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Thierens NDE, Verdonk RC, Löhr JM, van Santvoort HC, Bouwense SA, van Hooft JE. Chronic pancreatitis. Lancet 2025; 404:2605-2618. [PMID: 39647500 DOI: 10.1016/s0140-6736(24)02187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 09/20/2024] [Accepted: 10/01/2024] [Indexed: 12/10/2024]
Abstract
Chronic pancreatitis is a progressive fibroinflammatory disease primarily caused by a complex interplay of environmental and genetic risk factors. It might result in pancreatic exocrine and endocrine insufficiency, chronic pain, reduced quality of life, and increased mortality. The diagnosis is based on the presence of typical symptoms and multiple morphological manifestations of the pancreas, including pancreatic duct stones and strictures, parenchymal calcifications, and pseudocysts. Management of chronic pancreatitis consists of prevention and treatment of complications, requiring a multidisciplinary approach focusing on lifestyle modifications, exocrine insufficiency, nutritional status, bone health, endocrine insufficiency, pain management, and psychological care. To optimise clinical outcomes, screening for complications and evaluation of treatment efficacy are indicated in all patients with chronic pancreatitis.
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Affiliation(s)
- Naomi DE Thierens
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Research and Development, St Antonius Hospital, Nieuwegein, Netherlands.
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - J Matthias Löhr
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Stefan Aw Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
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Huang L, Xiao M, Huang X, Wu J, Luo J, Li F, Gu W. Analysis of clinical characteristics of hemorrhagic fever with renal syndrome with acute pancreatitis: a retrospective study. Ann Med 2025; 57:2453081. [PMID: 39829396 PMCID: PMC11748856 DOI: 10.1080/07853890.2025.2453081] [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: 10/22/2024] [Revised: 12/13/2024] [Accepted: 01/02/2025] [Indexed: 01/22/2025] Open
Abstract
OBJECTIVE This research aimed to analyze the impact of hemorrhagic fever with renal syndrome (HFRS) with acute pancreatitis (AP) on the severity and prognosis of patients, screen the risk factors of HFRS with AP, and establish a nomogram model. METHODS Data were collected from HFRS patients at the First Affiliated Hospital of Dali University and Dali Prefecture People's Hospital (2013-2023). Patients were divided into HFRS with AP (n = 34) and HFRS without AP groups (n = 356). Propensity Score Matching (PSM) and logistic regression analyzed the impact of AP on HFRS severity and short-term prognosis. LASSO-Logistic regression was used to screen risk factors and develop a nomogram model. RESULTS After PSM, HFRS patients with AP had higher rates of Continuous Renal Replacement Therapy (CRRT) and/or mechanical ventilation use, , ICU admission, and 30-day mortalitycompared with those without AP (p < 0.05). Further analysis revealed that smoking (OR: 3.702), ferritin (OR: 1.002), white blood cell (OR), fibrinogen (OR: 0.463), and platelet (OR: 0.987) were risk factors for HFRS with AP (p < 0.05). A nomogram model was constructed based on these factors, to predict the risk of HFRS with AP, with an Area Under the Curve (AUC) of 0.90 (95% CI: 0.84-0.95). Additionally, the model calibration curve fit well according to the Hosmer-Lemeshow test (χ2=8.51, p = 0.39). CONCLUSION Patients with HFRS with AP exhibit higher disease severity and poorer prognosis. Smoking, elevated ferritin and white blood cell levels, decreased fibrinogen and platelet levels are more susceptible to developing AP.
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Affiliation(s)
- Lihua Huang
- Department of Infection Disease, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Min Xiao
- Department of Clinical Laboratory, Sichuan Provincial People’s Hospital East Sichuan Hospital & DaZhou First People’s Hospital, Dazhou, Sichuan, China
| | - Xiaoling Huang
- Department of Respiratory Medicine, Sichuan Provincial People’s Hospital East Sichuan Hospital & Dazhou First People’s Hospital, Dazhou, Sichuan, China
| | - Jun Wu
- Department of Ophthalmology, Dali Prefecture People’s Hospital, Dali, Yunnan, China
| | - Jiao Luo
- Department of Infection Disease, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Fuxing Li
- Jiangxi Province Key Laboratory of Immunology and Inflammation, Jiangxi Provincial Clinical Research Center for Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Wei Gu
- Department of Infection Disease, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
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Tartari C, Porões F, Schmidt S, Abler D, Vetterli T, Depeursinge A, Dromain C, Violi NV, Jreige M. MRI and CT radiomics for the diagnosis of acute pancreatitis. Eur J Radiol Open 2025; 14:100636. [PMID: 39967811 PMCID: PMC11833635 DOI: 10.1016/j.ejro.2025.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 01/17/2025] [Accepted: 01/22/2025] [Indexed: 02/20/2025] Open
Abstract
Purpose To evaluate the single and combined diagnostic performances of CT and MRI radiomics for diagnosis of acute pancreatitis (AP). Materials and methods We prospectively enrolled 78 patients (mean age 55.7 ± 17 years, 48.7 % male) diagnosed with AP between 2020 and 2022. Patients underwent contrast-enhanced CT (CECT) within 48-72 h of symptoms and MRI ≤ 24 h after CECT. The entire pancreas was manually segmented tridimensionally by two operators on portal venous phase (PVP) CECT images, T2-weighted imaging (WI) MR sequence and non-enhanced and PVP T1-WI MR sequences. A matched control group (n = 77) with normal pancreas was used. Dataset was randomly split into training and test, and various machine learning algorithms were compared. Receiver operating curve analysis was performed. Results The T2WI model exhibited significantly better diagnostic performance than CECT and non-enhanced and venous T1WI, with sensitivity, specificity and AUC of 73.3 % (95 % CI: 71.5-74.7), 80.1 % (78.2-83.2), and 0.834 (0.819-0.844) for T2WI (p = 0.001), 74.4 % (71.5-76.4), 58.7 % (56.3-61.1), and 0.654 (0.630-0.677) for non-enhanced T1WI, 62.1 % (60.1-64.2), 78.7 % (77.1-81), and 0.787 (0.771-0.810) for venous T1WI, and 66.4 % (64.8-50.9), 48.4 % (46-50.9), and 0.610 (0.586-0.626) for CECT, respectively.The combination of T2WI with CECT enhanced diagnostic performance compared to T2WI, achieving sensitivity, specificity and AUC of 81.4 % (80-80.3), 78.1 % (75.9-80.2), and 0.911 (0.902-0.920) (p = 0.001). Conclusion The MRI radiomics outperformed the CT radiomics model to detect diagnosis of AP and the combination of MRI with CECT showed better performance than single models. The translation of radiomics into clinical practice may improve detection of AP, particularly MRI radiomics.
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Affiliation(s)
- Caterina Tartari
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fabio Porões
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniel Abler
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Vetterli
- Institute of Informatics, School of Management, HES-SO Valais-Wallis University of Applied Sciences and Arts Western Switzerland, Sierre, Switzerland
| | - Adrien Depeursinge
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Clarisse Dromain
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Naïk Vietti Violi
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Zhao M, Cui M, Fan M, Huang C, Wang J, Zeng Y, Wang X, Lu Y. Octreotide attenuates experimental severe acute pancreatitis through inhibiting pyroptosis and modulating intestinal homeostasis. Eur J Pharmacol 2025; 994:177314. [PMID: 39922420 DOI: 10.1016/j.ejphar.2025.177314] [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: 10/13/2024] [Revised: 01/23/2025] [Accepted: 01/24/2025] [Indexed: 02/10/2025]
Abstract
Severe acute pancreatitis (SAP) is a common clinical condition characterized by acute abdominal symptoms. Octreotide (OCT) is a commonly prescribed treatment for acute pancreatitis (AP). Recent research shows that pyroptosis and intestinal homeostasis significantly contribute to the progression of AP. However, it remains unclear whether OCT treats SAP through modulating pyroptosis and intestinal microbiota. Our study aimed to investigate and validate the potential therapeutic effects of OCT on SAP and underlying mechanisms. The inhibition of pyroptosis in mice using disulfiram was investigated to elucidate the role of pyroptosis in AP. Molecular biology experiments confirmed that OCT effectively inhibited the expression of pyroptosis-related markers. Additionally, the composition, abundance, and functionality of the intestinal microbiota were analyzed using 16S rRNA sequencing, while short-chain fatty acids (SCFAs) were quantified by targeted metabolomics. Our study demonstrated that the administration of OCT significantly mitigated the severity of SAP in a dose-dependent manner. Furthermore, the inhibition of pyroptosis in mice attenuated SAP, thereby highlighting the critical role of pyroptosis in this condition. OCT administration was observed to suppress the expression of key pyroptosis markers. Additionally, there was a notable reduction in intestinal permeability and bacterial translocation. OCT reverses gut dysbiosis caused by SAP, increasing beneficial bacteria while inhibiting pathogenic strains. Furthermore, OCT administration enhanced the levels of SCFAs, including propanoic acid, acetic acid, and butyric acid. Our findings indicate OCT has the potential to alleviate SAP by suppressing pyroptosis and restoring intestinal homeostasis.
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Affiliation(s)
- Mengqi Zhao
- Shanghai Key Laboratory of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China; Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China
| | - Mengyan Cui
- Shanghai Key Laboratory of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China; Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China
| | - Miaoyan Fan
- Shanghai Key Laboratory of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China; Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China
| | - Chunlan Huang
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China
| | - Jingjing Wang
- Shanghai Key Laboratory of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China
| | - Yue Zeng
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China
| | - Xingpeng Wang
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China.
| | - Yingying Lu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China.
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Chen Z, Zheng R, Jiang H, Zhang X, Peng M, Jiang T, Zhang X, Shang H. Therapeutic efficacy of Xuebijing injection in treating severe acute pancreatitis and its mechanisms of action: A comprehensive survey. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2025; 140:156629. [PMID: 40101453 DOI: 10.1016/j.phymed.2025.156629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 02/25/2025] [Accepted: 03/06/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Severe acute pancreatitis (SAP) is a life-threatening condition associated with high mortality and limited therapeutic options. Current management strategies focus on infection prevention, immune regulation, and anticoagulation. Xuebijing Injection (XBJ), a widely used traditional Chinese medicine-derived intravenous preparation, has shown promising therapeutic effects in SAP. Herein, we sought to evaluate clinical and preclinical evidence on XBJ to reveal its potential mechanisms of action, and provide insights to guide future research and clinical applications. METHODS We conducted a comprehensive survey of studies on XBJ in the treatment of SAP across PubMed, Embase, Cochrane Library, CBM, CNKI, Wanfang and VIP databases from their inception to March 21st, 2024. RESULTS A total of 239 studies were included, comprising 12 animal experiments, 7 systematic reviews, 220 clinical trials. Mechanistic studies suggest that XBJ downregulates the expression of inflammatory mediators, improves immune function, and alleviates oxidative stress via multiple signaling pathways, including the TLR4/NF-κB, p38-MAPK, HMGB1/TLR, TLR4/NF-κB, FPR1/NLRP3, and JAK/STAT pathways. These effects contribute to reducing organ damage. Compared to standard treatment, XBJ has more effective at reducing mortality and complications, improving overall clinical outcomes, shortening ventilator use time, and hospital stay in SAP patients. CONCLUSIONS Preclinical evidence and clinical trial data indicated that XBJ can simultaneously regulate inflammatory responses, immune function, microcirculatory disorders, oxidative stress, and apoptosis. However, further research is required to elucidate the specific mechanisms of action, clinical characteristics and safety of XBJ.
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Affiliation(s)
- Zhuo Chen
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Haiyuncang Lane, Dongcheng District, Beijing 100700, China
| | - Rui Zheng
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Haiyuncang Lane, Dongcheng District, Beijing 100700, China; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton L8N 1Y3, Canada.
| | - Huiru Jiang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Haiyuncang Lane, Dongcheng District, Beijing 100700, China
| | - Xinyi Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Haiyuncang Lane, Dongcheng District, Beijing 100700, China
| | - Mengqi Peng
- Shandong Second Medical University, Weifang 261053, China
| | - Tong Jiang
- Binzhou medical university, YanTai 264000, China
| | - Xiaowei Zhang
- Hunan University of Chinese Medicine, Changsha 410208, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Haiyuncang Lane, Dongcheng District, Beijing 100700, China; Dong-Fang Hospital of Beijing University of Chinese Medicine, No. 6 The First District of Fang-Xing-Yuan, Fengtai District, Beijing100078, China.
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Qian LJ, Xu C, Wang JR, Quan J. Efficacy of modified pancreatic duct stent drainage during endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastrointest Surg 2025; 17:101295. [DOI: 10.4240/wjgs.v17.i4.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 01/18/2025] [Accepted: 02/11/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated. However, there is still no optimal treatment approach.
AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography (ERCP) for treating common bile duct stones.
METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1, 2021, and November 30, 2023. The patients were divided into three groups-the modified pancreatic duct stent drainage group (59 cases), the nasobiliary drainage group (58 cases), and the standard biliary drainage group (58 cases). Preoperative general clinical data, laboratory indicators, and the visual analog scale (VAS) at two time points (24 hours before and after surgery) were compared, along with postoperative complications across the three groups.
RESULTS Serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyltransferase, total bilirubin, direct bilirubin, C-reactive protein, and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group (P < 0.05). However, no statistically significant differences were observed in white blood cells, hemoglobin, or neutrophil levels among the three groups (P > 0.05). The standard biliary drainage group had significantly lower VAS scores [(4.36 ± 1.18) points] than those for the modified pancreatic duct stent drainage group [(4.92 ± 1.68) points] (P = 0.033), and the nasobiliary drainage group [(5.54 ± 1.24) points] (P = 0.017). There were no statistically significant differences in complication rates across the three groups (P > 0.05).
CONCLUSION Compared to standard biliary drainage and nasobiliary drainage, the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury, improved liver function parameters, alleviated inflammation and pain, enhanced patient comfort, and demonstrated superior safety.
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Affiliation(s)
- Li-Jia Qian
- Department of Digestive Internal, Taizhou Fourth People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Chen Xu
- Department of Digestive Internal, Taizhou Fourth People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Jian-Rong Wang
- Department of Digestive Internal, Taizhou Fourth People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Jun Quan
- Department of Digestive Internal, Taizhou Fourth People's Hospital, Taizhou 225300, Jiangsu Province, China
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Li J, Zhang QY, Zhang MH, Jiang SY. Maternal and fetal death associated with acute pancreatitis during pregnancy: A case report. World J Clin Cases 2025; 13:102011. [DOI: 10.12998/wjcc.v13.i10.102011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 11/10/2024] [Accepted: 12/03/2024] [Indexed: 12/19/2024] Open
Abstract
BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss. Instances of pregnancy complicated by severe acute pancreatitis, particularly with subsequent respiratory and cardiac arrest, are rarely reported.
CASE SUMMARY We present the case of a 35-year-old woman, at 36 + 5 weeks of gestation, who presented with paroxysmal epigastric pain accompanied by low back pain, nausea, and vomiting. According to the clinical symptoms, B-ultrasound imaging and biochemical indicators, the patient was diagnosed with acute pancreatitis and initially managed conservatively. However, 3 hours after admission, the patient experienced respiratory and cardiac arrest, and the fetus died. In this case, the adverse outcomes occurred due to the lack of aggressive fluid resuscitation and an active surgical intervention.
CONCLUSION Implementing aggressive fluid resuscitation to sustain tissue perfusion, alongside the proactive evaluation of pharmacological agents that suppress gastric acid secretion and inhibit pancreatic enzyme activity, may be beneficial in mitigating the risk of a severely adverse prognosis. Effective management of acute pancreatitis during pregnancy requires careful timing of surgical intervention, a thorough evaluation of the risks and benefits regarding the continuation or termination of pregnancy, and a focus on safeguarding both maternal and fetal health.
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Affiliation(s)
- Jin Li
- Department of Anesthesiology, Kaihua County People’s Hospital, Quzhou 324300, Zhejiang Province, China
| | - Qing-Yan Zhang
- Department of Anesthesiology, Kaihua County People’s Hospital, Quzhou 324300, Zhejiang Province, China
| | - Mei-Hong Zhang
- Department of Anesthesiology, Kaihua County People’s Hospital, Quzhou 324300, Zhejiang Province, China
| | - Shan-Yun Jiang
- Center for Clinical Inspection and Quarantine, Kaihua County Center for Clinical Inspection and Quarantine, Quzhou 324300, Zhejiang Province, China
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Poddar U, Samanta A, Mohindra S, Upadhyaya VD, Kumar B, Srivastava A, Sen Sarma M, Yachha SK. Endoscopic retrograde cholangiopancreatography and endoscopic cystogastrostomy in very young children (aged <5 years): Feasibility, success, and safety. DEN OPEN 2025; 5:e70085. [PMID: 39995473 PMCID: PMC11847981 DOI: 10.1002/deo2.70085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/23/2025] [Accepted: 02/06/2025] [Indexed: 02/26/2025]
Abstract
Objectives Paucity of data and concerns about potential lower effectiveness and more adverse events limit the use of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic cystogastrostomy in younger children even in high-volume centers. We retrospectively analyzed indications, success rates, and adverse events of all the children (<18 years) who underwent ERCP and endoscopic cystogastrostomy between January 2010 to May 2024 at our center. Methods Data, including patient demographics, indications for the procedure, technical details, and adverse events, were collected from our prospectively kept database and compared according to age groups (<1 year, 1-5 years, 5-10 years, and 10-18 years). Results A total of 286 ERCP (273 therapeutic and 13 diagnostic) and 57 endoscopic cystogastrostomy were performed in 222 (138 boys) and 55 children (32 boys), respectively, during the study period with 20% ERCP procedures in under-five children. In children <5 years, the majority of the ERCPs were for biliary diseases (87%), while pancreatic duct procedures (39.5%) were done in higher numbers in children >5 years. For biliary ERCP, choledochal cyst (15, 33%) was the most common etiology in under-five children and choledocholithiasis (60, 34%) in children >5 years. Cannulation and technical success rates were 95% and 92%, respectively with no significant difference across age groups. Adverse events were noted in 36 (16%) with post-ERCP pancreatitis (8%) being the most common. All adverse events were managed conservatively with no mortality. Conclusion ERCP can safely be performed in all children, including those under five with various hepato-pancreato-biliary diseases with high technical success rates.
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Affiliation(s)
- Ujjal Poddar
- Department of Pediatric GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
| | - Arghya Samanta
- Department of Pediatric GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
| | - Samir Mohindra
- Department of GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
| | - Vijay Datta Upadhyaya
- Department of Pediatric Surgical SuperspecialtiesSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
| | - Basant Kumar
- Department of Pediatric Surgical SuperspecialtiesSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
| | - Anshu Srivastava
- Department of Pediatric GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
| | - Moinak Sen Sarma
- Department of Pediatric GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
| | - Surender Kumar Yachha
- Department of Pediatric GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
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Erdal BDY, Erdal H. Evaluation of retinal structural and microvascular changes in patients with acute pancreatitis. Photodiagnosis Photodyn Ther 2025; 52:104522. [PMID: 39961459 DOI: 10.1016/j.pdpdt.2025.104522] [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: 01/19/2025] [Revised: 02/10/2025] [Accepted: 02/14/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND This study aimed to show the changes in retinal vascular densities and thicknesses in the peripapillary and macular regions in the acute period in patients with acute pancreatitis (AP). METHODS This prospective cross-sectional study included 57 eyes of 30 patients with AP and 58 eyes of 30 healthy people. Optical coherence tomography angiography (OCTA) was taken within 24-72 h of AP patients' hospitalization. OCTA was used to evaluate the retinal microvascular structure and retinal thickness. RESULTS Peripapillary retinal nerve fiber layer (pp-RNFL) and perifoveolar ganglion cell complex (pef-GCC) thickness in patients with AP were significantly higher than in the healthy control group (p = 0.020 and p = 0.039, respectively). While whole image vessel density (wiVD) and perifoveal vessel density (pefVD) were significantly lower in the deep capillary plexus (DCP), choriocapillaris flow area (CCFA) in the macula were significantly lower in each of the 1 mm and 3 mm radius areas in patients with AP (p = 0.014, p = 0.011; p = 0.011, and p = 0.035 respectively). In the univariable and multivariable linear regression analysis, it was observed that serum lipase and procalcitonin levels affected the thickness of pp-RNFL and pef-GCC (for pp-RNFL, β= 0.001, p = 0.002, β=24.992, p < 0.001, and for pef-GCC, β= 0.001 p = 0.014, β=17.107 p < 0.001 respectively). CONCLUSIONS There are significant microvascular and structural changes in the optic nerve and macula in patients with AP. The relationship between these changes and serum lipase and procalcitonin levels was shown. Clinicians should consider ocular involvement in AP patients with high serum lipase and procalcitonin levels.
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Affiliation(s)
| | - Harun Erdal
- Department of Gastroenterology, Ankara Etlik City Hospital, Ankara, Turkey.
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Hawatian K, Sidani M, Hagerman T, Condon S, Chien C, Miller J. Contemporary Approach to Acute Pancreatitis in Emergency Medicine. J Am Coll Emerg Physicians Open 2025; 6:100063. [PMID: 40051813 PMCID: PMC11883301 DOI: 10.1016/j.acepjo.2025.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 12/18/2024] [Accepted: 12/30/2024] [Indexed: 03/09/2025] Open
Abstract
Acute pancreatitis is a commonly encountered pathology in the emergency department. We presented a clinical review summarizing the contemporary emergency medicine approach to managing acute pancreatitis. Although the diagnostic criteria for acute pancreatitis are straightforward, it has many possible causes, several treatment options, and both short- and long-term sequelae. We discussed diagnostic, intervention, and disposition considerations relevant to emergency clinicians and considered risk assessment using available clinical decision tools. We also discussed changes to traditional treatments and ongoing investigational therapies, including steroids, monoclonal antibodies, and calcium release-activated calcium channel inhibitors.
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Affiliation(s)
- Kegham Hawatian
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
| | - Munir Sidani
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Thomas Hagerman
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
| | - Shaun Condon
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
| | - Christine Chien
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
| | - Joseph Miller
- Department of Emergency Medicine, Henry Ford Hospital, Henry Ford Health and Michigan State University Health Sciences, Detroit, Michigan, USA
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Tang BJ, Li SJ, Wang PF, Xiang CH, Zeng JP, Shi J, Dong JH, Wang XD. Predictive value of postoperative serum lipase level for postoperative pancreatic fistula after pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int 2025; 24:197-205. [PMID: 39920036 DOI: 10.1016/j.hbpd.2025.01.002] [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: 04/02/2024] [Accepted: 01/14/2025] [Indexed: 02/09/2025]
Abstract
BACKGROUND The prediction of postoperative pancreatic fistula (POPF) is important. This study aimed to investigate the role of postoperative serum lipase level in predicting POPF. METHODS Data from 234 consecutive patients who underwent pancreaticoduodenectomy (PD) were collected. The predictive values of serum amylase and serum lipase during postoperative days (PODs) 1 to 3 for POPF were compared. Subgroup analyses were performed to determine the prognostic value of different levels and durations of elevated serum lipase. RESULTS Fifty-six patients developed POPF. The POPF group exhibited increased levels of serum amylase and lipase from PODs 1 to 3 (all P < 0.001). Compared with serum amylase, serum lipase has greater predictive value for POPF. Specifically, serum lipase had the highest area under the receiver operating characteristic curve (AUC) at POD 1 (0.791). Body mass index > 24 kg/m2 [odds ratio (OR) = 2.431, 95% confidence interval (CI): 1.094-5.404, P = 0.029], soft pancreatic texture (OR = 3.189, 95% CI: 1.263-8.056, P = 0.014), serum lipase > 60 U/L at POD 1 (OR = 5.135, 95% CI: 1.257-20.982, P = 0.023), and C-reactive protein > 167 mg/dL at POD 3 (OR = 3.607, 95% CI: 1.431-9.090, P = 0.007) were identified as independent risk factors for POPF. Patients with serum lipase ≤ 60 U/L at POD 1 (n = 104) exhibited lower rates of POPF (3.8% vs. 40.0%, P < 0.001) and severe complications (Clavien-Dindo ≥ IIIa) (4.8% vs. 25.4%, P < 0.001) than those with serum lipase > 60 U/L at POD 1. Moreover, no additional elevation or duration of serum lipase offered any further prognostic value. CONCLUSIONS Postoperative serum lipase outperformed serum amylase in the prediction of POPF, and patients with normal serum lipase level at POD 1 had favorable outcomes. A sustained increase in the serum lipase level offers no additional prognostic value.
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Affiliation(s)
- Bing-Jun Tang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Si-Jia Li
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Peng-Fei Wang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Can-Hong Xiang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Jian-Ping Zeng
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Jun Shi
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Jia-Hong Dong
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China; Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua University, Beijing 102218, China; Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences, Beijing 102218, China
| | - Xue-Dong Wang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China; Key Laboratory of Digital Intelligence Hepatology (Ministry of Education), School of Clinical Medicine, Tsinghua University, Beijing 102218, China; Research Unit of Precision Hepatobiliary Surgery Paradigm, Chinese Academy of Medical Sciences, Beijing 102218, China.
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12
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Wu W, Li Y, Zhang Y, Chen X, Zhang C, Qu X, Zhang Z, Zhang R, Peng Z. Atherogenic index of plasma as a novel predictor for acute kidney injury and disease severity in acute pancreatitis: a retrospective cohort study. Lipids Health Dis 2025; 24:111. [PMID: 40133966 PMCID: PMC11934589 DOI: 10.1186/s12944-025-02520-x] [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: 01/07/2025] [Accepted: 03/10/2025] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND The atherogenic index of plasma (AIP) can be used to reveal atherosclerosis. This study evaluated the AIP's efficacy in predicting the prognosis of acute kidney injury (AKI) and severity of acute pancreatitis (AP). METHODS This retrospective cohort study recruited AP cases from the First College of Clinical Medical Science of China Three Gorges University between January 2019 and October 2023, including 1470 patients. AIP was computed using the formula: log10 [serum triglyceride (mmol/L)/serum high-density lipoprotein cholesterol (mmol/L)]. The AIP relationships with AKI occurrence and AP severity were validated using multivariable logistic regression models, subgroup and sensitivity analyses, and curve fitting. RESULTS Among the 1470 patients with AP, 250 (17%) developed AKI and 166 (11.3%) with severe AP. AIP was positively correlated with AKI and the severity of AP. Potential confounders were adjusted, consequently, AIP was positively linearly related to AKI (P for non-linearity: 0.731, OR 2.5, 95% CI 1.31-4.77,) and the severity of AP (P for non-linearity: 0.145, OR 3.1, 95% CI 1.53-6.27), respectively. The strength of the association between AIP and AKI, along with the severity of AP, was demonstrated through stratified analyses. Significant interactions were not observed in sex, age, hypertension, BMI, diabetes mellitus, SOFA score, BISAP score, and etiology of AP (all P for interaction > 0.05). The areas under the curves for AIP in predicting the incidence of AKI and severity of AP were 0.64 and 0.65, respectively. CONCLUSIONS This is the first study to suggest that the AIP is critical for the assessment of AKI risk, recommending early screening of severity among AP cases. Due to the observational nature of the study, the potential for residual confounding, and the need for external validation in larger, independent cohorts.
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Affiliation(s)
- Wen Wu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, Hubei, China
- Department of Emergency and Critical Care Medicine, Yichang Central People's Hospital, The First College of Clinical Medical Science of China Three Gorges University, Yichang, 443003, Hubei, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China
| | - Yiming Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, Hubei, China
| | - Yupei Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People's Hospital, The First College of Clinical Medical Science of China Three Gorges University, Yichang, 443003, Hubei, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China
| | - Xing Chen
- Department of Emergency and Critical Care Medicine, Yichang Central People's Hospital, The First College of Clinical Medical Science of China Three Gorges University, Yichang, 443003, Hubei, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China
| | - Chunzhen Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People's Hospital, The First College of Clinical Medical Science of China Three Gorges University, Yichang, 443003, Hubei, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China
| | - Xingguang Qu
- Department of Emergency and Critical Care Medicine, Yichang Central People's Hospital, The First College of Clinical Medical Science of China Three Gorges University, Yichang, 443003, Hubei, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China
| | - Zhaohui Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People's Hospital, The First College of Clinical Medical Science of China Three Gorges University, Yichang, 443003, Hubei, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China
| | - Rong Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People's Hospital, The First College of Clinical Medical Science of China Three Gorges University, Yichang, 443003, Hubei, China.
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China.
| | - Zhiyong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan430071, Hubei, China.
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, Hubei, China.
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13
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Syed-Abdul MM, Tian L, Hegele RA, Lewis GF. Futility of plasmapheresis, insulin in normoglycaemic individuals, or heparin in the treatment of hypertriglyceridaemia-induced acute pancreatitis. Lancet Diabetes Endocrinol 2025:S2213-8587(25)00028-2. [PMID: 40147461 DOI: 10.1016/s2213-8587(25)00028-2] [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] [Received: 11/25/2024] [Revised: 01/29/2025] [Accepted: 01/29/2025] [Indexed: 03/29/2025]
Abstract
There is a well-established link between the severity of hypertriglyceridaemia and acute pancreatitis and long-term triglyceride-lowering therapies known to prevent episodes of acute pancreatitis. Therefore, it has been assumed, without firm evidence, that rapid lowering of plasma triglycerides would be an effective strategy for reducing the clinical severity of acute pancreatitis and improving health outcomes. Therapies, such as intravenous heparin, intravenous insulin in normoglycaemic individuals (with glucose to prevent hypoglycaemia), and plasmapheresis, continue to be widely used as therapeutic interventions to rapidly reduce serum triglyceride concentration. These therapies are all associated with a risk of adverse reactions, require increased resources, and increase health-care costs. Randomised controlled clinical trials of these therapies have generally shown more rapid reductions in plasma triglycerides than conventional supportive care with the patient made nil by mouth. However, these three therapies alone or in combination, have failed to show effectiveness in improving substantial health benefit outcome measures. While we recognise the theoretical basis for rapidly reducing plasma triglycerides in hypertriglyceridaemia-induced pancreatitis-based on our review of studies using heparin, insulin, plasmapheresis, or a combination of these-these strategies overall do not reduce complications associated with acute pancreatitis or the rapidity of disease resolution. Therefore, we do not advocate the use of triglyceride-lowering therapies at this time, pending more convincing evidence.
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Affiliation(s)
- Majid M Syed-Abdul
- Departments of Medicine and Physiology and Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Lili Tian
- Departments of Medicine and Physiology and Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Gary F Lewis
- Departments of Medicine and Physiology and Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada.
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14
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Tan P, Lu S, Chen Q, Ma H, Kong W, Huang X, Yu C, Jin M. LESS IS MORE: classified management of hypertriglyceridemia-induced acute pancreatitis on the basis of a propensity score matching cohort study. Lipids Health Dis 2025; 24:108. [PMID: 40119347 PMCID: PMC11929198 DOI: 10.1186/s12944-025-02511-y] [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: 12/23/2024] [Accepted: 02/28/2025] [Indexed: 03/24/2025] Open
Abstract
BACKGROUND Effective management of hypertriglyceridemia is crucial in the treatment of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). The prognosis of HTG-AP may vary with different serum triglyceride levels, suggesting the need for stratified treatment approaches. In this study, we investigated hypertriglyceridemia management in HTG-AP patients and the optimal strategy. METHODS Patients with HTG-AP from October 2020 to October 2022 were included in the study. Propensity score matching was used to balance the bias and confounding variables. A mixed-effects model was used to analyse the decreasing tendency of triglycerides. RESULTS A total of 171 patients who were diagnosed with HTG-AP were enrolled in this cohort. Patients with very severe serum triglycerides (> 22.6mmol/L) had a higher proportion of severe acute pancreatitis (p < 0.05) than patients with severe hypertriglyceridemia (11.3-22.6 mmol/L). For the very severe hypertriglyceridemia group, no significant differences in prognosis were noted between the insulin and heparin group and the plasma exchange group. The cost of the insulin and heparin group was significantly lower than that of the plasma exchange group (p < 0.01). In patients with severe hypertriglyceridemia, no significant differences in prognosis were noted between the nothing-by-mouth (NPO) group and the insulin and heparin group. Compared with the insulin and heparin group, the NPO group had lower hospital costs (p < 0.05). CONCLUSION HTG-AP patients with very severe hypertriglyceridemia may be treated safely and effectively with insulin and heparin, potentially offering a more cost-effective treatment approach. Similarly, patients with severe hypertriglyceridemia might benefit from treatment involving NPO, which may be associated with lower costs. Further studies are needed to validate these findings in diverse populations and through long-term follow-up.
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Affiliation(s)
- Pan Tan
- Department of Gastroenterology, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Shasha Lu
- Department of Gastroenterology, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Qingxia Chen
- Department of Gastroenterology, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Huijian Ma
- Department of Gastroenterology, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Wei Kong
- Department of Emergency, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Xiawei Huang
- Department of Gastroenterology, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Chaohui Yu
- Department of Gastroenterology, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China.
| | - Meng Jin
- Department of Gastroenterology, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China.
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15
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Chen WJ, Su QY, Zhong M, Zheng YJ, Wang XF, Qu HP, Mao EQ, Yang ZT, Chen EZ, Chen Y. Establishment and validation of a prediction model for acute kidney injury in moderate severe and severe acute pancreatitis patients. Eur J Med Res 2025; 30:187. [PMID: 40108645 PMCID: PMC11924734 DOI: 10.1186/s40001-025-02394-w] [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: 12/11/2024] [Accepted: 02/18/2025] [Indexed: 03/22/2025] Open
Abstract
PURPOSE This study aimed to develop a nomogram for predicting acute kidney injury (AKI) in patients with moderate severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). METHODS This study enrolled a total of 1,077 patients with MSAP and SAP, categorizing them into three groups: training (n = 646), internal validation (n = 278), and external validation (n = 153). In the training cohort, logistic regression analysis identified independent predictors of AKI in patients with MSAP and SAP. A nomogram was developed based on these independent predictors. The model's performance was assessed using the receiver operating characteristics (ROC) curve, precision-recall (PR) curve, calibration curve, and decision curve analysis (DCA). RESULTS The incidence rates of AKI in the training set, internal validation set, and external validation set were 32.82%, 32.01%, and 27.45%, respectively. Independent predictors of AKI in patients with MSAP and SAP included: shock index (odds ratio [OR] = 7.42, 95% confidence interval [CI] 2.18-25.19), blood urea nitrogen (OR = 1.32, 95% CI 1.22-1.43), uric acid (OR = 1.002, 95% CI 1.000-1.003), serum calcium (OR = 0.38, 95% CI 0.18-0.79), triglycerides (OR = 1.02, 95% CI 1.004-1.041), hematocrit > 0.5 (OR = 3.24, 95% CI 1.10-9.59), serum sodium < 135 mmol/L (OR = 2.01, 95% CI 1.15-3.49), creatine kinase isoenzyme > 4 ng/mL (OR = 2.61, 95% CI 1.48-4.61), and thrombin time < 14 s (OR = 2.83, 95% CI 1.28-6.27). In the training, internal validation, and external validation sets, the areas under the ROC curves for the nomogram were 0.841, 0.789, and 0.853, respectively. Similarly, the areas under the PR curves were 0.807, 0.733, and 0.770. The calibration curves demonstrated that the predicted outcomes were well-aligned with the actual results. The decision curve analysis (DCA) indicated that the model had satisfactory clinical applicability. CONCLUSIONS Nine indicators have been identified as independent predictors of AKI in patients with MSAP and SAP. The developed nomogram exhibits robust predictive capability and shows promise for clinical application.
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Affiliation(s)
- Wen-Jie Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2# Road No. 197, Shanghai, 200025, China
| | - Qin-Yue Su
- Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2# Road No. 197, Shanghai, 200025, China
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Ming Zhong
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan-Jun Zheng
- Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2# Road No. 197, Shanghai, 200025, China
| | - Xiao-Feng Wang
- Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2# Road No. 197, Shanghai, 200025, China
| | - Hong-Ping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - En-Qiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2# Road No. 197, Shanghai, 200025, China
| | - Zhi-Tao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2# Road No. 197, Shanghai, 200025, China
| | - Er-Zhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2# Road No. 197, Shanghai, 200025, China.
- Shanghai Institute of Aviation Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2# Road No. 197, Shanghai, 200025, China.
- Department of Emergency and Critical Care Medicine, Ruijin Hospital Wuxi Branch, Shanghai Jiao Tong University School of Medicine, Wuxi, China.
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16
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Jeon CY, Ye Y, Papachristou GI, Buxbaum JL, Pisegna JR, Cherpitel CJ, Adeniran EA, Apte M, Chang E, Dasyam AK, Jalluri GD, Lansky CA, Lugea A, Shah ZK, Waldron RT, Pandol SJ, Yadav D. Differential impact of recent heavy drinking on first and recurrent acute pancreatitis. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2025. [PMID: 40108779 DOI: 10.1111/acer.70030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 02/15/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND While alcohol is known to sensitize the pancreas to acute injury, the role of short-term episodic drinking in regular drinkers is unknown. METHODS We conducted a case-crossover study to (1) determine the hazardous period of drinking prior to a first episode of acute pancreatitis (FAP) or recurrent acute pancreatitis (RAP) and (2) evaluate the dose-response association between short-term drinking and FAP/RAP. Patients hospitalized for FAP/RAP with an AUDIT-C score of ≥3 were enrolled. Recent and lifetime drinking history were collected through interviews. Drinking prior to the index pancreatitis attack was compared to that of an asymptomatic control period. Conditional logistic regression quantified the association of heavy drinking and FAP/RAP. RESULTS Of 141 patients who completed a short-term drinking questionnaire, 77 had RAP, and 64 experienced FAP. We found that both FAP and RAP patients drank at moderate-to-heavy levels regularly, with modest day-to-day variation (intraclass correlation of drinks/day 67%-82%). Alcohol consumption increased 2 days preceding the onset of the index pancreatitis attack as compared to the week prior. Stratifying by prior AP history, heavy drinking in the hazard period was associated with RAP (OR = 3.79, 95% confidence interval [CI] 1.57-9.12). Each drink was associated with 1.22-fold (95%CI 1.10-1.35) increased odds of RAP. Short-term heavy drinking was not associated with a FAP (OR = 1.06, 95%CI 0.43-2.57). CONCLUSION In summary, we found that patients with a prior history of AP face a higher risk of RAP due to excess drinking. Drinking intensity did not increase prior to a FAP, which may have been triggered by other cofactors warranting further examination.
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Affiliation(s)
- Christie Y Jeon
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Yu Ye
- Public Health Institute, Alcohol Research Group, Emeryville, California, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James L Buxbaum
- Division of Gastroenterology, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Joseph R Pisegna
- Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Cheryl J Cherpitel
- Public Health Institute, Alcohol Research Group, Emeryville, California, USA
| | - Esther A Adeniran
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Minoti Apte
- Pancreatic Research Group, South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Eleanor Chang
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Anil K Dasyam
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gayathri D Jalluri
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charlotte A Lansky
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Aurelia Lugea
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zarine K Shah
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard T Waldron
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephen J Pandol
- Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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17
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Lv J, Zhou Y, Tao C, Cai Y, Yang H, Xu J, Chen J, Sun R. Association between the triglyceride glucose index and the risk of acute respiratory failure in patients with acute pancreatitis. BMC Gastroenterol 2025; 25:182. [PMID: 40102760 PMCID: PMC11916307 DOI: 10.1186/s12876-025-03771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 03/07/2025] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND The triglyceride glucose (TyG) index serves as a dependable marker for insulin resistance and has shown a significant correlation with the severity of acute pancreatitis (AP). However, no research exists regarding the association between the TyG index and the development of acute respiratory failure (ARF) in AP. This study assesses the association between TyG index and ARF in patients with AP. METHODS Retrospective cohort analysis was conducted with the MIMIC-IV 2.2 critical care data. The endpoint focused on ARF during hospitalization. Statistical analysis encompassed univariate and multivariate logistic regressions, alongside restricted cubic spline (RCS) analysis to explore potential nonlinear associations. Receiver operating characteristic (ROC) curve analysis was employed to identify the optimal TyG index cutoff, leading to the classification of patients into Low TyG and High TyG groups. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were subsequently applied to minimize the influence of confounding factors, thereby further clarifying the relationship between the TyG index and ARF in patients with AP. RESULTS A total of 758 patients were involved in this study, the incidence of ARF was 21.64%. Logistic regression analyses demonstrated a significant association between the TyG index and the incidence of ARF in patients with AP. The RCS model illustrated a nonlinear relationship between a higher TyG index and an increased risk of ARF. The cutoff value of TyG index was 9.099 for ARF in patients with AP based on the ROC curve analysis. Furthermore, following PSM and IPTW, multivariate logistic regression analysis indicated that the High TyG group exhibited a significantly higher risk of ARF compared to the Low TyG group (P < 0.05). CONCLUSIONS The TyG index is associated with ARF risk in AP patients and may aid in early risk assessment.
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Affiliation(s)
- Jiao Lv
- Department of Gastroenterology, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu Province, China
| | - Yuanjun Zhou
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, No. 8 Dian Li Road, Zhenjiang, Jiangsu Province, 212000, China
| | - Changyan Tao
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, No. 8 Dian Li Road, Zhenjiang, Jiangsu Province, 212000, China
| | - Yan Cai
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, No. 8 Dian Li Road, Zhenjiang, Jiangsu Province, 212000, China
| | - Hongfeng Yang
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, No. 8 Dian Li Road, Zhenjiang, Jiangsu Province, 212000, China
| | - Juan Xu
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, No. 8 Dian Li Road, Zhenjiang, Jiangsu Province, 212000, China
| | - Jun Chen
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, No. 8 Dian Li Road, Zhenjiang, Jiangsu Province, 212000, China
| | - Ruxian Sun
- Department of Critical Care Medicine, Zhenjiang First People's Hospital, No. 8 Dian Li Road, Zhenjiang, Jiangsu Province, 212000, China.
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18
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Zhao B, Sun W, Wang Y, Ma L, Gui M, Li J, Yu X, Qi X, Ning N, Sun S, Li M, Yao Y, Ni T, He J, Yang Z, Chen Y, Sheng H, Shen M, Li J, Huang J, Mao E. High-dose intravenous vitamin C reduce C-reactive protein levels, fluid retention, and APACHE II scores in patients with moderately severe acute pancreatitis: a prospective, randomized, double-blinded, placebo-controlled study. Ann Intensive Care 2025; 15:30. [PMID: 40091112 PMCID: PMC11911288 DOI: 10.1186/s13613-025-01437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 01/13/2025] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND The aim of this study was to investigate whether high-dose intravenous vitamin C (HDIVC) could decrease the mortality rate within 28 days among patients moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). METHODS In this randomized, placebo-controlled trial, patients diagnosed with predicted MSAP or SAP within 72 h of symptom onset were enrolled to receive either a vitamin C infusion (200 mg/kg/24 h) or a matched placebo for 7 days. The primary outcome was 28-day mortality. RESULTS 212 adults including 155 MSAP and 57 SAP were enrolled from September 2019 to June 2023. The trial was terminated prematurely due to a lower than expected 28-day mortality rate which showed no difference between the HDIVC and Control group (3/109 vs. 4/103, unadjusted OR: 0.70, 95% CI, 0.15-3.21, p = 0.647). Among patients with MSAP, the HDIVC group exhibited a more pronounced reduction in C-reactive protein levels compared to the Control group (Day0 to Day3, median 72 mg/L vs. 46 mg/L, p = 0.003; Day0 to Day7, median 168 mg/L vs. 121 mg/L, p = 0.013); The volume of fluid retention was lower in the HDIVC group compared to the Control group (Day0-Day1, median 676.5 ml vs. 1130 ml, P = 0.04; Day0-Day2, median 511 ml vs. 1290 ml, P = 0.02; Day0-Day3, median 692 ml vs. 1534 ml, P = 0.04). The APACHE II scores reduction from Day0 to Day7 was significantly greater in the HDIVC group in APACHE II scores (median change of 3 vs. 2, P = 0.01). No significant difference was observed among patients with SAP. CONCLUSION HDIVC did not significantly reduce 28-day mortality in MSAP and SAP patients. While it showed potential benefits in reducing CRP, fluid retention, and APACHE II scores in MSAP patients, these effects may not be directly related to the study drug, and no similar changes were observed in SAP patients. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR1900022022. Registered March 21 2019, https//www.chictr.org.cn/showproj.html?proj=37,106 .
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Affiliation(s)
- Bing Zhao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Wenwu Sun
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
- Department of Emergency Medicine, Daping Hospital, State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University, Chongqing, 400042, China
| | - Yihui Wang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Li Ma
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Menglu Gui
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Jiaoyan Li
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Xianxian Yu
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Xing Qi
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Ning Ning
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Silei Sun
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Mengjiao Li
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Yi Yao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Tongtian Ni
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Juan He
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Zhitao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Huiqiu Sheng
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - Meihua Shen
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, Shanghai, PR China.
- Department of Critical Care Unit, Shanghai Provincial CorpsHospital, Chinese People's Armed Police Forces, Shanghai, PR China.
| | - Jian Li
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China.
| | - Jun Huang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China.
| | - Enqiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China.
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Liu K, Lv T, He L, Tang W, Zhang Y, Xiao X, Li Y, Chang X, Wang S, Pandol SJ, Li L, Han X, Zhu Y. Endocrine-exocrine miR-503-322 drives aging-associated pancreatitis via targeting MKNK1 in acinar cells. Nat Commun 2025; 16:2613. [PMID: 40097383 PMCID: PMC11914046 DOI: 10.1038/s41467-025-57615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 02/23/2025] [Indexed: 03/19/2025] Open
Abstract
Aging is the risk factor for chronic pancreatitis and severity determinant for its acute attack, yet the underlying cause is unclear. Here, we demonstrate that senescent β-cells of endocrine pancreas decide the onset and severity of chronic and acute pancreatitis. During physiological aging, senescent β-cells increase the expression of miR-503-322 which is secreted as small extracellular vesicles to enter exocrine acinar cells, driving a causal and reversible role on aging-associated pancreatitis. Mechanistically, miR-503-322 targets MKNK1 to inhibit acinar-cell secretion leading to autodigestion and repress proliferation causing repair damage of exocrine pancreas. In the elderly population, serum miR-503 concentration is negatively correlated with amylase, prone to chronic pancreatitis due to increased miR-503 and decreased MKNK1 in the elderly pancreas. Our findings highlight the miR-503-322-MKNK1 axis mediating the endocrine-exocrine regulatory pathway specifically in aged mice and humans. Modulating this axis may provide potential preventive and therapeutic strategies for aging-associated pancreatitis.
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Affiliation(s)
- Kerong Liu
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Endocrinology, Affiliated Children's Hospital of Jiangnan University, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Tingting Lv
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lu He
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Tang
- Department of Endocrinology, Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Zhang
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiao Xiao
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yating Li
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoai Chang
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shusen Wang
- Organ Transplant Center, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Stephen J Pandol
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Ling Li
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
| | - Xiao Han
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China.
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Yunxia Zhu
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China.
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20
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Cozma MA, Angelescu C, Haidar A, Mateescu RB, Diaconu CC. Incidence, Risk Factors, and Prevention Strategies for Post-ERCP Pancreatitis in Patients with Biliopancreatic Disorders and Acute Cholangitis: A Study from a Romanian Tertiary Hospital. Biomedicines 2025; 13:727. [PMID: 40149703 DOI: 10.3390/biomedicines13030727] [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: 01/31/2025] [Revised: 03/02/2025] [Accepted: 03/11/2025] [Indexed: 03/29/2025] Open
Abstract
Background/Objectives: Pancreatitis is the most frequent and serious complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence between 2 and 10% and a mortality rate of 1 in 500 patients. Etiopathogenesis remains poorly understood. The aim of this study was to analyze the incidence of post-ERCP pancreatitis (PEP) and to identify potential patient- and procedure-related risk factors (RF) in a cohort of patients from a tertiary referral center in Romania. Methods: We conducted a retrospective, observational, single-center study in which we analyzed ERCP procedures performed in the Gastroenterology Department of Colentina Clinical Hospital, Bucharest, Romania, between January 2019 and September 2024. All patients received intrarectal diclofenac before the ERCP and were hydrated with at least 1500 mL of Ringer's solution after the procedure in the absence of contraindications, according to the latest international recommendations. Results: In total, 2743 ERCPs were performed in the given time period, while 2350 procedures were analyzed in the study. PEP occurred in 350 cases (14.9%). Of these, 191 (54.6%) occurred in males with a mean age of 66.5 years. Procedural RF with adjusted odds ratios (OR) were as follows: difficult cannulation of the common bile duct, OR = 3.734, p < 0.001, main pancreatic duct catheterization, OR = 1.454, p = 0.022, and endoscopic papillary balloon dilatation, with an OR of 3.258, p < 0.001. Pancreatic duct stent placement was shown to prevent PEP in this study group (p < 0.001). Conclusions: PEP remains a serious complication of ERCP, associated with significant morbidity and occasional mortality. While some proven risk factors, such as age, gender, or comorbidities, are unmodifiable, avoiding Wirsung duct cannulation and pancreatography, or prophylactic pancreatic duct stent placement, could play a significant role in PEP prevention.
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Affiliation(s)
- Matei-Alexandru Cozma
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Cristina Angelescu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Andrei Haidar
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Radu Bogdan Mateescu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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21
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Wang Y, Dai GF, Xiao WB, Shi JS, Lin BW, Lin JD, Xiao XJ. Effects of continuous venous-venous hemofiltration with or without hemoperfusion on patients with hypertriglyceride acute pancreatitis. Clin Res Hepatol Gastroenterol 2025; 49:102572. [PMID: 40107658 DOI: 10.1016/j.clinre.2025.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/18/2025] [Accepted: 03/15/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND The role of continuous venous-venous hemofiltration (CVVH) and combined CVVH with hemoperfusion (HP) in patients with acute pancreatitis (AP) is diverse. We hypothesized HP+CVVH, rather than CVVH alone, could have significant benefits in hypertriglyceridemia (HTG)-AP patients. METHODS This single-center retrospective study included 347 patients with hypertriglyceride (HTH) -AP treated from January 2020 to December 2023. We assessed the association of short- and long-term outcomes (including incidence of systemic and local complications, length of ICU and hospital stays, and costs) between the HP+CVVH and CVVH groups. A subgroup analysis was performed to explore the effects of heterogeneity upon the incidence of severe AP (SAP). RESULTS Among 86 included patients, 40 received HP+CVVH therapy, and 46 received CVVH. Subgroup analysis revealed a lower incidence of severe AP after HP+CVVH therapy in patients with high procalcitonin, C-reactive protein, and interleukin-6 levels (46.4 % vs. 80.0 %, p = 0.019; 33.3 % vs. 72.7 %, p = 0.010; 37.5 % vs. 79.2 %, respectively). A significantly decreased hospital length of stay (LOS) in the HP+CVVH group was observed (10.40 [8.63-12.17] vs. 15.48 [13.02-17.94] days, p = 0.001). Furthermore, HP+CVVH showed a tendency towards lower hospital costs than CVVH ($5128 [4312-5943] vs. $8168 [6416-9920], p = 0.001). No significant differences were observed in the incidence of systemic or local complications, recurrence rates, or quality of life. CONCLUSIONS The use of HP+CVVH yielded superior outcomes in terms of the incidence of SAP compared to that of CVVH, for HTG-AP patients with a high inflammatory burden.
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Affiliation(s)
- Ying Wang
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Gao-Fan Dai
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Wen-Biao Xiao
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jing-Shi Shi
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Bing-Wen Lin
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jian-Dong Lin
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
| | - Xiong-Jian Xiao
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
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22
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Saab O, Al-Obaidi H, Algodi M, Algodi A, Rashid Y, Al-Sagban A, Merza N, Abuelazm M, Alzubaidy L, Baig MU, Sharaiha R. Metal versus plastic stents for EUS-guided walled-off necrosis drainage: a systematic review and meta-analysis of randomized controlled trials. Surg Endosc 2025:10.1007/s00464-025-11665-w. [PMID: 40097850 DOI: 10.1007/s00464-025-11665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Accepted: 03/09/2025] [Indexed: 03/19/2025]
Abstract
BACKGROUND & OBJECTIVE The endoscopic step-up approach is the mainstay of walled-off necrosis management (WON). However, using metal stents versus plastic stents during WON drainage is debatable, with limited high-quality evidence. Therefore, we aim to investigate the comparative safety and efficacy of metal versus plastic stents for endoscopic ultrasound (EUS) guided WON drainage. METHODS A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), retrieved by systematically searching PubMed, EMBASE, WOS, SCOPUS, and Cochrane through July 2024. Continuous and dichotomous outcome variables were pooled using mean difference (MD) and risk ratio (RR), with confidence interval (CI) using Stata MP v. 17. We assessed heterogeneity using the chi-square test and I2 statistic. PROSPERO ID CRD42024573859. RESULTS Six RCTs with 352 patients were included. There was no difference between both groups regarding clinical success (RR: 1.04 with 95% CI [0.88-1.23], p = 0.61), WON recurrence (RR: 1.46 with 95% CI [0.59-3.61], p = 0.41), the need of necrosectomy (RR: 0.96 with 95% CI [0.65-1.41], p = 0.84), the total number of necrosectomy sessions (MD: 1.03 with 95% CI [- 0.33, 2.40], p = 0.14), total number of interventions (MD: - 0.09 with 95% CI [- 0.72, 0.54], p = 0.79), mortality (RR: 0.87 with 95% CI [0.32-2.37], p = 0.79), bleeding (RR: 1.35 with 95% CI [0.58-3.12], p = 0.48), and stent migration (RR: 0.69 with 95% CI [0.28-1.71], p = 0.42). However, metal stents significantly decreased the procedure duration (MD: - 11.27 with 95% CI [- 17.69, - 4.86], p < 0.001). CONCLUSION There was no significant difference between metal and plastic stents in efficacy and safety outcomes during WON EUS-guided drainage, except for a shorter procedural duration with metal stents.
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Affiliation(s)
- Omar Saab
- The University of Texas Health Sciences Center at Houston, 6411 Fannin Street, Houston, TX, 77030, USA.
| | | | - Marwah Algodi
- University of Baghdad College of Medicine, Baghdad, Iraq
| | - Asma Algodi
- University of Baghdad College of Medicine, Baghdad, Iraq
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23
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Ren D, Tan J, Zhou Y, Luo Z. Efficacy of DaXianXiong decoction in preventing the progression of severity of acute pancreatitis: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2025. [PMID: 40098229 DOI: 10.2196/67392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND Developing countries are facing an increase in the incidence of acute pancreatitis (AP) - characterized by rapid onset, fast progression, high rate of severity, and high mortality. Progression of AP into severe acute pancreatitis (SAP) results in a series of complications such as organ dysfunction, local abscesses, pseudocysts, and necrosis. Although the treatment of AP is primarily supportive, including fluid resuscitation and organ support, there is still a lack of consensus on the optimal management regimen for fluid therapy , and strategies to promote gastrointestinal recovery remain limited. As no effective intervention measure has yet been developed, supportive therapy remains the major approach for the early treatment of AP. DaXianXiong decoction is a widely used TCM formulation; however, limited research is conducted on its clinical efficacy. Here, we propose a standardized clinical trial to evaluate the effectiveness and safety of DaXianXiong decoction in preventing the progression of AP to SAP. OBJECTIVE This study aims to evaluate the efficacy and safety of DaXianXiong decoction in preventing AP from progressing to SAP. Assessing its impact on SAP incidence, clinical severity scores, inflammation markers, and gastrointestinal function, providing evidence for AP management.The primary outcomes will include incidence of SAP, modified CTSI score, APACHE II score, Modified Marshall score, and levels of the inflammation factor. The secondary outcomes will include the effect of the gastrointestinal dysfunction treatment. Evaluations will be conducted at baseline, 24 h after intervention, and days 3, 7, and 28 after intervention in both groups. METHODS This study is a randomized, double-blind, placebo-controlled, single-center clinical trial. Sixty eligible patients will be randomly allocated in a 1:1 ratio to the intervention group and the control group. Both groups will receive standard Western medical treatment for pancreatitis. The intervention group will additionally receive DaXianXiong decoction, while the control group will receive a placebo similar to the decoction. RESULTS This study has been funded by the Performance Incentive Project of Scientific Research Institutions in Chongqing. The trial was registered in April 2024, and data analysis is expected to be completed by April 2025. The study results will be presented at both national and international conferences and published in peer-reviewed journals. CONCLUSIONS This trial will help us assess the effectiveness and safety of DaXianXiong decoction in patients with AP. This study will provide clinical evidence on the efficacy and safety of DaXianXiong decoction in preventing the progression of AP to SAP. By evaluating its impact, the findings will contribute to the understanding of DaXianXiong decoction as an adjunct therapy in AP management and may offer a novel complementary treatment strategy for AP, potentially improving patient outcomes and reducing complications. CLINICALTRIAL Registration:http://www.chictr.org.cn/, ChiCTR2300076885, https://www.chictr.org.cn/showproj.html?proj=207084.
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Affiliation(s)
- Dongsheng Ren
- Department of Emergency and Intensive Critical Unit, Chongqing Hospital of Traditional Chinese Medicine, No.6, Seventh Branch Road, Panxi, Jiangbei District, Chongqing, Chongqing, CN
| | - Judan Tan
- Department of Emergency and Intensive Critical Unit, Chongqing Hospital of Traditional Chinese Medicine, No.6, Seventh Branch Road, Panxi, Jiangbei District, Chongqing, Chongqing, CN
| | - Yuling Zhou
- Department of Emergency and Intensive Critical Unit, Chongqing Hospital of Traditional Chinese Medicine, No.6, Seventh Branch Road, Panxi, Jiangbei District, Chongqing, Chongqing, CN
| | - Zhenchun Luo
- Department of Emergency and Intensive Critical Unit, Chongqing Hospital of Traditional Chinese Medicine, No.6, Seventh Branch Road, Panxi, Jiangbei District, Chongqing, Chongqing, CN
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24
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Xia T, Han F, Wang Y, Xie X, Yuan C, Lu G, Xiao W, Tu B, Ren H, Gong W, Wang Y. Inhibition of CD53 Reduces the Formation of ROS-Induced Neutrophil Extracellular Traps and Protects Against Inflammatory Injury in Acute Pancreatitis. J Inflamm Res 2025; 18:3725-3739. [PMID: 40098997 PMCID: PMC11913036 DOI: 10.2147/jir.s507886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 03/04/2025] [Indexed: 03/19/2025] Open
Abstract
Background The tetraspanin CD53 transmembrane protein is vital in immune cells like B cells and T cells, playing a crucial role in various inflammatory conditions. However, its involvement in neutrophils regarding inflammation remains uncertain. This study aims to examine the impact of CD53 on neutrophil extracellular traps (NETs) formation. Methods Phorbol 12-myristate 13-acetate (PMA) was utilized to establish an in vitro classical NETs model to investigate the influence of CD53 on NETs formation and its regulatory mechanisms. Subsequently, the link between CD53 and acute pancreatitis (AP), a model of aseptic inflammatory responses connected to NETs, was verified. Peripheral blood neutrophils from clinical AP patients were collected to explore the role of CD53 in AP, while an AP mouse model induced by caerulein was employed to confirm the impact of CD53 inhibition on AP mice pancreatic tissue. Results Our study has shown that CD53 is significantly elevated in in vitro NETs models and neutrophils from AP patients. The expression of CD53 is closely related to the clinical prognosis of AP patients. At the same time, CD53 neutralizing antibody (Anti-CD53) can significantly inhibit the formation of NETs in vitro, inflammatory injury in AP mice and the formation of NETs in damaged tissues. Mechanistically, CD53 can modulate the PI3K/AKT pathway and promote the formation of NETs. Finally, targeted regulation of CD53 can effectively reduce inflammatory injury and NETs formation in damaged tissues of AP mice. Conclusion The results of this study mark the first confirmation that CD53 plays a crucial role in NETs formation. Targeting CD53 inhibition could potentially serve as a novel therapeutic approach for the treatment of AP.
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Affiliation(s)
- Tianqi Xia
- Pancreatic Center, Department of Gastroenterology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
- Yangzhou Key Laboratory of Pancreatic Disease, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
| | - Fei Han
- Pancreatic Center, Department of Gastroenterology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
- Yangzhou Key Laboratory of Pancreatic Disease, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
| | - Yaning Wang
- Pancreatic Center, Department of Gastroenterology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
- Yangzhou Key Laboratory of Pancreatic Disease, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
| | - Xinyue Xie
- Pancreatic Center, Department of Gastroenterology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
- Yangzhou Key Laboratory of Pancreatic Disease, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
| | - Chenchen Yuan
- Pancreatic Center, Department of Gastroenterology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
- Yangzhou Key Laboratory of Pancreatic Disease, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
| | - Guotao Lu
- Pancreatic Center, Department of Gastroenterology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
- Yangzhou Key Laboratory of Pancreatic Disease, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
| | - Weiming Xiao
- Pancreatic Center, Department of Gastroenterology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
- Yangzhou Key Laboratory of Pancreatic Disease, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
| | - Bo Tu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Hongbo Ren
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong Province, 250012, People's Republic of China
| | - Weijuan Gong
- Pancreatic Center, Department of Gastroenterology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
- Yangzhou Key Laboratory of Pancreatic Disease, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225000, People's Republic of China
| | - Yaodong Wang
- Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Suzhou Key Laboratory of Integrated Traditional Chinese and Western Medicine of Digestive Diseases, Kunshan Affiliated Hospital of Yangzhou University, Kunshan, 215300, People's Republic of China
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Soliman GA, Alamri MA, Abdel-Rahman RF, Elbaset MA, Ogaly HA, Abdel-Kader MS. Tephrosia purpurea, with (-)-Pseudosemiglabrin as the Major Constituent, Alleviates Severe Acute Pancreatitis-Mediated Acute Lung Injury by Modulating HMGB1 and IL-22. Int J Mol Sci 2025; 26:2572. [PMID: 40141214 PMCID: PMC11942157 DOI: 10.3390/ijms26062572] [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: 12/21/2024] [Revised: 03/02/2025] [Accepted: 03/10/2025] [Indexed: 03/28/2025] Open
Abstract
Ischemia-reperfusion (IR) injury is a major cause of multiple organ failure. The purpose of this study was to look into the role of Tephrosia purpurea (TEP) and its active constituent pseudosemiglabrin (PS) in alleviating severe acute pancreatitis and its associated acute lung injury. We established a rat pancreatic IR model, and the rats were treated with TEP (200 mg/kg and 400 mg/kg) and PS (20 and 40 mg/kg), in addition to the IR control and sham groups. The results showed that the respiratory parameters, including inspiratory time (Ti), expiratory time (Te), duration (Dr), and respiratory rate (RR), were comparable among all groups, while peak inspiratory flow (PIF), forced vital capacity (FVC), and forced expiratory volume at 0.1 s (FEV0.1) were significantly impaired. Notably, PS at 40 mg/kg showed normal PIF, FVC, and FEV0.1/FVC compared to the IR group, indicating an improved lung function. Additionally, TEP and PS showed protective effects on pancreatic and lung tissues compared to the IR control group, with the following effects: alleviating pathological damage; reducing serum levels of trypsinogen activation peptide (TAP), lipase, and amylase; decreasing oxidative stress markers such as MDA and MPO; restoring antioxidant enzyme activity (GPx); suppressing inflammatory markers TNF-α, IL-6, and NF-κB; downregulating HMGB1 gene in pancreatic tissue; and upregulating the IL-22 gene in lung tissues. In conclusion, the obtained findings demonstrate that oral supplementation of TEP and PS to rats with pancreatic IR alleviates pancreatic and lung injuries by reducing oxidative stress and modulating inflammatory processes, which offers an attractive therapeutic option for severe acute pancreatitis and its associated acute lung injury.
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Affiliation(s)
- Gamal A. Soliman
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (G.A.S.); (M.A.A.)
| | - Mohammed A. Alamri
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (G.A.S.); (M.A.A.)
| | - Rehab F. Abdel-Rahman
- Department of Pharmacology, National Research Centre, Giza 12622, Egypt; (R.F.A.-R.); (M.A.E.)
| | - Marawan A. Elbaset
- Department of Pharmacology, National Research Centre, Giza 12622, Egypt; (R.F.A.-R.); (M.A.E.)
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Hanan A. Ogaly
- Department of Biochemistry, College of Veterinary Medicine, Cairo University, Giza 12613, Egypt;
| | - Maged S. Abdel-Kader
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
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26
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Liu Y, Ding L, Xu X, Guan L, He W, Xia L, Lu N, Zhu Y. Readmission of patients with hypertriglyceridemia-induced acute pancreatitis: a prospective cohort study. BMC Gastroenterol 2025; 25:167. [PMID: 40075294 PMCID: PMC11905672 DOI: 10.1186/s12876-025-03760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 03/04/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a common cause of acute hospital admissions in digestive system diseases. In East Asia, hypertriglyceridemia is gradually emerged as the second most common cause of pancreatitis. Vigilance for recurrence and unplanned readmissions due to other causes is still necessary after discharge. studies on hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are scarce and mainly consists of retrospective studies. METHODS This was a prospective cohort study of adult patients with first episode of HTG-AP from December 2019 to February 2021 who were followed up for two years. Unscheduled readmission after the index discharge was the primary outcome. The Cox proportional-hazards model, and the Fine and Gray's competing-risk model were applied to the analyses. RESULTS Totally, 293 survival patients were followed-up after discharge. The overall unplanned readmission rate was 30.0% in two years. Among them, 60 (20.5%) patients were readmitted to hospital once, 16 (5.5%) were readmitted twice, and 13 (4.4%) were readmitted three times or more. In summary, a total of 143 cases of readmission information were collected during the follow-up period. The recurrence accounts for a significant 77.3% proportion and stands as the primary cause for readmission. Cox regression model favors infection (Hazard ratio [HR], 3.066; 95% confidence interval [CI], 1.192-7.888; P = 0.02) and age lower than 41.5 years old (HR, 3.157; 95% CI 1.883-5.292; P < 0.01) as independent risk factors for patient readmission by multivariate analysis. The competing-risk model support the similar results compared with the former. CONCLUSION Unplanned readmission of patients with hypertriglyceridemia-induced acute pancreatitis is common, especially for young patients with occurrence of any infection during hospitalization, and warrant further investigation.
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Affiliation(s)
- Yuxiang Liu
- Department of Gastroenterology, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Ling Ding
- Department of Gastroenterology, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Xin Xu
- Department of Gastroenterology, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Langyi Guan
- Department of Gastroenterology, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Wenhua He
- Department of Gastroenterology, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Liang Xia
- Department of Gastroenterology, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Nonghua Lu
- Department of Gastroenterology, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Yin Zhu
- Department of Gastroenterology, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China.
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Munigala S, Subramaniam DS, Subramaniam DP, Xian H, Munigala SM, Kottapalli KC, Burroughs TE, Sheth SG. Decreased Life Expectancy in Patients with Acute and Chronic Pancreatitis. Dig Dis Sci 2025:10.1007/s10620-025-08944-w. [PMID: 40056301 DOI: 10.1007/s10620-025-08944-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 02/18/2025] [Indexed: 03/10/2025]
Abstract
BACKGROUND AND AIMS Population-based data on the life expectancy and mortality for acute (AP) and chronic pancreatitis (CP) in the United States are limited. This study evaluates the life expectancy, mortality rates and the cause of death in AP and CP patients. METHODS Using the nationwide Veterans Administration database from 1999 to 2015, we identified AP and CP patients (using ICD-9 codes) and non-pancreatitis patients (controls). Age at the time of death was used as a surrogate indicator of life expectancy. Life expectancy in AP and CP patients was compared with the controls, using Cox-proportional hazards model. The mortality rates and cause of death for AP, CP, and controls were also assessed. RESULTS Overall, we selected 35,550 AP and 12,545 CP patients and 100,000 controls. The life expectancy was significantly lower for both AP (69 years) and CP (71 years) patients compared to the controls (81 years, p < 0.001). The risk of mortality was higher for AP (adjusted hazard ratio (aHR) 1.61, 95% CI 1.58-1.65, p < 0.001) and CP (aHR 1.64, 95% CI 1.59-1.68, p < 0.001) than in controls. Approximately forty-two percent of all patients died during the follow-up (AP-44.3%, CP-52.1% and controls-39.7%). Circulatory disorders, neoplasms, and respiratory disorders were the leading causes of death in AP and CP patients. CONCLUSIONS Acute and chronic pancreatitis are associated with decreased life span and higher mortality emphasizing their clinical importance. Although the deaths due to gastrointestinal/digestive system disorders were significantly higher, most of the deaths in AP and CP patients were primarily due to non-gastrointestinal causes.
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Affiliation(s)
- Satish Munigala
- College for Public Health and Social Justice, Saint Louis University, HCOR Office St. Louis, 3545 Lafayette Ave, Salus Center 4th Floor, Saint Louis, MO, 63104, USA.
- Department of Internal Medicine, Washington University in St. Louis, Saint Louis, MO, USA.
| | - Divya S Subramaniam
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, Saint Louis, MO, USA
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University, Saint Louis, MO, USA
| | - Dipti P Subramaniam
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Hong Xian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Sarah M Munigala
- Department of Internal Medicine, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Thomas E Burroughs
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Sunil G Sheth
- Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
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28
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Davis P, Evans D. Fluid Resuscitation in the Treatment of Acute Pancreatitis: Rate and Volume Controversies. Adv Emerg Nurs J 2025:01261775-990000000-00024. [PMID: 40106784 DOI: 10.1097/tme.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
The aim of the Research to Practice column is to enhance the research critique abilities of both advanced practice registered nurses and emergency nurses, while also aiding in the translation of research findings into clinical practice. Each column focuses on a specific topic and research study. In this article, we used a scenario of left upper quadrant pain to explore the study by de-Madaria et al., titled "Aggressive or moderate fluid resuscitation in acute pancreatitis".
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Affiliation(s)
- Philip Davis
- Author Affiliations: Nell Hodgson Woodruff School of Nursing, Emory University (Dr Davis); Emergency Department, Emory University Hospital (Dr Davis); and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Davis)
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Wang Y, Wan X, Liu Z, Liu Z, Huang X. Radiomics-based prediction of recurrent acute pancreatitis in individuals with metabolic syndrome using T2WI magnetic resonance imaging data. Front Med (Lausanne) 2025; 12:1502315. [PMID: 40115788 PMCID: PMC11922943 DOI: 10.3389/fmed.2025.1502315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 02/24/2025] [Indexed: 03/23/2025] Open
Abstract
Objective This study sought to clarify the utility of T2-weighted imaging (T2WI)-based radiomics to predict the recurrence of acute pancreatitis (AP) in subjects with metabolic syndrome (MetS). Methods Data from 196 patients with both AP and MetS from our hospital were retrospectively analyzed. These patients were separated into two groups according to their clinical follow-up outcomes, including those with first-onset AP (n = 114) and those with recurrent AP (RAP) (n = 82). The 196 cases were randomly divided into a training set (n = 137) and a test set (n = 59) at a 7:3 ratio. The clinical characteristics of these patients were systematically compiled for further analysis. For each case, the pancreatic parenchyma was manually delineated slice by slice using 3D Slicer software, and the appropriate radiomics characteristics were retrieved. The K-best approach, the least absolute shrinkage and selection operator (LASSO) algorithm, and variance thresholding were all used in the feature selection process. The establishment of clinical, radiomics, and combined models for forecasting AP recurrence in patients with MetS was then done using a random forest classifier. Model performance was measured using the area under the receiver operating characteristic curve (AUC), and model comparison was done using the DeLong test. The clinical utility of these models was evaluated using decision curve analysis (DCA), and the optimal model was determined via a calibration curve. Results In the training set, the clinical, radiomics, and combined models yielded respective AUCs of 0.651, 0.825, and 0.883, with corresponding test sets of AUCs of 0.606, 0.776, and 0.878. Both the radiomics and combined models exhibited superior predictive effectiveness compared to the clinical model in both the training (p = 0.001, p < 0.001) and test sets (p = 0.04, p < 0.001). The combined model outperformed the radiomics model (training set: p = 0.025, test set: p = 0.019). The DCA demonstrated that the radiomics and combined models had greater clinical efficacy than the clinical model. The calibration curve for the combined model demonstrated good agreement between the predicted probability of AP recurrence and the observed outcomes. Conclusion These findings highlight the superior predictive power of a T2WI-based radiomics model for predicting AP recurrence in patients with MetS, potentially supporting early interventions that can mitigate or alleviate RAP.
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Affiliation(s)
- Yuan Wang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiyao Wan
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ziyan Liu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ziyi Liu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaohua Huang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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30
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Podda M, Pisanu A, Pellino G, De Simone A, Selvaggi L, Murzi V, Locci E, Rottoli M, Calini G, Cardelli S, Catena F, Vallicelli C, Bova R, Vigutto G, D'Acapito F, Ercolani G, Solaini L, Biloslavo A, Germani P, Colutta C, Occhionorelli S, Lacavalla D, Sibilla MG, Olmi S, Uccelli M, Oldani A, Giordano A, Guagni T, Perini D, Pata F, Nardo B, Paglione D, Franco G, Donadon M, Di Martino M, Bruzzese D, Pacella D. Machine learning for the rElapse risk eValuation in acute biliary pancreatitis: The deep learning MINERVA study protocol. World J Emerg Surg 2025; 20:17. [PMID: 40033414 DOI: 10.1186/s13017-025-00594-7] [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: 07/15/2024] [Accepted: 02/22/2025] [Indexed: 03/05/2025] Open
Abstract
BACKGROUND Mild acute biliary pancreatitis (MABP) presents significant clinical and economic challenges due to its potential for relapse. Current guidelines advocate for early cholecystectomy (EC) during the same hospital admission to prevent recurrent acute pancreatitis (RAP). Despite these recommendations, implementation in clinical practice varies, highlighting the need for reliable and accessible predictive tools. The MINERVA study aims to develop and validate a machine learning (ML) model to predict the risk of RAP (at 30, 60, 90 days, and at 1-year) in MABP patients, enhancing decision-making processes. METHODS The MINERVA study will be conducted across multiple academic and community hospitals in Italy. Adult patients with a clinical diagnosis of MABP, in accordance with the revised Atlanta Criteria, who have not undergone EC during index admission will be included. Exclusion criteria encompass non-biliary aetiology, severe pancreatitis, and the inability to provide informed consent. The study involves both retrospective data from the MANCTRA-1 study and prospective data collection. Data will be captured using REDCap. The ML model will utilise convolutional neural networks (CNN) for feature extraction and risk prediction. The model includes the following steps: the spatial transformation of variables using kernel Principal Component Analysis (kPCA), the creation of 2D images from transformed data, the application of convolutional filters, max-pooling, flattening, and final risk prediction via a fully connected layer. Performance metrics such as accuracy, precision, recall, and area under the ROC curve (AUC) will be used to evaluate the model. DISCUSSION The MINERVA study aims to address the specific gap in predicting RAP risk in MABP patients by leveraging advanced ML techniques. By incorporating a wide range of clinical and demographic variables, the MINERVA score aims to provide a reliable, cost-effective, and accessible tool for healthcare professionals. The project emphasises the practical application of AI in clinical settings, potentially reducing the incidence of RAP and associated healthcare costs. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT06124989.
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Affiliation(s)
- Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy.
| | - Adolfo Pisanu
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Adriano De Simone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Lucio Selvaggi
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Valentina Murzi
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Eleonora Locci
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Matteo Rottoli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giacomo Calini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Cardelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Raffaele Bova
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Gabriele Vigutto
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fabrizio D'Acapito
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Forlì, Italy
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Forlì, Italy
| | - Alan Biloslavo
- General Surgery Department, Trieste University Hospital, Trieste, Italy
| | - Paola Germani
- General Surgery Department, Trieste University Hospital, Trieste, Italy
| | - Camilla Colutta
- General Surgery Department, Trieste University Hospital, Trieste, Italy
| | | | - Domenico Lacavalla
- Emergency Surgery Department, Ferrara University Hospital, Ferrara, Italy
| | | | - Stefano Olmi
- Università Vita-Salute San Raffaele, Milan, Italy
- Department of General and Oncological Surgery, Minimally Invasive Surgery Center, San Marco Hospital GSD, Bergamo, Zingonia, Italy
| | - Matteo Uccelli
- Department of General and Oncological Surgery, Minimally Invasive Surgery Center, San Marco Hospital GSD, Bergamo, Zingonia, Italy
| | - Alberto Oldani
- Department of General and Oncological Surgery, Minimally Invasive Surgery Center, San Marco Hospital GSD, Bergamo, Zingonia, Italy
| | - Alessio Giordano
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Tommaso Guagni
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Davina Perini
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, 87036, Italy
- Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Bruno Nardo
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, 87036, Italy
- Azienda Ospedaliera Annunziata, Cosenza, Italy
| | | | | | - Matteo Donadon
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Jiang M, Wu XP, Lin XC, Li CL. Explainable machine learning model for predicting acute pancreatitis mortality in the intensive care unit. BMC Gastroenterol 2025; 25:131. [PMID: 40033198 DOI: 10.1186/s12876-025-03723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 02/24/2025] [Indexed: 03/05/2025] Open
Abstract
BACKGROUND Current prediction models are suboptimal for determining mortality risk in patients with acute pancreatitis (AP); this might be improved by using a machine learning (ML) model. In this study, we aimed to construct an explainable ML model to calculate the risk of mortality in patients with AP admitted in intensive care unit (ICU) and compared it with existing scoring systems. METHODS A gradient-boosting ML (XGBoost) model was developed and externally validated based on two public databases: Medical Information Mart for Intensive Care (MIMIC, training cohort) and the eICU Collaborative Research Database (eICU-CRD, validation cohort). We compared the performance of the XGBoost model with validated clinical risk scoring systems (the APACHE IV, SOFA, and Bedside Index for Severity in Acute Pancreatitis [BISAP]) by area under receiver operating characteristic curve (AUC) analysis. SHAP (SHapley Additive exPlanations) method was applied to provide the explanation behind the prediction outcome. RESULTS The XGBoost model performed better than the clinical scoring systems in correctly predicting mortality risk of AP patients, achieving an AUC of 0.89 (95% CI: 0.84-0.94). When set the sensitivity at 100% for death prediction, the model had a specificity of 38%, much higher than the APACHE IV, SOFA and BISAP score, which had a specificity of 1%, 16% and 1% respectively. CONCLUSIONS This model might increase identification of very low-risk patients who can be safely monitored in a general ward for management. By making the model explainable, physicians would be able to better understand the reasoning behind the prediction.
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Affiliation(s)
- Meng Jiang
- Emergency and Trauma Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China.
| | - Xiao-Peng Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xing-Chen Lin
- Emergency and Trauma Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, P.R. China
| | - Chang-Li Li
- Department of FSTC Clinic, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, P.R. China.
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Parolin M, Ceschia G, Bertazza Partigiani N, La Porta E, Verrina E, Vidal E. Non-infectious complications of peritoneal dialysis in children. Pediatr Nephrol 2025:10.1007/s00467-025-06713-5. [PMID: 40029413 DOI: 10.1007/s00467-025-06713-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 01/31/2025] [Accepted: 02/06/2025] [Indexed: 03/05/2025]
Abstract
Peritoneal dialysis (PD) remains a cornerstone treatment for children with stage 5 chronic kidney disease, offering significant benefits in terms of quality of life and patient autonomy compared to hemodialysis. Recent advances in care protocols, particularly in infection prevention, have led to a substantial reduction in peritonitis and other infectious complications in pediatric patients on PD. Despite these improvements, non-infectious complications continue to pose significant challenges to the long-term efficacy of PD. Mechanical issues, such as catheter malposition and dysfunction, are common and can lead to discomfort and diminished dialysis efficiency. A more serious concern is peritoneal membrane failure, which results from prolonged PD, particularly with glucose-based solutions, and recurrent peritonitis, leading to structural changes in the membrane. Encapsulating peritoneal sclerosis (EPS), although rare, is a severe and often devastating complication that significantly impacts patient morbidity and mortality. Despite its low incidence, EPS underscores the importance of careful monitoring and management of long-term PD patients. Additional complications, including metabolic disturbances, pancreatitis, and hemoperitoneum, further complicate care. Looking ahead, improving catheter management, preserving peritoneal membrane function, and exploring new dialysis solutions are essential to reducing these complications and optimizing outcomes for pediatric patients on PD.
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Affiliation(s)
- Mattia Parolin
- Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Giovanni Ceschia
- Department of Medicine (DMED), University of Udine, Udine, Italy
| | | | - Edoardo La Porta
- Pediatric Nephrology Unit, University Hospital of Padua, Padua, Italy
| | - Enrico Verrina
- Pediatric Nephrology Unit, University Hospital of Padua, Padua, Italy
| | - Enrico Vidal
- Department of Medicine (DMED), University of Udine, Udine, Italy.
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
- Institute of Pediatric Research "Città Della Speranza", Padua, Italy.
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Wannhoff A, Canakis A, Sharaiha RZ, Fayyaz F, Schlag C, Sharma N, Elsayed I, Khashab MA, Baron TH, Caca K, Irani SS. Endoscopic ultrasound-guided gastroenterostomy for the treatment of gastric outlet obstruction secondary to acute pancreatitis. Endoscopy 2025; 57:249-254. [PMID: 39529322 DOI: 10.1055/a-2452-5307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a minimally invasive technique for treating gastric outlet obstruction (GOO). The aim of this study was to assess the outcomes of EUS-GE in managing benign GOO caused by duodenal stenosis in patients with acute pancreatitis. METHODS This international retrospective study analyzed patients treated with EUS-GE for GOO caused by acute pancreatitis until December 2023, evaluating technical and clinical success, adverse events, and reintervention. RESULTS 39 patients (median age 55 years, 15 women) were included. There was a 92.3% technical success rate, with only three patients unable to undergo EUS-GE owing to a long distance between the stomach and small bowel or an inadequate window for puncture. Clinical success was observed in 34 patients (87.2%). The median Gastric Outlet Obstruction Scoring System (GOOSS) improved from 0 before EUS-GE to 2 afterward (P <0.001). Follow-up (≥3 months) was available in 25 patients. During a median follow-up of 23 months, four patients required reintervention. It was possible to remove the lumen-apposing metal stent in 18 patients. The only adverse event was a gastrocolic fistula detected incidentally after 3 months. CONCLUSION EUS-GE is an effective and safe method for managing benign GOO in the setting of acute pancreatitis.
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Affiliation(s)
- Andreas Wannhoff
- Department of Internal Medicine and Gastroenterology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | - Farimah Fayyaz
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, United States
| | - Christoph Schlag
- Department of Gastroenterology and Hepatology, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Neil Sharma
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Health, Fort Wayne, United States
| | - Ismaeil Elsayed
- Department of Internal Medicine and Gastroenterology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, United States
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Karel Caca
- Department of Internal Medicine and Gastroenterology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Shayan S Irani
- Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States
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Ito K, Takuma K, Okano N, Yamada Y, Saito M, Watanabe M, Igarashi Y, Matsuda T. Current status and future perspectives for endoscopic treatment of local complications in chronic pancreatitis. Dig Endosc 2025; 37:219-235. [PMID: 39364545 PMCID: PMC11884972 DOI: 10.1111/den.14926] [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: 01/18/2024] [Accepted: 08/25/2024] [Indexed: 10/05/2024]
Abstract
Chronic pancreatitis is a progressive disease characterized by irregular fibrosis, cellular infiltration, and parenchymal loss within the pancreas. Chronic pancreatitis treatment includes lifestyle modifications based on disease etiology, dietary adjustments appropriate for each stage and condition, drug therapy, endoscopic treatments, and surgical treatments. Although surgical treatments of symptomatic chronic pancreatitis provide good pain relief, endoscopic therapies are recommended as the first-line treatment because they are minimally invasive. In recent years, endoscopic therapy has emerged as an alternative treatment method to surgery for managing local complications in patients with chronic pancreatitis. For pancreatic stone removal, a combination of extracorporeal shock wave lithotripsy and endoscopic extraction is used. For refractory pancreatic duct stones, intracorporeal fragmentation techniques, such as pancreatoscopy-guided electrohydraulic lithotripsy and laser lithotripsy, offer additional options. Interventional endoscopic ultrasound has become the primary treatment modality for pancreatic pseudocysts, except in the absence of disconnected pancreatic duct syndrome. This review focuses on the current status of endoscopic therapies for common local complications of chronic pancreatitis, including updated information in the past few years.
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Affiliation(s)
- Ken Ito
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Omori Medical CenterTokyoJapan
| | - Kensuke Takuma
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Naoki Okano
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Yuto Yamada
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Omori Medical CenterTokyoJapan
| | - Michihiro Saito
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Omori Medical CenterTokyoJapan
| | - Manabu Watanabe
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Omori Medical CenterTokyoJapan
| | - Yoshinori Igarashi
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Takahisa Matsuda
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Ohashi Medical CenterTokyoJapan
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Hamesch K, Hollenbach M, Guilabert L, Lahmer T, Koch A. Practical management of severe acute pancreatitis. Eur J Intern Med 2025; 133:1-13. [PMID: 39613703 DOI: 10.1016/j.ejim.2024.10.030] [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: 07/31/2024] [Revised: 10/29/2024] [Accepted: 10/30/2024] [Indexed: 12/01/2024]
Abstract
Acute pancreatitis (AP) represents one of the most common reasons for hospital admission and intensive care treatment in internal medicine. The incidence of AP is increasing, posing significant financial burden on healthcare systems due to the necessity for frequent medical interventions. Severe acute pancreatitis (SAP) is a potentially life-threatening condition with substantial morbidity and mortality. The management of SAP requires prolonged hospitalization and the expertise of a multidisciplinary team, comprising emergency physicians, intensivists, internists, gastroenterologists, visceral surgeons, and experts in nutrition, infectious disease, endoscopy, as well as diagnostic and interventional radiology. Effective management and beneficial patient outcomes depend on continuous interdisciplinary collaboration. This review synthesizes recent evidence guiding the practical management of SAP, with a particular focus on emergency and intensive care settings. Both established as well as new diagnostic and therapeutic paradigms are highlighted, including workup, risk stratification, fluid management, analgesia, nutrition, organ support, imaging modalities and their timing, along with anti-infective strategies. Furthermore, the review explores interventions for local and vascular complications of SAP, with particular attention to the indications, timing and selection between endoscopic (both endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS)), percutaneous and surgical approaches. Similarly, the management of biliary AP due to obstructive gallstones, including the imaging, timing of ERCP and cholecystectomy, are discussed. By integrating new evidence with relevant guidance for everyday clinical practice, this review aims to enhance the interdisciplinary approach essential for improving outcomes in SAP management.
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Affiliation(s)
- Karim Hamesch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcus Hollenbach
- Department of Gastroenterology, Endocrinology, Infectious Diseases, University of Marburg UKGM, Marburg, Germany
| | - Lucía Guilabert
- Department of Gastroenterology, Dr. Balmis General University Hospital- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Tobias Lahmer
- Clinic for Internal Medicine II, Klinikum rechts der Isar der Technischen, University of Munich, Munich, Germany
| | - Alexander Koch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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Jain A, Gokun Y, Hart PA, Ramsey ML, Papachristou GI, Han S, Lee PJ, Shah H, Burlen J, Shah R, Park E, Krishna SG. Evolving trends in interventions and outcomes for acute biliary pancreatitis during pregnancy: A two-decade analysis. Pancreatology 2025; 25:200-207. [PMID: 40021427 DOI: 10.1016/j.pan.2025.02.006] [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: 08/07/2024] [Revised: 01/26/2025] [Accepted: 02/08/2025] [Indexed: 03/03/2025]
Abstract
BACKGROUND/OBJECTIVES Cholelithiasis is the most common cause of acute pancreatitis in pregnancy. We analyzed trends in acute biliary pancreatitis (ABP) among pregnant women over the past two decades to evaluate changes in outcomes, including the incidence of severe acute pancreatitis, mortality rates, and hospital length of stay. METHODS Using the National Inpatient Sample, we identified adult women of childbearing age (age 18-50 years) with hospitalization for ABP from 2002 to 2020. Trends were analyzed using Cochran-Armitage and F-tests. Multivariable binary logistic regression was used to evaluate the outcome of severe acute pancreatitis (SAP). RESULTS 45,064 pregnant and 212,009 non-pregnant women were hospitalized for ABP (2002-2020), with a significant increase in ABP during pregnancy (14.1 %→17.8 %; p < 0.001). Trend analyses in the pregnant cohort revealed increasing age (mean 27 → 28.1 years; p < 0.001), Class-III obesity (0.7 %→7.8 %; p < 0.001), comorbidities (Elixhauser index ≥3) (2.9 %→11.2 %; p < 0.001), and SAP (2.2 %→5.0 %; p < 0.001). Mortality remained very low (<0.01 %). Performance of ERCP (22.2 %→26.5 %; p < 0.001) and cholecystectomy (41.0 %→54.1 %; p < 0.001) increased while duration of hospitalization decreased (Mean 4.9 → 3.6 days; p < 0.001). Multivariable analysis revealed that the development of SAP was associated with Black race (OR 1.70, 95 % CI: 1.10-2.63) and comorbidities (OR 5.10, 95 % CI 3.64-7.14). CONCLUSIONS Pregnant women represent a significant portion of hospitalized ABP cases, paralleling increases in age, comorbidities, and obesity rates. Racial disparities are linked to higher odds of SAP, though comorbidities have a dominant effect. There has been an increase in guideline-recommended procedures (ERCP and cholecystectomy); however, further research is needed to address the implementation gap, considering the increased complexity of pregnant women with ABP.
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Affiliation(s)
- Ayushi Jain
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Yevgeniya Gokun
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mitchell L Ramsey
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Lee
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hamza Shah
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan Burlen
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raj Shah
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erica Park
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Bofill A, Law R, Storm AC, Vargas EJ, Martin JA, Petersen BT, Majumder S, Vege S, Abu Dayyeh BK, Chandrasekhara V. The role of MRCP for preventing pancreatic fluid collection recurrence after EUS-guided drainage of walled-off necrosis. Gastrointest Endosc 2025; 101:608-616. [PMID: 39053654 DOI: 10.1016/j.gie.2024.07.009] [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: 03/12/2024] [Revised: 06/21/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND AIMS Pancreatic fluid collections (PFCs) may recur after initial successful endoscopic drainage of walled-off necrosis (WON), most commonly due to disconnected pancreatic duct syndrome (DPDS). The primary aim of this study was to assess the role of MRCP for identifying DPDS to guide appropriate management and prevent PFC recurrence. METHODS Patients with WON undergoing lumen-apposing metal stent drainage of a PFC were retrospectively identified and categorized as those with MRCP versus those without MRCP before removal of transmural stents. Data on patient demographic characteristics, procedural details, cross-sectional imaging, and recurrence rates were collected through chart review. RESULTS A total of 121 patients with WON were identified, of whom 44 (36.4%) had an MRCP before transmural stent removal. In patients without MRCP, 13 (16.8%) of 77 had PFC recurrence versus 0 of 44 (0%; P = .003) in those with MRCP. MRCP identified DPDS in 12 (27.2%) patients, all of whom were managed with indefinite drainage with double-pigtail plastic stents without recurrence. In the group without MRCP, PFCs recurred at a median interval of 284 days (interquartile range, 182-618 days) after transmural stent removal. Among the 13 patients with PFC recurrence, 11 (85%) had undiagnosed DPDS detected on subsequent imaging, of whom 9 were subsequently managed with indefinite double-pigtail plastic stents, with no further PFC recurrence. CONCLUSIONS Patients with WON who underwent MRCP before transmural stent removal had a lower rate of PFC recurrence largely due to the identification of DPDS with appropriate endoscopic management.
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Affiliation(s)
- Aliana Bofill
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shounak Majumder
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Santhi Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
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Zhu Q, Tan D, Wang H, Ling B, Zhao R. Construction and validation of a nomogram for predicting survival in diabetic patients with severe acute pancreatitis: A retrospective study from a tertiary center. Saudi J Gastroenterol 2025; 31:68-74. [PMID: 39918039 DOI: 10.4103/sjg.sjg_178_24] [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: 05/16/2024] [Accepted: 01/07/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND There is currently a lack of nomograms specifically designed for predicting the risk of death in diabetic patients with severe acute pancreatitis (SAP). The objective of this study was to develop a nomogram tailored to diabetic patients with SAP to predict overall survival. METHODS Diabetic patients diagnosed with SAP between January 1, 2018 and December 31, 2023 were included in the study. Risk factors were identified through least absolute shrinkage and selection operator regression analysis. Subsequently, a novel nomogram model was developed through multivariable logistic regression analysis. The predictive performance of the nomogram was evaluated using metrics such as the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). RESULTS A total of 206 patients were included in the analysis, with 171 in the survival group and 35 in the deceased group. Multivariate logistic regression indicated that age, platelet, total bilirubin, and potassium were independent prognostic factors for the survival of diabetic patients with SAP. The nomogram demonstrated a performance comparable to sequential organ failure assessment ( P = 0.570). Additionally, the calibration curve showed satisfactory predictive accuracy, and the DCA highlighted the clinical application value of the nomogram. CONCLUSION We have identified key demographic and laboratory parameters that are associated with the survival of diabetic patients with SAP. These parameters have been utilized to create a precise and user-friendly nomogram, which could be an effective and valuable clinical tool for clinicians.
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Affiliation(s)
- Qingcheng Zhu
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
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Mahapatra SJ, Garg PK. Organ Failure and Prediction of Severity in Acute Pancreatitis. Gastroenterol Clin North Am 2025; 54:1-19. [PMID: 39880521 DOI: 10.1016/j.gtc.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
Organ failure (OF) is a sinister development in the clinical course of acute pancreatitis, and its prediction is crucial for triaging the patient. Persistent systemic inflammatory response syndrome and raised interleukin-6 levels have a good predictive accuracy. Pathophysiology involves the release of damage-associated molecular patterns as a consequence of pancreatic injury, recruitment of inflammatory cells, and the release of proinflammatory cytokines and chemokines causing cytokine storm. Respiratory system is the most common and earliest to fail. Although a few therapeutic options are in the pipeline, renewed efforts are required to develop targeted therapies to mitigate systemic inflammation and OF.
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Affiliation(s)
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
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Basha J, Maharshi TS, Lakhtakia S. Endoscopic Step-Up Approach in Management of Necrotizing Pancreatitis. Gastroenterol Clin North Am 2025; 54:37-51. [PMID: 39880532 DOI: 10.1016/j.gtc.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
The endoscopic step-up approach in the management of necrotizing pancreatitis involves sequential steps of intervention at different time points in the clinical course of the disease. EUS -guided drainage of walled-off necrosis is the first step of the endoscopic step-up approach. Lumen-apposing metal stents are preferred over plastic stents for safe and effective drainage because of their wide caliber. Successive steps in the endoscopic step-up approach include direct endoscopic necrosectomy and/or irrigation using naso-cystic tube in symptomatic patients, primarily based on necrotic debris characteristics. Minimally invasive percutaneous radiological and/or surgical drainage are considered when endoscopic drainage is not feasible or successful.
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Affiliation(s)
- Jahangeer Basha
- Department of Gastroenterology, Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, India
| | | | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, India.
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Kayashima A, Horibe M, Iwasaki E, Bazerbachi F, Kawasaki S, Kanai T. Bodyweight-Adjusted Nonsteroidal Anti-inflammatory Drugs Dose in the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis. Pancreas 2025; 54:e188-e193. [PMID: 39999311 DOI: 10.1097/mpa.0000000000002418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2025]
Abstract
OBJECTIVES Although rectal nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the incidence of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP), their optimal dosage is unknown. Given possible interindividual variability in the pharmacodynamics of NSAIDs, we hypothesized that the dose required to achieve adequate PEP prophylaxis varies with body weight. MATERIALS AND METHODS We conducted an analysis using single-center, prospective, observational cohort study data. The primary outcome was PEP incidence by NSAID dosage per body weight (mg/kg). Patients meeting the inclusion criteria were classified into 3 groups. RESULTS We included 891 patients, with 400, 454, and 37 patients in the control group with no NSAID therapy, the NSAID <1.0 mg/kg group, and the NSAID ≥1.0 mg/kg group, respectively. In the adjusted cohort, the odds ratio of PEP was 0.18 (95% confidence interval: 0.041-0.79; P = 0.023) for NSAID ≥1.0 mg/kg and 1.3 (95% confidence interval: 0.76-2.3; P = 0.31) for NSAID <1.0 mg/kg compared to the control group without NSAID. CONCLUSIONS PEP was not prevented by NSAID dosages below 1.0 mg/kg body weight whereas a dosage above 1.0 mg/kg body weight had a significant prophylactic effect. An NSAID dosage adjusted to body weight may be necessary to achieve an adequate prophylactic effect against PEP.
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Affiliation(s)
- Atsuto Kayashima
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Eisuke Iwasaki
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Shintaro Kawasaki
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Maatman TK, Zyromski NJ. Surgical Step-Up Approach in Management of Necrotizing Pancreatitis. Gastroenterol Clin North Am 2025; 54:53-74. [PMID: 39880533 DOI: 10.1016/j.gtc.2024.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Abstract
Necrotizing pancreatitis often demands intervention; contemporary management is directed by the step-up approach. Timing of intervention and specific approach is best directed by a multi-disciplinary team including advanced endosocpists, interventional radiologists, and surgeons with interest and experience managing this complex problem. The intervention is often a combination of percutaneous drainage, transluminal endoscopic approaches, and surgical debridement (minimally invasive or open). Goals of treatment are to evacuate solid infected necrosis, gain enteral access when needed, and to prevent recurrence-cholecystectomy in the setting of biliary pancreatitis. Experienced clinical judgment leads to optimal patient outcomes.
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Affiliation(s)
- Thomas K Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Suresh Kumar VC, Singh S, Moond V, Mohan BP, Aswath G, Khan HMA, Sapkota B, Adler DG. Safety and efficacy of lumen-apposing metal stents for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a systematic review and meta-analysis. Endoscopy 2025; 57:282-290. [PMID: 39603249 DOI: 10.1055/a-2461-3773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) has variable outcomes according to the type of lumen-apposing metal stent (LAMS) used. We aimed to perform a systematic review and meta-analysis of the available data.Online databases, including EMBASE, PubMed, and SCOPUS, were searched from inception to 30 January 2024. The outcomes of interest were technical success, clinical success, adverse events (AEs), and the need for endoscopic necrosectomy. Pooled estimates stratified by the type of stent (Axios, Nagi, or Spaxus), severity of bleeding, and type of PFC were calculated using a random-effects model. Heterogeneity was assessed by I 2 values.37 studies were included in the final analysis. The pooled outcomes (95%CIs) for PFC drainage using the Axios, Nagi, and Spaxus stents, respectively, were: technical success 97.7% (96.4%-98.8%), 96.9% (94.6%-98.5%), 98.2% (94.4%-99.9%); clinical success 90.9% (88.7%-92.8%), 88.5% (79.9%-95.0%), 93.5% (91.0%-95.6%); total AEs 20.4% (16.6%-24.6%), 17.1% (8.3%-28.3%), 7.6% (3.6%-13.0); migration 4.2% (2.9%-5.7%), 7.8% (4.1%-12.4%), 0.9% (0.1%-2.8%); overall bleeding 7.0% (4.9%-9.5%), 4.4% (2.2%-7.4%), 1.8% (0.8%-3.3%); and endoscopic necrosectomy 54.5% (38.9%-69.7%), 16.0% (11.4%-21.3%), 19.9% (6.6%-38.1%). In terms of severity, moderate-severe bleeding was most common with all three stents. AEs were higher in patients with walled-off necrosis compared with pseudocysts. Substantial-to-considerable heterogeneity (I 2 >60%) was present for total AEs for all of the stents.Our study shows good technical and clinical success rates with all three LAMSs for EUS-guided PFC drainage. Total AEs and bleeding were highest with the Axios stent and lowest with the Spaxus. Stent migration was highest with the Nagi stent and lowest with the Spaxus.
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Affiliation(s)
| | - Sahib Singh
- Internal Medicine, Sinai Hospital, Baltimore, United States
| | - Vishali Moond
- Gastroenterology, Robert Wood Johnson Health System, West Orange, United States
| | - Babu P Mohan
- Gastroenterology and Hepatology, Orlando Gastroenterology PA, Orlando, United States
| | - Ganesh Aswath
- Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, United States
| | - Hafiz M A Khan
- Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, United States
| | - Bishnu Sapkota
- Gastroenterology and Hepatology, SUNY Upstate Medical University, Syracuse, United States
- Gastroenterology, Syracuse VA Medical Center, Syracuse, United States
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Porter Adventist Hospital, Denver, United States
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Sandhyav R, Mohapatra N, Agrawal N, Patidar Y, Arora A, Chattopadhyay TK. Diffusion weighted MRI and neutrophil lymphocyte ratio non-invasively predict infection in pancreatic necrosis: a pilot study. ANZ J Surg 2025; 95:363-369. [PMID: 39498984 DOI: 10.1111/ans.19301] [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: 05/22/2024] [Revised: 10/22/2024] [Accepted: 10/23/2024] [Indexed: 11/07/2024]
Abstract
BACKGROUND Infected pancreatic necrosis (IPN) is a major determinant of mortality in acute pancreatitis (AP). Non-invasive diagnosis of IPN could guide the intervention in AP. We aimed to investigate the role of non-invasive methods like diffusion weighted magnetic resonance imaging (DW-MRI) and clinico-laboratory parameters as predictors of IPN. METHODS Prospective evaluation for predictors of IPN by diffusion restriction (DR) on DW-MRI and clinico-laboratory parameters was performed. RESULTS Out of 39 patients included, 31 were analysed after exclusion. Twenty-six (83.8%) patients had moderately severe AP, and the rest had severe disease. They were categorized into Group A: patients with documented infection after intervention (n = 17) and Group B: successfully managed without intervention or negative culture after intervention (n = 14). On univariate analysis, Group A had significantly more incidence of fever (P = 0.020), persistent unwellness (P = 0.003), elevated neutrophil count (P = 0.007), lymphocyte count (P = 0.007), neutrophil lymphocyte ratio (NLR) (P = 0.028), DR on DW-MRI (P = 0.001) and low apparent diffusion coefficient (ADC) (P = 0.086). Multivariate analysis revealed DR on DW-MRI (P = 0.004) and NLR (P = 0.035) as significant predictors of IPN, among other factors. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DW-MRI were 94.1%, 78.6%, 91.66%, and 84.21%, respectively. The area under curve of NLR on the ROC plot was 0.85 and the best cutoff was >3.5, with sensitivity, specificity, PPV, and NPV of 70.6%, 78.6%, 80%, and 68.7% respectively. CONCLUSION DW-MRI and NLR are promising non-invasive tools for accurate prediction of IPN and hence can guide the need for intervention in acute pancreatitis.
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Affiliation(s)
- Rommel Sandhyav
- Department of HPB Surgery and Liver Transplantation, Aster RV Hospital, Bangalore, -560078, India
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, -70, India
| | - Nihar Mohapatra
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, -70, India
| | - Nikhil Agrawal
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, -70, India
- Department of Gastrointestinal-HPB Surgery and Oncology, Max Superspeciality Hospital, New Delhi, -17, India
| | - Yashwant Patidar
- Department of Intervention Radiology, Institute of Liver and Biliary Sciences, New Delhi, -70, India
| | - Asit Arora
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, -70, India
| | - Tushar Kanti Chattopadhyay
- Department of HPB Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, -70, India
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Holanda EU, Fondelli AA, de Freitas Kleimmann R, Pauperio PM, Tschaen JM, Fernandes MV. Metal stents versus plastic stents for drainage of pancreatic fluid collections: a systematic review and meta-analysis of randomized trials with trial sequential analysis. Surg Endosc 2025; 39:1449-1461. [PMID: 39849071 DOI: 10.1007/s00464-024-11522-2] [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: 09/09/2024] [Accepted: 12/30/2024] [Indexed: 01/25/2025]
Abstract
BACKGROUND AND AIMS Pancreatic fluid collections (PFCs), including walled-off necrosis (WON), are significant complications of acute pancreatitis, and their management often involves drainage, although the optimal type of stent for this purpose remains uncertain. This meta-analysis aimed to compare metal versus plastic stents for endoscopic ultrasound (EUS)-guided drainage of PFCs. METHODS We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing metal with plastic stents for drainage of PFCs. The odds ratio (OR) was used for binary outcomes and the mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI). RESULTS This study included eight RCTs and over 500 patients. Procedure duration was shorter in the metal stent arm compared with the plastic stent arm (MD - 10.63; 95% CI - 16.12 to - 5.15, p < 0.001). However, there was no statistically significant difference between metal and plastic stents in clinical success (OR 1.10; 95% CI 0.56 to 2.14), technical success (OR 1.53; 95% CI 0.23 to 10.0), overall mortality (OR 0.75; 95% CI 0.34 to 1.67), recurrence (OR 1.76; 95%CI 0.70 to 4.44), total number of interventions (MD 0.06; 95% CI - 0.52 to 0.64), need of necrosectomy (OR 1.27; 95% CI 0.77 to 2.11), length of hospitalization (MD - 0.41; 95% CI - 5.10 to 4.27), exocrine insufficiency (OR 1.37; 95% CI 0.50 to 3.71), endocrine insufficiency (OR 1.11; 95% CI 0.57 to 2.16), and adverse events (OR 0.74; 95% CI 0.39 to 1.41). CONCLUSION Metal stents for EUS-guided drainage of WON are associated with a shorter procedure duration. Besides that, it may not improve other clinically relevant outcomes in comparison with plastic stents.
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Affiliation(s)
- Erica Uchoa Holanda
- University Center Christus, 133 João Adolfo Gurgel Street, Fortaleza, 60192-345, Brazil.
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Zeng J, He H, Song Y, Wei W, Han Y, Su X, Lyu W, Zhao J, Han L, Wu Z, Wang Z, Wei K. Adjuvant non-opioid analgesics decrease in-hospital mortality in targeted patients with acute pancreatitis receiving opioids. Eur J Gastroenterol Hepatol 2025; 37:263-271. [PMID: 39919002 PMCID: PMC11781558 DOI: 10.1097/meg.0000000000002868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 09/22/2024] [Indexed: 02/09/2025]
Abstract
OBJECTIVES Opioid administration in acute pancreatitis (AP) exacerbates its severity, prompting concerns regarding the increased requirement for intensive care and its potential impact on patient survival. We aimed to elucidate the influence of analgesic patterns on mortality among patients with AP hospitalized in the ICU. METHODS We included 784 patients (198 receiving opioid monotherapy and 586 receiving opioid polytherapy) from the Medical Information Mart for Intensive Care database. The primary outcome was in-hospital mortality. Propensity score matching was used to account for baseline differences. We used Kaplan-Meier survival curves and multivariate regression models to indicate survival discrepancies and potential associations. RESULTS Polytherapy group exhibited prolonged hospital survival (79.8 vs. 57.3 days, P < 0.001); polytherapy was associated with decreasing in-hospital mortality adjusted for confounders (HR = 0.49, 95% CI: 0.26-0.92; P = 0.027). Stratification analysis indicated that patients receiving adjunctive acetaminophen had prolonged hospital survival (opioid vs. opioid + acetaminophen, P < 0.001; opioid vs. opioid + NSAIDs + acetaminophen, P = 0.026). Opioid polytherapy benefited patients with APACHE III scores >83 and those with mean oral morphine equivalent >60 mg/day (HR = 0.17, 95% CI: 0.1-0.3, P < 0.001 and HR = 0.32, 95% CI: 0.2-0.52, P < 0.001, respectively). CONCLUSION Our findings suggest that an opioid-based analgesic regimen offers a survival advantage for patients with AP, particularly those in critical condition or with concerns about opioid use. This approach provides a viable clinical strategy for pain management. Further randomized clinical trials are warranted to validate these results.
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Affiliation(s)
- Jiahui Zeng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Hairong He
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yiqun Song
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Wanzhen Wei
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yimin Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Xinhao Su
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Weiqi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jinpeng Zhao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Liang Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Zheng Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Kongyuan Wei
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
- Pancreatic Disease Center of Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Wang H, Ciccocioppo R, Terai S, Shoeibi S, Carnevale G, De Marchi G, Tsuchiya A, Ishii S, Tonouchi T, Furuyama K, Yang Y, Mito M, Abe H, Di Tinco R, Cardinale V. Targeted animal models for preclinical assessment of cellular and gene therapies in pancreatic and liver diseases: regulatory and practical insights. Cytotherapy 2025; 27:259-278. [PMID: 39755978 DOI: 10.1016/j.jcyt.2024.11.008] [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: 05/31/2024] [Revised: 11/08/2024] [Accepted: 11/10/2024] [Indexed: 01/07/2025]
Abstract
Cellular and gene therapy (CGT) products have emerged as a popular approach in regenerative medicine, showing promise in treating various pancreatic and liver diseases in numerous clinical trials. Before these therapies can be tested in human clinical trials, it is essential to evaluate their safety and efficacy in relevant animal models. Such preclinical testing is often required to obtain regulatory approval for investigational new drugs. However, there is a lack of detailed guidance on selecting appropriate animal models for CGT therapies targeting specific pancreatic and liver conditions, such as pancreatitis and chronic liver diseases. In this review, the gastrointestinal committee for the International Society for Cell and Gene Therapy provides a summary of current recommendations for animal species and disease model selection, as outlined by the US Food and Drug Administration, with references to EU EMA and Japan PMDA. We discuss a range of small and large animal models, as well as humanized models, that are suitable for preclinical testing of CGT products aimed at treating pancreatic and liver diseases. For each model, we cover the associated pathophysiology, commonly used metrics for assessing disease status, the pros and limitations of the models, and the relevance of these models to human conditions. We also summarize the use and application of humanized mouse and other animal models in evaluating the safety and efficacy of CGT products. This review aims to provide comprehensive guidance for selecting appropriate animal species and models to help bridge the gap between the preclinical research and clinical trials using CGT therapies for specific pancreatic and liver diseases.
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Affiliation(s)
- Hongjun Wang
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA; Ralph H Johnson Veteran Medical Center, Charleston, South Carolina, USA.
| | - Rachele Ciccocioppo
- Department of Medicine, Gastroenterology Unit, Pancreas Institute, A.O.U.I. Policlinico G.B. Rossi & University of Verona, Verona, Italy
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Sara Shoeibi
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gianluca Carnevale
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia De Marchi
- Department of Medicine, Gastroenterology Unit, Pancreas Institute, A.O.U.I. Policlinico G.B. Rossi & University of Verona, Verona, Italy
| | - Atsunori Tsuchiya
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Soichi Ishii
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takafumi Tonouchi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kaito Furuyama
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yuan Yang
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Masaki Mito
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiroyuki Abe
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Rosanna Di Tinco
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Cardinale
- Department of Translational and Precision Medicine, University of Rome, Rome, Italy.
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Ma JM, Wang PF, Yang LQ, Wang JK, Song JP, Li YM, Wen Y, Tang BJ, Wang XD. Machine learning model-based prediction of postpancreatectomy acute pancreatitis following pancreaticoduodenectomy: A retrospective cohort study. World J Gastroenterol 2025; 31:102071. [DOI: 10.3748/wjg.v31.i8.102071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/07/2024] [Accepted: 01/03/2025] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND The International Study Group of Pancreatic Surgery has established the definition and grading system for postpancreatectomy acute pancreatitis (PPAP). There are no established machine learning models for predicting PPAP following pancreaticoduodenectomy (PD).
AIM To explore the predictive model of PPAP, and test its predictive efficacy to guide the clinical work.
METHODS Clinical data from consecutive patients who underwent PD between 2016 and 2024 were retrospectively collected. An analysis of PPAP risk factors was performed, various machine learning algorithms [logistic regression, random forest, gradient boosting decision tree, extreme gradient boosting, light gradient boosting machine, and category boosting (CatBoost)] were utilized to develop predictive models. Recursive feature elimination was employed to select several variables to achieve the optimal machine algorithm.
RESULTS The study included 381 patients, of whom 88 (23.09%) developed PPAP. PPAP patients exhibited a significantly higher incidence of postoperative pancreatic fistula (55.68% vs 14.68%, P < 0.001), grade C postoperative pancreatic fistula (9.09% vs 1.37%, P = 0.001). The CatBoost algorithm outperformed other algorithms with a mean area under the receiver operating characteristic curve of 0.859 [95% confidence interval (CI): 0.814-0.905] in the training cohort and 0.822 (95%CI: 0.717-0.927) in the testing cohort. According to shapley additive explanations analysis, pancreatic texture, main pancreatic duct diameter, body mass index, estimated blood loss, and surgery time were the most important variables based on recursive feature elimination. The CatBoost algorithm based on selected variables demonstrated superior performance, with an area under the receiver operating characteristic curve of 0.837 (95%CI: 0.788-0.886) in the training cohort and 0.812 (95%CI: 0.697-0.927) in the testing cohort.
CONCLUSION We developed the first machine learning-based predictive model for PPAP following PD. This predictive model can assist surgeons in anticipating and managing this complication proactively.
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Affiliation(s)
- Ji-Ming Ma
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Peng-Fei Wang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Liu-Qing Yang
- Department of Information Administration, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Jun-Kai Wang
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Jian-Ping Song
- Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yu-Mei Li
- Department of Otorhinolaryngology, Xiangyang No. 1 People’s Hospital, Xiangyang 441000, Hubei Province, China
| | - Yan Wen
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Bing-Jun Tang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Xue-Dong Wang
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
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Yamao K, Takenaka M, Yoshida A, Yamazaki T, Omoto S, Minaga K, Kamata K, Takada Y, Uetsuki K, Iida T, Mizutani Y, Ishikawa T, Kawashima H, Kudo M. Concealed pancreatic cancer in acute pancreatitis: Early MRCP and EUS surveillance improves prognosis and identifies high-risk patients. Pancreatology 2025:S1424-3903(25)00041-9. [PMID: 40102117 DOI: 10.1016/j.pan.2025.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 02/03/2025] [Accepted: 02/27/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND/OBJECTIVES Acute pancreatitis (AP) may obscure small pancreatic cancers (PCs) on computed tomography during the acute phase. Surveillance with magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) may enhance early detection and improve patient outcomes. This study evaluated the impact of early MRCP/EUS surveillance on PC outcomes in AP patients and identified high-risk subgroups for early screening. METHODS We retrospectively analyzed 1562 AP patients treated between 2010 and 2021, categorizing them into early surveillance (MRCP/EUS within three months of AP onset; n = 760) and nonearly surveillance groups (n = 802). Key outcomes included time to PC diagnosis, surgical resection rate, tumor stage, and overall survival. Multivariate analysis was performed to identify risk factors for concealed PC in AP patients. RESULTS Among 27 PC cases analyzed, the early surveillance group achieved significantly earlier diagnosis, higher surgical resection rates, increased detection of early-stage PC, and improved overall survival compared with the nonearly surveillance group. Multivariate analysis revealed that subthreshold main pancreatic duct (MPD) dilation (≥2.5 mm) and moderately severe AP were significant predictors of PC. CONCLUSIONS Early MRCP/EUS surveillance in AP patients facilitates timely detection of occult PC and enhances patient prognosis. These findings support prioritizing early surveillance for AP patients with subthreshold MPD dilation and moderately severe disease. Further large-scale studies are warranted to validate these strategies in clinical practice.
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Affiliation(s)
- Kentaro Yamao
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan; Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
| | - Akihiro Yoshida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Tomohiro Yamazaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yoshihisa Takada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kota Uetsuki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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Cai W, Bhattacharya P, Li Y, Wen Y, Shi N, Liu T, Xia Q, Sutton R, Huang W, Mukherjee R. Circulating cyclophilin A levels elevate in animal models and can predict mortality in patients with acute pancreatitis. Pancreatology 2025:S1424-3903(25)00040-7. [PMID: 40050183 DOI: 10.1016/j.pan.2025.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 02/08/2025] [Accepted: 02/27/2025] [Indexed: 03/17/2025]
Abstract
BACKGROUND/OBJECTIVES Cyclophilin A (CypA) is released into the blood following cellular injury and correlates with acute pancreatitis (AP) severity, however, investigations into circulating CypA in experimental AP and hypertriglyceridaemia-associated AP (HTG-AP) prevalent cohorts are lacking. METHODS C57Bl/6 mice received 4, 8, and 12 caerulein injections to induce escalating severity of AP models (CER-AP). Mice were sacrificed 1 h after the last injection of caerulein to assess severity of CER-AP through biochemical and histopathological analyses, and serum CypA levels were also measured. Golden Syrian hamsters fed with a high-cholesterol/high-fat diet were given 10 caerulein injections to induce experimental HTG-AP to assess severity and serum CypA. Human blood plasma samples taken within 24 h after admission from a patient cohort with a predominance of HTG-AP cases, stored in a prospectively collected AP Biobank, were assessed for plasma CypA levels and correlated with clinical data. RESULTS In mice, CER-AP models showed significantly increased pancreatic histopathological scores and biochemical parameters, with severity highest after 12 caerulein injections. Serum CypA levels were significantly higher in all CER-AP models compared to controls. In hamsters, CypA levels were significantly higher in HTG-AP model than controls. In AP patients, CypA levels in non-haemolytic plasma samples varied by aetiology, with the highest levels in HTG-AP, corresponding to HTG levels and AP severity. ROC analysis revealed CypA ≥9.9 ng/ml as a significant predictor of mortality (AUC = 0.865). CONCLUSION Circulating CypA levels are significantly increased in mouse CER-AP and hamster HTG-AP models. We have identified a novel association of raised plasma CypA levels with severity of HTG-AP and confirmed its significant prognostic ability to predict mortality in AP patients.
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Affiliation(s)
- Wenhao Cai
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre West China Hospital, Sichuan University, Chengdu, China; Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Priyanka Bhattacharya
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester, UK
| | - Yuying Li
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre West China Hospital, Sichuan University, Chengdu, China
| | - Yongjian Wen
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre West China Hospital, Sichuan University, Chengdu, China
| | - Na Shi
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre West China Hospital, Sichuan University, Chengdu, China
| | - Tingting Liu
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre West China Hospital, Sichuan University, Chengdu, China
| | - Qing Xia
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre West China Hospital, Sichuan University, Chengdu, China
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of General Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre West China Hospital, Sichuan University, Chengdu, China.
| | - Rajarshi Mukherjee
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of General Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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