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Sasaki T, Takayama Y, Tanaka S, Hamada Y, Nakashima R, Naito S, Kajiwara M, Hasegawa S. Pancreatic extracellular volume fraction on routine contrast-enhanced computed tomography can predict pancreatic fibrosis and postoperative pancreatic fistula. Pancreatology 2025; 25:153-159. [PMID: 39672754 DOI: 10.1016/j.pan.2024.12.003] [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: 09/14/2024] [Revised: 11/25/2024] [Accepted: 12/05/2024] [Indexed: 12/15/2024]
Abstract
BACKGROUND/OBJECTIVES Postoperative pancreatic fistula (POPF) is a critical complication of pancreatectomy, with a higher risk associated with the absence of pancreatic fibrosis. We investigated whether pancreatic extracellular volume fraction (ECV) calculated from preoperative contrast-enhanced computed tomography (CE-CT) images can be used to predict pancreatic fibrosis and POPF. METHODS This retrospective study included patients who underwent CE-CT before pancreatectomy. ECV map was created by subtracting unenhanced from equilibrium-phase images. We assessed the relationship between pancreatic ECV, the histopathological grade of fibrosis at the pancreatic resection margin, and the occurrence of POPF. RESULTS Among the 107 patients included, 66 underwent pancreaticoduodenectomy (PD) and 41 underwent distal pancreatectomy (DP). The median ECV at the pancreatic resection margin was 22.5 %. Pancreatic ECV significantly correlated with the histopathological grade of pancreatic fibrosis (ρ = 0.689; p < 0.001). In PD cases, the ECV was an independent risk factor for all-grade POPF (odds ratio, 0.852; 95 % confidence interval, 0.755-0.934), with excellent predictive capability (area under the curve, 0.912; 95 % confidence interval, 0.842-0.983). In DP cases, pancreatic thickness was the only factor associated with all-grade POPF. CONCLUSIONS Pancreatic ECV obtained from routine CE-CT images accurately predicted the histopathological grade of pancreatic fibrosis and was an independent risk factor for POPF after PD.
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Affiliation(s)
- Takahide Sasaki
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yukihisa Takayama
- Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shinji Tanaka
- Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshihiro Hamada
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryo Nakashima
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shigetoshi Naito
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masatoshi Kajiwara
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Zhong YQ, Zhu XX, Huang XT, Luo YJ, Huang CS, Xu QC, Yin XY. Prediction of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy based on multifrequency magnetic resonance elastography. J Gastrointest Surg 2025; 29:101886. [PMID: 39547592 DOI: 10.1016/j.gassur.2024.101886] [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: 08/01/2024] [Revised: 11/06/2024] [Accepted: 11/08/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Clinically relevant postoperative pancreatic fistula (CR-POPF) is the major complication of pancreatoduodenectomy, and the pancreatic texture is one of the potential affecting factors. Multifrequency magnetic resonance elastography (MRE) is a novel technique for measuring tissue stiffness, but its value in predicting CR-POPF preoperatively has not been well documented. METHODS A total of 70 patients who underwent multifrequency MRE before pancreatoduodenectomy between July 2021 and April 2024 were retrospectively recruited into the study. The parameters of MRE, shear wave speed (c) and phase angle (φ), and clinical data were collected. Logistic regression and the receiver operating characteristic curve analyses were used to assess the performance of multifrequency MRE in predicting CR-POPF. RESULTS CR-POPF was developed in 14 of 70 patients (20%), all categorized as grade B. The CR-POPF group had significantly lower c (1.339 ± 0.210 m/s) and longer hospital stays (21 [IQR, 15.50-37.75] days) than the no-CR-POPF group. The MRE parameters, c and φ, were moderately correlated with pancreas stiffness (eta2 for φ = 0.189 and eta2 for c = 0.106). Dilated major pancreatic duct (MPD ≥ 3 mm) and higher c were independently associated with a lower risk of CR-POPF in univariant and multivariant analyses (odds ratio [OR] for c, 0.041 [95% CI, 0.002-0.879]; OR for dilated MPD, 0.129 [95% CI, 0.022-0.768]). The area under the curve (AUC) of the predictive model based on c and MPD diameter was 0.786, which was better than the fistula risk score (FRS) (AUC = 0.587) and alternative FRS (AUC = 0.556) in our center, with the DeLong test P = .028 and P = .002, respectively. CONCLUSION The MRE parameters were associated with pancreatic stiffness, and c was an independent predictor of CR-POPF after pancreatoduodenectomy.
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Affiliation(s)
- Yu-Qing Zhong
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiao-Xu Zhu
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Burn and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangdong, China
| | - Xi-Tai Huang
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan-Ji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chen-Song Huang
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiong-Cong Xu
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiao-Yu Yin
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Hong JJ, Park HJ, Lee ES, Kim MJ. Severity of hyperechoic pancreas on preoperative ultrasonography: high potential as a clinically useful predictor of a postoperative pancreatic fistula. Ultrasonography 2024; 43:272-283. [PMID: 38881310 PMCID: PMC11222128 DOI: 10.14366/usg.24046] [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: 03/22/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024] Open
Abstract
PURPOSE This study aimed to evaluate the effectiveness of using the severity of hyperechoic pancreas (HP) observed on preoperative ultrasonography (US) as a predictor of clinically relevant postoperative pancreatic fistula (CR-POPF). METHODS A retrospective study was conducted with 94 patients who underwent pancreatectomy between April 2006 and March 2021. The severity of HP on US was classified into two categories (normal to mild vs. moderate to severe [obvious HP]). Multiple preoperative and intraoperative parameters were analyzed to predict CR-POPF. RESULTS Out of the 94 patients, CR-POPF occurred in 21 (22%) patients, and obvious HP was observed in 30 (32%). Univariate analysis revealed that moderate to severe HP (obvious HP) was significantly associated with an increased incidence of CR-POPF (P<0.001). Factors such as the absence of pancreatitis, a small main pancreatic duct (<3 mm), intraoperative soft pancreas, increased body mass index, and lower pancreatic attenuation and attenuation index were also associated with CR-POPF (all P<0.05). Multivariate analysis showed that obvious HP and soft pancreatic texture were independent predictors of CR-POPF, with odds ratios of 11.53 (P=0.001) and 14.12 (P=0.003), respectively. The combination of obvious HP and soft pancreatic texture provided the most accurate prediction for CR-POPF. CONCLUSION The severity of HP, as observed on preoperative US, was significantly associated with CR-POPF. Severe HP may serve as a clinically useful predictor of POPF, especially when evaluated alongside the intraoperative pancreatic texture.
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Affiliation(s)
- Jung Joo Hong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Min Ju Kim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Morino K, Nakano K, Goto T, Tanaka H, Machimoto T. Proposal of the novel predictive model for postoperative pancreatic fistula in distal pancreatectomy for pancreatic tumor based on preoperative imaging parameters and stapler handling. World J Surg 2024; 48:932-942. [PMID: 38375966 DOI: 10.1002/wjs.12113] [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] [Received: 11/09/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Distal pancreatectomy (DP) using linear staplers is widely performed; however, postoperative pancreatic fistulas (POPF) remain an issue. This study aimed to analyze preoperative risk factors for POPF and assess stapler handling. METHODS We retrospectively analyzed consecutive patients who underwent DP for pancreatic tumors using a linear stapler between 2014 and 2022. Preoperative measurements included pancreas-to-muscle signal intensity ratio (SIR) on fat-suppressed T1-weighted magnetic resonance imaging (MRI). The main outcome was clinically relevant POPF of the 2016 International Study Group of Pancreatic Fistulas definition. The predictive ability of the model was compared with the distal fistula risk score (D-FRS) by using the area under the receiver operating characteristic curve (AUROC). RESULTS Among the 81 patients, POPF occurred in 31 (38.2%). Multivariate analysis identified computed tomography-measured pancreatic thickness (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.05-1.61, p = 0.009) and SIR on T1-weighted MRI (OR 6.85, 95% CI 1.71-27.4, p = 0.002) as preoperative predictors. A novel preoperative model, "Thickness × MRI (TM)"-index, was established by multiplying these two variables. The TM-index exhibited the highest predictability preoperatively (AUROC 0.757, 95% CI 0.649-0.867). In the intraoperative variable analyses, TM-index (p < 0.001), thin cartridge application (p = 0.032), and short pre-firing compression (p = 0.047) were identified as significant risk factors for POPF. The model's AUROC combined with these two stapler handling methods was higher than D-FRS (0.851 vs. 0.660, p = 0.006). CONCLUSIONS The novel preoperative model exhibited excellent predictability. Thick cartridge use and long pre-firing compression were protective factors against POPF. This model may facilitate preventive surgical strategy development to reduce POPF.
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Affiliation(s)
- Koshiro Morino
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan
| | - Kenzo Nakano
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan
| | - Toshihiko Goto
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan
| | - Hirokazu Tanaka
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan
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Zhu L, Sun Z, Dai M, Wu H, Wang X, Xu J, Xue H, Jin Z, Nickel MD, Guo J, Sack I. Tomoelastography and Pancreatic Extracellular Volume Fraction Derived From MRI for Predicting Clinically Relevant Postoperative Pancreatic Fistula. J Magn Reson Imaging 2024; 59:1074-1082. [PMID: 37209387 DOI: 10.1002/jmri.28788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Pancreatic stiffness and extracellular volume fraction (ECV) are potential imaging biomarkers for pancreatic fibrosis. Clinically relevant postoperative fistula (CR-POPF) is one of the most severe complications after pancreaticoduodenectomy. Which imaging biomarker performs better for predicting the risk of CR-POPF remains unknown. PURPOSE To evaluate the diagnostic performance of ECV and tomoelastography-derived pancreatic stiffness for predicting the risk of CR-POPF in patients undergoing pancreaticoduodenectomy. STUDY TYPE Prospective. POPULATION Eighty patients who underwent multiparametric pancreatic MRI before pancreaticoduodenectomy, among whom 16 developed CR-POPF and 64 did not. FIELD STRENGTH/SEQUENCE 3 T/tomoelastography and precontrast and postcontrast T1 mapping of the pancreas. ASSESSMENT Pancreatic stiffness was measured on the tomographic c-map, and pancreatic ECV was calculated from precontrast and postcontrast T1 maps. Pancreatic stiffness and ECV were compared with histological fibrosis grading (F0-F3). The optimal cutoff values for predicting CR-POPF were determined, and the correlation between CR-POPF and imaging parameters was evaluated. STATISTICAL TESTS The Spearman's rank correlation and multivariate linear regression analysis was conducted. The receiver operating characteristic curve analysis and logistic regression analysis was performed. A double-sided P < 0.05 indicated a statistically significant difference. RESULTS Pancreatic stiffness and ECV both showed a significantly positive correlation with histological pancreatic fibrosis (r = 0.73 and 0.56, respectively). Patients with advanced pancreatic fibrosis had significantly higher pancreatic stiffness and ECV compared to those with no/mild fibrosis. Pancreatic stiffness and ECV were also correlated with each other (r = 0.58). Lower pancreatic stiffness (<1.38 m/sec), lower ECV (<0.28), nondilated main pancreatic duct (<3 mm) and pathological diagnosis other than pancreatic ductal adenocarcinoma were associated with higher risk of CR-POPF at univariate analysis, and pancreatic stiffness was independently associated with CR-POPF at multivariate analysis (odds ratio: 18.59, 95% confidence interval: 4.45, 77.69). DATA CONCLUSION Pancreatic stiffness and ECV were associated with histological fibrosis grading, and pancreatic stiffness was an independent predictor for CR-POPF. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 5.
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Affiliation(s)
- Liang Zhu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Zhaoyong Sun
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Menghua Dai
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| | - Xuan Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Jia Xu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | | | - Jing Guo
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Kalayarasan R, Himaja M, Ramesh A, Kokila K. Radiological parameters to predict pancreatic texture: Current evidence and future perspectives. World J Radiol 2023; 15:170-181. [PMID: 37424737 PMCID: PMC10324497 DOI: 10.4329/wjr.v15.i6.170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/03/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
Preoperative prediction of the postoperative pancreatic fistula risk is critical in the current era of minimally invasive pancreatic surgeries to tailor perioperative management, thereby minimizing postoperative morbidity. Pancreatic duct diameter can be readily measured by any routine imaging used to diagnose pancreatic disease. However, radiological evaluation of pancreatic texture, an important determinant of pancreatic fistula, has not been widely used to predict the risk of postoperative pancreatic fistula. Qualitative and quantitative assessment of pancreatic fibrosis and fat fraction provides the basis for predicting pancreatic texture. Traditionally computed tomography has been utilized in identifying and characterizing pancreatic lesions and background parenchymal pathologies. With the increasing utilisation of endoscopic ultrasound and magnetic resonance imaging for evaluating pancreatic pathologies, elastography is emerging as a promising tool for predicting pancreatic texture. Also, recent studies have shown that early surgery for chronic pancreatitis is associated with better pain relief and preservation of pancreatic function. Pancreatic texture assessment can allow early diagnosis of chronic pancreatitis, facilitating early intervention. The present review outlines the current evidence in utilizing various imaging modalities for determining the pancreatic texture based on different parameters and image sequences. However, multidisciplinary investigations using strong radiologic-pathologic correlation are needed to standardize and establish the role of these non-invasive diagnostic tools in predicting pancreatic texture.
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Affiliation(s)
- Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Mandalapu Himaja
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Ananthakrishnan Ramesh
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Kathirvel Kokila
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
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Mavroeidis VK, Russell TB, Clark J, Adebayo D, Bowles M, Briggs C, Denson J, Aroori S. Pancreatoduodenectomy for suspected malignancy: nonmalignant histology confers increased risk of serious morbidity. Ann R Coll Surg Engl 2023; 105:446-454. [PMID: 35904332 PMCID: PMC10149251 DOI: 10.1308/rcsann.2022.0055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/AIMS A tissue diagnosis is not always obtained prior to pancreatoduodenectomy (PD) and a proportion of patients are found to have noncancerous histology postoperatively. It is unknown if these patients have different outcomes when compared with those who have malignancy confirmed. METHODS A retrospective paired case matched control study was undertaken. Patients who underwent PD for suspected malignancy but ultimately had nonmalignant histology were identified. Each was matched to a confirmed malignant control using the following criteria: age, gender, body mass index, American Society of Anesthesiologists grade, neoadjuvant treatment, preoperative serum bilirubin, preoperative biliary stenting and type of pancreatic anastomosis. Matching was blinded to the measured outcomes, which included perioperative morbidity and mortality. RESULTS Forty-five cases were compared with 45 well-matched controls. There was no difference in 30- or 90-day mortality, or length of stay. While overall morbidity rates were the same, patients with nonmalignant disease were more likely to experience major (Clavien-Dindo grade III-IV) morbidity (40.0% versus 17.8%, p = 0.0352). Independently, rates of clinically relevant pancreatic fistula (CR-POPF) were higher in the nonmalignant group (22.2% versus 4.44%, p = 0.0131). CONCLUSIONS In our study, PD patients with nonmalignant histology had significantly higher incidence of major morbidity and CR-POPF when compared with those who had malignancy confirmed. This should be considered when planning the management of patients with known or presumed benign/premalignant disease.
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Affiliation(s)
- VK Mavroeidis
- University Hospitals Plymouth NHS Trust, UKPreliminary findings presented at the 2015 E-AHPBA Congress, Manchester, United Kingdom, UK
| | - TB Russell
- University Hospitals Plymouth NHS Trust, UKPreliminary findings presented at the 2015 E-AHPBA Congress, Manchester, United Kingdom, UK
| | - J Clark
- University Hospitals Plymouth NHS Trust, UKPreliminary findings presented at the 2015 E-AHPBA Congress, Manchester, United Kingdom, UK
| | - D Adebayo
- University Hospitals Plymouth NHS Trust, UKPreliminary findings presented at the 2015 E-AHPBA Congress, Manchester, United Kingdom, UK
| | - M Bowles
- University Hospitals Plymouth NHS Trust, UKPreliminary findings presented at the 2015 E-AHPBA Congress, Manchester, United Kingdom, UK
| | - C Briggs
- University Hospitals Plymouth NHS Trust, UKPreliminary findings presented at the 2015 E-AHPBA Congress, Manchester, United Kingdom, UK
| | - J Denson
- University Hospitals Plymouth NHS Trust, UKPreliminary findings presented at the 2015 E-AHPBA Congress, Manchester, United Kingdom, UK
| | - S Aroori
- University Hospitals Plymouth NHS Trust, UKPreliminary findings presented at the 2015 E-AHPBA Congress, Manchester, United Kingdom, UK
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Choudhury SR, Verma M, Gupta P, Singh H, Sharma V, Kochhar R. Ultrasound Shear Wave Elastography of Normal Pancreas in Adult Subjects. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1758126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background and Purpose Transabdominal ultrasound (US)-based shear wave elastography (SWE) provides an attractive method of estimating pancreatic stiffness. There is limited data on the SWE values of the healthy pancreas in Indian subjects. The current study aimed to evaluate SWE of the normal pancreas.
Methods We performed a study from January 2019 to March 2019. We included adult patients who presented for the US of the upper abdomen for vague abdominal symptoms, unrelated to the pancreas. The SWE values were obtained from the pancreatic head and body. The association of pancreatic SWE with age, gender, fatty liver, chronic liver disease, and cholelithiasis was recorded.
Results During the study period, 205 subjects underwent SWE of the pancreas. The mean age of subjects was 41.3 (standard deviation [SD] 15.3) years. There were 93 males and 112 females. The mean SWE value in the head of the pancreas was 8.98 (SD 2.46 kPa), and that in the body region was 8.67 (SD 2.67 kPa). There was a positive correlation of SWE with age. The SWE of the pancreatic body was significantly higher in patients who had a fatty liver on US (p < 0.05). There was no significant association of SWE of the pancreas with gender, presence of chronic liver disease, or gallstones.
Conclusion The normal values of pancreatic SWE are correlated with age and fatty change in the liver.
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Affiliation(s)
- Shayeri Roy Choudhury
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mansi Verma
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sano S, Okamura Y, Ohgi K, Sugiura T, Ito T, Yamamoto Y, Ashida R, Sasaki K, Uesaka K. Histological pancreatic findings correlate with computed tomography attenuation and predict postoperative pancreatic fistula following pancreatoduodenectomy. HPB (Oxford) 2022; 24:1519-1526. [PMID: 35367128 DOI: 10.1016/j.hpb.2022.03.008] [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: 08/23/2021] [Revised: 12/12/2021] [Accepted: 03/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although a soft pancreas is a widely-accepted reliable risk factor for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD), there is no established preoperative evaluation of pancreatic texture. METHODS Two hundred thirty-seven patients who underwent PD with histological pancreatic assessment were retrospectively enrolled. The degree of fibrosis and fatty infiltration was scored histologically as seven grades and five grades, respectively. Computed tomography (CT) attenuation of the pancreas was measured on preoperative unenhanced CT images. Correlations between the CT attenuation of the pancreas and the histological pancreatic findings, and the development of POPF were analyzed. RESULTS The fibrosis grade was significantly higher for hard pancreas than for soft pancreas (p < 0.001), whereas the fatty infiltration grade was similar between the two types (p = 0.161). CT attenuation of the pancreas was inversely correlated with both fibrosis grade (Spearman's rank correlation coefficient ([r] = -0.609, p < 0.001) and fatty infiltration grade (r = -0.382, p < 0.001). Multivariate analysis showed that body mass index ≥25 kg/m2 (odds ratio [OR]: 5.64, p < 0.001) and fibrosis grade ≤2 (OR: 18.0, p < 0.001) were independent risk factors for clinically significant POPF. CONCLUSION Histological pancreatic texture can be evaluated with CT attenuation and might be helpful in preoperatively predicting the development of POPF after PD.
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Affiliation(s)
- Shusei Sano
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan; Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan.
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan; Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Katsuhisa Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
| | - Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
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Hassan RA, Zidan A, Jabir MA, Abdelshafy M, Abdallah M, Taha AM. Risk factors predicting the development of a pancreatic fistula following pancreaticoduodenectomy: A retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rifu K, Watanabe J, Sasanuma H, Taniguchi N. Evaluation of the Elasticity of the Pancreas Using Acoustic Radiation Force Impulse Elastography in Patients with Acute Pancreatitis: A Systematic Review and Meta-Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:406-413. [PMID: 34980499 DOI: 10.1016/j.ultrasmedbio.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
Acoustic radiation force impulse (ARFI) elastography has been used to diagnose acute pancreatitis (AP). The present study aimed to assess the effectiveness of ARFI elastography in the diagnosis of AP. Studies examining the efficacy of ARFI elastography in AP were selected by searching MEDLINE, EMBASE, CENTRAL, ICTRP, and ClinicalTrial.gov. until September 2021. Meta-analyses were performed using random effects models. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of the evidence. Eight case-control studies (994 patients) were included in the meta-analysis. The ARFI-Virtual Touch Quantification value (or ARFI shear wave propagation velocity) of the AP patient group was 0.83 m/s higher (95% confidence interval [CI]: 0.36-1.3) than that in the control group (95% CI: 1.0-1.28). The sensitivity and specificity of ARFI elastography for diagnosing AP were 98.3% (95% CI: 92.6-96.6%) and 95.5% (95% CI: 87.5-98.5%), respectively. The results showed that physicians could use ARFI elastography to accurately diagnose patients with AP. Additional well-designed studies are necessary to validate the efficacy of ARFI elastography in patients with AP.
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Affiliation(s)
- Kazuma Rifu
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Jun Watanabe
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hideki Sasanuma
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Nobuyuki Taniguchi
- Division of Gastroenterological, General and Transplant Surgery, Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Pancreatic Steatosis Is Associated with Both Metabolic Syndrome and Pancreatic Stiffness Detected by Ultrasound Elastography. Dig Dis Sci 2022; 67:293-304. [PMID: 33651254 DOI: 10.1007/s10620-021-06844-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/10/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There is increasing evidence that pancreatic steatosis (PS) is associated with metabolic syndrome (MS). However, it is not known whether it is associated with PS grade and pancreatic stiffness, or not. We aimed to evaluate the relationship between PS and its grade detected by transabdominal ultrasound, and pancreatic stiffness determined by two-dimensional shearwave elastography (2D-SWE), whether it has clinical significance and its relationship with MS. METHODS Patients with and without PS were evaluated prospectively. RESULTS Patients with PS had higher odds ratio for MS (OR 5.49). Also, ultrasonographic grade of PS was associated with MS parameters and hepatosteatosis. Pancreatic SWE value was significantly higher in PS group and positively correlated with PS grade, liver fat, MS, number of MS criteria. DISCUSSION/CONCLUSION PS and its grade were associated with MS. In this first comprehensive PS-SWE study, we found that pancreas stiffness increased in the presence of PS, in correlation with PS grade and MS.
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A modified alternative fistula risk score (a-FRS) obtained from the computed tomography enhancement pattern of the pancreatic parenchyma predicts pancreatic fistula after pancreatoduodenectomy. HPB (Oxford) 2021; 23:1759-1766. [PMID: 33975799 DOI: 10.1016/j.hpb.2021.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alternative fistula risk score (a-FRS) is useful to predict clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD). METHODS Clinical data from 239 patients undergoing PD were collected. The CT value of the pancreatic parenchyma was measured in the nonenhanced (N), arterial (A), portal venous (P), and late (L) phases. The A/N, A/P, P/L and A/L ratios were calculated and their correlation with CR-POPF were analyzed. By replacing pancreatic texture with the best CT attenuation ratio, a modified a-FRS was developed. RESULTS Forty-seven patients developed CR-POPF. The A/P ratio (P < 0.001), P/L ratio (P = 0.002) and A/L ratio (P < 0.001) were significantly higher in the CR-POPF group. The A/L ratio performed best in predicting CR-POPF (AUC: 0.803) and the cut-off value is 1.36. A/L ratio >1.36 (P < 0.001), body mass index (P = 0.005) and duct diameter (P = 0.037) were independently associated with CR-POPF. By replacing soft texture with an A/L ratio >1.36, a modified a-FRS was developed and performed better than the a-FRS (AUC: 0.823 vs 0.748, P = 0.006) in predicting CR-POPF. CONCLUSIONS The modified a-FRS is an objective and preoperative model for predicting the occurrence of CR-POPF after PD.
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Sofue K, Ueshima E, Masuda A, Shirakawa S, Zen Y, Ueno Y, Tsujita Y, Yamaguchi T, Yabe S, Tanaka T, Inomata N, Toyama H, Fukumoto T, Kodama Y, Murakami T. Estimation of pancreatic fibrosis and prediction of postoperative pancreatic fistula using extracellular volume fraction in multiphasic contrast-enhanced CT. Eur Radiol 2021; 32:1770-1780. [PMID: 34636963 DOI: 10.1007/s00330-021-08255-4] [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] [Received: 07/14/2021] [Revised: 07/30/2021] [Accepted: 08/07/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the diagnostic performance of the extracellular volume (ECV) fraction in multiphasic contrast-enhanced computed tomography (CE-CT) for estimating histologic pancreatic fibrosis and predicting postoperative pancreatic fistula (POPF). METHODS Eighty-five patients (49 men; mean age, 69 years) who underwent multiphasic CE-CT followed by pancreaticoduodenectomy with pancreaticojejunal anastomosis between January 2012 and December 2018 were retrospectively included. The ECV fraction was calculated from absolute enhancements of the pancreas and aorta between the precontrast and equilibrium-phase images, followed by comparisons among histologic pancreatic fibrosis grades (F0‒F3). The diagnostic performance of the ECV fraction in advanced fibrosis (F2‒F3) was evaluated using receiver operating characteristic curve analysis. Multivariate logistic regression analysis was used to evaluate the associations of the risk of POPF development with patient characteristics, histologic findings, and CT imaging parameters. RESULTS The mean ECV fraction of the pancreas was 34.4% ± 9.5, with an excellent intrareader agreement of 0.811 and a moderate positive correlation with pancreatic fibrosis (r = 0.476; p < 0.001). The mean ECV fraction in advanced fibrosis was significantly higher than that in no/mild fibrosis (44.4% ± 10.8 vs. 31.7% ± 6.7; p < 0.001), and the area under the receiver operating characteristic curve for the diagnosis of advanced fibrosis was 0.837. Twenty-two patients (25.9%) developed clinically relevant POPF. Multivariate logistic regression analysis demonstrated that the ECV fraction was a significant predictor of POPF. CONCLUSIONS The ECV fraction can offer quantitative information for assessing pancreatic fibrosis and POPF after pancreaticojejunal anastomosis. KEY POINTS • There was a moderate positive correlation of the extracellular volume (ECV) fraction of the pancreas in contrast-enhanced CT with the histologic grade of pancreatic fibrosis (r = 0.476; p < 0.001). • The ECV fraction was higher in advanced fibrosis (F2‒F3) than in no/mild fibrosis (F0‒F1) (p < 0.001), with an AUC of 0.837 for detecting advanced fibrosis. • The ECV fraction was an independent risk factor for predicting subclinical (odds ratio, 0.81) and clinical (odds ratio, 0.80) postoperative pancreatic fistula.
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Affiliation(s)
- Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Atsuhiro Masuda
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sachiyo Shirakawa
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoh Zen
- Institute of Liver Studies, King's College Hospital & King's College London, London, UK
| | - Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yushi Tsujita
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takeru Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinji Yabe
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takeshi Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriko Inomata
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Fukumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Sezgin O, Yaraş S, Özdoğan O. The course and prognostic value of increased pancreas stiffness detected by ultrasound elastography during acute pancreatitis. Pancreatology 2021; 21:1285-1290. [PMID: 34344610 DOI: 10.1016/j.pan.2021.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/03/2021] [Accepted: 07/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In this study, we determined the pancreatic stiffness (PS) changes in the course of acute pancreatitis (AP) by ultrasound elastography and evaluated its relation with prognosis. MATERIAL/METHODS Pancreatic shear wave velocity measurements (SWM) were evaluated at the time of admission to the hospital, following clinical improvement, and one-month after for AP patients and compared to healthy volunteers. Its relationship with clinical severity indexes was evaluated. RESULTS The pancreatic SWM value in the healthy group was 7.72 ± 2.50 kPa, and in AP group was 10.97 ± 2.26 kPa (p = 0.000). There was no difference between mild and severe pancreatitis. The mean SWM was 8.96 ± 1.53 kPa after disease remission, and 8.83 ± 1.24 kPa after 1-month. CONCLUSIONS PS increases significantly during AP and decreases with clinical improvement, but this was still higher than controls, and it kept its elevation after 1-month. We think that larger, long-term studies are needed to determine the clinicopathological significance of this.
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Affiliation(s)
- Orhan Sezgin
- Mersin University Faculty of Medicine Gastroenterology Department, Mersin, Turkey
| | - Serkan Yaraş
- Mersin University Faculty of Medicine Gastroenterology Department, Mersin, Turkey.
| | - Osman Özdoğan
- Mersin University Faculty of Medicine Gastroenterology Department, Mersin, Turkey
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Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy. ACTA ACUST UNITED AC 2021; 57:medicina57070650. [PMID: 34202601 PMCID: PMC8307575 DOI: 10.3390/medicina57070650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
Background and Objectives: Postoperative pancreatic fistula after cephalic pancreatoduodenectomy (CPD) is still the leading cause of postoperative morbidity, entailing long hospital stay and costs or even death. The aim of this study was to propose the use of morphologic parameters based on a preoperative multisequence computer tomography (CT) scan in predicting the clinically relevant postoperative pancreatic fistula (CRPF) and a risk score based on a multiple regression analysis. Materials and Methods: For 78 consecutive patients with CPD, we measured the following parameters on the preoperative CT scans: the density of the pancreas on the unenhanced, arterial, portal and delayed phases; the unenhanced density of the liver; the caliber of the main pancreatic duct (MPD); the preoperatively estimated pancreatic remnant volume (ERPV) and the total pancreatic volume. We assessed the correlation of the parameters with the clinically relevant pancreatic fistula using a univariate analysis and formulated a score using the strongest correlated parameters; the validity of the score was appreciated using logistic regression models and an ROC analysis. Results: When comparing the CRPF group (28.2%) to the non-CRPF group, we found significant differences of the values of unenhanced pancreatic density (UPD) (44.09 ± 6.8 HU vs. 50.4 ± 6.31 HU, p = 0.008), delayed density of the pancreas (48.67 ± 18.05 HU vs. 61.28 ± 16.55, p = 0.045), unenhanced density of the liver (UDL) (44.09 ± 6.8 HU vs. 50.54 ± 6.31 HU, p = 0.008), MPD (0.93 ± 0.35 mm vs. 3.14 ± 2.95 mm, p = 0.02) and ERPV (46.37 ± 10.39 cm3 vs. 34.87 ± 12.35 cm3, p = 0.01). Based on the odds ratio from the multiple regression analysis and after calculating the optimum cut-off values of the variables, we proposed two scores that both used the MPD and the ERPV and differing in the third variable, either including the UPD or the UDL, producing values for the area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI 0.694-0.941) and 0.774 (95% CI 0.599-0.850), respectively. Conclusions: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula.
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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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Chronic pancreatitis for the clinician. Part 1: Etiology and diagnosis. Interdisciplinary position paper of the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:231-248. [PMID: 34157366 DOI: 10.1016/j.gastrohep.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/13/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
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Furukawa K, Gocho T, Sakamoto T, Tsunematsu M, Haruki K, Horiuchi T, Shirai Y, Yasuda J, Shiozaki H, Onda S, Shiba H, Sato S, Takahashi H, Ikegami T. Intraoperative amylase level of pancreatic juice as a simple predictor of pancreatic fistula after pancreaticoduodenectomy. Pancreatology 2021; 21:299-305. [PMID: 33214083 DOI: 10.1016/j.pan.2020.10.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION A soft remnant texture of the pancreas is commonly accepted as a risk factor for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). However, its assessment is subjective. The aim of this study was to evaluate the significance of intraoperative amylase level of the pancreatic juice as a risk factor of POPF after PD. METHOD This study included 75 patients who underwent PD between November 2014 and April 2020 at Jikei University Hospital. We investigated the relationship between pancreatic texture, intraoperative amylase level of pancreatic juice, results of the pathological evaluations, and the incidence of POPF. RESULTS Twenty-three patients (31%) developed POPF. The significant predictors of POPF were non-ductal adenocarcinoma (p < 0.01), soft pancreatic remnant (p < 0.01), high intraoperative blood loss (p < 0.01), high intraoperative amylase level of pancreatic juice (p < 0.01), and low pancreatic fibrosis (p < 0.01). Multivariate analysis revealed that the significant independent predictors of POPF were high intraoperative blood loss (p < 0.01) and high intraoperative amylase level of pancreatic juice (p = 0.02). Receiver operating characteristic (ROC) analysis showed that the cut-off value for the intraoperative amylase level of pancreatic juice was 2.17 × 105 IU/L (area under the curve = 0.726, sensitivity = 95.7%, and specificity = 50.0%) CONCLUSIONS: The intraoperative amylase level of pancreatic juice is a reliable objective predictor for POPF after PD.
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Affiliation(s)
- Kenei Furukawa
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Takeshi Gocho
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Taro Sakamoto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masashi Tsunematsu
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Koichiro Haruki
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takashi Horiuchi
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshihiro Shirai
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Jungo Yasuda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hironori Shiozaki
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shinji Onda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroaki Shiba
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toru Ikegami
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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A deep pancreas is a novel predictor of pancreatic fistula after pancreaticoduodenectomy in patients with a nondilated main pancreatic duct. Surgery 2020; 169:1471-1479. [PMID: 33390302 DOI: 10.1016/j.surg.2020.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND We investigated the risk factors for clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy in patients with a nondilated main pancreatic duct. METHODS We investigated a total of 354 patients who underwent pancreaticoduodenectomy. The diameter of the main pancreatic duct, the shortest distance from the body surface to the pancreas (the pancreatic depth), and the computed tomography attenuation index (the difference between the pancreatic and splenic computed tomography attenuation) were measured in preoperative computed tomography. RESULTS One hundred eighty-one (51.1%) patients had a nondilated main pancreatic duct, and 50 (27.6%) of the 181 patients with a nondilated main pancreatic duct developed a clinically relevant postoperative pancreatic fistula. Univariate analyses revealed that the calculated body mass index (≥21.8 kg/m2) (P = .004), deep pancreas (pancreatic depth ≥51.2 mm) (P = .001), and low computed tomography attenuation index (≤-3.8 Hounsfield units) (P = .02) were significant risk factors for clinically relevant postoperative pancreatic fistula. The multivariate logistic regression analysis revealed that deep pancreas (odds ratio 2.370; 95% confidence interval 1.0019-5.590; P = .049) was an independent risk factor for clinically relevant postoperative pancreatic fistula. Among patients with a nondilated main pancreatic duct, deep pancreas (in comparison to patients without deep pancreas) was associated with male sex (72.7% vs 54.9%; P = .016), higher body mass index (22.5 kg/m2 vs 19.6 kg/m2; P < .001), a history of diabetes mellitus (24.5% vs 8.5%; P = .006), a lower computed tomography attenuation index (-9.6 Hounsfield units vs -4.6 Hounsfield units; P = .007), a longer operative time (454 minutes vs 420 minutes; P = .007), and a higher volume of intraoperative blood loss (723 mL vs 500 mL; P < .001), respectively. CONCLUSION Deep pancreas may be an important parameter associated with significant risk factors for clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy in patients with a nondilated main pancreatic duct.
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Role of ultrasound shear wave elastography in preoperative prediction of pancreatic fistula after pancreaticoduodenectomy. Pancreatology 2020; 20:1764-1769. [PMID: 33139201 DOI: 10.1016/j.pan.2020.10.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Majority of predictors of postoperative pancreatic fistula (POPF) use intraoperative variables. We aimed to study the role of preoperative ultrasound shear wave elastography (USWE) to predict POPF. METHODS The consecutive patients who underwent pancreaticoduodenectomy (PD) between January 2019 to March 2020 were prospectively enrolled. All patients underwent USWE assessment at the pancreatic neck level. Intraoperative variables including pancreatic texture, pancreatic duct diameter, blood loss and histological grading of fibrosis were also recorded. Associations between USWE and intraoperative variables and histological grading with the development of POPF were analyzed. RESULTS Of the 62 patients assessed, 50 patients (mean age: 53 ± 14 years; 31 males) were included. POPF and clinically relevant POPF (CRPOPF) were observed in 22 (44%) and 7 (14%) patients respectively. Soft pancreas was an independent predictor of CRPOPF (p = 0.04). The mean USWE valve was significantly lower in patients with CRPOPF as compared to no CRPOPF (9.7 Kpa vs. 12.8Kpa, p = 0.016). At receiver operating characteristic curve analysis, USWE value of 12.65Kpa yielded sensitivity and specificity of 100% and 47%, respectively, for prediction of CRPOPF. USWE showed significant correlation with intraoperative pancreatic texture (Spearman's rank correlation coefficient (ρ) = 0.565, p = 0.001). CONCLUSION USWE helps in preoperative prediction of CRPOPF. This may further help to customize management strategy in high risk patients.
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Drozdov ES, Koshel AP, Rodionova OV, Dibina TV, Klokov SS. [Predictors of external pancreatic fistulae after pancreatic resection]. Khirurgiia (Mosk) 2020:107-114. [PMID: 33210516 DOI: 10.17116/hirurgia2020111107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite a significant decrease in postoperative mortality after pancreatic resections in recent years (5.2-15% after pancreatoduodenectomy and about 5% after distal pancreatectomy), incidence of postoperative complications remains high (30-50% and 22-50%, respectively). Postoperative pancreatic fistula is one of the most common and formidable complications. Currently, most authors use the classification proposed by the International Study Group for Pancreatic Fistula (biochemical failure, fistula type B and C). Prediction of the risk of postoperative fistula is still a complex and unresolved problem of modern surgical pancreatology. According to the literature, the main risk factors of postoperative pancreatic fistulae are obesity and high body mass index, concomitant cardiovascular diseases, no neoadjuvant chemo- and radiotherapy, soft pancreatic texture, narrow pancreatic duct, no fibrotic changes in parenchyma, adipose infiltration of the pancreas, advanced intraoperative blood loss, as well as center experience. Most often, magnetic resonance imaging, computed tomography, ultrasound elastography and various multivariate risk assessment systems are used to estimate the risk of pancreatic fistulae. However, a generally accepted technique does not exist. This manuscript is devoted to analysis of risk factors of postoperative pancreatic fistulae and diagnostic methods for assessment of this risk.
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Affiliation(s)
- E S Drozdov
- Siberian State Medical University, Tomsk, Russia.,Tomsk Regional Oncology Hospital, Tomsk, Russia
| | - A P Koshel
- Siberian State Medical University, Tomsk, Russia.,Alperovich Tomsk City Clinical Hospital No. 3, Tomsk, Russia
| | | | | | - S S Klokov
- Siberian State Medical University, Tomsk, Russia.,Zherlov Medical Center, Seversk, Russia
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23
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Marasco G, Ricci C, Buttitta F, Dajti E, Ravaioli F, Ingaldi C, Alberici L, Serra C, Festi D, Colecchia A, Casadei R. Is Ultrasound Elastography Useful in Predicting Clinically Relevant Pancreatic Fistula After Pancreatic Resection?: A Systematic Review and Meta-analysis. Pancreas 2020; 49:1342-1347. [PMID: 33122523 DOI: 10.1097/mpa.0000000000001685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Ultrasound (US) elastography has been proposed for the non-invasive prediction of clinically relevant pancreatic fistula (CR-POPF) in patients undergoing pancreatic resection. We aimed to perform a systematic review with meta-analysis to assess the diagnostic value of US elastography in predicting CR-POPF. METHODS MEDLINE via PubMed, Ovid Embase, Scopus, and Cochrane Library databases, and abstracts of international conference proceedings were searched up to April 20, 2020. Studies assessing the performance of abdominal US elastography in predicting CR-POPF in patients undergoing pancreatic resection were included. The quality of the studies was assessed using Quality Assessment of Diagnostic Accuracy Studies. RESULTS Five studies, including 247 patients who underwent partial pancreatic resection of whom 72 patients experiencing CR-POPF, were selected. All studies performed US elastography in different pancreatic sites. The pooled mean strain value was lower in pancreatic segments of patients experiencing CR-POPF than in those without, with a pooled weighted mean difference of -0.187 (95% confidence intervals, -0.303 to -0.071; P = 0.002). There was low heterogeneity between studies (I = 7.6%), and all studies were at "high risk" or "unclear risk" of bias. CONCLUSIONS This study provides evidence that US elastography values are statistically significantly lower in patients experiencing CR-POPF.
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Affiliation(s)
- Giovanni Marasco
- From the Azienda Ospedaliero-Universitaria di Bologna, Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Claudio Ricci
- From the Azienda Ospedaliero-Universitaria di Bologna, Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Francesco Buttitta
- From the Azienda Ospedaliero-Universitaria di Bologna, Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Elton Dajti
- From the Azienda Ospedaliero-Universitaria di Bologna, Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Federico Ravaioli
- From the Azienda Ospedaliero-Universitaria di Bologna, Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Carlo Ingaldi
- From the Azienda Ospedaliero-Universitaria di Bologna, Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Laura Alberici
- From the Azienda Ospedaliero-Universitaria di Bologna, Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Carla Serra
- From the Azienda Ospedaliero-Universitaria di Bologna, Bologna.,Department of Organ Failure and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Antonio Colecchia
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
| | - Riccardo Casadei
- From the Azienda Ospedaliero-Universitaria di Bologna, Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna
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Acoustic radiation force impulse imaging of pancreas in patients with early onset idiopathic recurrent acute pancreatitis. Eur J Gastroenterol Hepatol 2020; 32:950-954. [PMID: 32282546 DOI: 10.1097/meg.0000000000001732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Patients with recurrent acute pancreatitis (RAP) may progress to chronic pancreatitis (CP). A critical step in this progression is the development of fibrosis. Elastography has been used to assess degree of fibrosis by measurement of shear wave velocity (SWV). The aim of this study was to measure the stiffness of pancreas as a surrogate for pancreatic fibrosis in patients with RAP and compare it with a group of individuals without any history of pancreatic disorders. MATERIAL AND METHODS Using acoustic radiation force impulse (ARFI) imaging SWV was calculated in 31 patients with idiopathic RAP having disease onset ≤30 years. A control group of 31 individuals with no history pancreatic disorder and no features of CP on endosonography was selected for comparison. ARFI imaging was done by a single radiologist who was blinded to the cases and controls RESULTS:: Mean age of patients with RAP was 24.8 (SD 9.86) years, disease duration was 3.45 (interquartile range 1-5) years, mean number of episodes 4.9 (SD 2.72). There was a significant difference in SWV between patients (1.27 ± 0.50 m/s) and controls (1.00 ± 0.17 m/s) (P = 0.001)). There was a positive correlation between SWV and number of pain episodes (P = 0.026) and negative correlation with BMI (P = 0.002). CONCLUSION SWV was high in patients with RAP indicating a stiff pancreas. The stiffness increases with the number of episodes of pancreatitis.
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Intraoperative Ultrasound Elastography Is Useful for Determining the Pancreatic Texture and Predicting Pancreatic Fistula After Pancreaticoduodenectomy. Pancreas 2020; 49:799-805. [PMID: 32541635 DOI: 10.1097/mpa.0000000000001576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Pancreatic fistula (PF) is one of the most common complications after pancreaticoduodenectomy (PD). The soft pancreatic texture is known to be an important predictive factor for PF after PD. However, its evaluation is dependent on the sense of touch by the operator during operation, thus not objective. The aim of this study was to investigate the relationship between mean elasticity via intraoperative ultrasound elastography and histological pancreatic hardness, as well as predictive factor of PF after PD. METHODS Forty-eight patients who underwent ultrasound elastography during PD and had pancreatic parenchyma histologically evaluated were included. RESULTS Pancreatic fistula was noted in 20 patients. There were significant differences in the histological pancreatic fibrosis rate between soft pancreas group (8.2%) and hard pancreas group (28.4%, P < 0.05) and in the mean elasticity between soft pancreas group (1.94 m/s) and hard pancreas group (3.17 m/s, P < 0.05). The mean elasticity was significantly correlated with pancreatic fibrosis rate (P < 0.05). A multivariate analysis revealed that the mean elasticity of less than 2.2 m/s was a significant predictor of PF after PD (P = 0.003). CONCLUSIONS Intraoperative ultrasound elastography could predict pancreatic texture objectively. The mean elasticity of less than 2.2 m/s was a significant predictor of PF after PD.
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Pancreatic ultrasound elastography is not useful to predict the risk of pancreatic fistulas after pancreatic resection. Updates Surg 2020; 72:1081-1087. [PMID: 32248425 DOI: 10.1007/s13304-020-00748-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/18/2020] [Indexed: 12/17/2022]
Abstract
The clinical usefulness of pancreatic elastography (PE) in the assessment of the pancreatic texture before pancreatic resection still remains uncertain. The aims are: to evaluate the value of pancreatic stiffness in both healthy volunteers and patients affected by pancreatic tumor; to evaluate the ability of PE in predicting clinically relevant postoperative pancreatic fistula (CR-POPF). Pancreatic stiffness of healthy subjects was compared with those of pancreatic tumors measuring shear wave velocity (SWV). In the last group, the ability of preoperative SWV in predicting CR-POPF was evaluated using linear regression. Ninety subjects were consecutively enrolled. No difference was found in SWV in the two groups (1.33 ± 0.31 vs 1.26 ± 0.30, p = 0.337). Multivariate analyses showed that male gender was associated with a softer pancreas (OR 0.74, CI 0.55-0.98, p = 0.035). In the 45 patients suitable for a secondary endpoint, the presence of soft pancreas assessed by surgeon's palpation (OR 61.21; CI 2.14- > 1000; p = 0.016) and preoperative risk score (OR 1.72; CI 1.01-2.96; p = 0.049) was predictors of CR-POPF. SWV showed a trend in predicting CR-POPF. The pancreatic stiffness far to the pancreatic neoplasm is the same as healthy controls. SWV showed a trend in predicting CR-POPF but the clinical utility is limited.
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27
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Cao F, Tong X, Li A, Li J, Li F. Meta-analysis of modified Blumgart anastomosis and interrupted transpancreatic suture in pancreaticojejunostomy after pancreaticoduodenectomy. Asian J Surg 2020; 43:1056-1061. [PMID: 32169516 DOI: 10.1016/j.asjsur.2020.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/12/2019] [Accepted: 01/13/2020] [Indexed: 12/21/2022] Open
Abstract
Postoperative pancreatic fistula (POPF) remains the main cause of surgery related mortality after pancreaticoduodenectomy. Various pancreatoenteric anastomosis methods have been developed to reduce the POPF rate. However, the optimum choice has not been clarified. A literature search is performed in electronic databases, including PubMed, Medline, Embase, CNKI and the Cochrane Library. Studies comparing modified Blumgart anastomosis with interrupted transpancreatic suture are included in this meta-analysis. Grade B/C POPF, overall POPF rate and overall sever complication rate (Clavien-Dindo classification IIIa or more) are measured as primary outcomes. Revman 5.3 was used to perform the analysis. Five retrospective comparative studies and 1 randomized controlled trial with a total number of 1409 patients are included in our analysis. Meta-analysis revealed that modified Blumgart anastomosis is associated with lower rate of grade B/C POPF [Odds Ratio (OR) 95% confidence interval (CI),0.32 (0.12-0.84); P = 0.02] and intra-abdominal abscess [OR 95%CI, 0.43 (0.29-0.65); P < 0.01] comparing with interrupted transpancreatic suture. However, this procedure could not reduce overall POPF [OR 95%CI,0.70 (0.34-1.44); P = 0.34] and overall sever complication rate [OR 95%CI,0.91 (0.48-1.72); P = 0.77]. At current level of evidence, modified Blumgart anastomosis is superior to interrupted transpancreatic suture in terms of grade B/C POPF and intra-abdominal abscess. However, high-grade evidence will be necessary to confirm these results.
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Affiliation(s)
- Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
| | - Xiaogang Tong
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
| | - Jia Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China.
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China.
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28
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He Y, Jin Y, Li X, Wu L, Jin C. Quantification of pancreatic elasticity in type 2 diabetes: A new potential imaging marker for evaluation of microangiopathy. Eur J Radiol 2020; 124:108827. [PMID: 31951892 DOI: 10.1016/j.ejrad.2020.108827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to noninvasively explore pancreatic morphological and mechanical changes in diabetic patients with or without microangiopathy and to investigate the clinical correlations of pancreatic stiffness or size with diabetic microangiopathy. METHODS A total of 213 type 2 diabetic patients with / without microangiopathy (91/122) were prospectively enrolled. Microangiopathy included diabetic retinopathy, diabetic nephropathy and diabetic peripheral neuropathy. Each subject underwent pancreatic ultrasonography and elastography. The shear wave velocity (SWV) and thickness of the head, body and tail were measured and compared. Receiver operating characteristic (ROC) curves was performed in the diagnosis of microangiopathy. Risk factors of the occurrence of more microvascular complications were explored. RESULTS The SWV in pancreas increased significantly in patients with microangiopathy (P < 0.01) while the thickness was similar in all patients. The area under ROC curve for the SWV in pancreatic body was greatest (0.747) and the sensitivity, specificity were 73.0, 70.9 %. There was a significant shift towards the occurrence of more microvascular complications for patients with increasing of the SWV in pancreatic body (OR 39.25), long duration of diabetes (OR 1.077), aging (OR 1.039) and elevation of microalbuminuria (OR 1.004). CONCLUSIONS The SWV in pancreatic body was significantly high in diabetic patients with microangiopathy and was prominently correlated with the number of microvascular complications. The SWV in pancreatic body may be considered as a potential marker for diabetic microangiopathy and its occurrence.
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Affiliation(s)
- Yu He
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Ying Jin
- Department of Surgery, the First Hospital of Jilin University, Changchun, China.
| | - Xiaoping Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Lingyu Wu
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Chunxiang Jin
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China.
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29
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Pancreatic attenuation on computed tomography predicts pancreatic fistula after pancreaticoduodenectomy. HPB (Oxford) 2020; 22:67-74. [PMID: 31229490 DOI: 10.1016/j.hpb.2019.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/27/2018] [Accepted: 05/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Some parameters using preoperative computed tomography (CT) have been evaluated to predict the development of pancreatic fistula (PF) after pancreaticoduodenectomy (PD). The present retrospective study evaluated the predictive value of pancreatic attenuation for PF after PD. METHODS A retrospective review was conducted of the patients who underwent PD between January 2010 and December 2014. The pancreatic attenuation was measured in unenhanced preoperative CT images. Pre- and intraoperative variables were analyzed for the risk of PF after PD. RESULTS Of the 346 consecutive patients, PF occurred in 116 (34%). The pancreatic attenuation was significantly greater in patients with PF than in those without PF (median, 40.0 vs. 33.3 Hounsfield units [HU], P < 0.001). A multivariate analysis showed that a pancreatic attenuation ≥30.0 HU (odds ratio [OR], 3.72; P < 0.001), a body mass index ≥25.0 kg/m2 (OR, 3.67; P < 0.001) and a diameter of the main pancreatic duct <3.0 mm (OR, 1.84; P = 0.034) were independent risk factors for PF after PD. CONCLUSION The degree of pancreatic attenuation on preoperative CT images was significantly associated with PF, and a pancreatic attenuation ≥30.0 HU was an independent risk factor of PF after PD.
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30
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Hashizume K, Hirooka Y, Kawashima H, Ohno E, Ishikawa T, Kawai M, Suhara H, Takeyama T, Koya T, Tanaka H, Sakai D, Yamamura T, Furukawa K, Funasaka K, Nakamura M, Miyahara R, Watanabe O, Ishigami M, Kuwahara T, Hashimoto S, Goto H. The Propagation Display Method Improves the Reproducibility of Pancreatic Shear Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2242-2247. [PMID: 31103347 DOI: 10.1016/j.ultrasmedbio.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 03/02/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
Evaluation of the pancreatic elastic modulus (PEM) using shear wave elastography (SWE) requires at least 5 measurements to ensure reproducibility. The aim of this study was to evaluate improvement in reproducibility of SWE, using the propagation display method in normal pancreas ([NP] phase 1) and to examine the differences in PEM between NP and chronic pancreatitis (CP), intraductal papillary mucinous neoplasm (IPMN) and autoimmune pancreatitis ([AIP] phase 2). In phase 1, the measurement success rate, median PEM in repeated measurements and appropriate number of SWE measurements were determined in 109 cases with NP. In phase 2, PEM was measured in CP (n = 10), IPMN (n = 31) and AIP (n = 5), using the required number of SWE measurements determined in phase 1. In phase 1, the measurement success rate was 93.9% (92/109 cases). The median PEM for NP was 14.6 kPa and the appropriate number of SWE measurements was at least 3. In phase 2, the median PEMs in CP, IPMN and AIP were 19.6, 18.1 and 17.2 kPa, respectively, with significant differences between NP and CP (p = 0.0133) and between NP and IPMN (p = 0.0436). Use of the propagation display method in SWE improves the reproducibility of measurement of PEM.
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Affiliation(s)
- Kiyotaka Hashizume
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Manabu Kawai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Hiroki Suhara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Tomoaki Takeyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Toshinari Koya
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Hiroyuki Tanaka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Daisuke Sakai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | | | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Osamu Watanabe
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
| | - Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Senju Hashimoto
- Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, Toyoake, Japan
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate, School of Medicine, Nagoya, Japan
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Abstract
Ultrasound elastography (USE) of the pancreas allows pancreatic tissue stiffness assessment by virtual palpation. Two main types of USE are used. For the pancreas strain elastography applying by endoscopic ultrasound has been established for the characterisation of small solid pancreatic lesions (SPL). In larger SPL >30 mm the results are less convincing mainly due to the heterogenicity of the lesions but also by concomitant changes of the surrounding pancreatic parenchyma. The current role of shear wave elastography has to be determined. This article reviews the current use of elastography of the pancreas.
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Affiliation(s)
- Christoph F Dietrich
- Ultrasound Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Internal Medicine, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
| | - Michael Hocke
- Department of Internal Medicine, HELIOS Klinikum Meiningen, Meiningen, Germany
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32
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Xingjun G, Feng Z, Meiwen Y, Jianxin J, Zheng H, Jun G, Tao H, Rui Z, Leida Z, Min W, Renyi Q. A score model based on pancreatic steatosis and fibrosis and pancreatic duct diameter to predict postoperative pancreatic fistula after Pancreatoduodenectomy. BMC Surg 2019; 19:75. [PMID: 31269932 PMCID: PMC6610813 DOI: 10.1186/s12893-019-0534-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSES To establish a scoring model for the risk of postoperative pancreatic fistula (POPF) following pancreatoduodenectomy (PD). METHODS PD Patients from 7 institutions in 2 independent sets: developmental (n = 457) and validation cohort (n = 152) were retrospectively enrolled and analyzed. Pancreatic Fibrosis (PF) and Pancreatic Steatosis (PS) were assessed by pathological examination of the pancreatic stump. RESULTS Stepwise univariate and multivariate analysis indicated that pancreatic duct diameter ≤ 3 mm, increased PS and decreased PF were independent risk factors for POPF and Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF). Based on the relative weight and odds ratio of each factor in the POPF, a simplified scoring model was developed. And patients were stratified into high-risk group (22~28 points), medium-risk group (15~21 points) and low-risk group (8~14 points). The receiver operating characteristic curve demonstrated that the Area under the curve for the predictive model was 0.868 and 0.887 in the model design group and the external validation group. CONCLUSIONS This study establishes a simplified scoring model based on accurately and quantitatively measuring the PS, PF and pancreatic duct diameter. The scoring model accurately predicted the risk of POPF.
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Affiliation(s)
- Guo Xingjun
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan City, Hubei Province, 430030, People's Republic of China
| | - Zhu Feng
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan City, Hubei Province, 430030, People's Republic of China
| | - Yang Meiwen
- The First Affiliated Hospital of Third Military Medical University, 30 Gaotanyan Str, Chongqing City, 400038, People's Republic of China
| | - Jiang Jianxin
- Department of Hepatic-Biliary-Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - He Zheng
- Department of Hepatic-Biliary-Pancreatic Surgery, Yichang Central People's Hospital, Yichang, China
| | - Gao Jun
- Department of Hepatic-Biliary-Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Huang Tao
- Department of Hepatic-Biliary-Pancreatic Surgery, Henan Cancer Hospital, Zhengzhou, China
| | - Zhao Rui
- Department of Hepatic-Biliary-Pancreatic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhang Leida
- The First Affiliated Hospital of Third Military Medical University, 30 Gaotanyan Str, Chongqing City, 400038, People's Republic of China.
| | - Wang Min
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan City, Hubei Province, 430030, People's Republic of China.
| | - Qin Renyi
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan City, Hubei Province, 430030, People's Republic of China.
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Shi Z, Li X, Li Y, You R, Cao D, Chen Q, Ramen K, Loosa VS. Assessment of acute obstructive pancreatitis by magnetic resonance imaging: Predicting the occurrence of pancreatic fistula following pancreatoduodenectomy. Mol Clin Oncol 2019; 10:371-376. [PMID: 30847176 DOI: 10.3892/mco.2019.1799] [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: 06/21/2018] [Accepted: 10/20/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to assess the effect of preoperative acute obstructive pancreatitis on the risk of the occurrence of pancreatic fistula (PF) following pancreaticoduodenectomy. A total of 22 patients who developed postoperative PF were carefully matched with 22 control patients without PF according to demographic data, pancreatic pathology, presenting symptoms and other surgery-associated parameters. These parameters were compared between these two groups. The mean pancreatic apparent diffusion coefficient (ADC) values in the fistula group were 1.14±0.31×10-3 mm2/s, which was significantly decreased compared with the non-fistula group (1.48±0.44×10-3 mm2/s) (P=0.005). The pancreas-muscle signal intensity (SI) ratio on fat-suppressed T1 weighted image (rT1) in the fistula group was 1.71±0.25, which was significantly increased compared with the non-fistula group (1.25±0.29) (P<0.001). The pancreas-muscle SI ratios on fat-suppressed T2 weighted image (T2WI) in the fistula group and the non-fistula group were 0.72±0.08 and 0.62±0.07, respectively (P=0.79). There was no significant difference in pancreas-muscle SI ratio on fat-suppressed T2-weighted image (rT2) value between these two groups. Based on the receiver operating characteristic curve, the optimal cut-off value of ADC as a criterion for prediction of pancreatic fistula was 1.29×10-3 mm2/s, which yielded a sensitivity of 77.3% and a specificity of 63.6%. In conclusion, the severity of acute obstructive pancreatitis was negatively associated with ADC values and pancreas-muscle SI ratio on rT1 images, which may be useful for predicting the occurrence of PF preoperatively.
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Affiliation(s)
- Zhenshan Shi
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Xiumei Li
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Yueming Li
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Ruixiong You
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Qunlin Chen
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Kamisha Ramen
- Department of Radiology, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Vikash Sahadeo Loosa
- Department of Radiology, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
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Huang CT, Liang YJ. Comparison of Duodenal Mucosal Chromogranin-A Expression in Non-Alcoholic Fatty Pancreas Dyspeptic Patients with and without Endosonography-Diagnosed Early Chronic Pancreatitis: A Case Series Study. Case Rep Gastroenterol 2019; 13:102-112. [PMID: 31011309 PMCID: PMC6465733 DOI: 10.1159/000497777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/31/2019] [Indexed: 12/20/2022] Open
Abstract
Nonalcoholic fatty pancreas (NAFP) is hypothetically related to progressive fibro-inflammation of the pancreas whose exocrine function is controlled by enteroendocrine cells (EEC). There is little evidence of pancreatic fibrosis in fatty pancreas and of whether there are quantitative differences for EEC. This study aimed to prove the coexistence of NAFP and pancreatic fibrosis or early chronic pancreatitis (ECP) using acoustic radiation force impulse (ARFI) and endosonography. Besides, the expression of duodenal mucosal chromogranin-A, a surrogate for EEC, was analyzed. Dyspeptic patients were surveyed at the digestive clinic and received abdominal sonography, endosonography, and serology tests. Cases with organic causes of dyspepsia were excluded. Pancreatic fibrosis was defined as an ARFI value ≥1.3 m/s. ECP was defined by at least 2 scores of the Japan Pancreas Society endosonographic criteria. During endosonography, 4 biopsy samples of mucosa in the duodenal first part were obtained for analysis of chromogranin-A expression by Western blot. Mucosal biopsy was also performed at the gastric antrum for surveillance of Helicobacter pylori. Between January and June 2018, a total of 24 patients with NAFP were enrolled among 48 candidates and divided into 2 groups based on whether they had pancreatic fibrosis or not. In the pancreatic fibrosis group (n = 11, pancreatic ARFI: 1.76 ± 0.34 m/s), there was a higher endosonographic criteria score (2.45 vs. 1.61, p = 0.002), increased expression of chromogranin-A (p = 0.001), and more severe fatty pancreas that was defined by pancreatic duct blurring on abdominal sonography (91 vs. 46%, p = 0.062) as compared to the non-pancreatic fibrosis group (n = 13, pancreatic ARFI: 1.11 ± 0.09 m/s). A total of 54 endosonographic abnormalities of ECP was present in these 24 patients in the head (52%), body (31%), and tail (17%), an anatomic pattern similar to pancreatic adenocarcinoma. In conclusion, among dyspeptic patients with NAFP, the duodenal mucosa chromogranin-A showed increased expression in those with pancreatic fibrosis and endosonography-diagnosed ECP.
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Affiliation(s)
- Chung-Tsui Huang
- Gastroenterology and Hepatology Division, Internal Medicine Department, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yao-Jen Liang
- Department of Life Science Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
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Computed Tomography Enhancement Pattern of the Pancreatic Parenchyma Predicts Postoperative Pancreatic Fistula After Pancreaticoduodenectomy. Pancreas 2019; 48:209-215. [PMID: 30589830 DOI: 10.1097/mpa.0000000000001229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between the computed tomography (CT) pancreatic parenchyma attenuation value and clinically relevant postoperative pancreatic fistula (POPF). METHODS The medical records of 115 patients who underwent pancreaticoduodenectomy and preoperative dynamic CT were retrospectively reviewed. The CT attenuation values of the nonenhanced (N), arterial (A), portal venous (P), and late (L) phase in the pancreatic parenchyma were determined via CT, and the A/N, A/P, and P/L ratios were calculated. The CT attenuation values and value ratios were compared between the POPF and non-POPF groups. RESULTS Thirty-two patients (28%) were categorized in the POPF group. On univariate analysis, the A/P ratio (P < 0.001) and P/L ratio (P = 0.018) were significantly higher in the POPF group. On receiver operating characteristic curve analysis, the A/P and P/L ratio cutoff values for predicting POPF were 1.19 and 1.17, respectively. Of the preoperative evaluable factors, A/P ratio of 1.19 or greater (P < 0.001; odds ratio, 10.3) and P/L ratio of 1.17 or greater (P = 0.049; odds ratio, 3.23) were independent predictive factors for POPF, and the combination of the 2 ratios was useful in detecting POPF preoperatively. CONCLUSIONS The enhancement pattern of the pancreatic parenchyma is associated with the development of clinically relevant POPF.
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Abstract
OBJECTIVES The aim of this study was to evaluate the utility of magnetic resonance imaging (MRI) for the noninvasive assessment of pancreatic fibrosis (PF). METHODS Fifty-two patients who underwent surgical resection of the pancreas, histological examination of resection margins, preoperative abdominal MRI, and fecal elastase-1 test were enrolled in the study. Pancreatic tissue was identified on the MRI T1-, T2-, and diffusion-weighted imaging sequences. Apparent diffusion coefficient (ADC) was measured at the expected resection margin of the pancreas. RESULTS There was a significant negative correlation between the ADC mean and histologically determined PF (r = -0.752, P = 0.001). For equal to or greater than 25% of PF, the ADC cutoff value was 1.331 or less, with a sensitivity of 77% and specificity of 88%. The unenhanced T1-weighted signal intensity ratio (T1SI) cutoff value was 172.1 or less. For equal to or greater than 50% of PF, the ADC cutoff value was 1.316 or less with a sensitivity of 85% and specificity of 88%. The highest sensitivity was obtained by combining ADC and T1SI values. CONCLUSIONS Combining both the ADC and T1SI measurement allows the detection of early PF with good sensitivity and specificity. Magnetic resonance imaging has the advantage of being noninvasive and widely used in the clinical setting, thus making our results easily transferable to routine clinical practice.
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Püttmann S, Koch J, Steinacker JP, Schmidt SA, Seufferlein T, Kratzer W, Schmidberger J, Manfras B. Ultrasound point shear wave elastography of the pancreas: comparison of patients with type 1 diabetes and healthy volunteers - results from a pilot study. BMC Med Imaging 2018; 18:52. [PMID: 30545313 PMCID: PMC6293554 DOI: 10.1186/s12880-018-0295-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aims of this study were to establish shear wave elastography of the pancreas by comparing measurements in patients with type 1 diabetes (T1D) and healthy volunteers and to consider whether this method could contribute to the screening or prevention of T1D. Methods This pilot study included 15 patients with T1D (10 men, 5 women) and 15 healthy volunteers (10 men, 5 women) as controls. Measurements were performed with a Siemens Acuson S3000 (Siemens Healthcare, Erlangen, Germany) using a 6C1 convex transducer and the Virtual Touch™ tissue quantification (VTQ) method. Results The mean shear wave velocity of the head of the pancreas was 1.0 ± 0.2 m/s (median: 1.1 m/s) for the study group and likewise 1.0 ± 0.2 m/s (median: 0.9 m/s) for the control group. Velocities of 1.2 ± 0.2 m/s (median: 1.2 m/s) were measured in the body of the pancreas in both groups. There was a significant difference between the values obtained in the tail of the pancreas: patients 1.1 ± 0.1 m/s (median: 1.0 m/s) versus controls 0.9 ± 0.1 m/s (median: 0.8 m/s) (p = 0.0474). The mean value in the whole pancreas of the study group was not significantly above that of the control group: 1.1 ± 0.1 m/s (median: 1.0 m/s) versus 1.0 ± 0.1 m/s (median: 1.0 m/s) (p = 0.2453). Conclusions Sonoelastography of the pancreas revealed no overall difference between patients with T1D and healthy volunteers. Patients with T1D showed higher values only in the tail segment. Future studies need to determine whether specific regional differences can be found in a larger study population.
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Affiliation(s)
- Sophie Püttmann
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Janina Koch
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Jochen Paul Steinacker
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Stefan Andreas Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Thomas Seufferlein
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Eshmuminov D, Schneider MA, Tschuor C, Raptis DA, Kambakamba P, Muller X, Lesurtel M, Clavien PA. Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture. HPB (Oxford) 2018; 20:992-1003. [PMID: 29807807 DOI: 10.1016/j.hpb.2018.04.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/09/2018] [Accepted: 04/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In 2016, the International Study Group of Pancreatic Fistula (ISGPS) proposed an updated definition for postoperative pancreatic fistula (POPF). Pancreas texture (PT) is an established risk factor of POPF. The definition of soft vs. hard texture, however, remains elusive. METHODS A systematic search was performed to identify PT definitions and a meta-analysis linking POPF to PT using the updated ISGPS definition. RESULTS 122 studies including 22 376 patients were identified. Definition criteria for PT varied among studies and most classified PT in hard and soft based on intraoperative subjective assessment. The total POPF rate (pooled grades B and C) after pancreatoduodenectomy was 14.5% (n = 10 395) and 15.5% (n = 3767) after distal pancreatectomy. In pancreatoduodenectomy, POPF rate was higher in soft compared to hard pancreas (RR, 4.4, 3.3 to 6.1; p < 0.001; n = 6393), where PT grouped as soft and hard. No data were available for intermediate PT. CONCLUSION The reported POPF rates may be used in planning future prospective studies. A widely accepted definition of PT is lacking and a correlation with the risk of POPF is based on subjective evaluation, which is still acceptable. Classification of PT into 2-groups is more reasonable than classification into 3-groups.
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Affiliation(s)
- Dilmurodjon Eshmuminov
- Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Zurich, Switzerland
| | - Marcel A Schneider
- Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Tschuor
- Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri A Raptis
- Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Zurich, Switzerland
| | - Patryk Kambakamba
- Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Zurich, Switzerland
| | - Xavier Muller
- Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Zurich, Switzerland
| | - Mickaël Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, University of Lyon, Lyon, France
| | - Pierre-Alain Clavien
- Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Zurich, Switzerland.
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Evaluation of Pancreatic Fibrosis With Acoustic Radiation Force Impulse Imaging and Automated Quantification of Pancreatic Tissue Components. Pancreas 2018; 47:1277-1282. [PMID: 30286012 DOI: 10.1097/mpa.0000000000001179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to determine whether computer-assisted digital analysis and acoustic radiation force impulse (ARFI) imaging were useful for assessing pancreatic fibrosis, and if ARFI imaging predicted postoperative pancreatic fistula (POPF). METHODS Seventy-eight patients scheduled to undergo pancreatic resection were enrolled. Shear wave velocity (SWV) at the pancreatic neck was measured preoperatively using ARFI imaging. Pancreatic tissue components on a whole slide image were quantified using an automatic image processing software. The relationship between SWV, fibrotic tissue content, and POPF incidence and clinical severity was analyzed. RESULTS The median collagen fiber, fatty tissue, and acinar cell contents were 11.6%, 8.5%, and 61.3%, respectively. Unlike fatty tissue, collagen fiber content and acinar cells were correlated with SWV (ρ = 0.440, P < 0.001 and ρ = -0.428, P < 0.001, respectively). Although collagen fiber content and SWV were associated with the overall incidence of POPF (P = 0.004 and 0.001, respectively), collagen fiber content and SWV had no statistical correlation with clinically relevant POPF (P = 0.268 and 0.052, respectively). CONCLUSIONS We objectively quantified the pancreatic tissue components using an automatic image processing software. Shear wave velocity was significantly related to collagen fiber content and suggests that ARFI imaging can be useful for evaluating pancreatic fibrosis.
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Barreto SG, Dirkzwager I, Windsor JA, Pandanaboyana S. Predicting post‐operative pancreatic fistulae using preoperative pancreatic imaging: a systematic review. ANZ J Surg 2018; 89:659-665. [PMID: 30306712 DOI: 10.1111/ans.14891] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/19/2018] [Accepted: 09/02/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Savio G. Barreto
- Hepatobiliary and Oesophagogastric Unit, Division of Surgery and Perioperative MedicineFlinders Medical Centre Adelaide South Australia Australia
- School of Medicine, Faculty of Medicine, Nursing and Health SciencesFlinders University Adelaide South Australia Australia
| | - Ilse Dirkzwager
- Department of RadiologyAuckland City Hospital Auckland New Zealand
| | - John A. Windsor
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- HBP Unit, Department of General SurgeryAuckland City Hospital Auckland New Zealand
| | - Sanjay Pandanaboyana
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- HBP Unit, Department of General SurgeryAuckland City Hospital Auckland New Zealand
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Rungsakulkij N, Mingphruedhi S, Tangtawee P, Krutsri C, Muangkaew P, Suragul W, Tannaphai P, Aeesoa S. Risk factors for pancreatic fistula following pancreaticoduodenectomy: A retrospective study in a Thai tertiary center. World J Gastrointest Surg 2017; 9:270-280. [PMID: 29359033 PMCID: PMC5752962 DOI: 10.4240/wjgs.v9.i12.270] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/15/2017] [Accepted: 10/31/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the risk factors of postoperative pancreatic fistula following pancreaticoduodenectomy in a Thai tertiary care center.
METHODS We retrospectively analyzed 179 patients who underwent pancreaticoduodenectomy at our hospital from January 2001 to December 2016. Pancreatic fistula were classified into three categories according to a definition made by an International Study Group on Pancreatic Fistula. The risk factors for pancreatic fistula were analyzed by univariate analysis and multivariate logistic regression analysis.
RESULTS Pancreatic fistula were detected in 88/179 patients (49%) who underwent pancreaticoduodenectomy. Fifty-eight pancreatic fistula (65.9%) were grade A, 22 cases (25.0%) were grade B and eight cases (9.1%) were grade C. Clinically relevant pancreatic fistula were detected in 30/179 patients (16.7%). The 30-d mortality rate was 1.67% (3/179 patients). Multivariate logistic regression analysis revealed that soft pancreatic texture (odds ratio = 3.598, 95%CI: 1.77-7.32) was the most significant risk factor for pancreatic fistula. A preoperative serum bilirubin level of > 3 mg/dL was the most significant risk factor for clinically relevant pancreatic fistula according to univariate and multivariate analysis.
CONCLUSION Soft pancreatic tissue is the most significant risk factor for postoperative pancreatic fistula. A high preoperative serum bilirubin level (> 3 mg/dL) is the most significant risk factor for clinically relevant pancreatic fistula.
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Affiliation(s)
- Narongsak Rungsakulkij
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Somkit Mingphruedhi
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pongsatorn Tangtawee
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Chonlada Krutsri
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Paramin Muangkaew
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Wikran Suragul
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Penampai Tannaphai
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suraida Aeesoa
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Kuwahara T, Hirooka Y, Kawashima H, Ohno E, Yokoyama Y, Fujii T, Nakamura S, Kodera Y, Nagino M, Goto H. Usefulness of endoscopic ultrasonography-elastography as a predictive tool for the occurrence of pancreatic fistula after pancreatoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:649-656. [PMID: 29032609 DOI: 10.1002/jhbp.514] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic fistula (PF) is a major complication following pancreatoduodenectomy (PD). Pancreatic texture is a risk factor for PF, but its evaluation depends on the subjective judgment. The aim of this study was to investigate whether preoperative endoscopic ultrasonography-elastography (EUS-EG), which objectively assesses tissue elasticity, predict the development of PF following PD. METHODS Fifty-nine patients who underwent EUS-EG before PD and had pancreas parenchyma histologically evaluated were included. Using histogram analysis, mean elasticity (ME), which represents tissue elasticity and is inversely correlated with pancreatic fibrosis, was calculated. RESULTS Among 59 patients, 19 developed PF (32.2%). The ME in patients with PF was significantly higher than that in patients without PF (85.4 vs. 55.6, P < 0.001). Area under the receiver operating characteristic curve for the accuracy of pancreatic texture and ME for predicting PF were 0.718 and 0.846, respectively. When a ME of 70.0 was used as a cut-off value for predicting PF, the sensitivity and specificity were 84.2% and 80.0%, respectively. In a multivariate logistic regression analysis, only a ME of >70.0 was an independent predictor of PF (odds ratio 10.02, P = 0.008). CONCLUSIONS Endoscopic ultrasonography-elastography may be an accurate and objective method for predicting PF following PD.
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Affiliation(s)
- Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsutomu Fujii
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeo Nakamura
- Department of Pathology and Molecular Diagnostics, Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Chantarojanasiri T, Kongkam P. Endoscopic ultrasound elastography for solid pancreatic lesions. World J Gastrointest Endosc 2017; 9:506-513. [PMID: 29085561 PMCID: PMC5648993 DOI: 10.4253/wjge.v9.i10.506] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 02/05/2023] Open
Abstract
Elastography is one of technologies assisting diagnosis of solid pancreatic lesions (SPL). This technology has been previously used for measuring the stiffness of various organs based on a principle of “harder the lesions, higher chance for malignancy”. Two elastography techniques; strain and shear wave elastography, are available. For endoscopic ultrasound (EUS), only the former is existing. To interpret results of EUS elastography for SPL, 3 methods are used: (1) pattern recognition; (2) strain ratio; and (3) strain histogram. Based on results of existing studies, these 3 techniques provide high sensitivity but low to moderate specificity and accuracy rate. This review will summarize all available information in order to update current situation of using elastography for an evaluation of SPLs to readers.
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Affiliation(s)
| | - Pradermchai Kongkam
- Gastrointestinal Endoscopy Excellent Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
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Liang Z, Li T, Jiang S, Xu J, Di W, Yang Z, Hu W, Yang Y. AMPK: a novel target for treating hepatic fibrosis. Oncotarget 2017; 8:62780-62792. [PMID: 28977988 PMCID: PMC5617548 DOI: 10.18632/oncotarget.19376] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/08/2017] [Indexed: 12/19/2022] Open
Abstract
Fibrosis is a common process of excessive extracellular matrix (ECM) accumulation following inflammatory injury. Fibrosis is involved in the pathogenesis of almost all liver diseases for which there is no effective treatment. 5'-AMP-activated protein kinase (AMPK) is a cellular energy sensor that can ameliorate the process of hepatic fibrogenesis. Given the existing evidence, we first introduce the basic background of AMPK and hepatic fibrosis and the actions of AMPK in hepatic fibrosis. Second, we discuss the three phases of hepatic fibrosis and potential drugs that target AMPK. Third, we analyze possible anti-fibrosis mechanisms and other benefits of AMPK on the liver. Finally, we summarize and briefly explain the current objections to targeting AMPK. This review may aid clinical and basic research on AMPK, which may be a novel drug candidate for hepatic fibrosis.
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Affiliation(s)
- Zhenxing Liang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Tian Li
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences, Northwest University, Xi'an 710069, China.,Department of Biomedical Engineering, The Fourth Military Medical University, Xi'an 710032, China
| | - Shuai Jiang
- Department of Aerospace Medicine, The Fourth Military Medical University, Xi'an 710032, China
| | - Jing Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Wencheng Di
- Department of Cardiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zhi Yang
- Department of Biomedical Engineering, The Fourth Military Medical University, Xi'an 710032, China
| | - Wei Hu
- Department of Biomedical Engineering, The Fourth Military Medical University, Xi'an 710032, China
| | - Yang Yang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences, Northwest University, Xi'an 710069, China.,Department of Biomedical Engineering, The Fourth Military Medical University, Xi'an 710032, China
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Pancreatic Elastography From Acoustic Radiation Force Impulse Imaging for Evaluation of Diabetic Microangiopathy. AJR Am J Roentgenol 2017; 209:775-780. [PMID: 28705067 DOI: 10.2214/ajr.16.17626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purposes of this study were to compare pancreatic shear-wave velocity (SWV) in subjects with and those without diabetic microvascular complications and to investigate the feasibility of pancreatic SWV in evaluating diabetic microangiopathy. SUBJECTS AND METHODS SWV measurements were prospectively performed in 115 patients with diabetes mellitus and 115 healthy persons by use of acoustic radiation force impulse imaging. Patients with diabetes were divided into subgroups with and without microangiopathy. Pancreatic SWV was compared in three groups. Factors associated with increased SWV were studied. RESULTS Pancreatic SWV increased significantly in the subgroups with diabetes mellitus compared with the control group (p < 0.01). Especially, the SWV in the pancreatic body was significantly higher when microangiopathy was present (p < 0.01). In patients with diabetes, microangiopathy (standardized β = 0.208, p = 0.022), age (standardized β = 0.265, p = 0.004), and total cholesterol level (standardized β = 0.223, p = 0.011) were positively and markedly correlated with high SWV in the pancreatic body. CONCLUSION The increased SWV in the pancreatic body was significantly related to the presence of microangiopathy. It is feasible to use SWV in the pancreatic body to evaluate diabetic microangiopathy.
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Marchegiani G, Ballarin R, Malleo G, Andrianello S, Allegrini V, Pulvirenti A, Paini M, Secchettin E, Boriero F, Di Benedetto F, Bassi C, Salvia R. Quantitative Assessment of Pancreatic Texture Using a Durometer: A New Tool to Predict the Risk of Developing a Postoperative Fistula. World J Surg 2017; 41:2876-2883. [DOI: 10.1007/s00268-017-4073-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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47
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Tajima Y, Kawabata Y, Hirahara N. Preoperative imaging evaluation of pancreatic pathologies for the objective prediction of pancreatic fistula after pancreaticoduodenectomy. Surg Today 2017; 48:140-150. [PMID: 28421350 DOI: 10.1007/s00595-017-1529-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/31/2017] [Indexed: 12/13/2022]
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A novel preoperative predictor of pancreatic fistula using computed tomography after distal pancreatectomy with staple closure. Surg Today 2017; 47:1180-1187. [PMID: 28265770 DOI: 10.1007/s00595-017-1495-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/24/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE A thick pancreas has proven to be a conspicuous predictor of pancreatic fistula (PF) following distal pancreatectomy (DP) using staples. Other predictors for this serious surgical complication currently remain obscure. This study sought to identify novel predictors of PF following DP. METHODS One hundred and twenty-two patients were retrospectively assessed to determine the correlation between PF occurrence and the clinicopathological findings and radiologic data from preoperative computed tomography (CT). CT assessments included the thickness of the pancreas (TP) and pancreatic CT number (pancreatic index; PI), calculated by dividing the pancreatic CT by the splenic CT density. RESULTS Twenty-four patients (19.7%) developed a clinically relevant PF. TP was identified as an independent risk factor for PF in multivariate analyses (odds ratio 1.17; P = 0.0095). In subgroup analyses, a lower PI in a thick pancreas was a significant predictor of PF (P = 0.032). The combination of these two prediction parameters, known as the TP-to-PI ratio (TPIR), showed a significantly better prediction ability than TP alone (area under the receiver operating characteristic curve for the incidence of PF, TPIR 0.80 vs. TP 0.69; P = 0.037). CONCLUSION Combining the CT number with TP substantially improves the prediction ability for the incidence of PF following DP with staple use.
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Chang YR, Kang JS, Jang JY, Jung WH, Kang MJ, Lee KB, Kim SW. Prediction of Pancreatic Fistula After Distal Pancreatectomy Based on Cross-Sectional Images. World J Surg 2017; 41:1610-1617. [DOI: 10.1007/s00268-017-3872-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kuwahara T, Hirooka Y, Kawashima H, Ohno E, Sugimoto H, Hayashi D, Morishima T, Kawai M, Suhara H, Takeyama T, Yamamura T, Funasaka K, Nakamura M, Miyahara R, Watanabe O, Ishigami M, Shimoyama Y, Nakamura S, Hashimoto S, Goto H. Quantitative evaluation of pancreatic tumor fibrosis using shear wave elastography. Pancreatology 2016; 16:1063-1068. [PMID: 27692969 DOI: 10.1016/j.pan.2016.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS There is no established non-invasive method for diagnosis of pancreatic fibrosis. Shear wave elastography (SW-EG) may be a candidate for this purpose. The aims of this study were to assess the reproducibility of SW-EG in the normal imaging pancreas (Phase 1) and to evaluate the diagnostic performance of SW-EG for pancreatic fibrosis classified histologically (Phase 2). METHODS Phase 1: This included 127 cases that underwent SW-EG of the normal imaging pancreas. SW-EG was measured at least five times in the pancreatic parenchyma and the median of repeated measurements was defined as the pancreatic elastic modulus (PEM). Phase 2: This included 53 cases that underwent SW-EG of the pancreatic parenchyma preoperatively and in which pancreas parenchyma were evaluated histologically. Histological fibrosis was graded in 4 stages: normal, mild, moderate, and severe. RESULTS Phase 1: Median PEM in the head, body, and tail of the pancreas were 3.23, 3.17, and 2.91 kPa, respectively, with no significant difference among regions (P = 0.554). The intraclass correlation coefficient showed good reproducibility (ρ = 0.71) after 5 measurements. Phase 2: There was a significant positive correlation between PEM and the histological pancreatic fibrosis stage (rs = 0.63, P < 0.001). Areas under the receiver operating characteristic curve for the accuracy of SW-EG for diagnosis of pancreatic fibrosis were 0.85 (≥mild), 0.84 (≥moderate), and 0.87 (severe). CONCLUSION SW-EG can be used to determine the stage of pancreatic fibrosis non-invasively with high accuracy and reproducibility.
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Affiliation(s)
- Takamichi Kuwahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Sugimoto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daijuro Hayashi
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomasa Morishima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Manabu Kawai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Suhara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoaki Takeyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Kohei Funasaka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Watanabe
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshie Shimoyama
- Department of Pathology and Molecular Diagnostics, Nagoya University Hospital, Nagoya, Japan
| | - Shigeo Nakamura
- Department of Pathology and Molecular Diagnostics, Nagoya University Hospital, Nagoya, Japan
| | - Senju Hashimoto
- Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, Toyoake, Japan
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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