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Thierens NDE, Verdonk RC, Löhr JM, van Santvoort HC, Bouwense SA, van Hooft JE. Chronic pancreatitis. Lancet 2025; 404:2605-2618. [PMID: 39647500 DOI: 10.1016/s0140-6736(24)02187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 09/20/2024] [Accepted: 10/01/2024] [Indexed: 12/10/2024]
Abstract
Chronic pancreatitis is a progressive fibroinflammatory disease primarily caused by a complex interplay of environmental and genetic risk factors. It might result in pancreatic exocrine and endocrine insufficiency, chronic pain, reduced quality of life, and increased mortality. The diagnosis is based on the presence of typical symptoms and multiple morphological manifestations of the pancreas, including pancreatic duct stones and strictures, parenchymal calcifications, and pseudocysts. Management of chronic pancreatitis consists of prevention and treatment of complications, requiring a multidisciplinary approach focusing on lifestyle modifications, exocrine insufficiency, nutritional status, bone health, endocrine insufficiency, pain management, and psychological care. To optimise clinical outcomes, screening for complications and evaluation of treatment efficacy are indicated in all patients with chronic pancreatitis.
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Affiliation(s)
- Naomi DE Thierens
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Research and Development, St Antonius Hospital, Nieuwegein, Netherlands.
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - J Matthias Löhr
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Stefan Aw Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
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2
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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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Zhang C, Chen S, Wang Z, Zhang J, Yu W, Wang Y, Si W, Zhang Y, Zhang Y, Liang T. Exploring the mechanism of intestinal bacterial translocation after severe acute pancreatitis: the role of Toll-like receptor 5. Gut Microbes 2025; 17:2489768. [PMID: 40243695 PMCID: PMC11980482 DOI: 10.1080/19490976.2025.2489768] [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: 01/04/2025] [Revised: 03/31/2025] [Accepted: 04/01/2025] [Indexed: 04/18/2025] Open
Abstract
Severe acute pancreatitis (SAP)-induced intestinal bacterial translocation and enterogenic infection are among the leading causes of mortality in patients. However, the mechanisms by which SAP disrupted the intestinal barrier and led to bacterial translocation remained unclear. Therefore, we employed multi-omics analysis including microbiome, metabolome, epigenome, transcriptome, and mass cytometry (CyTOF) to identify potential targets, followed by functional validation using transgenic mice. The integrated multi-omics analysis primarily indicated overgrowth of intestinal flagellated bacteria, upregulation of intestinal Toll-like receptor 5 (TLR5) and acute inflammatory response, and increased infiltration of intestinal high-expressing TLR5 lamina propria dendritic cells (TLR5hi LPDC) after SAP. Subsequently, intestinal flagellin-TLR5 signaling was activated after SAP. Intestinal barrier disruption, bacterial translocation, and helper T cells (Th) differentiation imbalance caused by SAP were alleviated in TLR5 knocked out (Tlr5-/-) or conditionally knocked out on LPDC (Tlr5ΔDC) mice. However, TLR5 conditional knockout on intestinal epithelial cells (Tlr5ΔIEC) failed to improve SAP-induced bacterial translocation. Moreover, depletion of LPDC and regulatory T cells (Treg) ameliorated bacterial translocation after SAP. Our findings identify TLR5 on LPDC as a potential novel target for preventing or treating intestinal bacterial translocation caused by SAP.
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Affiliation(s)
- Cheng Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang Province, China
- Innovation Center for the Study of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
- MOE Joint International Research Laboratory of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
| | - Shiyin Chen
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang Province, China
- Innovation Center for the Study of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
- MOE Joint International Research Laboratory of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
| | - Zhien Wang
- Department of Rehabilitation, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jian Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang Province, China
- Innovation Center for the Study of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
- MOE Joint International Research Laboratory of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
| | - Wenqiao Yu
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yanshuai Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang Province, China
- Innovation Center for the Study of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
- MOE Joint International Research Laboratory of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
| | - Weiwei Si
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang Province, China
- Innovation Center for the Study of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
- MOE Joint International Research Laboratory of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
| | - Yuwei Zhang
- College of Science, Mathematics and Technology, Wenzhou-Kean University, Wenzhou, Zhejiang Province, China
| | - Yun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang Province, China
- Innovation Center for the Study of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
- MOE Joint International Research Laboratory of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
- Department of Nutrition, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang Province, China
- Innovation Center for the Study of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
- MOE Joint International Research Laboratory of Pancreatic Diseases, Hangzhou, Zhejiang Province, China
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Cai WL, Fang C, Leng HX, Zheng JY, Liu LF, Gong GW, Xin GZ. Pseudotargeted metabolomics profiles potential damage-associated molecular patterns as machine learning predictors for acute pancreatitis. J Pharm Biomed Anal 2025; 262:116874. [PMID: 40220635 DOI: 10.1016/j.jpba.2025.116874] [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: 12/26/2024] [Revised: 03/17/2025] [Accepted: 04/04/2025] [Indexed: 04/14/2025]
Abstract
Acute pancreatitis (AP) is a common gastrointestinal disease characterized by pancreatic cell damage and inflammation. Given the early clinical diagnosis and management challenges, exploring novel analytical frameworks from new orientations for interrogating AP is urgent. The release of damage-associated molecular patterns (DAMPs) and their receptor recognition initiate sterile inflammation, serving as key drivers in the development and progression of AP. Thus, this study aimed to delineate the underlying correlations between alterations in the DAMP profile and the AP state. We have developed a new framework combining potential DAMPs profiles obtained from pseudotargeted metabolomics method with machine learning (ML) models for AP prediction. 2-(1-Piperazinyl) pyrimidine chemical labeling was utilized to provide characteristic fragment ions and improve the quantitative sensitivity of targeted metabolites. A total of 49 potential DAMPs were identified and semi-quantified from collected serum samples (n = 84), positive or negative for APs. For modeling obtained datasets with five different ML algorithms, the support vector machine model was chosen as the optimal model to differentiate with high accuracy, achieving an area under the receiver-operating characteristic curve (AUROC) of 0.944. It also showed a strong performance in an external independent validation set (AUROC: 0.907). Moreover, the model was interpreted using the Shapley Additive exPlanations analysis to specify the important features and identify specific free fatty acids as key contributors. Overall, the novel framework enables high accuracy in predicting the presence of AP status. Meanwhile, it underlines the utility of DAMPs in inflammatory diseases and provides reference values for diagnosing in first-line clinics.
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Affiliation(s)
- Wen-Lu Cai
- Pukou Hospital of Chinese Medicine Affiliated to China Pharmaceutical University, Department of Chinese Medicines Analysis, China Pharmaceutical University, Nanjing, China
| | - Can Fang
- Pukou Hospital of Chinese Medicine Affiliated to China Pharmaceutical University, Department of Chinese Medicines Analysis, China Pharmaceutical University, Nanjing, China
| | - Hong-Xu Leng
- Pukou Hospital of Chinese Medicine Affiliated to China Pharmaceutical University, Department of Chinese Medicines Analysis, China Pharmaceutical University, Nanjing, China
| | - Jia-Yi Zheng
- Pukou Hospital of Chinese Medicine Affiliated to China Pharmaceutical University, Department of Chinese Medicines Analysis, China Pharmaceutical University, Nanjing, China
| | - Li-Fang Liu
- Pukou Hospital of Chinese Medicine Affiliated to China Pharmaceutical University, Department of Chinese Medicines Analysis, China Pharmaceutical University, Nanjing, China
| | - Guan-Wen Gong
- Department of General Surgery, Affiliated Hospital of Nanjing, University of Chinese Medicine, Nanjing, China..
| | - Gui-Zhong Xin
- Pukou Hospital of Chinese Medicine Affiliated to China Pharmaceutical University, Department of Chinese Medicines Analysis, China Pharmaceutical University, Nanjing, China.
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Inoue Y, Yata Y, Yokota Y, Li ZL, Kawabata K. Acute pancreatitis after total aortic arch replacement leading to walled-off necrosis: A case report and review of literature. World J Clin Cases 2025; 13:104165. [DOI: 10.12998/wjcc.v13.i22.104165] [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: 12/15/2024] [Revised: 03/05/2025] [Accepted: 04/15/2025] [Indexed: 05/14/2025] Open
Abstract
BACKGROUND Although acute pancreatitis and walled-off necrosis (WON) are rare complications following aortic surgery, they are serious risk factors for postoperative mortality. Considering the poor general condition of the postoperative patient, more effective and less invasive treatments are favorable.
CASE SUMMARY A 67-year-old man was referred to our hospital for the treatment of WON after acute pancreatitis. He had undergone total aortic arch replacement due to aortic arch aneurysm and coronary artery bypass grafting due to angina pectoris 6 weeks prior in another hospital. On the second postoperative day, laboratory data and computed tomography showed that the patient had developed acute pancreatitis. Although conservative management (antibiotics, hydration, etc.) had helped in relieving the symptoms of acute pancreatitis, peripancreatic fluid collection (PFC) persisted, accompanied by duodenal obstruction and vomiting. Contrast-enhanced computed tomography showed that the heterogeneous enhancement and fluid collection in the pancreatic body and tail had increased, consistent with walled-off WON. We therefore performed endoscopic ultrasound-guided transluminal drainage for the PFC. As a result, the WON resolved gradually, resulting in improved oral intake.
CONCLUSION Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery. To the best of our knowledge, this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage for PFC.
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Affiliation(s)
- Yuma Inoue
- Department of Gastroenterology, Hanwa Memorial Hospital, Osaka 558-0041, Japan
| | - Yutaka Yata
- Department of Gastroenterology, Hanwa Memorial Hospital, Osaka 558-0041, Japan
- Department of Hepatology, Osaka Metropolitan University, Osaka 545-0051, Japan
| | - Yuta Yokota
- Department of Gastroenterology, Hanwa Memorial Hospital, Osaka 558-0041, Japan
| | - Zhao-Liang Li
- Department of Gastroenterology, Takarazuka City Hospital, Takarazuka 665-0827, Hyōgo, Japan
| | - Kazumi Kawabata
- Department of Gastroenterology, Hanwa Memorial Hospital, Osaka 558-0041, Japan
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Marston NA, Bergmark BA, Alexander VJ, Karwatowska-Prokopczuk E, Kang YM, Moura FA, Prohaska TA, Zimerman A, Zhang S, Murphy SA, Tsimikas S, Giugliano RP, Sabatine MS. Design and rationale of the CORE-TIMI 72a and CORE2-TIMI 72b trials of olezarsen in patients with severe hypertriglyceridemia. Am Heart J 2025; 286:125-135. [PMID: 40064331 PMCID: PMC12065585 DOI: 10.1016/j.ahj.2025.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 03/02/2025] [Accepted: 03/04/2025] [Indexed: 04/03/2025]
Abstract
BACKGROUND Severe hypertriglyceridemia (HTG), defined as a serum triglyceride (TG) concentration ≥500 mg/dl, is present in approximately 1 in every 100 individuals and carries direct clinical consequences, including pancreatitis, which can be life-threatening. Olezarsen is an investigational antisense oligonucleotide targeted to the mRNA for apolipoprotein C-III (apoC-III), a protein known to impair TG clearance by inhibiting lipoprotein lipase and the hepatic uptake of triglyceride-rich remnants. No dedicated trial has tested olezarsen in patients with severe HTG. METHODS In these 2 pivotal phase 3 trials, CORE-TIMI 72a and CORE2-TIMI 72b, patients with severe HTG were randomized in a 2:1 fashion to either olezarsen (80 mg or 50 mg dose) or matching placebo. Patients will be treated for a total of 12 months and evaluated for the primary endpoint of percent change in TGs from baseline to 6 months compared with placebo. Pooled analyses of CORE and CORE2 will also assess olezarsen's effect on acute pancreatitis events and change in hepatic steatosis. RESULTS A total of 617 subjects in CORE-TIMI 72a and 446 subjects in CORE2-TIMI 72b were randomized. In these 2 trials, the median age was 54 and 55 years, women made up 24% and 23% of the study population, and the baseline TGs were 836 mg/dl and 749 mg/dl, respectively. A total of 333 subjects, 129 from CORE-TIMI 72a and 204 from CORE2-TIMI 72b, were enrolled in the hepatic MRI substudy. DISCUSSION Together, CORE-TIMI 72a and CORE2-TIMI 72b are designed to establish the efficacy and safety of olezarsen in patients with severe HTG. TRIAL REGISTRATION Clinicaltrials.gov: NCT05079919 and NCT05552326.
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Affiliation(s)
- Nicholas A Marston
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Brian A Bergmark
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - Yu Mi Kang
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Filipe A Moura
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Disivion of Cardiovascular Medicine, VA Connecticut Healthcare System, West Haven, CT
| | | | - Andre Zimerman
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Clinical Trials Unit, Academic Research Organization, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Shuanglu Zhang
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sabina A Murphy
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sotirios Tsimikas
- Ionis Pharmaceuticals, Carlsbad, CA; Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Blanke EN, Holmes GM. Dysfunction of pancreatic exocrine secretion after experimental spinal cord injury. Exp Neurol 2025; 389:115257. [PMID: 40221007 PMCID: PMC12063635 DOI: 10.1016/j.expneurol.2025.115257] [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: 01/08/2025] [Revised: 04/07/2025] [Accepted: 04/09/2025] [Indexed: 04/14/2025]
Abstract
Pancreatic exocrine dysfunction is an underdiagnosed comorbidity in individuals living with spinal cord injury (SCI) who often present cholestasis, acute pancreatitis or high levels of serum pancreatic enzymes. Parasympathetic control of pancreatic exocrine secretion (PES) is mediated in the medullary dorsal vagal complex in part through cholecystokinin (CCK) release. Our previous reports indicate high thoracic (T3-) SCI reduces vagal afferent sensitivity to GI regulatory peptides, like CCK and thyrotropin releasing hormone (TRH). To date, the effects of experimental SCI on PES are unknown. Here we investigated the modulation of PES following T3-SCI in rats. We measured PES volume and amylase concentration in control and T3-SCI rats (3-days or 3-weeks after injury) following: (i) intra-duodenal administration of a mixed-nutrient liquid meal (Ensure® ™) or (ii) central TRH injection (100 pmol) in the dorsal motor nucleus of the vagus. In a separate cohort of overnight-fasted rats, basal serum amylase levels were measured. The baseline volume of PES secretion was lower in 3-week rats destined to receive Ensure® or TRH following T3-SCI surgery compared to control. PES protein concentration was significantly reduced at baseline in 3-week T3-SCI and elevated in 3-day and 3-week T3-SCI rats postprandially but only elevated in 3-day rats following TRH microinjection. Serum amylase activity levels were elevated in 3-day T3-SCI rats and remained at similar levels post 3-weeks T3-SCI. Our data suggest that vagally-mediated regulation of multiple visceral organs is disrupted in the days and weeks following experimental SCI.
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Affiliation(s)
- Emily N Blanke
- Department of Neural and Behavioral Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States of America; Department of Biology, Pennsylvania State University, York, PA 17403, United States of America
| | - Gregory M Holmes
- Department of Neural and Behavioral Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, United States of America.
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Kang X, Xia M, Wang J, Wang X, Luo H, Qin W, Liang Z, Zhao G, Yang L, Sun H, Tao J, Ning B, Zhong L, Zhang R, Ma X, Zhao J, Yue L, Jin H, Kang C, Ren G, Liang S, Wang H, Wang L, Nie Y, Wu K, Fan DM, Pan Y. Rectal diclofenac versus indomethacin for prevention of post-ERCP pancreatitis (DIPPP): a multicentre, double-blind, randomised, controlled trial. Gut 2025; 74:1094-1102. [PMID: 40113243 DOI: 10.1136/gutjnl-2024-334466] [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: 12/03/2024] [Accepted: 02/02/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND Recent meta-analyses suggested diclofenac may be superior to indomethacin in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). The aim of our study was to compare the efficacy of 100 mg rectal indomethacin versus diclofenac on PEP incidences. DESIGN This multicentre, double-blinded, randomised controlled trial was conducted in nine tertiary centres in China. Patients with low and high risk for PEP and native papilla were randomly allocated (1:1) to receive 100 mg diclofenac or 100 mg indomethacin rectally before ERCP. The primary outcome was the occurrence of PEP defined by the Cotton consensus. The intention-to-treat principle was conducted for the analysis. RESULTS The trial was terminated early for futility after the predetermined first interim analysis. Between June 2023 and May 2024, 1204 patients were randomised into the diclofenac group (n=600) or indomethacin group (n=604). Baseline characteristics were balanced. The primary outcome occurred in 53 patients (8.8%) of 600 patients allocated to the diclofenac group and 37 patients (6.1%) of 604 patients allocated to the indomethacin group (relative risk 1.44; 95% CI 0.96 to 2.16, p=0.074). PEP occurred in 35 (14.2%) of 247 high-risk patients in the diclofenac group and 26 (9.8%) of 266 high-risk patients in the indomethacin group (p=0.124). PEP incidences were also comparable in low-risk patients between the two groups (18/353 (5.1%) vs 11/338 (3.3%), p=0.227). Other ERCP-related complications did not differ between the two groups. CONCLUSION Pre-procedure 100 mg rectal diclofenac was not superior to the same dose of rectal indomethacin regarding preventing PEP. These findings supported current clinical practice guidelines of 100 mg indomethacin or diclofenac for PEP prophylaxis in patients without contraindications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT05947461).
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Affiliation(s)
- Xiaoyu Kang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Mingxing Xia
- Department of Gastroenterology and Endoscopy, Eastern Hepatobiliary Surgery Hospital, National Center for Liver Cancer, Second Military Medical University, Shanghai, China
| | - Jun Wang
- Department of Gastroenterology, The 986th Hospital of Xijing Hospital, Fourth Militrary Medical University, Xian, China
| | - Xiangping Wang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hui Luo
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wenhao Qin
- Department of Gastroenterology and Endoscopy, Eastern Hepatobiliary Surgery Hospital, National Center for Liver Cancer, Second Military Medical University, Shanghai, China
| | - Zirong Liang
- Department of Gastroenterology, The 986th Hospital of Xijing Hospital, Fourth Militrary Medical University, Xian, China
| | - Gang Zhao
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Longbao Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hao Sun
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jie Tao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bo Ning
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Zhong
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongchun Zhang
- Department of Gastroenterology, Hongai Hospital, Xiamen, Fujian, China
| | - Xuyuan Ma
- Department of Gastroenterology, Hongai Hospital, Xiamen, Fujian, China
| | - Jianghai Zhao
- Department of Gastroenterology, Huaihe Hospital of Henan University, Kaifeng, Henan, China
| | - Laifu Yue
- Department of Gastroenterology, Huaihe Hospital of Henan University, Kaifeng, Henan, China
| | - Haifeng Jin
- Department of Gastroenterology, The 980th Hospital of the PLA Joint Logistics Support Force (Primary Bethune International Peace Hospital of PLA), Shijiazhuang, Hebei, China
| | - Chenxi Kang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Gui Ren
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shuhui Liang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haiying Wang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ling Wang
- Department of Health Statistics, School of Preventive Medicine, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yongzhan Nie
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Kaichun Wu
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dai-Ming Fan
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yanglin Pan
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, 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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10
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Napolitano LM, Biffl WL, Costantini TW, Diaz JJ, Inaba K, Livingston DH, Salim A, Winchell RJ, Coimbra R. Evidence-based cost-effective management of acute pancreatitis: An algorithm of the Journal of Trauma and Acute Care Surgery emergency general surgery algorithms work group. J Trauma Acute Care Surg 2025; 98:850-857. [PMID: 40232149 DOI: 10.1097/ta.0000000000004622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2025]
Affiliation(s)
- Lena M Napolitano
- From the Division of Acute Care Surgery, Department of Surgery (L.M.N.), University of Michigan School of Medicine, Ann Arbor, Michigan; Division of Trauma/Acute Care Surgery (W.L.B.), Scripps Clinic/Scripps Clinic Medical Group, La Jolla, California; Division of Critical Care and Acute Care Surgery, Department of Surgery (T.W.C.), University of Minnesota Medical School, Minneapolis, Minnesota; Division of Acute Care Surgery, Department of Surgery (J.J.D.), University of South Florida Morsani College of Medicine, Tampa, Florida; Trauma Surgery and Surgical Critical Care (K.I.), University of Southern California, Los Angeles, California; Department of Surgery (D.H.L.), Rutger's Health, New Jersey Medical School, NJ; Department of Surgery (A.S.), Brigham and Women's Hospital, Harvard, Boston, Massachusetts; Division of Trauma, Burns, Acute and Critical Care, Department of Surgery (R.W.), Weill Cornell Medicine, New York, New York; and Division of Acute Care Surgery, Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), Riverside University Health System Medical Center, Riverside, California
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11
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Willis J, vanSonnenberg E. Updated Review of Radiologic Imaging and Intervention for Acute Pancreatitis and Its Complications. J Intensive Care Med 2025; 40:588-597. [PMID: 38414385 DOI: 10.1177/08850666241234596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
This is a current update on radiologic imaging and intervention of acute pancreatitis and its complications. In this review, we define the various complications of acute pancreatitis, discuss the imaging findings, as well as the timing of when these complications occur. The various classification and scoring systems of acute pancreatitis are summarized. Advantages and disadvantages of the 3 primary radiologic imaging modalities are compared. We then discuss radiologic interventions for acute pancreatitis. These include diagnostic aspiration as well as percutaneous catheter drainage of fluid collections, abscesses, pseudocysts, and necrosis. Recommendations for when these interventions should be considered, as well as situations in which they are contraindicated are discussed. Fortunately, acute pancreatitis usually is mild; however, serious complications occur in 20%, and admission of patients to the intensive care unit (ICU) occurs in over 10%. In this paper, we will focus on the imaging and interventional radiologic aspects for the serious complications and patients admitted to the ICU.
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Affiliation(s)
- Joshua Willis
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
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12
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Tsujimae M, Saito T, Sakai A, Takenaka M, Omoto S, Hamada T, Ota S, Shiomi H, Takahashi S, Fujisawa T, Suda K, Matsubara S, Uemura S, Iwashita T, Yoshida K, Maruta A, Okuno M, Iwata K, Hayashi N, Mukai T, Yasuda I, Isayama H, Nakai Y, Masuda A. Necrosectomy and its timing in relation to clinical outcomes of EUS-guided treatment of walled-off pancreatic necrosis: a multicenter study. Gastrointest Endosc 2025; 101:1174.e1-1174.e20. [PMID: 39603541 DOI: 10.1016/j.gie.2024.11.039] [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: 07/31/2024] [Revised: 10/29/2024] [Accepted: 11/18/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND AND AIMS EUS-guided transmural drainage with on-demand endoscopic necrosectomy (EN) is increasingly used to manage walled-off necrosis (WON). It has not been fully elucidated how EN and its timing are correlated with treatment outcomes compared with the drainage-based approach. METHODS Within a multi-institutional cohort of 423 patients with pancreatic fluid collections, including 227 patients with WON, 153 patients were identified who received the step-up treatment after the initial EUS-guided drainage of symptomatic WON; this included 102 EN patients and 51 non-EN (drainage) patients. Using the competing-risks multivariable proportional hazards regression model with adjustment for potential confounders, we calculated subdistribution hazard ratios (SHRs) for clinical treatment success (WON resolution) according to use of EN and its timing. RESULTS Compared with drainage alone, the EN-based treatment was associated with a shorter time to clinical success with a multivariable SHR of 1.66 (95% confidence interval, 1.12-2.46). Despite a higher risk of procedure-related bleeding in the EN group, there were no differences in the rates of severe adverse events (7.8% vs 5.9% in the EN and non-EN groups, respectively) or mortality (6.9% vs 9.8%). In the EN-treated patients, the timing of EN was not statistically significantly associated with the time to clinical success (Ptrend = .34). CONCLUSIONS Among patients receiving EUS-guided treatment of symptomatic WON, the use of EN in addition to drainage procedures was associated with earlier disease resolution. Further research is desired to determine the optimal timing of initiating EN considering a risk-benefit balance and cost-effectiveness.
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Affiliation(s)
- Masahiro Tsujimae
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Arata Sakai
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shogo Ota
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan
| | - Hideyuki Shiomi
- Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan
| | - Sho Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Toshio Fujisawa
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kentaro Suda
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Saburo Matsubara
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shinya Uemura
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Kensaku Yoshida
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Akinori Maruta
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Mitsuru Okuno
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Keisuke Iwata
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Nobuhiko Hayashi
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Atsuhiro Masuda
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
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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; 13:528-536. [PMID: 40147461 DOI: 10.1016/s2213-8587(25)00028-2] [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: 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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Zhang Z, Wang Z, Li F, Liu X. Comparison of different scoring systems for predicting 28-day mortality in critically ill patients with acute pancreatitis: a retrospective cohort study. Scand J Gastroenterol 2025; 60:608-616. [PMID: 40354481 DOI: 10.1080/00365521.2025.2504077] [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: 03/10/2025] [Revised: 04/18/2025] [Accepted: 05/06/2025] [Indexed: 05/14/2025]
Abstract
BACKGROUND This study compared eight scoring systems for predicting 28-day and 1-year all-cause mortality in critically ill patients with acute pancreatitis (AP). METHODS Data from the Medical Information Mart for Intensive Care IV were used to conduct a comparative analysis of several predictive scoring systems. Predictive performance for 28-day and 1-year mortality was assessed using receiver operating characteristic (ROC) curves (area under the curve [AUC]), restricted cubic splines (RCS) for nonlinearity testing, and multivariable logistic regression for independent predictor analysis. RESULTS A total of 694 patients were included (28-day mortality: 15.56%; 1-year mortality: 24.78%). Acute Physiology Score III (APSIII) demonstrated the highest accuracy for 28-day mortality (AUC: 0.847, 95% confidence interval (CI): 0.808-0.886), followed by Bedside Index for Severity in Acute Pancreatitis (BISAP) (AUC: 0.835, 95% CI: 0.794-0.875). Linear relationships between scores and 28-day mortality were confirmed (all p for nonlinear > 0.05). Multivariable regression identified APSIII and BISAP as independent 28-day mortality predictors. For 1-year mortality, APSIII, BISAP, and Simplified Acute Physiology Score II (SAPS II) were independent predictors. CONCLUSIONS Both APSIII and BISAP were identified as independent predictors of 28-day mortality, while APSIII, BISAP, and SAPSII were associated with 1-year mortality. Among them, APSIII showed the best overall discriminative ability for both short- and long-term outcomes. However, BISAP remains an attractive alternative for its simplicity and comparable performance.
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Affiliation(s)
- Zeyu Zhang
- Department of General Surgery, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu, China
| | - Zheng Wang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Xing Liu
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Liao Y, Zhang W, Huang Z, Yang L, Lu M. Diagnostic and prognostic value of miR-146b-5p in acute pancreatitis. Hereditas 2025; 162:93. [PMID: 40450371 DOI: 10.1186/s41065-025-00466-9] [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: 01/15/2025] [Accepted: 05/26/2025] [Indexed: 06/03/2025] Open
Abstract
OBJECTIVE MicroRNAs hold great potential as biomarkers for assessing the progression of acute pancreatitis (AP). This study aimed to explore the value of miR-146b-5p in the diagnosis and prognosis of AP patients. METHODS 110 AP patients were included and divided into 40 severe AP (SAP) patients and 70 non-SAP patients based on disease severity. Serum miR-146b-5p levels were measured using RT-qPCR. The diagnostic value of miR-146b-5p was evaluated utilizing ROC curves. Pearson correlation coefficient was employed to analyze the correlations between APACHEII, BISAP, and MCTSI scores and miR-146b-5p levels. The AP cell model was constructed by treating AR42J cells with deoxycholic acid (DCA), the proliferative capacity of cells was measured with CCK-8, apoptosis was measured by flow cytometry, and IL-6 and IL-8 protein levels were analyzed by ELISA. RESULTS Serum miR-146b-5p levels were decreased in SAP and unfavorable patients. Serum miR-146b-5p was able to effectively differentiate between SAP and non-SAP patients, and also effectively differentiate between unfavorable and favorable patients. MiR-146b-5p levels were significantly negatively correlated with APACHEII score (r=-0.6676), BISAP score (r=-0.5696), and MCTSI score (r=-0.5857). Furthermore, in the AP cell model, miR-146b-5p expression was down-regulated, proliferative capacity was diminished, apoptosis was increased, and IL-6 and IL-8 levels were elevated, but overexpression of miR-146b-5p partially reversed these changes. CONCLUSION miR-146b-5p expression is down-regulated in the serum of SAP patients and cells, and it has a good diagnostic effect. It may be a potential biomarker and therapeutic target for AP.
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Affiliation(s)
- Ying Liao
- Department of Critical Care Medicine, Ganzhou People's Hospital, Ganzhou City, Jiangxi Province, 341100, China
| | - Weiwei Zhang
- Department of Critical Care Medicine, Ganzhou People's Hospital, Ganzhou City, Jiangxi Province, 341100, China
| | - Zhenfei Huang
- Department of Critical Care Medicine, Ganzhou People's Hospital, Ganzhou City, Jiangxi Province, 341100, China
| | - Liu Yang
- Department of Critical Care Medicine, Ganzhou People's Hospital, Ganzhou City, Jiangxi Province, 341100, China
| | - Mingjin Lu
- Supply Room, The Fifth People's Hospital of Ganzhou, No. 666, Dongjiangyuan Avenue, Shuixi Town, Zhanggong District, Ganzhou City, Jiangxi Province, 341000, China.
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16
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Wu W, Zhang YP, Zhang YL, Qu XG, Zhang ZH, Zhang R, Peng ZY. Nonlinear association between estimated plasma volume status and acute kidney injury in acute pancreatitis patients. World J Gastroenterol 2025; 31:105269. [DOI: 10.3748/wjg.v31.i20.105269] [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: 01/16/2025] [Revised: 04/18/2025] [Accepted: 05/12/2025] [Indexed: 05/28/2025] Open
Abstract
BACKGROUND Acute pancreatitis (AP), a severe pancreatic inflammatory condition, with a mortality rate reaching up to 40%. Recently, AP shows a steadily elevating prevalence, which causes the greater number of hospital admissions, imposing the substantial economic burden. Acute kidney injury (AKI) complicates take up approximately 15% of AP cases, with an associated mortality rate of 74.7%-81%.
AIM To evaluate the efficacy of estimated plasma volume status (ePVS) in forecasting AKI in patients with AP.
METHODS In this retrospective cohort study, AP cases were recruited from the First College of Clinical Medical Science of China Three Gorges University between January 2019 and October 2023. Electronic medical records were adopted for data extraction, including demographic data and clinical characteristics. The association between ePVS and AKI was analyzed using multivariate logistic regression models, with potential confounders being adjusted. Nonlinear relationship was examined with smooth curve fitting, and infection points were calculated. Further analyses were performed on stratified subgroups and interaction tests were conducted.
RESULTS Among the 1508 AP patients, 251 (16.6%) developed AKI. ePVS was calculated using Duarte (D-ePVS) and Kaplan-Hakim (KH-ePVS) formulas. After adjusting for covariates, the AKI risk exhibited 46% [odds ratio (OR) = 1.46, 95% confidence interval (CI): 0.96-2.24] and 11% (OR = 1.11, 95%CI: 0.72-1.72) increases in the low tertile (T1) of D-ePVS and KH-ePVS, respectively, and 101% (OR = 2.01, 95%CI: 1.31-3.05) and 51% (OR = 1.51, 95%CI: 1.00-2.29) increases in the high tertile (T3) relative to the reference tertile (T2). Nonlinear curve fitting revealed a U-shaped association of D-ePVS with AKI and a J-shaped association for KH-ePVS, with inflection points at 4.3 dL/g and -2.8%, respectively. Significant interactions were not observed in age, gender, hypertension, diabetes mellitus, sequential organ failure assessment score, or AP severity (all P for interaction > 0.05).
CONCLUSION Our results indicated that ePVS demonstrated the nonlinear association with AKI incidence in AP patients. A U-shaped curve was observed with an inflection point at 4.3 dL/g for the Duarte formula, and a J-shaped curve at -2.8% for the Kaplan-Hakim formula.
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Affiliation(s)
- Wen Wu
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei Province, China
| | - Yu-Pei Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Yi-Lan Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Xing-Guang Qu
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Zhao-Hui Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Rong Zhang
- Department of Emergency and Critical Care Medicine, Yichang Central People’s Hospital, Yichang 443000, Hubei Province, China
- The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
| | - Zhi-Yong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei Province, China
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Qian XZ, Hu JY, Zeng YM, Wei H, Wang XY, Chen C, Ge QM, Zou J, Zhou XM, Ling Q, He LQ, Liao X, Shao Y. Retinal microvasculature alteration in patients with acute pancreatitis: an observational OCTA study. Eur J Med Res 2025; 30:426. [PMID: 40437618 PMCID: PMC12121281 DOI: 10.1186/s40001-025-02566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 04/07/2025] [Indexed: 06/01/2025] Open
Abstract
OBJECTIVE To evaluate changes in retinal layer thickness and microvascular density in pancreatitis patients using optical coherence tomography angiography (OCTA). METHODS The study involved 16 pancreatitis patients and 16 healthy controls. Each participant underwent a superficial OCTA scan, with images divided into nine subregions to compare macular retinal thickness (RT) and superficial vascular density (SVD) between groups. RESULTS Pancreatitis patients exhibited reduced retinal thickness in specific macular areas, including inner, full, and outer layers (p < 0.05). Additionally, decreased superficial vascular density was noted in inner superior (IS), outer superior (OS), inner nasal (IN), and outer nasal (ON) regions (p < 0.05). ROC curve analysis showed high diagnostic accuracy for full-layer inner superior, outer superior, and outer inferior thickness with areas under the curve of 0.9429, 0.9233, and 0.9990, respectively. CONCLUSIONS Pancreatitis is associated with macular retinal thinning and decreased superficial vascular density, offering potential for improved diagnostic imaging.
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Affiliation(s)
- Xian-Zhe Qian
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jin-Yu Hu
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yan-Mei Zeng
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Hong Wei
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xiao-Yu Wang
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Cheng Chen
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jie Zou
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xian-Mei Zhou
- Ophthalmology Department of Affiliated Hospital, Medical School of Ophthalmology and Optometry, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Qian Ling
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Liang-Qi He
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xuan Liao
- Ophthalmology Department of Affiliated Hospital, Medical School of Ophthalmology and Optometry, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China.
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, 200080, China.
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Zeng Y, Zhang JW, Yang J. Endoscopic management of infected necrotizing pancreatitis: Advancing through standardization. World J Gastroenterol 2025; 31:107451. [DOI: 10.3748/wjg.v31.i20.107451] [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: 03/23/2025] [Revised: 04/12/2025] [Accepted: 05/12/2025] [Indexed: 05/28/2025] Open
Abstract
Infected necrotizing pancreatitis (INP) remains a life-threatening complication of acute pancreatitis. Despite advancements such as endoscopic ultrasound (EUS)-guided drainage, lumen-apposing metal stents, and protocolized step-up strategies, the clinical practice remains heterogeneous, with variability in endoscopic strategies, procedural timing, device selection, and adjunctive techniques contributing to inconsistent outcomes. This review synthesizes current evidence to contribute to a structured framework integrating multidisciplinary team decision-making, advanced imaging (three-dimensional reconstruction, contrast-enhanced computed tomography/magnetic resonance imaging), EUS assessment, and biomarker-driven risk stratification (C-reactive protein, procalcitonin) to optimize patient selection, intervention timing, and complication management. Key standardization components include endoscopic assessment and procedural strategies, optimal timing of intervention, personalized approaches for complex pancreatic collections, and techniques to reduce the number of endoscopic debridements and mitigate complications. This work aims to enhance clinical outcomes, minimize practice heterogeneity, and establish a foundation for future research and guideline development in endoscopic management of INP.
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Affiliation(s)
- Yan Zeng
- Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jun-Wen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jian Yang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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19
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Lu Y, Wu L, Yue X, Peng T, Yang M, Chen J, Han P. Quantitative Evaluation of Acute Pancreatitis Based on Dual-Energy Computed Tomography. J Comput Assist Tomogr 2025:00004728-990000000-00460. [PMID: 40423618 DOI: 10.1097/rct.0000000000001768] [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: 12/03/2024] [Accepted: 04/21/2025] [Indexed: 05/28/2025]
Abstract
OBJECTIVE To evaluate the value of dual-energy computed tomography (DECT) parameters for the quantitative diagnosis of acute pancreatitis (AP) and classification of its severity. METHODS Patients with AP underwent a plain CT scan and three contrast-enhanced DECT scans. We analyzed the group differences in iodine concentration (IC) and slope of the spectral Hounsfield unit curve (λHU) of the 3-phase enhanced scans (arterial, venous, and delayed phases). RESULTS The study included 60 AP patients (38 males and 22 females; mean age: 47.43±13.47 y). On the basis of the CT severity index (CTSI), the patients were divided into 2 groups: group A (mild AP, n=26) and group B (moderate/severe AP, n=34). IC and λHU in the arterial and venous phases were all significantly higher in group A than in group B (P<0.001) and could effectively differentiate the 2 groups. The areas under the curve were 0.753 (95% CI: 0.624-0.855), 0.799 (95% CI: 0.676-0.892), 0.774 (95% CI: 0.647-0.872), and 0.842 (95% CI: 0.724-0.923) for IC at arterial and venous phases and λHU at arterial and venous phases, respectively. These parameters decreased with the increase of CTSI, showing significant negative correlations, with r were -0.512 (95% CI: -0.678 to -0.297), -0.492 (95% CI: -0.663 to -0.272), -0.552 (95% CI: -0.707 to -0.346), -0.569 (95% CI: -0.719 to -0.368) for IC at arterial and venous phases and λHU at arterial and venous phases, respectively (P<0.001). CONCLUSIONS DECT imaging can quantitatively analyze AP, and the IC and λHU can be used to distinguish mild and severe cases, adding functional information to the CT morphology to determine the severity and prognosis of the disease.
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Affiliation(s)
- Yuting Lu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Laboratory of Molecular Imaging
| | - Linxia Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Laboratory of Molecular Imaging
| | - Xiaofei Yue
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Laboratory of Molecular Imaging
| | - Tao Peng
- Departments of Pancreatic Surgery
| | - Ming Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Laboratory of Molecular Imaging
| | - Jinhuang Chen
- Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Laboratory of Molecular Imaging
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20
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Liu YL, Liu J, Jiang WJ, Zhang KG, Wang YT. Ultrasound-guided endoscopic drainage for the management of pancreatic pseudocysts: A case report. World J Gastrointest Surg 2025; 17:106784. [DOI: 10.4240/wjgs.v17.i5.106784] [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: 03/06/2025] [Revised: 03/21/2025] [Accepted: 04/15/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND The treatment strategy for pancreatic pseudocysts (PPC) is comprehensive and warrants multidisciplinary participation. However, at present, the treatment concepts for PPC are inconsistent. Moreover, the timing of interventional therapy is unclear, and complication management is insufficient. Therefore, the development of a multidisciplinary expert consensus on PPC is warranted. At present, endoscopic treatment is recommended for managing PPC in American Society for Gastrointestinal Endoscopy guideline and Chinese Consensus guidelines.
CASE SUMMARY In this study, we present a rare case of PPC identified by endoscopy and imaging examination, and successfully managed by endoscopic and percutaneous drainage. In detail, an obese patient with a history of recurrent pancreatitis presents an irregular, elliptical cystic low-density shadow in the pancreatic region. Endoscopic ultrasound combined with double knife incision technique was used to endoscopic drainage, resulting in a favorable prognosis.
CONCLUSION Ultrasound-guided endoscopic drainage for the management of PPC may provide additional insights to current clinical guidelines.
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Affiliation(s)
- Ying-Ling Liu
- Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Jie Liu
- Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Wen-Jun Jiang
- Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Kai-Guang Zhang
- Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Ye-Tao Wang
- Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
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21
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Dupont B, Lozac'h J, Alves A. Etiological treatment of gallstone acute pancreatitis. World J Gastrointest Surg 2025; 17:105410. [DOI: 10.4240/wjgs.v17.i5.105410] [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: 01/20/2025] [Revised: 02/25/2025] [Accepted: 03/07/2025] [Indexed: 05/23/2025] Open
Abstract
Gallstone pancreatitis is the leading cause of acute pancreatitis, accounting for more than 40% of cases. Etiological treatment is a critical issue in acute biliary pancreatitis as it helps reduce the risk of recurrence. Patients who have experienced a complicated form of biliary disease are at high risk for recurrent episodes, and the severity of these new episodes can be unpredictable. In recent years, the role and timing of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP), which are the main therapeutic interventions in the etiological treatment, have been considerably clarified. This review aims to detail the different aspects of the etiological treatment of acute biliary pancreatitis. Currently, it is established that cholecystectomy should be performed early during the initial hospitalization in cases of non-severe acute pancreatitis. However, the optimal timing of this procedure in severe acute pancreatitis remains a subject of debate. Emergency ERCP is no longer indicated for acute biliary pancreatitis, except in cases of associated acute cholangitis. ERCP can be useful for the management of persistent bile duct stones. Finally, the role of interval sphincterotomy in frail or elderly patients or to reduce the risk of recurrence in those awaiting cholecystectomy in cases of severe acute pancreatitis remains to be fully established.
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Affiliation(s)
- Benoît Dupont
- Department of Hepato-Gastroenterology and Nutrition, Caen Normandy University Hospital, Normandy University, Caen 14000, Normandie, France
- 'Anticipe' U1086 INSERM, Normandy University, Unicaen, Caen 14000, Normandie, France
| | - Justine Lozac'h
- Department of Hepato-Gastroenterology and Nutrition, Caen Normandy University Hospital, Normandy University, Caen 14000, Normandie, France
| | - Arnaud Alves
- 'Anticipe' U1086 INSERM, Normandy University, Unicaen, Caen 14000, Normandie, France
- Department of Digestive Surgery, Caen Normandy University Hospital, Normandy University, Unicaen, Caen 14000, Normandie, France
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22
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Lee J, Park JS. Dome vs tapered tip sphincterotomes in endoscopic retrograde cholangiopancreatography: A pilot study on cannulation success and postprocedural pancreatitis. World J Gastrointest Surg 2025; 17:104043. [DOI: 10.4240/wjgs.v17.i5.104043] [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: 12/15/2024] [Revised: 02/14/2025] [Accepted: 03/12/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND Despite advancements, endoscopic retrograde cholangiopancreatography (ERCP) poses challenges, including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.
AIM To compare dome and tapered tip sphincterotomes, focusing on their efficacy in achieving successful biliary cannulation and reducing the incidence of post-ERCP pancreatitis.
METHODS In this prospective, single-blind, randomized pilot study conducted at Inha University Hospital, 85 patients undergoing ERCP were equally divided into dome and tapered tip sphincterotome groups. The co-primary outcomes were the success rate of selective biliary cannulation and incidence of post-ERCP pancreatitis. The secondary outcomes included biliary cannulation time, number of unintended pancreatic duct access events, and total procedure time.
RESULTS The success rates of selective biliary cannulation were 74.4% and 85.7% in the dome and tapered tip groups, respectively, with no significant difference (P = 0.20). Similarly, the incidence of post-ERCP pancreatitis did not differ significantly between the groups (5 cases in the tapered tip group vs 6 in the dome tip group, P = 0.72). However, difficult cannulation was significantly more common in the dome tip group than in the tapered tip group (P = 0.05). Selective biliary cannulation time emerged as a significant predictor of post-ERCP pancreatitis (multivariate odds ratio = 9.33, 95% confidence interval: 1.31-66.44, P = 0.03).
CONCLUSION This study indicated that the sphincterotome tip type does not markedly affect biliary cannulation success or post-ERCP pancreatitis rates. However, cannulation duration is a key risk factor for post-ERCP pancreatitis. These findings provide preliminary insights that highlight the importance of refining ERCP practices, including sphincterotome selection, while underscoring the need for larger multicenter studies to improve procedure time and patient safety.
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Affiliation(s)
- Jungnam Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon 22332, South Korea
| | - Jin-Seok Park
- Department of Internal Medicine, Shihwa Medical Center, Siheung-si 15034, Gyeonggi-do, South Korea
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Li H, Wen H, Liu J, Luo X, Pei B, Ge P, Sun Z, Liu J, Wang J, Chen H. The glycocalyx: a key target for treatment of severe acute pancreatitis-associated multiple organ dysfunction syndrome. Hum Cell 2025; 38:107. [PMID: 40411704 PMCID: PMC12103372 DOI: 10.1007/s13577-025-01227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 04/28/2025] [Indexed: 05/26/2025]
Abstract
The endothelial glycocalyx is a dynamic brush-like layer composed of proteoglycans and glycosaminoglycans, including heparan sulfate (HS) and hyaluronic acid (HA), and is an important regulator of vascular homeostasis. Its structure (thickness ranges from 20 to 6450 nm in different species) not only provides a charge-selective barrier but also serves to anchor mechanosensors such as the glypican-1 (GPC-1)/caveolin-1 (CAV-1) complex and buffers shear stress. In severe acute pancreatitis (SAP), inflammatory factors promote the expression of matrix metalloproteinases (MMPs) and heparinases, which degrade syndecan-1 (SDC-1) and HS, while oxidative stress disrupts HA-CD44 binding, leading to increased capillary leakage and neutrophil adhesion. This degradation process occurs before the onset of multiple organ dysfunction syndrome (MODS), highlighting the potential of the glycocalyx as an early biomarker. More importantly, the regeneration of glycocalyx through endothelial cell synthesis of glycosaminoglycans (GAGs) and shear stress-driven SDC recycling provides therapeutic prospects. This review redefines the pathophysiology of severe acute pancreatitis-associated multiple organ dysfunction (SAP-MODS) by exploring the glycocalyx's central mechanistic role and proposes stabilizing glycocalyx structure as a potential strategy to prevent microcirculatory failure.
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Affiliation(s)
- Huijuan Li
- The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
| | - Haiyun Wen
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
| | - Jie Liu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
| | - Xinyu Luo
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
| | - Boliang Pei
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
| | - Peng Ge
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
| | - Zhenxuan Sun
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
| | - Jin Liu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China
| | - Junjie Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China.
| | - Hailong Chen
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China.
- The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China.
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China.
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China.
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Chen J, Xu H, Gao L, Niu L, Huang Z, Liu S, Huang S, Chen Y, Li J, Tan P, Fu W. Network pharmacology analysis reveals that coumestrol targets ZYX to inhibit ferroptosis and alleviate acute pancreatitis. Int Immunopharmacol 2025; 159:114948. [PMID: 40414075 DOI: 10.1016/j.intimp.2025.114948] [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: 01/08/2025] [Revised: 05/09/2025] [Accepted: 05/21/2025] [Indexed: 05/27/2025]
Abstract
AIM The therapeutic effect of CMS on acute pancreatitis (AP) and the mechanism of targeting Zyxin (ZYX) to regulate ferroptosis in acinar cells. METHODS To assess the therapeutic effects of CMS in AP, we established caerulein-induced AP and caerulein plus LPS-induced SAP mouse models. Subsequently, weighted gene co-expression network analysis (WGCNA) and network pharmacology analysis were used to investigate the mechanism and target of CMS in the treatment of AP. Molecular docking and cell biology techniques were used to explore the molecular mechanisms by which CMS mitigated ferroptosis in AP animal and cell models. RESULTS CMS could alleviate the pathological damage of AP and SAP, inhibit ferroptosis and reduce inflammatory response. ZYX was an important target for CMS in the treatment of AP, and CMS could specifically bind to ZYX, down-regulate ZYX expression, and reduce TGF-β/SMAD pathway activity, thereby inhibiting acinar cell ferroptosis and improving pancreatic injury in AP. And we found that ZYX overexpression counteracted the inhibitory effects of CMS on TGF-β/Smad signaling and ferroptosis processes. CONCLUSION These results suggested that coumestrol targeting ZYX regulated the TGF-β/SMAD pathway, inhibited ferroptosis in acinar cells, and alleviated AP. Our research provided new drugs and targets for the treatment of AP.
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Affiliation(s)
- Jiatong Chen
- Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China
| | - Hai Xu
- Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China
| | - Lin Gao
- Department of Health Management, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China
| | - Liangkun Niu
- Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China
| | - Zhiwei Huang
- Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China
| | - Shenglu Liu
- Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China
| | - Shiyao Huang
- Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China
| | - Yingjun Chen
- Department of Endocrinology, Hejiang County People's Hospital, Luzhou 646000, China
| | - Jing Li
- Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China
| | - Peng Tan
- Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China; Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China.
| | - Wenguang Fu
- Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China; Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China.
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25
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Zhang Y, Wen S, Zhao G, Cui Y. Risk factors for peripancreatic and pancreatic infection of acute pancreatitis and the development of a clinical prediction model. Medicine (Baltimore) 2025; 104:e42595. [PMID: 40419919 DOI: 10.1097/md.0000000000042595] [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] [Indexed: 05/28/2025] Open
Abstract
Infected necrotizing pancreatitis (INP) is a serious complication that can increase the length of hospital stay and the cost of treatment, and is the leading cause of death in patients with acute pancreatitis (AP). This article aimed to predict the possibility of pancreatic and peripancreatic infections by early clinical indicators of AP and construct a clinical prediction model. We retrospectively studied consecutive patients admitted to the Nankai Hospital for moderate severe AP and severe AP, which developed within 2 weeks. Logistic regression was used to evaluate potential factors that could lead to INP and to develop clinical prediction model. Persistent organ failure, pancreatic necrosis area, and procalcitonin account were risk factors for INP. A prediction model was constructed based on the risk factors. The results showed that the model had good predictive performance. We developed a clinical prediction model with good predictive results that can be helpful for clinicians to identify and prevent the development of INP at an early stage.
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Affiliation(s)
- Yu Zhang
- Tianjin NanKai Hospital, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin, China
- Institute of Integrative Medicine for Acute Abdominal Diseases, Tianjin, China
| | - Shuaiyong Wen
- Tianjin NanKai Hospital, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin, China
- Institute of Integrative Medicine for Acute Abdominal Diseases, Tianjin, China
| | - Guijie Zhao
- Tianjin NanKai Hospital, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin, China
- Institute of Integrative Medicine for Acute Abdominal Diseases, Tianjin, China
| | - Yunfeng Cui
- Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
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26
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Yang X, Zhang M, Lv L, Chen X, Li Z. Total bilirubin-to-albumin ratio and short- and long-term all-cause mortality in acute pancreatitis: Evidence from the MIMIC-IV database. PLoS One 2025; 20:e0323330. [PMID: 40403080 PMCID: PMC12097592 DOI: 10.1371/journal.pone.0323330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Accepted: 04/06/2025] [Indexed: 05/24/2025] Open
Abstract
BACKGROUND The Total Bilirubin-to-Albumin Ratio (TBAR) is widely recognized and applied as a biomarker in the prognostic evaluation of various diseases. However, its role in predicting survival outcomes in patients with acute pancreatitis (AP) remains underexplored. This study aims to investigate the association between TBAR levels and mortality rates in AP patients, thereby providing a novel prognostic indicator for clinical use. METHODS This study investigates the association between TBAR and mortality in AP patients. We stratified patient data using X-tile software to analyze intergroup differences. Risk factors significantly associated with mortality were identified through univariate and multivariate regression analyses. Kaplan-Meier (KM) analysis evaluated TBAR's impact on survival, while Receiver Operating Characteristic (ROC) analysis assessed its predictive accuracy, sensitivity, and Area Under the Curve (AUC) for mortality. To ensure robustness, we used Restricted Cubic Spline (RCS) modeling to explore non-linear relationships and performed subgroup analyses to verify the consistency of the TBAR mortality association across patient subgroups. RESULT This study included 477 patients. Using X-tile software, we set the optimal TBAR cutoff at 1.33 based on 28-day mortality. Patients were categorized into high-risk (TBAR ≥ 1.33) and low-risk (TBAR < 1.33) groups. Elevated TBAR significantly correlated with increased mortality at multiple time points (7, 14, 21, 28, 90, and 365 days; P < 0.05). KM analysis confirmed lower survival rates in the high-risk group at all time points (P < 0.05). ROC analysis showed TBAR's predictive accuracy for mortality was comparable to the SOFA score and superior to other indicators. RCS modeling revealed a linear TBAR mortality relationship. Subgroup analyses showed no significant interactions between TBAR and most subgroups. CONCLUSION The TBAR is strongly correlated with short-term and long-term mortality in patients with acute pancreatitis.
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Affiliation(s)
- XingYi Yang
- Department of Gastroenterology Disease, XianJu People’s Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People’s Hospital, Affiliated Xianju’s Hospital, Hangzhou Medical College, Xianju, Taizhou, Zhejiang, China
| | - Min Zhang
- Department of Gastroenterology Disease, XianJu People’s Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People’s Hospital, Affiliated Xianju’s Hospital, Hangzhou Medical College, Xianju, Taizhou, Zhejiang, China
| | - LiHong Lv
- Department of Gastroenterology Disease, XianJu People’s Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People’s Hospital, Affiliated Xianju’s Hospital, Hangzhou Medical College, Xianju, Taizhou, Zhejiang, China
| | - XuYong Chen
- Department of Gastroenterology Disease, XianJu People’s Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People’s Hospital, Affiliated Xianju’s Hospital, Hangzhou Medical College, Xianju, Taizhou, Zhejiang, China
| | - ZhenMei Li
- Department of Gastroenterology Disease, XianJu People’s Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People’s Hospital, Affiliated Xianju’s Hospital, Hangzhou Medical College, Xianju, Taizhou, Zhejiang, China
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Keller K, Hobohm L, Schmitt VH, Hahad O, Labenz C, Espinola-Klein C, Möhler M, Sivanathan V. Cardiovascular comorbidities predict mortality in acute pancreatitis. Int J Cardiol 2025; 435:133409. [PMID: 40403851 DOI: 10.1016/j.ijcard.2025.133409] [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: 03/04/2025] [Revised: 04/26/2025] [Accepted: 05/19/2025] [Indexed: 05/24/2025]
Abstract
BACKGROUND The in-hospital mortality of acute pancreatitis (AP) is determined by severity of AP, but also significantly impacted by patients' comorbidities. Therefore, we aimed to examine the association between comorbid risk-profiles and survival in hospitalized patients admitted with AP. METHODS We utilized the German nationwide inpatient statistics to identify all AP patient-cases (ICD code K85) admitted to hospitals in Germany between 2005 and 2019. Hospitalization cases for AP were stratified by survival, and risk factors for in-hospital mortality were examined. RESULTS In total, 797,364 hospitalization-cases of patients admitted due to AP (median age 56.0 [IQR 44.0-71.0] years, 39.2 % females) were treated in Germany 2005-2019. Of these, 22,022 (2.8 %) patients died during hospitalization. AP survivors were younger (56.0 [44.0-71.0] vs. 76.0 [64.0-84.0], P < 0.001), more often males (61.0 % vs. 54.1 %, P < 0.001), and were less often afflicted by cardiovascular risk factors and diseases than non-survivors. Cardiovascular diseases (OR 2.08 (95 %CI 2.02-2.15), P < 0.001) and raising number of cardiovascular diseases (OR 1.48 (95 %CI 1.45-1.50), P < 0.001) were independently associated with increasing mortality. In particular, heart failure (OR 2.16 [95 %CI 2.09-2.24], P < 0.001), peripheral artery disease (OR 1.25 [1.15-1.35], P < 0.001), atrial fibrillation/flutter (OR 1.61 [95 %CI 1.55-1.66], P < 0.001), myocardial infarction (OR 4.71 [95 %CI 4.28-5.18], P < 0.001), pulmonary embolism (OR 12.19 [95 %CI 10.91-13.62], P < 0.001), and stroke (OR 7.21 [95 %CI 6.42-8.11], P < 0.001) were independently associated with in-hospital mortality. CONCLUSIONS Between 2005 and 2019, the in-hospital mortality among hospitalized AP patients was 2.8 % in Germany. Presence of cardiovascular diseases was associated with significantly reduced survival in AP patients.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Volker H Schmitt
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Christian Labenz
- Department of Gastroenterology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Markus Möhler
- Department of Gastroenterology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Visvakanth Sivanathan
- Department of Gastroenterology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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de Jong MJP, van Delft F, van Geenen EJM, Bogte A, Verdonk RC, Venneman NG, Vrolijk JM, Straathof JWA, Voermans RP, Bijlsma RA, Kuiken SD, Quispel R, Hadithi M, Basiliya K, Vleggaar FP, Bisseling TM, de Wijkerslooth TR, Bruno MJ, van Wanrooij RLJ, Siersema PD. Endoscopic ultrasound-guided choledochoduodenostomy results in fewer complications than percutaneous drainage following failed ERCP in malignant distal biliary obstruction. Endoscopy 2025. [PMID: 40209763 DOI: 10.1055/a-2580-1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2025]
Abstract
Percutaneous transhepatic biliary drainage (PTBD) and endoscopic ultrasound-guided biliary drainage (EUS-BD), including choledochoduodenostomy (EUS-CDS), are alternative methods for biliary drainage in patients with distal malignant biliary obstruction (MBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). Data on long-term outcomes, adverse events (AEs), and quality of life (QoL) after EUS-CDS and PTBD are limited. Therefore, we created a registry to evaluate the outcomes of both drainage procedures.Patients with distal MBO who underwent EUS-CDS or PTBD after unsuccessful ERCP were included in this multicenter investigator-initiated prospective registry over an 18-month inclusion period. Primary end points were procedure-related AEs and mortality within 90 days post-procedure. Secondary end points included technical and clinical success, reinterventions, hospital stay, and QoL.55 patients were included, with 12 patients undergoing PTBD (technical success 100%) and 43 patients EUS-CDS (technical success 97.7%). Prior to ERCP, 7/12 patients in the PTBD group and 12/43 patients in the EUS-CDS group opted for best supportive care. The 90-day mortality rate was 66.7% in the PTBD group and 20.9% in the EUS-CDS group (P = 0.005). Furthermore, 11/12 patients (91.7%) in the PTBD group and 19/43 (44.2%) in the EUS-CDS group developed one or more AEs (P = 0.004). The median post-procedural hospital stay was 4 days (interquartile range [IQR] 2-6) in the PTBD group vs. 1 day (IQR 1-2) in the EUS-CDS group (P = 0.001).When both modalities were available and technically feasible, gastroenterologists preferred EUS-CDS over PTBD. EUS-CDS seems to be associated with lower mortality and AE rates, shorter hospital admission, and fewer reinterventions, but a randomized controlled trial should confirm these observations.
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Affiliation(s)
- Mike J P de Jong
- Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
- Research and Development, St Antonius Hospital, Nieuwegein, Netherlands
| | - Foke van Delft
- Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Erwin-Jan M van Geenen
- Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Auke Bogte
- Gastroenterology and Hepatology, UMC Utrecht, Utrecht, Netherlands
| | - Robert C Verdonk
- Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - Niels G Venneman
- Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, Netherlands
| | | | | | - Rogier P Voermans
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Rina A Bijlsma
- Gastroenterology and Hepatology, Martini Hospital, Groningen, Netherlands
| | - Sjoerd D Kuiken
- Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Rutger Quispel
- Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, Netherlands
| | - Muhammed Hadithi
- Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands
| | - Kirill Basiliya
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Frank P Vleggaar
- Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Tanya M Bisseling
- Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Marco J Bruno
- Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Roy L J van Wanrooij
- Gastroenterology and Hepatology, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Peter D Siersema
- Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
- Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
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Rosales-Muñoz GJ, Souza-Arroyo V, Bucio-Ortiz L, Miranda-Labra RU, Gomez-Quiroz LE, Gutiérrez-Ruiz MC. Acute pancreatitis experimental models, advantages and disadvantages. J Physiol Biochem 2025:10.1007/s13105-025-01091-w. [PMID: 40380027 DOI: 10.1007/s13105-025-01091-w] [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: 01/18/2024] [Accepted: 05/05/2025] [Indexed: 05/19/2025]
Abstract
Acute pancreatitis represents a severe health problem, not only because of the number of people affected but also because of the severity of its clinical presentation that can eventually lead to the death of patients. The study of the disease is complex, and we lack optimized models that can approach the clinical presentation in patients, in addition to the significant vulnerability of the organ itself. In the present work, we undertook the task of reviewing and analyzing the experimental methods most currently used for the induction of acute pancreatitis, emphasizing the advantages and disadvantages of each model and their delimitation based on experimental objectives. We aimed to provide an actual and quick-access guide for researchers interested in experimental acute pancreatitis.
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Affiliation(s)
- Genaro J Rosales-Muñoz
- Posgrado en Biología Experimental, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
- Departamento de Ciencias de La Salud, Área de Medicina Experimental y Traslacional, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - Verónica Souza-Arroyo
- Departamento de Ciencias de La Salud, Área de Medicina Experimental y Traslacional, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
- Laboratorio de Medicina Experimental, Unidad de Medicina Traslacional IIB/UNAM, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Leticia Bucio-Ortiz
- Departamento de Ciencias de La Salud, Área de Medicina Experimental y Traslacional, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
- Laboratorio de Medicina Experimental, Unidad de Medicina Traslacional IIB/UNAM, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Roxana U Miranda-Labra
- Departamento de Ciencias de La Salud, Área de Medicina Experimental y Traslacional, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
- Laboratorio de Medicina Experimental, Unidad de Medicina Traslacional IIB/UNAM, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Luis E Gomez-Quiroz
- Departamento de Ciencias de La Salud, Área de Medicina Experimental y Traslacional, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
- Laboratorio de Medicina Experimental, Unidad de Medicina Traslacional IIB/UNAM, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - María Concepción Gutiérrez-Ruiz
- Departamento de Ciencias de La Salud, Área de Medicina Experimental y Traslacional, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico.
- Laboratorio de Medicina Experimental, Unidad de Medicina Traslacional IIB/UNAM, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
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30
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Chen Y, Liu J, Ge Q, Wang M, Zhou J. A risk nomogram for 30-day mortality in Chinese patients with acute pancreatitis using LASSO-logistic regression. Sci Rep 2025; 15:17097. [PMID: 40379755 PMCID: PMC12084589 DOI: 10.1038/s41598-025-02055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Accepted: 05/12/2025] [Indexed: 05/19/2025] Open
Abstract
This study proposed to explore the 30-day mortality risk factors in patients with acute pancreatitis (AP) and construct a prognosis nomogram based on the Least absolute shrinkage and selection operator (LASSO) logistic regression. A retrospective study on 965 adult AP patients started from January 2017 and December 2019 was conducted. Feature selection is carried out by using LASSO regression, and the model was established through logistic regression (P < 0.05). The area under the receiver operating characteristic curve (AUC), calibration curves, bootstrap and decision curve analysis (DCA) were utilized for evaluating the performance of the nomogram. A sum of 965 eligible patients were participated, of whom 922 were assigned into a survival group and 43 in a non-survival group. Six independent predictors were identified as the most valuable characteristics in AP patients, including age, activated partial thromboplastin time (APTT), direct bilirubin (DBIL), lactate dehydrogenase (LDH), total protein (TP) and blood urea nitrogen (UREA). The AUC of the nomogram was 0.862 (0.806-0.918). The DCA curve indicates that this nomogram possesses good clinical application value. The nomogram we constructed demonstrates a strong capability in predicting the 30-day mortality of AP patients.
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Affiliation(s)
- Ying Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Jingping Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Qiuxia Ge
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Min Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China.
| | - Jun Zhou
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China.
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31
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Cho SH, Lee Y, Song TJ, Oh D, Seo DW. The Efficacy and Safety of Endoscopic Ultrasound-Guided Retroperitoneal Fluid Collection Drainage with Novel Electrocautery-Enhanced Lumen-Apposing Metal Stents (with Video). Gut Liver 2025; 19:454-461. [PMID: 40169395 PMCID: PMC12070217 DOI: 10.5009/gnl240452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 12/05/2024] [Accepted: 12/08/2024] [Indexed: 04/03/2025] Open
Abstract
Background/Aims Various lumen-apposing metal stents (LAMS) have been used for the endoscopic ultrasound-guided transmural drainage (EUS-TD) of postoperative pancreatic fluid collections (POPFC) and peripancreatic fluid collections (PFC). In this study, we aimed to assess the efficacy and safety of novel electrocautery-enhanced LAMSs (Hot-Plumber with Z-EUS IT) with different inter-flange lengths (13 to 33 mm) for managing POPFC and PFC. Methods We reviewed the interventional EUS database of Asan Medical Center to identify consecutive patients with POPFC or PFC who underwent EUS-TD with the novel LAMSs between April 2023 and December 2023. Technical success, clinical success, and adverse events were evaluated. Results Ten patients (5 with POPFCs and 5 with PFCs) were included in the analysis. The technical and clinical success rates were 100% and 90%, respectively. The LAMS was placed using either the freehand technique (n=5) or the over-the-guide wire technique (n=5). One patient successfully underwent endoscopic necrosectomy for walled-off necrosis through a novel LAMS. Two patients experienced adverse events (one stent migration and one infection). The LAMS was removed in 7 out of 10 patients after resolution of the fluid collection at a median of 61 days (interquartile range, 31 to 69 days) post-LAMS placement. Conclusions EUS-TD using the novel LAMS for POPFC and PFC demonstrated high efficacy and an acceptable safety profile. This novel LAMS represents a viable option when selecting stents for EUS-guided drainage of the POPFC and PFC.
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Affiliation(s)
- Sung Hyun Cho
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoonchan Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Jun Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dongwook Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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32
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Kang C, Ji YS, Susi A, Nylund CM. Impact of the COVID-19 pandemic on hospitalizations for acute pancreatitis in children. J Pediatr Gastroenterol Nutr 2025. [PMID: 40371459 DOI: 10.1002/jpn3.70086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 04/02/2025] [Accepted: 04/16/2025] [Indexed: 05/16/2025]
Affiliation(s)
- Charles Kang
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Yun Seong Ji
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Cade M Nylund
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Valera RJ, Hossain MS, Patnaik R, Valdivieso C, Montorfano L, Parlade A, Augustin T, Walsh RM, Simpfendorfer CH, Roy M. Retrospective analysis of surgical pancreatic necrosectomy outcomes in patients with and without obesity. Surgery 2025; 184:109410. [PMID: 40373503 DOI: 10.1016/j.surg.2025.109410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 04/02/2025] [Accepted: 04/16/2025] [Indexed: 05/17/2025]
Abstract
BACKGROUND Acute necrotizing pancreatitis is associated with high morbidity and mortality. This study aims to compare surgical necrosectomy outcomes in acute necrotizing pancreatitis between patients with and without obesity. METHODS A retrospective chart review was performed for all patients who underwent surgical necrosectomy via a minimally invasive approach or an open approach over a 10-year period at a large US healthcare system. Patients were divided into 2 groups: those with obesity (body mass index ≥30 kg/m2) and those without obesity (body mass index <30 kg/m2). The primary end point was the incidence of early complications or postoperative death within 30 and 90 days. The secondary end point was the incidence of long-term complications. RESULTS In total, 80 patients were included with 36 (45%) with obesity, and 44 (55%) without obesity. A total of 52 patients (65%) had an open approach and 28 (35%) had an minimally invasive approach. The average age was 54.79 ± 15.25 years, and the median follow-up time was 83.5 days (interquartile range, 40.25-149.75 days). The median body mass index of the patient group with obesity was 34.55 kg/m2 (interquartile range, 31.55-40.61), and that for the patient group without obesity was 25.97 kg/m2 (interquartile range, 23.22-28.35 kg/m2) (P ≤ .0001). Days from admission to surgical intervention was longer in obese patients but it was not statistically significant (44.50 [interquartile range, 12-88] vs 27 [interquartile range, 15-42.5], P = .831). 30 and 90-day complication rates and mortality were similar between the groups. CONCLUSION Operative outcomes of pancreatic necrosectomy in patients with obesity appears to be comparable with patients without obesity. Surgical pancreatic necrosectomy can be performed safely, effectively, and in a similar time frame regardless of the presence of obesity.
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Affiliation(s)
- Roberto J Valera
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/Valera
| | - Mir Shanaz Hossain
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Cleveland Clinic, Cleveland, OH
| | - Ronit Patnaik
- Department of General Surgery, University of Texas Health Science Center, San Antonio, TX
| | - Cesar Valdivieso
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Lisandro Montorfano
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/Montorfano
| | - Albert Parlade
- Department of Imaging, Cleveland Clinic Florida, Weston, FL
| | - Toms Augustin
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Cleveland Clinic, Cleveland, OH. https://twitter.com/Augustin
| | - R Matthew Walsh
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Cleveland Clinic, Cleveland, OH
| | - Conrad H Simpfendorfer
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Mayank Roy
- Department of General Surgery, Section of Hepatobiliary and Pancreatic Surgery, Cleveland Clinic Florida, Weston, FL.
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Alkaissy Z, Yost KK, Ghai MB, Malkawi K, Nawaz M, Wassef W. Beyond the Basics: Recommended Approach to Severe Acute Pancreatitis Management in the Critical Care Setting. J Intensive Care Med 2025:8850666251338044. [PMID: 40356559 DOI: 10.1177/08850666251338044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2025]
Abstract
Acute Pancreatitis (AP) poses a significant healthcare burden globally. While most cases present with a mild course, approximately one-fifth progress to severe forms characterized by severe pancreatitis and systemic complications, leading to a mortality rate of up to 40%. Effective management of severe acute pancreatitis necessitates a multidisciplinary approach involving gastroenterologists, interventional radiologists, intensive care teams, and surgeons. The advances in treatment modalities, including early hydration, nutrition, and pain control, have led to a decrease in the morbidity and long-term complications associated with severe acute pancreatitis down to 20%. In this review, we focus on the management challenges and outcomes associated with the difficult condition of severe acute pancreatitis.
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Affiliation(s)
- Zaid Alkaissy
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Kelli Kosako Yost
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Megan B Ghai
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Khaled Malkawi
- Department of Radiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Mustafa Nawaz
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Wahid Wassef
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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35
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Li Q, Liu C, Fan Z, Zhang H, Kai Z. Computed tomography-based conventional imaging features and texture analysis characteristics of chemotherapy drug-related acute pancreatitis. Front Med (Lausanne) 2025; 12:1497944. [PMID: 40421297 PMCID: PMC12104288 DOI: 10.3389/fmed.2025.1497944] [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: 11/18/2024] [Accepted: 04/22/2025] [Indexed: 05/28/2025] Open
Abstract
Purpose Chemotherapy drug-related acute pancreatitis (CDRAP) is a rare adverse event that poses significant challenges to clinicians. This study aimed to describe plain computed tomography (CT)- and contrast-enhanced computed tomography (CECT)-based conventional imaging features and texture analysis characteristics of CDRAP. Methods A total of 62 patients with initial clinical and/or biochemical evidence of pancreatitis and 34 patients with normal pancreatic manifestations who underwent CT during chemotherapy were retrospectively included. The diagnosis of CDRAP was established based on clinical, imaging, and biochemical findings. Conventional imaging features, texture analysis characteristics, clinical and biochemical parameters, other complications, chemotherapy drugs, and patient outcomes related to CDRAP were recorded. Results A total of 20 (32.26%) patients who were clinically diagnosed with CDRAP had normal pancreatic morphology on CT, while 42 (67.74%) patients presented with changes indicative of acute pancreatitis. The CT findings of 62 CDRAP cases were as follows: diffuse (n = 19) or focal (n = 21) pancreatic enlargement, diffuse (n = 12) or focal (n = 4) heterogeneous enhancement, peripancreatic stranding (n = 20), acute peripancreatic fluid collection (n = 10), and pseudocyst (n = 2). A total of 17 texture features were identified to differentiate CDRAP from normal pancreatic manifestations. Conclusion CDRAP mainly manifested as interstitial edematous pancreatitis with/without normal pancreatic morphology on CT. Imaging texture analysis may serve as a potential biomarker for its detection. By combining conventional imaging features with texture analysis characteristics, there is potential to assist radiologists and clinicians in the identification of CDRAP, thereby improving the quality of life for cancer patients.
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Affiliation(s)
- Quanlin Li
- Department of Radiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Chuanmei Liu
- Department of Radiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Zijian Fan
- Department of Radiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Hong Zhang
- Department of Radiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Zhiguo Kai
- Department of Radiology, The 4th People’s Hospital of Jinan, Jinan, China
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Hamm J, Busana A, Amanzada A, Arlt A, Asendorf T, Carswell S, Denzer U, Elsing L, Frost F, Guilabert L, Hamesch K, Hollenbach M, Hegyi P, Kleger A, Krivinka J, Kunovsky L, Meinhardt C, Phillip V, Schlosser-Hupf S, Sirtl S, Welsch L, Cardinal von Widdern J, Neesse A, Ammer-Herrmenau C. Effect of proton pump inhibitors on occlusion of lumen-apposing metal stents and rate of endoscopic necrosectomies: a Europe-wide multicenter cohort study. Endoscopy 2025. [PMID: 40164133 DOI: 10.1055/a-2569-7056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
BACKGROUND Lumen-apposing metal stents (LAMS) are widely used to drain walled-off necrosis (WON). LAMS occlusion is a significant clinical problem and identification of risk factors for LAMS occlusion could contribute to novel preventive strategies. A previous study suggested contradictory effects of proton pump inhibitors (PPIs) on occlusion and necrosectomy rates. METHODS We conducted a Europe-wide multicenter retrospective cohort study assessing WONs drained by LAMS. The primary aims were to assess the strength of association between PPI intake and LAMS occlusion and necrosectomy rates, respectively. The secondary aim was to assess the strength of association between PPI intake and other LAMS-associated complications. Multiple mixed-effects models were used to control for possible confounding covariates. RESULTS 893 patients with 967 LAMS from 17 centers were included. After excluding incomplete datasets and patients who took PPIs intermittently, 768 LAMS remained. The overall occlusion rate was 28.0 %. Most occlusions occurred within 10 days. Most patients received PPIs continuously (n = 577 vs. no intake n = 191). In patients who did not use PPIs continuously, lower rates of LAMS occlusion (odds ratio [OR] 0.61, P = 0.04) and necrosectomies (incidence rate ratio 0.8, P = 0.006) were observed. A post hoc analysis exhibited a dose- and compound-dependent effect of PPI intake on necrosectomy rate. No increase in other complications in the non-PPI group, such as bleeding events (OR 1.14) were observed. CONCLUSION PPI intake was associated with higher rates of LAMS occlusion and necrosectomy.
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Affiliation(s)
- Jacob Hamm
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
| | - Alzbeta Busana
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
| | - Ahmad Amanzada
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
| | - Alexander Arlt
- Department of Gastroenterology, University Hospital Oldenburg, Oldenburg, Germany
- Department of Gastroenterology, Israelitisches Krankenhaus, Hamburg, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Samantha Carswell
- HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Ulrike Denzer
- Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
| | - Louis Elsing
- Department of Oncology, Gastroenterology, Hepatology and Pneumology, University Hospital Leipzig, Leipzig, Germany
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Lucia Guilabert
- Department of Gastroenterology, Hospital General Universitario Dr. Balmis, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, Spain
| | - Karim Hamesch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcus Hollenbach
- Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
- Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany
| | - Péter Hegyi
- Translational Pancreatology Research Group, Interdisciplinary Center of Excellence for Research Development and Innovation, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases and Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Alexander Kleger
- Institute of Molecular Oncology and Stem Cell Biology, University Hospital Ulm, Ulm, Germany
- Division of Interdisciplinary Pancreatology, Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
| | - Jan Krivinka
- 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Lumir Kunovsky
- 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Christian Meinhardt
- Department of Gastroenterology, University Hospital Oldenburg, Oldenburg, Germany
| | - Veit Phillip
- Department of Clinical Medicine II, Technical University of Munich, TUM School of Medicine and Health, TUM University Hospital, Munich, Germany
| | - Sophie Schlosser-Hupf
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Bavaria, Germany
| | - Simon Sirtl
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
| | - Lukas Welsch
- Department of Gastroenterology, Diabetology and Infectiology, Klinikum Hanau, Hanau, Germany
| | | | - Albrecht Neesse
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
| | - Christoph Ammer-Herrmenau
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
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Wang Q, Zhang X, Han C, Lv Z, Zheng Y, Liu X, Du Z, Liu T, Xue D, Li T, Wang L. Immunodynamic axis of fibroblast-driven neutrophil infiltration in acute pancreatitis: NF-κB-HIF-1α-CXCL1. Cell Mol Biol Lett 2025; 30:57. [PMID: 40335899 PMCID: PMC12060353 DOI: 10.1186/s11658-025-00734-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 04/17/2025] [Indexed: 05/09/2025] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a sterile inflammation, and 10-20% of cases can progress to severe acute pancreatitis (SAP), which seriously threatens human life and health. Neutrophils and their extracellular traps (NETs) play an important role in the progression of AP. However, the immunodynamic factors between the excessive infiltration of neutrophils during the occurrence of AP have not been fully elucidated. METHODS Adult male C57BL/6 J mice were selected. An AP model was induced by cerulein, and a control group was set up. Single-cell sequencing technology was used to reveal the cell atlas of AP pancreatitis tissue. In vivo, the model mice were treated with anti-Ly6G antibody, DNase I, SC75741, PX-478, and SRT3109 respectively. In vitro, human pancreatic stellate cells were treated with hypoxia, H2O2, NAC, and JSH-2, and co-cultured with neutrophils in Transwell chambers. The severity of inflammation was evaluated, and the molecular mechanism by which fibroblasts exacerbate AP was revealed through techniques such as cell colony formation assay, cell migration assay, cell transfection, immunofluorescence, flow cytometry, Western blot, reverse-transcription quantitative polymerase chain reaction (RT-qPCR), and co-immunoprecipitation (co-IP). RESULTS The study showed that the elimination of neutrophils and NETs could significantly improve AP. Single-cell RNA sequencing (scRNA-seq) indicated that both neutrophils and fibroblasts in pancreatic tissue exhibited heterogeneity during AP. Among them, neutrophils highly expressed CXCR2, and fibroblasts highly expressed CXCL1. Further experimental results demonstrated that the infiltration of neutrophils in the early stage of AP was related to the activation of fibroblasts. The activation of fibroblasts depended on the nuclear factor kappa B (NF-κB) signaling pathway induced by hypoxia. NF-κB enhanced the activation of pancreatic stellate cells (PSCs) and the secretion of CXCL1 by directly promoting the transcription of HIF-1α and indirectly inhibiting PHD2, resulting in the accumulation of HIF-1α protein. The NF-κB-HIF-1α signal promoted the secretion of CXCL1 by fibroblasts through glycolysis and induced the infiltration of neutrophils. Finally, blocking the NF-κB-HIF-1α-CXCL1 signaling axis in vivo reduced the infiltration of neutrophils and improved AP. CONCLUSIONS This study, for the first time, demonstrated that activation of fibroblasts is one of the immunological driving factors for neutrophil infiltration and elucidated that glycolysis driven by the NF-κB-HIF-1α pathway is the intrinsic molecular mechanism by which fibroblasts secrete CXCL1 to chemotactically attract neutrophils. This finding provides a highly promising target for the treatment of AP.
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Affiliation(s)
- Qiang Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Chenglong Han
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zhenyi Lv
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yi Zheng
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuxu Liu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhiwei Du
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tianming Liu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongbo Xue
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Tao Li
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China.
| | - Liyi Wang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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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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Liberto JD, Butt A, Bhuiyan MN. 56-Year-Old Man With Abdominal Pain, Decreased Urine Output, Nausea, and Vomiting. Mayo Clin Proc 2025:S0025-6196(24)00434-8. [PMID: 40319405 DOI: 10.1016/j.mayocp.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 05/07/2025]
Affiliation(s)
- Julia D Liberto
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Ahsan Butt
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - M Nadir Bhuiyan
- Advisor to residents and Consultant in Internal Medicine, Mayo Clinic, Rochester, MN.
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Chen H, Yuan X. The predictive efficacy of dynamic level changes of plasma endothelial microparticles and plasma soluble thrombomodulin on the prognosis of severe acute pancreatitis. BMC Surg 2025; 25:195. [PMID: 40316920 PMCID: PMC12049059 DOI: 10.1186/s12893-025-02929-2] [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: 11/02/2024] [Accepted: 04/17/2025] [Indexed: 05/04/2025] Open
Abstract
OBJECTIVE To investigate the predictive efficacy of dynamic level changes of plasma endothelial microparticles (EMP) and plasma soluble thrombomodulin (sTM) on the prognosis of severe acute pancreatitis (SAP). METHODS This study retrospectively selected 128 eligible SAP patients admitted to our hospital from May 2021 to April 2023. According to the final outcome, the patients were grouped as the survival group (n = 95) and death group (n = 33). The EMP, sTM and microcirculation related indexes (lactic acid level, central venous pressure (CVP), mean arterial pressure (MAP)) of SAP patients were monitored at admission, 24 h, 48 h and 72 h after admission. Pearson was adopted to analyze the correlation between EMP and sTM levels with microcirculation disorder related indicators. The levels of EMP and sTM were compared between the survival group and the death group. The EMP high level group was ≥ 150.00 ng / mL, and the EMP low level group was < 150.00 ng / mL. The sTM high-level group was ≥ 300.00 ng / mL, and the low-level group was < 300.00 ng / mL. The differences in survival curves between different groups were compared by Kaplan-Meier. AUC was used to analyze the prognostic value of EMP and sTM levels alone and in combination in SAP patients. RESULTS Compared with admission, the levels of EMP, sTM, lactic acid and CVP in 128 SAP patients were all significantly increased at 24 h, 48 h and 72 h after admission, but the MAP was largely decreased (p < 0.05). EMP and sTM were positively correlated with lactic acid and CVP respectively, but negatively correlated with MAP (p < 0.05). The death group had much higher levels of EMP and sTM than the survival group (p < 0.05). From the perspective of 1-year survival rate, the high-level group of EMP was lower than the low-level group (p < 0.05) and the high-level group of sTM was lower than the low-level group (p < 0.05). ROC curve analysis confirmed that the sensitivity and specificity of combined detection were 92.39% and 90.54%, respectively, with the AUC of 0.903 (95%CI:0.863-0.928), which was significantly higher than that of single detection (p < 0.05). CONCLUSION The levels of EMP and sTM were significantly increased in SAP patients, which were closely related to microcirculation disorders and poor prognosis. The combined detection of EMP and sTM has significant prognostic value in SAP.
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Affiliation(s)
- Hu Chen
- Department of Emergency Surgery, The First Affiliated Hospital of Anhui Medical University North District, Anhui Public Health Clinical Center, Hefei, Anhui, 230011, China
| | - Xiao Yuan
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University North District /Anhui Public Health Clinical Center, Hefei, Anhui, 230011, China.
- The First Affiliated Hospital of Anhui Medical University North District, Anhui Public Health Clinical Center, No. 100 Huaihai Avenue, Yaohai District,, Hefei, Anhui, 230011, China.
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Gupta P, Siddiqui R, Singh S, Pradhan N, Shah J, Samanta J, Jearth V, Singh A, Mandavdhare H, Sharma V, Mukund A, Birda CL, Kumar I, Kumar N, Patidar Y, Agarwal A, Yadav T, Sureka B, Tiwari A, Verma A, Kumar A, Sinha SK, Dutta U. Application of deep learning models for accurate classification of fluid collections in acute necrotizing pancreatitis on computed tomography: a multicenter study. Abdom Radiol (NY) 2025; 50:2258-2267. [PMID: 39347977 DOI: 10.1007/s00261-024-04607-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: 05/23/2024] [Revised: 09/05/2024] [Accepted: 09/17/2024] [Indexed: 10/01/2024]
Abstract
PURPOSE To apply CT-based deep learning (DL) models for accurate solid debris-based classification of pancreatic fluid collections (PFC) in acute pancreatitis (AP). MATERIAL AND METHODS This retrospective study comprised four tertiary care hospitals. Consecutive patients with AP and PFCs who had computed tomography (CT) prior to drainage were screened. Those who had magnetic resonance imaging (MRI) or endoscopic ultrasound (EUS) within 20 days of CT were considered for inclusion. Axial CT images were utilized for model training. Images were labelled as those with≤30% solid debris and >30% solid debris based on MRI or EUS. Single center data was used for model training and validation. Data from other three centers comprised the held out external test cohort. We experimented with ResNet 50, Vision transformer (ViT), and MedViT architectures. RESULTS Overall, we recruited 152 patients (129 training/validation and 23 testing). There were 1334, 334 and 512 images in the training, validation, and test cohorts, respectively. In the overall training and validation cohorts, ViT and MedVit models had high diagnostic performance (sensitivity 92.4-98.7%, specificity 89.7-98.4%, and AUC 0.908-0.980). The sensitivity (85.3-98.6%), specificity (69.4-99.4%), and AUC (0.779-0.984) of all the models was high in all the subgroups in the training and validation cohorts. In the overall external test cohort, MedViT had the best diagnostic performance (sensitivity 75.2%, specificity 75.3%, and AUC 0.753). MedVit had sensitivity, specificity, and AUC of 75.2%, 74.3%, and 0.748, in walled off necrosis and 79%, 74.2%, 75.3%, and 0.767 for collections >5 cm. CONCLUSION DL-models have moderate diagnostic performance for solid-debris based classification of WON and collections greater than 5 cm on CT.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ruby Siddiqui
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shravya Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikita Pradhan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Science, New Delhi, India
| | - Chhagan Lal Birda
- Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Niraj Kumar
- Department of Interventional Radiology, Institute of Liver and Biliary Science, New Delhi, India
| | - Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Science, New Delhi, India
| | - Ashish Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anurag Tiwari
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashish Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Richter BI, Weissbrot JH, Chung FR, Gonda TA, Huang C. Clinical Impact of Pancreatic and Peripancreatic Hemorrhage Associated With Acute Pancreatitis. J Comput Assist Tomogr 2025; 49:343-347. [PMID: 39761493 DOI: 10.1097/rct.0000000000001683] [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: 01/04/2025]
Abstract
PURPOSE The significance of pancreatitis-associated hemorrhage outside the context of a ruptured pseudoaneurysm remains unclear. This study aims to characterize the clinical significance of pancreatic hemorrhage during acute pancreatitis (AP). METHODS This retrospective study included adult patients diagnosed with hemorrhagic pancreatitis (HP) from 2010 to 2021. HP was defined as a clinical diagnosis of AP and the presence of pancreatic or peripancreatic hemorrhage on cross-sectional imaging. Two radiologists assessed the pancreatitis type, degree of necrosis, hemorrhage location, peripancreatic collections, and peripancreatic vessels. Demographic and disease data, AP severity, and treatment decisions from admission to 3 months after discharge were extracted from hospital electronic health records. RESULTS The study included 36 patients, stratified by AP severity into 12 (33.3%) mild, 13 (36.1%) moderate-severe, and 11 (30.6%) severe cases. Six (16.6%) of the patients experienced clinically significant bleeding, which led to changes in clinical management such as further imaging, modifications to anticoagulation regimens, or both. Among these, 50% (3 of 6) demonstrated active bleeding on further imaging, with 33% (2 of 6) of the bleeding being intrapancreatic. In contrast, 83% (30 of 36) of HP patients did not have clinically significant bleeding, and all but one did not require changes in clinical management. AP-associated splanchnic vein thrombosis occurred in 30.6% (11 of 36) of patients, and anticoagulation in these patients did not result in clinically significant bleeding. CONCLUSIONS HP without clinically significant bleeding does not necessitate changes in clinical management. However, hemorrhage may indicate more severe disease and is associated with a higher incidence of splanchnic vein thrombosis.
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Affiliation(s)
- Benjamin I Richter
- Department of Gastroenterology, Rutgers New Jersey Medical School, Newark, NJ
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Hajj Ali A, Bailey NJ, Fatima H, Watkins JL, Saleem N. An Unusual Cause of Acute Pancreatitis. ACG Case Rep J 2025; 12:e01694. [PMID: 40343218 PMCID: PMC12061459 DOI: 10.14309/crj.0000000000001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 04/02/2025] [Indexed: 05/11/2025] Open
Affiliation(s)
- Adel Hajj Ali
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Natashay J. Bailey
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Hala Fatima
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - James L. Watkins
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Nasir Saleem
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
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Zhao T, Kang Z, Zhang Q, Pu F, Zhang Y, Yin W, Yang H, Zhou Y, Zhu S. Lactated Ringer's solution versus saline fluid resuscitation for reducing progression to moderate-to-severe acute pancreatitis: a systematic review and meta-analysis. Int J Surg 2025; 111:3467-3480. [PMID: 40085761 DOI: 10.1097/js9.0000000000002330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 02/09/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Fluid resuscitation represents a pivotal early therapeutic intervention in the management of acute pancreatitis (AP), yet a consensus on the optimal fluid type remains elusive. The present study endeavors to elucidate the differential effects of lactated Ringer's solution (LR) and normal saline (NS) in the initial treatment of AP. METHODS A comprehensive literature search was conducted through the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, spanning from inception until July 2024. The primary outcome of interest was the likelihood of developing moderate-to-severe AP. RESULTS This meta-analysis synthesized evidence from six randomized controlled trials (RCTs) and four observational studies, involving a total of 1500 AP patients. Patients were stratified into two groups based on the administered fluid: LR (n = 689) and NS (n = 811). Our findings revealed that, compared to the NS group, patients in the LR group demonstrated a significantly lower risk of moderate-to-severe AP (OR 0.48; 95%Cl 0.34 to 0.67; P < 0.001; I2 = 0%), a shorter hospital stay (MD = -0.74, 95% confidence interval [CI] -1.20 to -0.28, P = 0.001; I2 = 0%), and a reduced intensive care unit (ICU) admission rate [relative risk (RR) = 0.42, 95% CI 0.20-0.89, P = 0.02; I2 = 0%]. Moreover, the LR group also showed a lower incidence of local complications (RR = 0.58, 95% CI 0.34-0.98, P = 0.04). Conversely, no statistically significant differences were observed between the two groups in terms of mortality, organ failure rates, Fluid administered 24 h, systemic inflammatory response syndrome (SIRS). CONCLUSIONS Our analysis underscores the superior efficacy of LR solution in comparison to NS. It provides compelling evidence of LR's ability to significantly mitigate the onset of moderate to severe pancreatitis. Additionally, our findings reveal that LR is associated with a reduced need for ICU admissions, a lower incidence of local complications, and a shorter overall hospital stay, thereby offering a more favorable clinical outcome. However, no notable differences were discerned in other complications. Subgroup analyses further suggest LR's potential to curb pancreatic necrosis and other indices, albeit these findings necessitate corroboration through extensive experimentation.
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Affiliation(s)
- Tang Zhao
- Department of Hepatobiliary surgery, The Affiliated Hospital of Southwest Medical University, Lu Zhou, China
- Organ Transplant Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhiqiang Kang
- Organ Transplant Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiu Zhang
- Department of Hepatobiliary surgery, The Affiliated Hospital of Southwest Medical University, Lu Zhou, China
- Organ Transplant Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Pu
- Organ Transplant Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yun Zhang
- Sichuan Provincial KeyLaboratory for Clinical Immunology Translational Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China,Chengdu, China
| | - Wenqing Yin
- Department of Kidney Medicine, Cleveland Clinic Fairview Hospital, Cleveland, Ohio, USA
| | - Hongji Yang
- Organ Transplant Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial KeyLaboratory for Clinical Immunology Translational Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China,Chengdu, China
| | - Yu Zhou
- Sichuan Provincial KeyLaboratory for Clinical Immunology Translational Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China,Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shikai Zhu
- Department of Hepatobiliary surgery, The Affiliated Hospital of Southwest Medical University, Lu Zhou, China
- Organ Transplant Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Chhoda A, Liyen Cartelle A, Manoj MA, Noriega M, Anderson K, Zuberi SA, Sur A, Olivares M, Kelly J, Freedman SD, Galler Rabinowitz L, Sheth SG. Investigation of the Association of Acute Pancreatitis Outcomes with Social Vulnerability Indicators. Am J Med 2025; 138:827-834. [PMID: 39743189 DOI: 10.1016/j.amjmed.2024.12.026] [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: 10/30/2024] [Revised: 12/12/2024] [Accepted: 12/14/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND AND AIM Geospatial analyses integrate location-based sociodemographic data, offering a promising approach to investigate the impact of social determinants on acute pancreatitis outcomes. This study aimed to examine the association of Social Vulnerability Index (SVI) and its constituent 16 attributes in 4 domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation), with outcomes in patients with acute pancreatitis. METHODS This study included acute pancreatitis patients hospitalized between 1/1/2008 and 12/31/2021 and recorded their demographics and clinical outcomes. Physical addresses were geocoded to determine SVI, a composite variable which was ranked and divided into quartiles (I-IV: IV representing the highest vulnerability). RESULT In 824 eligible patients [age of 53.0 ± 10 years and 48.2% females], with 993 acute pancreatitis-related hospitalizations, we noted a significant association in patients residing in communities with higher SVI, a higher prevalence of no/federal/state insurance (P < .001) and underserved ethnic/racial background (P < .001). We observed a significant association of alcohol withdrawal in patients with residence in areas with higher SVI despite adjustment for age, body mass index, and comorbidities (odds ratios: 1.62 [95% CI: 1.19-2.22]; P = .003). However, we observed no association of SVI with severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality. CONCLUSIONS We noted significantly higher alcohol withdrawal in patients residing in areas with higher SVI ranks, despite no differences in severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.
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Affiliation(s)
- Ankit Chhoda
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Anabel Liyen Cartelle
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Matthew Antony Manoj
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Marco Noriega
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Kelsey Anderson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Shaharyar A Zuberi
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Alana Sur
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Miriam Olivares
- Geographical Information System Library, Yale University, New Haven, Conn
| | - Jill Kelly
- Yale School of Public Health, Yale University, New Haven, Conn
| | - Steven D Freedman
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Loren Galler Rabinowitz
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Sunil G Sheth
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
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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] [MESH Headings] [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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Dong Y, Su L, Lam SM, Yan C, Deng Y, Lu G, Yang J, Shui G, Feng Y. TRMT6 and TRMT61A facilitated acute pancreatitis severity via regulation of neutrophil function. SCIENCE CHINA. LIFE SCIENCES 2025; 68:1516-1519. [PMID: 39821836 DOI: 10.1007/s11427-024-2772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 11/04/2024] [Indexed: 01/19/2025]
Affiliation(s)
- Yuan Dong
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
- Department of Science and Development, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, 100069, China
| | - Li Su
- Neuroscience Research Institute, Peking University Center of Medical and Health Analysis, Peking University, Beijing, 100191, China
| | - Sin Man Lam
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Cen Yan
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Yalan Deng
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Guotao Lu
- Pancreatic Center, Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225003, China
| | - Jinkui Yang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100069, China
| | - Guanghou Shui
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Yingmei Feng
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
- Department of Science and Development, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, 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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49
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Liu J, Liang C, Yan W, Zhang Y, Pan Y, Yang Y, Zhang F, Liu X, Jin L. Pancreatitis Independently Induced by Hypertriglyceridaemia Outlines the Immune Profiles of HTGP in Clinic. Clin Exp Pharmacol Physiol 2025; 52:e70032. [PMID: 40069996 DOI: 10.1111/1440-1681.70032] [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: 05/03/2024] [Revised: 01/07/2025] [Accepted: 01/30/2025] [Indexed: 05/13/2025]
Abstract
Hypertriglyceridaemia (HTG) is a common and well-established aetiology of acute pancreatitis (AP). Although the underlying pathophysiology of hypertriglyceridaemic pancreatitis (HTGP) is complex, some animal models of HTAP have been successfully reproduced by repeated caerulein injections based on HTAP. However, most of the current HTGP models are critically dependent on the "two-attack" of cholecystokinin analogue, which may not be consistent with the fact of HTGP aetiologies due to ignored the initial effects of HTG in the development of HTGP. Here, we showed that HTGP could be induced by HTG independently, the HTGP mice with the typical characteristics and typical complications of pancreatitis. We found that the HTGP mice with mild pancreatic oedema, but the necrosis and immune cell infiltration were extensive. In addition, the immune cell infiltration and immune dysregulation that widely observed in HTGP patients were well reproduced in this model, including innate and adaptive immune cells. Our results suggest that the murine HTGP model independently induced by HTG could recapitulate the pathological and immunological profiles of HTGP in the clinic. More importantly, the model generated by this method could sustain a prolonged, non-life-threatening course of the disease and is suitable for research into the underlying mechanisms and for application to the preclinical evaluation of HTGP drugs.
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Affiliation(s)
- Jianxing Liu
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, School of Life Science and Technology, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Caixia Liang
- Taizhou Hospital of Zhejiang Province Afiliated to Wenzhou Medical University, Taizhou, China
| | - Wenjing Yan
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, School of Life Science and Technology, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Yanfeng Zhang
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, School of Life Science and Technology, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Yi Pan
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, School of Life Science and Technology, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Yue Yang
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, School of Life Science and Technology, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Fangfang Zhang
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, School of Life Science and Technology, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Xiaojian Liu
- Department of Surgery, Tongxiang First People's Hospital, Jiaxing, People's Republic of China
| | - Liang Jin
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, School of Life Science and Technology, China Pharmaceutical University, Nanjing, People's Republic of China
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50
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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; 49:1053-1063. [PMID: 40108779 DOI: 10.1111/acer.70030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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