow-up of 16 months. The effective and complete pain relief rate was 85% and 58%, respectively. The Izbicki score decreased from 53.4 preoperatively to 8.8 postoperatively. The general 12-Item Short Form Health Survey (SF-12) score increased from 45.2 to 75.4. The pancreatic insufficiency did not change significantly postoperatively. At three months after surgery, the complete pain relief and Izbicki score were more favorable in the Frey group than in the extended Partington group. CONCLUSION Both Frey and extended Partington procedures resulted in excellent pain relief and quality of life improvement and did not worsen pancreatic function. The Frey procedure could yield a more favorable result in the early postoperative period.
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Affiliation(s)
- Dai Nga Mai
- Hepatobiliary and Pancreatic Surgery, Cho Ray Hospital, Ho Chi Minh, VNM
| | - Quoc Vinh Nguyen
- Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, VNM
| | - Minh Tri Phan
- Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, VNM
| | - Tien My Doan
- Hepatobiliary and Pancreatic Surgery, Cho Ray Hospital, Ho Chi Minh, VNM
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18
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Yamane K, Anazawa T, Nagai K, Ito T, Hatano E. Current status of total pancreatectomy with islet autotransplantation for chronic and recurrent acute pancreatitis. Ann Gastroenterol Surg 2024; 8:401-412. [PMID: 38707227 PMCID: PMC11066494 DOI: 10.1002/ags3.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 05/07/2024] Open
Abstract
Total pancreatectomy with islet autotransplantation (TPIAT) is an established and effective treatment modality for patients diagnosed with intractable chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP). TPIAT primarily aims to manage debilitating pain leading to impaired quality of life among patients with CP or RAP, which can be successfully managed with medical, endoscopic, or surgical interventions. TPIAT is significantly successful in relieving pain associated with CP and improving health-related quality of life outcomes. Furthermore, the complete loss of pancreatic endocrine function attributed to total pancreatectomy (TP) can be compensated by autologous islet transplantation (IAT). Patients receiving IAT can achieve insulin independence or can be less dependent on exogenous insulin compared with those receiving TP alone. Historically, TPIAT has been mainly used in the United States, and its outcomes have been improving due to technological advancements. Despite some challenges, TPIAT can be a promising treatment for patients with CP-related intractable pain. Thus far, TPIAT is not commonly performed in Japan. Nevertheless, it may improve health-related quality of life in Japanese patients with CP, similar to Western patients. This review article aimed to provide an overview of the indications, related procedures, and outcomes of TPIAT and to discuss future prospects in Japan.
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Affiliation(s)
- Kei Yamane
- Department of SurgeryGraduate School of Medicine, Kyoto UniversityKyotoJapan
| | - Takayuki Anazawa
- Department of SurgeryGraduate School of Medicine, Kyoto UniversityKyotoJapan
| | - Kazuyuki Nagai
- Department of SurgeryGraduate School of Medicine, Kyoto UniversityKyotoJapan
| | - Takashi Ito
- Department of SurgeryGraduate School of Medicine, Kyoto UniversityKyotoJapan
| | - Etsuro Hatano
- Department of SurgeryGraduate School of Medicine, Kyoto UniversityKyotoJapan
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19
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Hines OJ, Pandol SJ. Management of chronic pancreatitis. BMJ 2024; 384:e070920. [PMID: 38408777 DOI: 10.1136/bmj-2023-070920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Chronic pancreatitis results from repeated episodes of pancreatic inflammation and associated fibrosis leading to the loss of functional exocrine and endocrine pancreatic function. The disease is manifested by abdominal pain, deterioration in quality of life, food maldigestion and malabsorption, diabetes, and an increased risk for pancreatic adenocarcinoma. This review summarizes the latest evidence on the diagnosis and management of chronic pancreatitis and its manifestations. In particular, this review discusses advances in understanding of the role of genetic disorders in the mechanisms of the disease and surgical options for patients refractory to medical therapy. Furthermore, clinical trials are under way to develop medical therapeutics.
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Affiliation(s)
- O Joe Hines
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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20
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Abdalla M, Abdalla S, Panda N, Castillo CFD. Haemosuccus pancreaticus and seven episodes of recurrent unlocalised upper gastrointestinal bleeding. BMJ Case Rep 2024; 17:e256960. [PMID: 38383120 PMCID: PMC10882450 DOI: 10.1136/bcr-2023-256960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Upper gastrointestinal (GI) bleeding is a common medical condition that results in extensive morbidity and mortality, as well as substantial healthcare costs. While there is variation among society and consensus guidelines, the approaches to assessment and evaluation are generally consistent. Our case describes a man in his 40s who presented with seven episodes of recurrent upper GI bleeding over 2 years secondary to haemosuccus pancreaticus. While rare, this case study highlights key principles to the initial diagnostic approach that, in appropriate clinical contexts, should be applied to patients with unlocalised upper GI bleeding. We further perform a complete systematic review of similar cases available in PubMed (36 patients in 24 case reports) to further refine these diagnostic principles.
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Affiliation(s)
- Moustafa Abdalla
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Salwa Abdalla
- Department of Computer Science, University of Toronto, Toronto, Toronto, Canada
| | - Nikhil Panda
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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21
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Cassar N, Cromwell P, Duggan S, van Veldhuisen C, Boermeester M, Besselink M, Conlon K. Surgery versus Endoscopy for the Management of Painful Chronic Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials. Dig Surg 2024; 41:1-11. [PMID: 38190810 DOI: 10.1159/000535588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/21/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Debate exists regarding the optimal treatment for painful chronic pancreatitis (CP). This meta-analysis aims to determine the outcomes of surgical intervention as compared to endoscopy in patients with painful CP. METHODS A systematic review and meta-analysis including studies from PubMed, Embase, Web of Science, and Cochrane Databases (1995 onwards) was done by two independent reviewers using PRISMA guidelines. Primary outcome was pain relief. RESULTS Among 8,479 studies, three were randomized trials, comprising a total of 199 patients. Compared with endoscopy, surgery was associated with a lower Izbicki score, both at medium term (mean difference (MD) 21.46, 95% confidence interval (CI) 13.48-29.43, p < 0.00001) and long term (MD: 17.80, 95% CI: 8.36-27.23, p = 0.0002). A higher proportion of surgical patients had some sort of pain relief compared with those who had endoscopy, both at medium term (72% vs. 46%, RR: 1.51, 95% CI: 1.19-1.90, p = 0.0006) and long term (73% vs. 47%, RR: 1.50, 95% CI: 1.19-1.89, p = 0.0007). Complete pain relief was more common in the surgical group compared to the endoscopy group, both at medium term (33% vs. 17%, RR: 1.97, 95% CI: 1.16-3.36, p = 0.01) and long term (35% vs. 18%, RR: 1.92, 95% CI: 1.15-3.20, p = 0.01). The pooled crossover rate from endoscopy to surgery was 22% (22/99). CONCLUSIONS Surgical treatment in patients with painful CP leads to better pain control, requiring fewer interventions as compared to endoscopic treatment.
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Affiliation(s)
- Noel Cassar
- Department of Hepatobiliary Surgery and Liver Transplantation, St Vincent's University Hospital, Dublin, Ireland
| | - Paul Cromwell
- Department of Hepatobiliary Surgery and Liver Transplantation, St Vincent's University Hospital, Dublin, Ireland
| | - Sinead Duggan
- Professorial Surgical Unit, Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Charlotte van Veldhuisen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Marja Boermeester
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Marc Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Kevin Conlon
- Department of Hepatobiliary Surgery and Liver Transplantation, St Vincent's University Hospital, Dublin, Ireland
- Professorial Surgical Unit, Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
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22
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Leonhardt CS, Niesen W, Pils D, Angelova Y, Hank T, Kaiser J, Scheele C, Hinz U, Hackert T, Büchler MW, Strobel O. Patient reported outcomes of duodenum-preserving pancreatic head resection in chronic pancreatitis: high effectivity is impaired by prolonged non-surgical management. HPB (Oxford) 2024; 26:73-82. [PMID: 37865592 DOI: 10.1016/j.hpb.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/20/2023] [Accepted: 10/01/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Chronic pancreatitis (CP) causes suffering and socioeconomic burden. This study evaluated perioperative results and patient-reported outcomes (PRO) in CP patients treated with duodenum-preserving pancreatic head resection (DPPHR). METHODS Data were analyzed of CP patients undergoing DPPHR between 01/2001-10/2014. PROs were measured using a specifically designed questionnaire and the EORTC QLQ-C30/PAN26. Associations between treatment variables and PROs were examined. RESULTS Of 332 patients who received DPPHR, most (n = 251, 75.6%) underwent the Berne modification. Surgical morbidity was 21.5% (n = 71) and 90-day mortality 1.5% (n = 5). Median follow-up was 79.9 months, 5-year survival 90.5%, and 1.8% of patients developed pancreatic cancer. Of 283 patients alive, 178 (62.9%) returned questionnaires. Referral for surgery was self-initiated (38.0% of cases), by gastroenterologists (27.5%) and by general practitioners (21.1%). QoL improved in 78.7% of patients, remained stable in 12.1%, and worsened in 9.1%. Median Izbicki scores decreased from 90 to 5 points after surgery (p < 0.0001). Time from diagnosis to DPPHR was an independent, proportional predictor of a higher postoperative Izbicki score (p = 0.04). CONCLUSION DPPHR is an effective, safe treatment for CP. A delay in surgery decreases surgical effectivity, hence CP patients should be referred to surgery early to ensure satisfactory outcomes.
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Affiliation(s)
- Carl-Stephan Leonhardt
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Willem Niesen
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dietmar Pils
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Yoana Angelova
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Hank
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jörg Kaiser
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Scheele
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulf Hinz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Strobel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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23
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Capurso G, Tacelli M, Vanella G, Ponz de Leon Pisani R, Dell'Anna G, Abati M, Mele R, Lauri G, Panaitescu A, Nunziata R, Zaccari P, Archibugi L, Arcidiacono PG. Managing complications of chronic pancreatitis: a guide for the gastroenterologist. Expert Rev Gastroenterol Hepatol 2023; 17:1267-1283. [PMID: 38093702 DOI: 10.1080/17474124.2023.2295498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Chronic pancreatitis is a heterogeneous and complex syndrome that, in most cases, causes pain as a cardinal symptom and affects both the morphology and function of the pancreas, leading to several serious complications. AREAS COVERED The present review, based on a non-systematic PubMed search updated to June 2023, aims to present the current available evidence on the role of gastroenterologists in the diagnosis and treatment of both local and systemic complications by either endoscopic or medical treatments. EXPERT OPINION At diagnosis and during chronic pancreatitis follow-up, particular care is needed to consider not only the clinically manifest signs and symptoms of the disease, such as pain, jaundice, gastrointestinal obstruction, and pseudocysts, which require multidisciplinary discussion to establish the best treatment option (endoscopic or surgical), but also less evident systemic complications. Pancreatic exocrine and endocrine insufficiency, together with chronic inflammation, addiction, and dysbiosis, contribute to malnutrition, sarcopenia, and osteopathy. These complications, in turn, increase the risk of infection, thromboembolic events, and death. Patients with chronic pancreatitis also have an increased risk of psychiatric disorders and pancreatic cancer onset. Overall, patients with chronic pancreatitis should receive a holistic evaluation, considering all these aspects, possibly through multidisciplinary care in dedicated expert centers.
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Affiliation(s)
- Gabriele Capurso
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Tacelli
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Ruggero Ponz de Leon Pisani
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Dell'Anna
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Martina Abati
- Nutrition Service, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Mele
- Nutrition Service, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaetano Lauri
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Afrodita Panaitescu
- Vita-Salute San Raffaele University, Milan, Italy
- Bucharest Clinical Emergency Hospital, Bucharest, Romania
| | - Rubino Nunziata
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Piera Zaccari
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Livia Archibugi
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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24
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Kňazovický M, Roškovičová V, Gajdzik T, Hildebrand T, Kaťuchová J, Radoňák J. The Role of Surgery in Chronic Pancreatitis. POLISH JOURNAL OF SURGERY 2023; 96:97-102. [PMID: 38348975 DOI: 10.5604/01.3001.0053.9841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Chronic pancreatitis is an inflammatory disease characterized by the progressive replacement of the functional pancreatic parenchyma with fibrotic tissue. This leads to exocrine and endocrine insufficiency. A typical clinical feature is recurrent, severe upper abdominal pain, which negatively affects the patient's quality of life. Conservative treatment as the method of first choice does not prevent irreversible changes in the pancreatic tissue. While endoscopic drainage can have some benefits in the early stages of the disease, it is generally unsuccessful in the long term. Based on recent studies, surgical intervention appears to be the most suitable treatment option for improving the patient's quality of life. It currently includes a wide range of effective, proven drainage and resection procedures. Advances in surgical techniques and postsurgical intensive care have increased the frequency of pancreatic surgeries, while improvements in diagnostic methods have increased the number of patients who meet the indications for such surgery, including elderly and chronically ill patients. However, despite mortality rates decreasing, high morbidity rates remain a problem. Currently, in patients with an inflammatory mass in the head of the pancreas, pyloric and duodenal-preserving resection offers the best results. Different variants of these techniques appear to produce similar results. Various techniques have shown similar outcomes in terms of mortality, morbidity, pain relief, life expectancy and improved quality of life. The optimal timing of surgery has been addressed by several studies and most surgeons now favor early surgical intervention in order to prevent extensive destruction of pancreatic tissue.
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Affiliation(s)
- Miloš Kňazovický
- Department of Surgery, Louis Pasteur University Hospital, Košice, Slovakia
| | | | - Tomáš Gajdzik
- Department of Surgery, Louis Pasteur University Hospital, Košice, Slovakia
| | - Tomáš Hildebrand
- Department of Surgery, Louis Pasteur University Hospital, Košice, Slovakia
| | - Jana Kaťuchová
- Department of Surgery, Louis Pasteur University Hospital, Košice, Slovakia
| | - Jozef Radoňák
- Department of Surgery, Louis Pasteur University Hospital, Košice, Slovakia
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25
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Jabłońska B, Mrowiec S. Pancreatectomy and Pancreatic Surgery. Life (Basel) 2023; 13:1400. [PMID: 37374182 PMCID: PMC10326818 DOI: 10.3390/life13061400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Pancreatectomy, including pancreaticoduodenectomy (PD), as well as central pancreatectomy (CP), distal pancreatectomy (DP) and total/subtotal pancreatectomy, is a major, complex and difficult surgical procedure performed for various benign and malignant pancreatic diseases: from chronic pancreatitis, through benign cystic tumors and neuroendocrine neoplasms to malignant neoplasms, including pancreatic ductal adenocarcinoma (PDAC) [...].
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Affiliation(s)
- Beata Jabłońska
- Department of Digestive Tract Surgery, Medical University of Silesia, 40-752 Katowice, Poland;
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26
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Chooklin S, Chuklin S, Posivnych M, Krystopchuk S. Hemosuccus pancreaticus as a rare cause of gastrointestinal bleeding. EMERGENCY MEDICINE 2023; 19:58-69. [DOI: 10.22141/2224-0586.19.2.2023.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Hemosuccus pancreaticus is a life-threatening condition that should be considered in patients with abdominal pain, gastrointestinal hemorrhage and high serum amylase. The varied presentation of hemosuccus pancreaticus and the limited literature evidence due to its rarity make it challenging to diagnose. Diagnostic modalities include contrast-enhanced computed tomography scans, endoscopic procedures (esophagoduodenoscopy and endoscopic retrograde cholangiopancreatography) and angiography. Therapeutic management through an interventional radiology using coil embolization is safe and effective in hemodynamically stable patients with hemosuccus pancreaticus. Endosonography can be an innovative approach for the diagnosis and treatment of patients in whom contrast cannot be administered; however, its safety and efficacy need to be confirmed by future studies. This review presents current views on the diagnosis and treatment of patients with hemosuccus pancreaticus.
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27
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Usenko O, Khomiak I, Khomiak A, Malik A, Kropelnytskyi V, Krol M. Duodenum-preserving pancreatic head resection or pancreatoduodenectomy for the surgical treatment of paraduodenal pancreatitis: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:178. [PMID: 37140631 DOI: 10.1007/s00423-023-02917-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Paraduodenal pancreatitis (PDP) is an uncommon yet well-described type of focal chronic pancreatitis. The aim of our study was to compare the outcomes of surgical treatment of patients with PDP using pancreatoduodenectomy and duodenum-preserving pancreatic head resection (DPPHR). METHODS A retrospective analysis of 153 consecutive patients with PDP was performed. Patients who were treated with either DPPHR or PD were enrolled. The primary endpoint of the study was pain control achieved at the time of follow-up. The secondary endpoints of the study were complication rate (Clavien-Dindo > 2), hospital length of stay, and 90-day mortality. All patients were followed up after discharge for the assessment of pain cessation for a minimal period of 10 months. RESULTS The final study population consisted of 71 patients. A total of 14 patients (19.7%) underwent pancreatoduodenectomy, and 57 (80.3%) were managed with DPPHR. Complication rate was significantly lower in DPPHR group at χ2 = 4.2677, p < 0.05. Mean hospital length of stay was 9.3 days (range 3-29) in DPPHR group and 13.9 days (range 7-35) in PD group (p < 0.05). No postoperative mortality was recorded. The mean follow-up period of the patients after surgery was 41.8 ± 20.6 months (range 10-88). Pain scores at the time of operation were calculated as 50.9 ± 12.1 in DPPHR group and 56.1 ± 11.4 in PD group. At the time of follow-up, pain scores improved significantly in both groups and were 10.3 ± 8.8 and 10.9 ± 8.6, respectively. CONCLUSION DPPHR achieves similar results in pain control as PD with a lower complication rate and shorter hospital LOS.
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Affiliation(s)
- Oleksandr Usenko
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Igor Khomiak
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Andrii Khomiak
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Aurora, CO, 80045, USA.
| | - Andrii Malik
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Vladislav Kropelnytskyi
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Mark Krol
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
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28
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Guo S, Zhou Q, Yang J, Tao J, Zhang J, Wang H. Duodenum-preserving pancreatic head resection compared to pancreaticoduodenectomy: A systematic review and network meta-analysis of surgical outcomes. Front Surg 2023; 10:1107613. [PMID: 37066008 PMCID: PMC10090510 DOI: 10.3389/fsurg.2023.1107613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
ObjectivesIn this systemic review and network meta-analysis, we investigated pancreaticoduodenectomy (PD), pylorus-preserving pancreaticoduodenectomy (PPPD), and different modifications of duodenum-preserving pancreatic head resection (DPPHR) to evaluate the efficacy of different surgical procedures.MethodsA systemic search of six databases was conducted to identify studies comparing PD, PPPD, and DPPHR for treating pancreatic head benign and low-grade malignant lesions. Meta-analyses and network meta-analyses were performed to compare different surgical procedures.ResultsA total of 44 studies were enrolled in the final synthesis. Three categories of a total of 29 indexes were investigated. The DPPHR group had better working ability, physical status, less loss of body weight, and less postoperative discomfort than the Whipple group, while both groups had no differences in quality of life (QoL), pain scale scores, and other 11 indexes. Network meta-analysis of a single procedure found that DPPHR had a larger probability of best performance in seven of eight analyzed indexes than PD or PPPD.ConclusionDPPHR and PD/PPPD have equal effects on improving QoL and pain relief, while PD/PPPD has more severe symptoms and more complications after surgery. PD, PPPD, and DPPHR procedures exhibit different strengths in treating pancreatic head benign and low-grade malignant lesions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022342427.
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Affiliation(s)
- Shixiang Guo
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
- Chongqing School, University of Chinese Academy of Sciences, Chongqing, China
| | - Qiang Zhou
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Jiali Yang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Junyu Tao
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Junfeng Zhang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Huaizhi Wang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
- Correspondence: Huaizhi Wang
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29
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de Ponthaud C, Daire E, Pioche M, Napoléon B, Fillon M, Sauvanet A, Gaujoux S. Cystic dystrophy in heterotopic pancreas. J Visc Surg 2023; 160:108-117. [PMID: 36966112 DOI: 10.1016/j.jviscsurg.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Cystic dystrophy in heterotopic pancreas, or paraduodenal pancreatitis, is a rare and complicated presentation involving heterotopic pancreatic tissue in the duodenal wall. This condition is present in 5% of the general population but disease mainly affects middle-aged alcoholic-smoking men with chronic pancreatitis (CP). It may be purely duodenal or segmental (pancreatico-duodenopathy). Its pathophysiology arises from alcohol toxicity with obstruction of small ducts of heterotopic pancreatic tissue present in the duodenal wall and the pancreatic-duodenal sulcus, leading to repeated episodes of pancreatitis. The symptomatology includes episodes of acute pancreatitis, weight loss, and vomiting due to duodenal obstruction. Imaging shows thickening of the wall of the second portion of the duodenum with multiple small cysts. A stepwise therapeutic approach is preferred. Conservative medical treatment is favored in first intention (analgesics, continuous enteral feeding, somatostatin analogues), which allows complete symptomatic regression in 57% of cases associated with a 5% rate of complications (arterial thrombosis and diabetes). Endoscopic treatment may also be associated with conservative measures. Surgery achieves a complete regression of symptoms in 79% of cases but with a 20% rate of complications. Surgery is indicated in case of therapeutic failure or in case of doubt about a malignant tumor. Pancreaticoduodenectomy and duodenal resection with pancreatic preservation (PPDR) seem to be the most effective treatments. PPDR has also been proposed as a first-line treatment for purely duodenal location of paraduodenal pancreatitis, thereby preventing progression to an extended segmental form.
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Affiliation(s)
- C de Ponthaud
- Department of hepatobiliary and pancreatic surgery and liver transplantation, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Department of general, visceral and endocrine surgery, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Sorbonne university, Paris, France
| | - E Daire
- Gastroenterology department, Édouard-Herriot hospital, Lyon, France
| | - M Pioche
- Gastroenterology department, Édouard-Herriot hospital, Lyon, France
| | - B Napoléon
- Gastroenterology department, Jean Mermoz hospital, Lyon, France
| | - M Fillon
- Radiology department, la Croix Rousse hospital, Lyon, France
| | - A Sauvanet
- Pancreatic and hepatobiliary surgery department, Beaujon hospital, AP-HP, Clichy, France; University of Paris, France
| | - S Gaujoux
- Department of hepatobiliary and pancreatic surgery and liver transplantation, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Department of general, visceral and endocrine surgery, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Sorbonne university, Paris, France.
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Kothari D, Ketwaroo G, Sheth SG. Building a Quality Practice in Chronic Pancreatitis. J Clin Gastroenterol 2023; 57:265-268. [PMID: 36598825 DOI: 10.1097/mcg.0000000000001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chronic pancreatitis (CP) is a fibroinflammatory disorder that results in irreversible scarring to pancreatic parenchyma and presents with a myriad of symptoms including abdominal pain, nausea, weight loss, steatorrhea, and diabetes. Furthermore, patients with CP often have comorbid chemical dependencies to alcohol and tobacco, which can further complicate the management of CP. Recent literature proposes guidelines on how best to care for patients with CP and establishes requirements for centers of excellence. Here, we review the available data on endoscopic therapies, pain management, chemical dependency, and nutrition for patients with CP and propose quality metrics that may be used to establish a quality practice.
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Affiliation(s)
- Darshan Kothari
- Division of Gastroenterology and Hepatology, Duke University School of Medicine
- Division of Gastroenterology, Durham Veteran's Affairs Medical Center, Durham, NC
| | - Gyanprakash Ketwaroo
- Division of Gastroenterology and Hepatology, Baylor University School of Medicine
- Division of Gastroenterology, DeBakey Veteran's Affairs Medical Center, Houston, TX
| | - Sheth G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Strum WB, Boland CR. Advances in acute and chronic pancreatitis. World J Gastroenterol 2023; 29:1194-1201. [PMID: 36926670 PMCID: PMC10011955 DOI: 10.3748/wjg.v29.i7.1194] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/18/2023] [Accepted: 02/14/2023] [Indexed: 02/21/2023] Open
Abstract
Acute pancreatitis (AP) and chronic pancreatitis are the third leading gastrointestinal causes for admissions and readmissions to hospitals in the United States. This review of articles published between 2019-2022 (December) from international sources identified four categories of crucial new findings: The report includes (1) New genetic pathogenic mutations (TRPV6); expected genetic outcomes in a Northern European population; (2) a new serum diagnostic marker for AP-fatty acid ethyl esters-distinguishing acute pancreatitis associated with alcohol; explanations of the impact of monocytes/macrophages on the inflammatory process that defines their future in diagnosis, staging, and treatment; (3) innovations in timing of per os low-fat, solid food intake immediately on admission; resolution of concepts of aggressive parenteral fluid intake; dramatic shifts to non-operative from operative treatment of infected pancreatic necrosis. Each modification reduced interventions, complications, and lengths-of-stay; and (4) authoritarian recommendations for medical treatment of chronic pain. These advances offer opportunities to initiate newly proven treatments to enhance outcomes, alter the natural history, and envision the future of two diseases that have no known cure.
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Affiliation(s)
- Williamson B Strum
- Department of Gastroenterology, Scripps Clinic, La Jolla, CA 92037, United States
| | - Clement Richard Boland
- Department of Medicine, University of California San Diego, La Jolla, CA 92037, United States
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Surgical outcomes of the Frey procedure for chronic pancreatitis: correlation between preoperative characteristics and the histological severity of pancreatic fibrosis. Surg Today 2023:10.1007/s00595-023-02653-5. [PMID: 36757617 DOI: 10.1007/s00595-023-02653-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/08/2022] [Indexed: 02/10/2023]
Abstract
PURPOSE To evaluate the efficacy of the Frey procedure and clarify the relationship between preoperative characteristics and the histological severity of chronic pancreatitis (CP). METHODS Thirty patients who underwent the Frey procedure for CP between January, 2002 and December, 2020, at our hospital, were enrolled in this study. The specimen cored out of the pancreatic head was assessed for CP severity. We evaluated preoperative status and surgical outcomes according to CP severity. RESULTS Long-term pain relief was achieved in all 26 patients with sustained long-term follow-up, with complete pain relief attained in 19 (63%). Albumin levels were significantly higher 1 year postoperatively than preoperatively (p = 0.038). Histological fibrosis was assessed in the 26 patients as follows: normal (n = 4; 15%), mild (n = 8; 31%), moderate (n = 2; 8%), and severe (n = 12; 46%). These patients were divided into two groups according to the severity of fibrosis: normal/mild (n = 12) and moderate/severe (n = 14). The rates of diffuse calcification on preoperative computed tomography (CT) (71% vs. 17%, p = 0.008) and islet atrophy on insulin immunohistochemistry (100% vs. 33%, p < 0.001) were significantly higher in the moderate/severe group than in the normal/mild group. CONCLUSION The Frey procedure can achieve good pain relief and improve nutritional status. The severity of fibrosis can be predicted based on the extent of calcification on preoperative imaging studies.
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Zeng XP, Zeng JH, Wang R, Wang W. Pathogenesis, diagnosis, and treatment of malnutrition in patients with chronic pancreatitis. Shijie Huaren Xiaohua Zazhi 2023; 31:92-97. [DOI: 10.11569/wcjd.v31.i3.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Chronic pancreatitis (CP) is a persistent and progressive pancreatic inflammatory disease. Malnutrition is a common clinical manifestation in CP patients, which is mainly caused by pancreatic exocrine insufficiency but may also be related to pancreatic endocrine insufficiency and changes of living habit. At present, there is still a lack of gold standard for the diagnosis of malnutrition in patients with CP. Clinicians should comprehensively evaluate such patients through anthropometric parameters, test parameters, imaging diagnosis, pancreatic exocrine function detection, etc., detect malnutrition early, and take timely intervention measures, including improving diet and living habits, enteral/parenteral nutrition, pancreatic enzyme replacement therapy, acid suppressant adjuvant therapy, regulating intestinal flora, and administration of Chinese medicine. And endoscopic and surgical treatment should be used when necessary.
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Affiliation(s)
- Xiang-Peng Zeng
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fuzhou 350001, Fujian Province, China
| | - Jing-Hui Zeng
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fuzhou 350001, Fujian Province, China
| | - Rong Wang
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fuzhou 350001, Fujian Province, China
| | - Wen Wang
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fuzhou 350001, Fujian Province, China
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Parhiala M, Waage A, Ignatavičius P, Olesen SS, Poulsen JL, Trond E, Dimcevski G, Nordaas I, Hadi A, Kalaitzakis E, Drewes AM, Nøjgaard C, Laukkarinen J. Surgical strategies for chronic pancreatitis in a 1,327- patient Scandinavian Baltic pancreatic Club (SBPC) register. Pancreatology 2023; 23:28-34. [PMID: 36543740 DOI: 10.1016/j.pan.2022.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/29/2022] [Accepted: 12/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic pancreatitis (CP) may cause intermittent or continuous pain and complications requiring invasive interventions. No specific recommendations for surgical interventions have been presented. Our aim was to determine the surgical treatment strategies for the treatment of CP in the Scandinavian and Baltic countries. METHODS This multi-centre cross sectional study included 1327 CP patients from eight centres. The data was gathered from the Scandinavian Baltic Pancreatic Club (SBPC) database. Patients who underwent pancreatic surgery were analysed. The baseline CP population from the eight centres was used as a reference. The information registered included comorbidities, pancreatic function, previous interventions, time and type of surgery and the EORTC-30 quality of life (QOL) questionnaire. RESULTS Overall, 95/1327 (7%) patients underwent pancreatic surgery. Fifty-one (54%) of these underwent pancreatic surgery for chronic pain (PSCP) and formed the final study group. Median follow-up time was two (range 0-8) years after surgery and seven (1-46) years after diagnosis. The most common surgical procedures were pancreatic resection combined with drainage (54%) followed by pancreatic resections (32%) and drainage procedures (14%). Postoperatively, 47% of the patients were pain free with or without pain medication while 16% had chronic pain episodes, this did not differ from the base CP population. In QOL questionnaires, PSCP patients reported the same QOL but worse social functioning and more symptoms compared to the CP population. CONCLUSIONS Pancreatic surgery for CP is rare: surgical procedures were performed on only 7% of the CP patients in the SBPC database. In half of the patients the indication was pain. Most of these patients underwent endoscopic procedures before surgery. Half of the patients reported being pain-free after surgery.
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Affiliation(s)
- Mikael Parhiala
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Anne Waage
- Department of Surgery, Oslo University Hospital, Oslo, Norway
| | - Povilas Ignatavičius
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Søren S Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - Jakob L Poulsen
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - Engjom Trond
- Department of Gastroenterology, Haukeland University Hospital, Norway
| | - Georg Dimcevski
- Department of Gastroenterology, Haukeland University Hospital, Norway
| | - Ingrid Nordaas
- Department of Gastroenterology, Haukeland University Hospital, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Amer Hadi
- Division of Gastroenterology, Digestive Disease Center K, Bispebjerg Hospital, Copenhagen, Denmark
| | - Evangelos Kalaitzakis
- Herlev Copenhagen University Hospital/Herlev, University of Copenhagen, Copenhagen, Denmark
| | - Asbjørn M Drewes
- Herlev Copenhagen University Hospital/Herlev, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Nøjgaard
- Pancreatitis Centre East (PACE), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Finland.
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Waage A, Vinge-Holmquist O, Labori KJ, Paulsen V, Aabakken L, Lenz H, Felix Magnus HC, Tholfsen T, Hauge T. Tailored surgery in chronic pancreatitis after implementation of a multidisciplinary team assessment; a prospective observational study. HPB (Oxford) 2022; 24:2157-2166. [PMID: 36272955 DOI: 10.1016/j.hpb.2022.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Optimal management of chronic pancreatitis involves several specialties. Selection of patients for surgery may benefit from evaluation by a multidisciplinary team (MDT), similar to cancer care. The aim of this study was to evaluate outcomes in patients selected for surgery after MDT decision. METHODS A prospective, observational study of consecutive patients operated for pain due to chronic pancreatitis after implementation of a MDT. The main outcome was Quality of life (QoL) assessed by EORTC-QLQ C30 and pain relief in patients followed >3 months. Complications were registered and predictive factors for pain relief analyzed. RESULTS Of 269 patients evaluated by the MDT, 60 (22%) underwent surgery. Postoperative surgical complications occurred in five patients (8.3%) and reoperation within 30 days in two. There was no 90-days mortality. Complete or partial pain relief was achieved in 44 of 50 patients followed >3 months (88%). Preoperative duration of pain predicted lower probability of success. Postoperative improvement in QoL was most prominent for pain, appetite and nausea. CONCLUSIONS After MDT evaluation, one in five patients was selected for surgery. Pain relief was obtained in a majority of patients with improved QoL. A tailored approach through a MDT seems warranted and efficient.
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Affiliation(s)
- Anne Waage
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
| | - Olof Vinge-Holmquist
- Department of Digestive Surgery, St Olav's University Hospital, Trondheim, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut J Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vemund Paulsen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Lars Aabakken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Harald Lenz
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Henrik C Felix Magnus
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Tore Tholfsen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Truls Hauge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
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Jeon HJ, Kim SG. Utilization of end to side inverted mattress pancreaticojejunostomy for Duval procedure: A case report. Ann Hepatobiliary Pancreat Surg 2022; 26:412-416. [PMID: 36414234 PMCID: PMC9721252 DOI: 10.14701/ahbps.22-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Although a pancreaticojejunostomy (PJ) is not required after a distal pancreatectomy in most cases, it needs to be performed to prevent atrophy of the remnant pancreas when the proximal duct is obstructed by a tumor, stone, or etc. In these conditions, the critical postoperative pancreatic fistula (POPF) gives surgeons cause to hesitate before performing a PJ. We previously presented the modified technique of Mattress PJ named "inverted mattress PJ" (IM-PJ) and published improved outcomes in the aspects of POPF after a pancreaticoduodenectomy and a central pancreatectomy. Recently, we had a case of a patient who has chronic pancreatitis with a proximal pancreatic duct obstruction, requiring a distal pancreatectomy and PJ. Based on the previous report, we decided to apply the "inverted mattress PJ" (IM-PJ) technique for a Roux-en Y PJ after a distal pancreatectomy. The patient was discharged after surgery without complications. We reviewed a case of a patient requiring PJ following a distal pancreatectomy and discussed the safety of our technique.
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Affiliation(s)
- Hyun Jeong Jeon
- Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Sang Geol Kim
- Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea,Corresponding author: Sang Geol Kim, MD Department of Surgery, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea Tel: +82-53-950-5015, Fax: +82-53-200-2027, E-mail: ORCID: https://orcid.org/0000-0003-0393-7061
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37
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Kalas MA, Leon M, Chavez LO, Canalizo E, Surani S. Vascular complications of pancreatitis. World J Clin Cases 2022; 10:7665-7673. [PMID: 36158481 PMCID: PMC9372863 DOI: 10.12998/wjcc.v10.i22.7665] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 02/06/2023] Open
Abstract
More than 200000 hospital admissions happen per year for acute pancreatitis and more than 50000 for chronic pancreatitis in the United States of America. Necrotizing pancreatitis accounts for 20%-30% of the cases. One-quarter of the patients with pancreatitis develop vascular complications, which carries a high mortality. This mini-review will address these complications that can help primary care physicians and hospitalists in managing their patients effectively.
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Affiliation(s)
- M Ammar Kalas
- Department of Medicine, Texas Tech University Health Center, El Paso, TX 79905, United States
| | - Monica Leon
- Department of General Surgery, Centro Medico ABC, Ciudad de Mexico 01120, Mexico
| | - Luis Omar Chavez
- Department of Medicine, Texas Tech University Health Center, El Paso, TX 79905, United States
| | - Eduardo Canalizo
- Department of General Surgery, Centro Medico ABC, Ciudad de Mexico 01120, Mexico
| | - Salim Surani
- Department of Medicine, Texas A&M University, Bryan, TX 77807, United States
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Yan J, Yu W, Yan J, Guo X, Hou L, Ren L, Fan H. Spontaneous Rupture and Hemorrhage of WON: A Case Report. Front Surg 2022; 9:906520. [PMID: 35846954 PMCID: PMC9276918 DOI: 10.3389/fsurg.2022.906520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pancreatic pseudocysts are characterized by the leakage of pancreatic juice caused by various reasons, which leads to pancreatic juice accumulates around the pancreas, and stimulates the greater omentum and other tissues to form an area of fibrotic loculated effusion with an integrated capsule. Approximately, one-third of patients experienced recurrent pancreatic juice leakage, compression symptoms, infection, and bleeding, which requires surgical intervention, but spontaneous rupture cases are extremely rare. CASE PRESENTATION We here present the case of 40-year-old male who presented with abdominal pain and vomiting for two days and 10 h, respectively. He had a history of chronic pancreatitis and pseudocysts. The symptoms of abdominal pain worsened in the second day. Laboratory tests showed a progressive decrease in hemoglobin. Then, emergency pancreatoduodenectomy was performed. Intraoperative exploration found a small blood clot in the abdominal cavity and a hematoma that had formed in the intestinal cavity and retroperitoneum. CONCLUSION This case showed that pseudocysts of the pancreas can rupture under certain circumstances, leading to intraperitoneal bleeding and hematoma formation, which can endanger the life of the patient. And surgical treatment can be the first choice for hemorrhagic pseudocysts.
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Affiliation(s)
- Jican Yan
- Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Xining, China
- Department of Postgraduate, Qinghai University, Xining, China
| | - Wenhao Yu
- Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Xining, China
- Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Qinghai Key Laboratory of Hydatid Research, Xining, China
| | - Jingxin Yan
- Department of Postgraduate, Qinghai University, Xining, China
- Department of Interventional Therapy, Qinghai University, Xining, China
| | - Xinjian Guo
- Department of Pathology, Affiliated Hospital of Qinghai University, Xining, China
| | - Lizhao Hou
- Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Xining, China
| | - Li Ren
- Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Xining, China
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Xining, China
- Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Qinghai Key Laboratory of Hydatid Research, Xining, China
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Dirweesh A, Trikudanathan G, Freeman ML. Endoscopic Management of Complications in Chronic Pancreatitis. Dig Dis Sci 2022; 67:1624-1634. [PMID: 35226223 DOI: 10.1007/s10620-022-07391-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Management of complications in patients with chronic pancreatitis is often suboptimal. This review discusses detailed endoscopic approaches for managing complications in CP. LITERATURE FINDINGS CP is characterized by progressive and irreversible destruction of pancreatic parenchyma and ductal system resulting in fibrosis, scarring, and loss of glandular function. Abdominal pain remains is the most common symptom of the disease and the main aim of medical, endoscopic, and surgical therapy is to help relieve symptoms, prevent disease progression, and manage complications related to CP. In fact, advances in our understanding of CP have improved medical care and quality of life in these patients. With significant sequela, morbidity and a progressive nature, a thorough understanding of the pathophysiology, natural course, diagnostic approaches, and optimal management strategies for this disease is warranted. The existing modalities and new innovations in this field are safe, effective, and likely to have a positive impact on management of complication in CP whenever used in the right context.
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Affiliation(s)
- Ahmed Dirweesh
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, MMC 36, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Guru Trikudanathan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, MMC 36, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Martin L Freeman
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, MMC 36, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
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40
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Affiliation(s)
- Santhi Swaroop Vege
- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (S.S.V.); and the Department of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, University of Texas M.D. Anderson Cancer Center, Houston (S.T.C.)
| | - Suresh T Chari
- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (S.S.V.); and the Department of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, University of Texas M.D. Anderson Cancer Center, Houston (S.T.C.)
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Vorontsov OF, Natroshvili IG, Mikhin IV, Graeb C. [Surgical treatment of chronic pancreatitis: indications, timing, methods]. Khirurgiia (Mosk) 2022:82-88. [PMID: 35147006 DOI: 10.17116/hirurgia202202182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The review is devoted to complex treatment of chronic pancreatitis considering modern data on pathogenesis of this disease. The authors analyze various aspects of endoscopic and surgical interventions in refractory pain syndrome and complications of chronic pancreatitis, as well as positive and negative aspects of each method. Various surgical interventions and indications are analyzed in detail. One of the important points was analysis of the period between disease onset and surgical treatment that affects quality of life in patients with chronic pancreatitis in mid- and long-term period.
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Affiliation(s)
- O F Vorontsov
- Sana Klinikum Hof, Hof, Germany
- Volgograd State Medical University, Volgograd, Russia
| | | | - I V Mikhin
- Volgograd State Medical University, Volgograd, Russia
| | - C Graeb
- Sana Klinikum Hof, Hof, Germany
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OUP accepted manuscript. Br J Surg 2022; 109:363-371. [DOI: 10.1093/bjs/znab473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/16/2021] [Accepted: 12/22/2021] [Indexed: 11/14/2022]
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Abstract
BACKGROUND Chronic pancreatitis (CP) is defined according to the recently proposed mechanistic definition as a pathological fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent pathological responses to parenchymal injury or stress. METHODS The clinical practice guidelines for CP in Japan were revised in 2021 based on the 2019 Japanese clinical diagnostic criteria for CP, which incorporate the concept of a pathogenic fibro-inflammatory syndrome in the pancreas. In this third edition, clinical questions are reclassified into clinical questions, background questions, and future research questions. RESULTS Based on analysis of newly accumulated evidence, the strength of evidence and recommendations for each clinical question is described in terms of treatment selection, lifestyle guidance, pain control, treatment of exocrine and endocrine insufficiency, and treatment of complications. A flowchart outlining indications, treatment selection, and policies for cases in which treatment is ineffective is provided. For pain control, pharmacological treatment and the indications and timing for endoscopic and surgical treatment have been updated in the revised edition. CONCLUSIONS These updated guidelines provide clinicians with useful information to assist in the diagnosis and treatment of CP.
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Cowan RW, Pratt ED, Kang JM, Zhao J, Wilhelm JJ, Abdulla M, Qiao EM, Brennan LP, Ulintz PJ, Bellin MD, Rhim AD. Pancreatic Cancer-Related Mutational Burden Is Not Increased in a Patient Cohort With Clinically Severe Chronic Pancreatitis. Clin Transl Gastroenterol 2021; 12:e00431. [PMID: 34797250 PMCID: PMC8604013 DOI: 10.14309/ctg.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Chronic pancreatitis is associated with an increased risk of developing pancreatic cancer, and patients with inherited forms of pancreatitis are at greatest risk. We investigated whether clinical severity of pancreatitis could also be an indicator of cancer risk independent of etiology by performing targeted DNA sequencing to assess the mutational burden in 55 cancer-associated genes. METHODS Using picodroplet digital polymerase chain reaction and next-generation sequencing, we reported the genomic profiles of pancreases from severe clinical cases of chronic pancreatitis that necessitated palliative total pancreatectomy with islet autotransplantation. RESULTS We assessed 57 tissue samples from 39 patients with genetic and idiopathic etiologies and found that despite the clinical severity of disease, there was no corresponding increase in mutational burden. The average allele frequency of somatic variants was 1.19% (range 1.00%-5.97%), and distinct regions from the same patient displayed genomic heterogeneity, suggesting that these variants are subclonal. Few oncogenic KRAS mutations were discovered (7% of all samples), although we detected evidence of frequent cancer-related variants in other genes such as TP53, CDKN2A, and SMAD4. Of note, tissue samples with oncogenic KRAS mutations and samples from patients with PRSS1 mutations harbored an increased total number of somatic variants, suggesting that these patients may have increased genomic instability and could be at an increased risk of developing pancreatic cancer. DISCUSSION Overall, we showed that even in those patients with chronic pancreatitis severe enough to warrant total pancreatectomy with islet autotransplantation, pancreatic cancer-related mutational burden is not appreciably increased.
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Affiliation(s)
- Robert W. Cowan
- Ahmed Cancer Center for Pancreatic Cancer Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA;
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA;
| | - Erica D. Pratt
- Ahmed Cancer Center for Pancreatic Cancer Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA;
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA;
| | - Jin Muk Kang
- Ahmed Cancer Center for Pancreatic Cancer Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA;
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA;
| | - Jun Zhao
- Ahmed Cancer Center for Pancreatic Cancer Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA;
- Department of Translational Molecular Pathology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Joshua J. Wilhelm
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA;
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Muhamad Abdulla
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Edmund M. Qiao
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA;
| | - Luke P. Brennan
- University of Michigan Medical School, Ann Arbor, Michigan, USA;
| | - Peter J. Ulintz
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA;
- BRCF Bioinformatics Core, University of Michigan, Ann Arbor, Michigan, USA.
| | - Melena D. Bellin
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA;
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Andrew D. Rhim
- Ahmed Cancer Center for Pancreatic Cancer Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA;
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA;
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45
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Monrabal Lezama M, Angeramo CA, Nazar ME, Capitanich P, Schlottmann F. Groove Pancreatitis and Gastric Outlet Obstruction. J Gastrointest Surg 2021; 25:3001-3003. [PMID: 33954900 DOI: 10.1007/s11605-021-05030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 01/31/2023]
Affiliation(s)
| | - Cristian A Angeramo
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Miguel E Nazar
- Department of Radiology, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Pablo Capitanich
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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46
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Yadav D, Palermo TM, Phillips AE, Bellin MD, Conwell DL. Painful chronic pancreatitis - new approaches for evaluation and management. Curr Opin Gastroenterol 2021; 37:504-511. [PMID: 34172622 PMCID: PMC8826115 DOI: 10.1097/mog.0000000000000769] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Management of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis. RECENT FINDINGS Chronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patients frequently changes and is not related to traditional patient and disease-related factors. Psychologic comorbidities, i.e. anxiety and depression, are frequent in patients with chronic pancreatitis, and are associated with more severe pain and pain interference. Adjunctive treatments, such as cognitive behavioral therapy, may positively influence pain management in chronic pancreatitis. Total pancreatectomy with islet autotransplantation (TPIAT) is an increasingly adopted treatment option in painful chronic pancreatitis. Ongoing multicenter studies will help define optimal candidates, predictors of successful pain remission and diabetes outcomes after TPIAT. Pancreatic quantitative sensory testing, a promising technique to interrogate nociception and sensory response, holds promise to identify patients with central sensitization. Initial studies show feasibility to stratify patients into defined pain profiles, and future studies will explore if these can help in prognostication of pain therapy. SUMMARY Several lines of investigations currently under evaluation are likely to have a positive impact on the management of pain in chronic pancreatitis.
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Affiliation(s)
- Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Anna E. Phillips
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Melena D. Bellin
- Division of Endocrinology and Metabolism, University of Minnesota Medical Center, Minneapolis, MN
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
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47
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Sled NY, Sled ON, Merzlikin NV, Tskhai VF, Narkevich AN, Bushlanov PS. [Analysis of the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of treatment of chronic pancreatitis]. Khirurgiia (Mosk) 2021:116-124. [PMID: 34363454 DOI: 10.17116/hirurgia2021081116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Compare the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of the surgery of chronic pancreatitis. MATERIALS AND METHODS There has been the analysis of the immediate and long-term results of various types of duodenum-saving operations in 48 patients with chronic pancreatitis since 2011 to 2020. The patients were divided into two groups: the control group (n=26) where typical duodenum-saving operations were performed, and the study group (n=22) - the original resection-draining method of surgery. RESULTS The groups had no difference in gender, age, clinical manifestations. After typical duodenum-saving operations, the number of postoperative complications was higher than after original resection-draining method (31 [14; 52]% and 23 [8; 45]% respectively). In the control group the incidence of pancreatic fistula 19% [7; 39], hemorrhagic complications 12% [2; 30] was higher. In both groups, one patient died in the early postoperative period. However, these differences were statistically insignificant. 12 (52% [31; 73]; p<0.001) patients have died in the control group for the 9-year observation period, mainly (7 cases) as a result of the progression of chronic pancreatitis against the background of alcoholism. The groups had no difference in the level of pain reduction, development of dyspeptic syndrome and diabetes mellitus. CONCLUSIONS The proposed original technique of subtotal resection of the head, ventral part of the body and tail of the pancreas with longitudinal pancreatojejunoanastomosis made it possible to improve the short-term results and reduce the incidence of pancreatic fistula formation. Taking into account the level of compliance the selection of patients permitted to achieve a better quality of life according to the results of the SF - 36 questionnaire and to reduce the lethality to 5 [0; 25]% (p<0.001) in the long-term period. Statistically significant difference was obtained for three of the five criteria, the total value of the physical (PCS, p=0.033) and mental (MCS, p=0.032) health components.
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Affiliation(s)
- N Yu Sled
- Regional state budget institution of Health «Krasnoyarsk inter-regional clinical hospital N20 named for I.S. Berzona», Krasnoyarsk, Russia
| | - O N Sled
- Regional state budget institution of Health «Krasnoyarsk inter-regional clinical hospital N20 named for I.S. Berzona», Krasnoyarsk, Russia
| | - N V Merzlikin
- Siberian State Medical University of the Ministry of Health of the Russian Federation, Tomsk, Russia
| | - V F Tskhai
- Siberian State Medical University of the Ministry of Health of the Russian Federation, Tomsk, Russia
| | - A N Narkevich
- Vojno-Jaseneckiy Krasnoyarsk State Medical University of the Ministry of Health of the Russian Federation, Krasnoyarsk, Russia
| | - P S Bushlanov
- Siberian State Medical University of the Ministry of Health of the Russian Federation, Tomsk, Russia
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48
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Kalayarasan R, Narayanan S, Sahoo J, Mohan P. Impact of surgery for chronic pancreatitis on the risk of pancreatic cancer: Untying the Gordian knot. World J Gastroenterol 2021; 27:4371-4382. [PMID: 34366610 PMCID: PMC8316902 DOI: 10.3748/wjg.v27.i27.4371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/10/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma is an aggressive tumor with poor long-term outcomes. Chronic pancreatitis (CP) is considered a risk factor for the development of pancreatic cancer (PC). Persistent pancreatic inflammation and activation of pancreatic stellate cells play a crucial role in the pathogenesis of CP-related PC by activating the oncogene pathway. While genetic mutations increase the possibility of recurrent and persistent pancreatic inflammation, they are not directly associated with the development of PC. Recent studies suggest that early surgical intervention for CP might have a protective role in the development of CP-related PC. Hence, the physician faces the clinical question of whether early surgical intervention should be recommended in patients with CP to prevent the development of PC. However, the varying relative risk of PC in different subsets of CP underlines the complex gene-environment interactions in the disease pathogenesis. Hence, it is essential to stratify the risk of PC in each individual patient. This review focuses on the complex relationship between CP and PC and the impact of surgical intervention on PC risk. The proposed risk stratification based on the genetic and environmental factors could guide future research and select patients for prophylactic surgery.
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Affiliation(s)
- Raja Kalayarasan
- Department of Surgical Gastroenterology, JIPMER, Puducherry 605006, India
| | - Sankar Narayanan
- Department of Surgical Gastroenterology, JIPMER, Puducherry 605006, India
| | | | - Pazhanivel Mohan
- Department of Medical Gastroenterology, JIPMER, Puducherry 605006, India
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49
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Baron RD, Sheel ARG, Farooq A, Kleeff J, Contin P, Halloran CM, Neoptolemos JP. The in situ near-total pancreatectomy (LIVOCADO procedure) for end-staged chronic pancreatitis. Langenbecks Arch Surg 2021; 406:2657-2668. [PMID: 34169341 PMCID: PMC8803758 DOI: 10.1007/s00423-021-02107-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Total pancreatectomy for severe pain in end-stage chronic pancreatitis may be the only option, but with vascular involvement, this is usually too high risk and/or technically not feasible. The purpose of the study was to present the clinical outcomes of a novel procedure in severe chronic pancreatitis complicated by uncontrollable pain and vascular involvement. METHODS We describe an in situ near-total pancreatectomy that avoids peripancreatic vascular dissection (Livocado procedure) and report on surgical and clinical outcomes. RESULTS The Livocado procedure was carried out on 18 (3.9%) of 465 patients undergoing surgery for chronic pancreatitis. There were 13 men and 5 women with a median (IQR) age of 48.5 (42.4-57) years and weight of 60.7 (58.0-75.0) kg. All had severe pain and vascular involvement; 17 had pancreatic parenchymal calcification; the median (IQR) oral morphine equivalent dose requirement was 86 (33-195) mg/day. The median (IQR) maximal pain scores were 9 (9-10); the average pain score was 6 (IQR 4-7). There was no peri-operative or 90-day mortality. At a median (IQR) follow-up of 32.5 (21-45.75) months, both maximal and average pain scores were significantly improved post-operatively, and at 12 months, two-thirds of patients were completely pain free. Six (33%) patients had employment pre-operatively versus 13 (72%) post-operatively (p = 0.01). CONCLUSIONS The Livocado procedure was safe and carried out successfully in patients with chronic pancreatitis with vascular involvement where other procedures would be contraindicated. Perioperative outcomes, post-operative pain scores, and employment rehabilitation were comparable with other procedures carried out in patients without vascular involvement.
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Affiliation(s)
- Ryan D Baron
- Department of Pancreato-Biliary Surgery, The Royal Liverpool University Hospital, Liverpool, UK
| | - Andrea R G Sheel
- Department of Pancreato-Biliary Surgery, The Royal Liverpool University Hospital, Liverpool, UK.,Department of Clinical Cancer Medicine, Institute of Translational Medicine, The University of Liverpool, Liverpool, UK
| | - Ammad Farooq
- Department of Radiology, The Royal Liverpool University Hospital, Liverpool, UK
| | - Jörg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, Martin, Halle (Saale), Germany
| | - Pietro Contin
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Baden-Württemberg, Germany
| | - Christopher M Halloran
- Department of Pancreato-Biliary Surgery, The Royal Liverpool University Hospital, Liverpool, UK.,Department of Clinical Cancer Medicine, Institute of Translational Medicine, The University of Liverpool, Liverpool, UK
| | - John P Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Baden-Württemberg, Germany.
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50
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Molero X, Ayuso JR, Balsells J, Boadas J, Busquets J, Casteràs A, Concepción M, Cuatrecasas M, Fernàndez Esparrach G, Fort E, Garcia Borobia F, Ginès À, Ilzarbe L, Loras C, Masachs M, Merino X, Olsina JJ, Puig-Diví V, Salord S, Serrano T, Vaquero EC. Chronic pancreatitis for the clinician. Part 2: Treatment and follow-up. Interdisciplinary Position Paper of the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:304-314. [PMID: 34171422 DOI: 10.1016/j.gastrohep.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
Chronic pancreatitis is associated with impaired quality of life, high incidence of comorbidities, serious complications and mortality. Healthcare costs are exorbitant. Some medical societies have developed guidelines for treatment based on scientific evidence, but the gathered level of evidence for any individual topic is usually low and, therefore, recommendations tend to be vague or weak. In the present position papers on chronic pancreatitis from the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees we aimed at providing defined position statements for the clinician based on updated review of published literature and on multidisciplinary expert agreement. The final goal is to propose the use of common terminology and rational diagnostic/therapeutic circuits based on current knowledge. To this end 51 sections related to chronic pancreatitis were reviewed by 21 specialists from 6 different fields to generate 88 statements altogether. Statements were designed to harmonize concepts or delineate recommendations. Part 2 of these paper series discuss topics on treatment and follow-up. The therapeutic approach should include assessment of etiological factors, clinical manifestations and complications. The complexity of these patients advocates for detailed evaluation in multidisciplinary committees where conservative, endoscopic, interventional radiology or surgical options are weighed. Specialized multidisciplinary units of Pancreatology should be constituted. Indications for surgery are refractory pain, local complications, and suspicion of malignancy. Enzyme replacement therapy is indicated if evidence of exocrine insufficiency or after pancreatic surgery. Response should be evaluated by nutritional parameters and assessment of symptoms. A follow-up program should be planned for every patient with chronic pancreatitis.
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Affiliation(s)
- Xavier Molero
- Servei d'Aparell Digestiu, Hospital Universitari Vall d'Hebron, Barcelona, España; Exocrine Pancreas Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España; Campus de la UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España.
| | - Juan Ramon Ayuso
- Servei de Radiologia, Centre de Diagnòstic per la Imatge Clínic, Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Joaquim Balsells
- Campus de la UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Servei de Cirurgia Hepato-Bilio-Pancreàtica, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Jaume Boadas
- Servei de Digestologia, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España
| | - Juli Busquets
- Unitat de Cirurgia Hepatobiliar i Pancreàtica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Anna Casteràs
- Servei d'Endocrinologia, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Mar Concepción
- Campus de la UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Servei de Gastroenterologia, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Míriam Cuatrecasas
- CIBERehd, Instituto de Salud Carlos III, Madrid, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Servei d'Anatomia Patològica, Hospital Clínic, Barcelona, España
| | - Gloria Fernàndez Esparrach
- CIBERehd, Instituto de Salud Carlos III, Madrid, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Unitat d'Endoscòpia, Servei de Gastroenterologia, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Esther Fort
- Servei de Gastroenterologia, Hospital Universitari Doctor Josep Trueta, Girona, España; Universitat de Girona (UdG), Girona, España
| | - Francisco Garcia Borobia
- Unitat de Cirurgia Hepatobiliopancreàtica, Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Àngels Ginès
- CIBERehd, Instituto de Salud Carlos III, Madrid, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Servei de Gastroenterologia, Hospital Universitari Doctor Josep Trueta, Girona, España
| | - Lucas Ilzarbe
- Servei de Digestiu, Hospital del Mar Parc Salut Mar, Barcelona, España
| | - Carme Loras
- CIBERehd, Instituto de Salud Carlos III, Madrid, España; Servei de Gastroenterologia, Unitat d'Endoscòpia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Miquel Masachs
- Servei d'Endoscòpia Digestiva, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Xavier Merino
- Unitat d'Imatge Abdominal, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Jorge J Olsina
- Servei de Cirurgia Gerenal i Aparell Digestiu, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - Valentí Puig-Diví
- Campus de la UAB, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Servei de Digestiu, Corporació Sanitària Universitaria Parc Taulí, Sabadell, Barcelona, España
| | - Sílvia Salord
- Servei de Gastroenterologia, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Teresa Serrano
- CIBERehd, Instituto de Salud Carlos III, Madrid, España; Servei d'Anatomia Patològica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Eva Cristina Vaquero
- CIBERehd, Instituto de Salud Carlos III, Madrid, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Servei de Gastroenterologia, ICMDiM, Hospital Clínic, Barcelona, España; Gastrointestinal and Pancreatic Oncology Research Group, Hospital Clínic, Barcelona, España
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