Search

The prevalence of non-alcoholic fatty pancreas disease (NAFPD) is estimated as 2–46% among patients without known pancreatic diseases. An association between NAFPD and non-alcoholic fatty liver disease (NAFLD) has been proposed, as well as an association between NAFPD and pancreatic exocrine insufficiency (PEI). Patients with histologically confirmed NAFLD were included in the study. The control group consisted of individuals included in a surveillance screening program. Magnetic resonance imaging (MRI) of the pancreas was performed in all patients and fat measurement was made using 2-point Dixon imaging. Fecal elastase-1 (FE-1) was performed to evaluate pancreatic exocrine function. Additionally, a 13C-mixed triglyceride breath test (13 C-MTG-BT) was performed in patients with FE-1 < 200 μg/g. Imaging signs of NAFPD were present in 17 (71%) patients; 11 (85%) from the NAFLD group and 6 (55%) from the control group. FE-1 < 200 μg/g was found in six (25%) patients (four in the NAFLD group and two in the control group); however, none of them had clinical symptoms of PEI. Therefore, in five out of six patients with low FE-1, a 13C-MTG-BT was performed, showing normal results (>20.9%) in all tested patients. Furthermore, the serum nutritional panel was normal in all patients with low FE-1. A systematic review identified five studies relevant to the topic. NAFPD was found in 85% of patients with NAFLD and in 55% of control patients. We did not diagnose PEI in either group. A literature review showed PEI in 9–56% of patients with NAFPD. [ABSTRACT FROM AUTHOR]

Diabetes type 1 and type 2 may develop gastrointestinal complications e.g., gastroparesis and gastroenteropathy. Concomitant celiac disease and pancreatic exocrine insufficiency occur with high prevalence in diabetes and with symptomatic overlap. Consequently, it is a challenge to disentangle symptoms of these conditions and separate them from functional dyspepsia. We aim to develop a clinical decision-support tool to differentiate the underlying disease in a plethora of gastrointestinal symptoms. An internet-based computerized survey will collect basic characteristics (diabetes type, age, gender, duration, HbA1c, treatment) and patient reported outcomes by validated questionnaires focusing on (1) gastroparesis using Gastroparesis Cardinal Symptom Index; (2) gastroenteropathy using Gastrointestinal Symptom Rating Scale; (3) celiac disease using Celiac Symptom Index and (4) pancreatic exocrine insufficiency with Pancreatic Exocrine Insufficiency Questionnaire. Logistic regression and multiple regression analyses will identify risk factors and gastrointestinal complications. Cluster analyses and machine learning will classify different symptoms and co-existing presentations, into a likely diagnosis. We seek biomarkers for autonomic neuropathy by characterizing development of retinopathy using the Visual Function Questionnaire-25 and peripheral neuropathy by the Michigan neuropathy questionnaire. Participants are re-examined yearly for disease progression over time. From focus group studies gastrointestinal symptoms are of major concern in diabetes. Potentially, estimates of symptom prevalence, risk factor identification and classifications of gastrointestinal complications can be unraveled for feedback to health care providers. The web-based DICODI project will open up possibilities to detect gastrointestinal complications of diabetes in a societal setting, benefitting people living with diabetes, health care professionals, and society. [ABSTRACT FROM AUTHOR]

Peroralcholangio-pancreatoscopy (POCP) is used for diagnosis and treatment of biliopancreatic disease when standard endoscopy (ERCP) or pre-operative imaging workup failed. We aimed to evaluate the diagnostic and therapeutic performance of POCP in complex biliary and pancreatic diseases. Patients with indeterminate biliary or pancreatic duct (PD) strictures, and patients with failure of complex biliary or pancreatic stones removal, were enrolled (six centers). The primary endpoint evaluated malignancy diagnostic performances (accuracy, sensitivity, specificity) and therapeutic performances (biliary or pancreatic stones extraction). Secondary endpoints evaluated: technical success in lesion visualization, ease of maneuvering, image quality and 30-days complications. From November 2016 to March 2018, 66 patients were included: 29/37 women/men, median age (IQR): 73 (64–82). Fifty-three patients had diagnostic POCP and 13 patients therapeutic POCP. One endoscopist with one or two endoscopy nurses performed 94% of the POCP. The 'POCP visual impression' of malignancy showed 92.0% sensitivity, 92.9 % specificity and 92.5 % overall accuracy compared with the final diagnosis. 'POCP-guided samples histological analysis' showed 75.0 % sensitivity and 91.6% specificity. The technical success for lesion visualization was 98.5%. The median VAS scores for insertions in bile and PD were respectively 9.0 (8.1–9.6) and 9.0 (8.8–10.0). Median VAS score for access to the lesion and image quality were respectively 9.0 (7.7–9.6) and 9.0 (7.9–9.7). Only three 30-day minor complications occurred without any major complications. POCP was an effective, safe and easy-to-use tool in routine clinical practice for the management of complex diagnostic and therapeutic biliary and pancreatic diseases (NCT03190343). [ABSTRACT FROM AUTHOR]

Background: Except for pancreas divisum (PD), the prevalence of anatomic variants of the main pancreatic duct (MPD) seems to be insufficiently investigated. To date, their role in the occurrence of pancreatic exocrine insufficiency (PEI) and morphological changes suggestive of chronic pancreatitis (CP) has remained unclear. Methods: A systematic review was performed, searching MEDLINE and Web of Science, limited to articles published between 1960 and 1 June 2019. Results: Our review included a total number of 3234 subjects. The most common variant of MPD was type 3, followed by type 1, indicating MPD drainage pattern into major papilla (MP) as the most frequent. A sub-variant of type 3, known as 'reverse pancreas divisum' had a prevalence of 2.2%. Type 4 variant- PD, was found in 6.4% of all cases. The most common sub-variant of PD was complete PD, followed by incomplete PD and variant with MPD as only pancreatic duct. Type 5 variant (including ansa pancreatica) was present in 2.9% of subjects. Apart from one study with a significantly higher frequency of morphological changes suggestive of CP in patients with ansa pancreatica, the studies stated no significant association between pancreatic disease and MPD variants. Furthermore, only one study examined the influence of MPD variants on exocrine pancreatic function. Although equivocal, this association is most likely found to be insignificant. Conclusion: To elucidate linkage between MPD variants and the occurrence of chronic pancreatitis and impairment of pancreatic exocrine function, further clinical investigations are warranted. [ABSTRACT FROM AUTHOR]

Objective: To examine lifetime drinking patterns in men and women with alcohol-induced pancreatitis (AIP) in comparison with patients with alcoholic use disorder (AUD) without pancreatic disease. Methods: Alcohol consumption patterns were assessed using a validated questionnaire, the Lifetime Drinking History (LDH), during an outpatient visit. Patients diagnosed with AIP were matched for gender and age (+/− 5 years) with patients with AUD in addiction treatment. Results: A total of 45 patients with AIP (35 males, 10 females) and 45 AUD patients were included. Alcohol consumption patterns were not significantly different between males and females with AIP and those with history of acute AIP and chronic pancreatitis (CP). Alcohol consumption patterns of AIP and AUD patients were similar in terms of onset age and duration of alcohol consumption, lifetime alcohol intake and drinks per drinking day. A higher proportion of binge drinking was found among patients with AUD than those with AIP (median 1.00 vs. 0.94, p = .01). Males with AUD had lower onset age (15 vs. 16 years, p = .03), higher total amount of spirits (35520 vs. 10450 drinks, p = .04) and higher proportion of binge drinking (1.00 vs. 0.97, p = .01) than males with AIP, whereas females with AIP and AUD had similar drinking patterns. Conclusions: Alcohol drinking patterns and lifetime drinking history was similar in patients with AIP and patients with AUD. Males with AIP had lower total amount of spirits and lower proportion of binge drinking than those with AUD, suggesting the idiosyncratic etiology of AIP. [ABSTRACT FROM AUTHOR]

Objective: The accurate diagnosis of undetermined pancreaticobiliary strictures remains challenging. Current ERCP-guided tissue sampling methods are of low sensitivity. Confocal laser endomicroscopy (CLE) is a new procedure and allows real optical biopsies that may improve the diagnosis of undetermined pancreaticobiliary strictures. The aim of this meta-analysis was to determine the diagnostic yield of CLE, tissue sampling, and CLE combined with tissue sampling for undetermined pancreaticobiliary strictures. Method: Pubmed, Embase, and the Cochrane Library database were reviewed for relevant studies. Pooled estimates of sensitivity and specificity with 95% confidence intervals (CIs) were calculated using the random-effects meta-analysis model. The summary receiver-operating characteristic (SROC) curve was constructed, and the area under the receiver operating characteristic curve (AUC) was calculated. Results: Twelve studies involving 591 patients were enrolled in our analysis. The overall sensitivity and the specificity estimate of CLE for discriminating benign and malignant pancreaticobiliary strictures were 87% (95%CI, 83-91%) and 76% (95%CI, 70-81%), respectively. The AUC to assess the diagnostic efficacy was 0.8705. For tissue sampling, the overall sensitivity and the specificity estimate were 64% (95%CI, 57-70%) and 94% (95%CI, 90-97%), respectively. The AUC to assess the diagnostic efficacy was 0.8040. A combination of both methods increased the sensitivity (93%; 95%CI, 88-96%) with a specificity of 82% (95%CI, 74-89%). The AUC to assess the diagnostic efficacy was 0.9377. There was no publication bias by Deeks’ Funnel Plot with p = .936. Conclusions: Compared with tissue sampling, CLE may increase the sensitivity for the diagnosis of malignant pancreaticobiliary strictures. A combination of both can effectively diagnose malignant pancreaticobiliary strictures. [ABSTRACT FROM AUTHOR]

Intraductal papillary mucinous neoplasm (IPMN) is one of the most common cystic neoplasms of the pancreas. It is a heterogeneous disease and can be divided into ductal types and morphological subtypes. The incidence of IPMN is increasing, likely due to the widespread use of cross-sectional imaging and a growing elderly population. IPMN poses an increasing demand on the health care system. Current guidelines provide indications for surgery and recommendations for surveillance, but management of IPMN is still challenging in routine clinical practice. In this article, we review current knowledge about IPMN and provide future directions for improving diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers. Methods: A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF. Results: A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained. Conclusions: Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF. [ABSTRACT FROM AUTHOR]

Background and study aimsEndoscopic retrograde cholangiopancreatography (ERCP) with a cytological sample is a valuable tool in the diagnosis of the aetiology of biliary stricture. Our aim was to evaluate whether a more dense Infinity® cytological brush is more sensitive in diagnosing malignancy than the regularly used brush.Patients and methodsWe recruited 60 patients with a biliary stricture suspicious for malignancy for a randomised controlled trial. Patients were randomly assigned to an Infinity® brush group (n = 30) and a regularly used cytology brush group (n = 30). All the patients had verified cancer during follow-up.ResultsCrossing the brush over the stricture was possible in each case without dilatation of the biliary duct. Brush cytology yield was good or excellent in 86.7% of cases with the Infinity® brush and 96.7% with the regular brush (p = 0.161). The cytological sample showed clear malignancy in three patients (10.0%) in the Infinity® group and in 12 (40.0%) patients of the regular brush group (p = 0.007). The cytological diagnosis was highly suspicious for malignancy or malignant in 14 patients (46.7%) in the Infinity® group and in 23 patients (76.7%) in the regular brush group (p = 0.017). The result was benign in 10 patients (33.3%) in the Infinity® group and in four patients (13.6%) in the regular brush group (p = 0.067).ConclusionsWith the standardised technique, the sensitivity of brush cytology is fairly good. The dense Infinity® brush does not show any advantage regarding sensitivity compared with the conventional cytology brush. [ABSTRACT FROM AUTHOR]

Background and aim: Pancreatic neuroendocrine tumors (pNETs) are histologically categorized according to the WHO 2010 classification by their mitotic index or Ki-67 index as G1, G2, or G3. The present study examined the efficacy of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis and grading of pNET.Methods: We retrospectively reviewed 61 pNETs in 51 patients who underwent EUS between January 2007 and June 2014. All lesions were pathologically diagnosed by surgical resection or EUS-FNA. We evaluated the detection rates of EUS for pNET and sensitivity of EUS-FNA, and compared the Ki-67 index between EUS-FNA samples and surgical specimens. EUS findings were compared between G1 and G2/G3 tumors.Results: EUS showed significantly higher sensitivity (96.7%) for identifying pNET than CT (85.2%), MRI (70.2%), and ultrasonography (75.5%). The sensitivity of EUS-FNA for the diagnosis of pNET was 89.2%. The concordance rate of WHO classification between EUS-FNA and surgical specimens was 69.2% (9/13). The concordance rate was relatively high (87.5%, 5/6) in tumors <20 mm but lower (57.1%; 4/7) in tumors ≥20 mm. Regarding EUS findings, G2/G3 tumors were more likely to be large (>20 mm), heterogeneous, and have main pancreatic duct (MPD) obstruction than G1 tumors. Multivariate analysis showed large diameter and MPD obstruction were significantly associated with G2/G3 tumors.Conclusions: EUS and EUS-FNA are highly sensitive and accurate diagnostic methods for pNET. Characteristic EUS findings such as large tumor size and MPD obstruction are suggestive of G2/G3 tumors and would be helpful for grading pNETs. [ABSTRACT FROM PUBLISHER]

Background and study aims:Trauma is one of the most common causes of morbidity and mortality in the pediatric population. The diagnosis of pancreatic injury is based on clinical presentation, laboratory and imaging findings, and endoscopic methods. CT scanning is considered the gold standard for diagnosing pancreatic trauma in children.Patients and methods:This retrospective study evaluates data from 25 pediatric patients admitted to the University Hospital Motol, Prague, with blunt pancreatic trauma between January 1999 and June 2013.Results:The exact grade of injury was determined by CT scans in 11 patients (47.8%). All 25 children underwent endoscopic retrograde cholangiopancreatography (ERCP). Distal pancreatic duct injury (grade III) was found in 13 patients (52%). Proximal pancreatic duct injury (grade IV) was found in four patients (16 %). Major contusion without duct injury (grade IIB) was found in six patients (24%). One patient experienced duodeno-gastric abruption not diagnosed on the CT scan. The diagnosis was made endoscopically during ERCP. Grade IIB pancreatic injury was found in this patient. One patient (4%) with pancreatic pseudocyst had a major contusion of pancreas without duct injury (grade IIA). Four patients (16%) with grade IIB, III and IV pancreatic injury were treated exclusively and nonoperatively with a pancreatic stent insertion and somatostatine. Two patients (8%) with a grade IIB injury were treated conservatively only with somatostatine without drainage. Eighteen (72 %) children underwent surgical intervention within 24 h after ERCP.Conclusion:ERCP is helpful when there is suspicion of pancreatic duct injury in order to exclude ductal leakage and the possibility of therapeutic intervention. ERCP can speed up diagnosis of higher grade of pancreatic injuries. [ABSTRACT FROM PUBLISHER]

Objective. Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) using the slow pull technique (SP-FNA) has recently attracted attention as an effective tissue acquisition technique. However, efficacy of SP-FNA with a 22-gauge conventional needle remains unclear. The aim of this study is to evaluate the diagnostic ability of SP-FNA with a 22-gauge needle. Material and methods. Patients with a pancreatic solid lesion were prospectively enrolled in this study. SP-FNA was performed at two needle passes with a 22-gauge needle. One dedicated pathologist evaluated the obtained samples in terms of quantity (Grade 0: scant; Grade 1: inadequate; Grade 2: adequate), quality (Grade 0: poor; Grade 1: moderate; Grade 2: good), and blood contamination (Grade 0: significant; Grade 1: moderate; Grade 2: low), and provided a pathological diagnosis. Additional EUS-FNA was performed by applying suction (SA-FNA). The evaluation points were as follows: diagnostic accuracy of SP-FNA compared with that of SA-FNA, and the quantity, quality, and blood contamination level of SP-FNA-obtained samples. Results. We enrolled 40 cases. The diagnostic accuracy of SP-FNA was 90% (36/40). There was no significant difference in the accuracy between SP-FNA and SA-FNA (90% vs. 90%, p = 1.000). The samples obtained using SP-FNA were assessed as Grade 2 for quantity in 29 cases (73%), quality in 31 (78%), and blood contamination in 25 (63%). Conclusions. Adequate, high-quality, and unsubstantially blood-contaminated samples could be obtained using SP-FNA. The diagnostic ability of SP-FNA was 90%, which appeared to be similar to that of SA-FNA. [ABSTRACT FROM AUTHOR]

Objective. Novel imaging modalities have supplanted endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of hepatobiliary pancreatic diseases, but the use of ERCP as a diagnostic and therapeutic tool in current clinical practice is not well known. The main objective of this study was to describe and evaluate contemporary use of ERCP in Norway. Material and methods. Prospective and consecutive data were collected between January 2007 and December 2009 from voluntary institutional reports of ERCP activity at participating hospitals in the Gastronet database. Results. A total of 3840 procedures at 14 hospitals were registered during the study period. Data from 3809 procedures (53% females) were available for evaluation. Patients were ≥≥60 years of age in 2567 (67%) procedures. High co-morbidity (ASA score ≥≥3) was present in 32% of patients. The main indication for ERCP was evaluation and therapy of bile duct-related disorders. Successful bile duct cannulation was achieved in 93%. Pre-cut sphincterotomy was performed in 5% of procedures, and a guide wire to facilitate duct access was employed in 63%. Sphincterotomy, treatment for common bile duct stones (CBDS), and an insertion or change of bile duct stents were the most commonly employed procedures. Complications occurred in 10% of the patients, with a procedure-related mortality of 1%. Conclusions. In Norway, ERCP is predominantly performed for CBDS and biliary strictures in elderly patients with associated co-morbidity. Patient selection, indications, and procedures are in concert with international guidelines and recommendations. Disease patterns in Norway differ slightly from those observed in central Europe and North America. [ABSTRACT FROM AUTHOR]

Objective. The introduction of non-invasive imaging for biliary-pancreatic diseases has changed the indications and volumes of endoscopic retrograde cholangiopancreatography (ERCP) over time. This study aimed to provide national figures on ERCP in Norway over the last decade. Material and methods. Data from four national surveys on ERCP activity collected from 1998 to 2009 at the surgical and medical departments of all Norwegian hospitals were analyzed for variations in volumes among centers, regions, and specialties over time. Results. A total of 42,260 procedures were reported (average 3842 procedures per year, range 3492-4632). The number of hospitals with ERCP decreased from 41 to 35 and the annual number of procedures decreased by 13% (from 4632 to 4036), but the number of ERCP endoscopists remained stable at -100. The proportion of procedures performed by surgeons decreased from 40% to 32% (p < 0.001) during the first half of the study period; the number of gastrointestinal surgeons performing ERCP remained stable in the latter half (46% and 48% for 2004 and 2008, respectively). In 2004, 15 endoscopists signed up for a formal ERCP training program, including 8 (53%) surgeons. This number increased to 21 (48%) in 2008. A non-significant decrease in referrals (49% in 2002 vs. 35% in 2005) between various ERCP centers was reported. Regional variation in ERCP volumes leveled off during the study period. Conclusions. Though the number of both procedures and hospitals performing ERCP in Norway decreased, the proportion of low-volume and high-volume centers remained steady. The proportion of procedures by gastroenterological surgeons decreased significantly, yet roughly half of the endoscopists in ERCP training programs are surgeons. Regional variation in the ERCP numbers appears to have diminished. [ABSTRACT FROM AUTHOR]

Objective. Based on the ampullary obstruction and reflux theory, six endoscopic retrograde cholangiopancreatography (ERCP) studies have investigated the effect of (early) biliary decompression versus conservative management on the course and outcome of patients with acute biliary pancreatitis (ABP) showing inconsistent and contradictory outcomes. We investigated the opinion and attitude of Dutch gastroenterologists regarding the application of (early) ERCP in the clinical management of ABP by means of a nationwide survey. Material and methods. An anonymous questionnaire was sent to all registered consultant gastroenterologists ( n = 283) across the Netherlands. Results. The response rate was 52%. The vast majority of consulting gastroenterologists declared that early ERCP may be indicated in ABP (96.6%). Fourteen percent stated that they always perform ERCP in ABP. The remainder of the respondents consider ERCP only if a concomitant condition is present such as a dilated CBD (95%), co-existent cholangitis (87%), common bile duct stone(s) (CBDS) (72%), jaundice (59%), ampullary stone (68%) or (predicted) severe ABP (35%). About half of the consultant gastroenterologists (51.4%) consider the optimal time point for ERCP in ABP to be within 24 h after admission or symptom onset. If ERCP is performed for suspected APB, 55% of the respondents perform an endoscopic sphincterotomy (ES), regardless of the findings on cholangiography. Conclusions. The vast majority of Dutch gastroenterologists attest to a role for ERCP in ABP, but indications when to perform ERCP, its timing, and the application of ES vary greatly and are not always in line with the Dutch or other published national guidelines. The results of this survey highlight the need for additional comparative randomized studies to define the role of (early) ERCP in ABP. [ABSTRACT FROM AUTHOR]

Chronic pancreatitis is a common disorder of which the underlying pathogenic mechanisms still are incompletely understood. In the last decade, increasing evidence has shown that activated pancreatic stellate cells play a key role in the fibrosis development associated with chronic pancreatitis as well as pancreatic cancer. During pancreatic injury or inflammation, quiescent stellate cells undergo a phenotypic transformation, characterized by smooth muscle α-actin expression and increased synthesis of extracellular matrix proteins. Hitherto, specific therapies to prevent or reverse pancreatic fibrosis are unavailable. This review addresses current insights into pathological mechanisms underlying chronic pancreatitis and their applicability as concerns the development of potential future therapeutic approaches. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with idiopathic acute pancreatitis (IAP), find factors predictive of a positive EUS finding in these patients and investigate whether these etiological findings are maintained during follow-up. Material and methods. We performed EUS in patients with IAP between July 2004 and August 2007. We recorded epidemiological data, the number and severity of previous bouts of pancreatitis and gallbladder status. Results. A total of 44 patients were included in the study. EUS was normal in seven patients (16%). In the remaining 37 patients (84%) we found cholelithiasis ( n = 3), microlithiasis ( n = 20), chronic pancreatitis ( n = 14), pancreas divisum ( n = 3), pancreatic mass ( n = 1), apudoma ( n = 1), cystic tumor of the pancreas ( n = 2) and choledocholithiasis ( n = 2). Positive EUS findings were not influenced by sex, severity of pancreatitis or recurrent disease. Patients aged < 65 years (age > or < 65 years: 73.9% versus 95.2%; P = 0.097) and patients with gallbladder in situ (cholecystectomy versus non-cholecystectomy: 63.6% versus 90.9%; P = 0.054) showed a tendency to have positive EUS findings. Mean follow-up was 28.95 ± 10.86 months (range 12–64 months; median 28 months). During follow-up the etiological diagnosis was changed in two patients, lowering the diagnostic yield to 79%. Conclusions. EUS identified the cause of IAP in 79% of patients. Patients with gallbladder in situ and patients aged < 65 years showed a tendency to have positive EUS findings. The majority of the diagnoses provided by EUS are maintained during follow-up and seem to be reliable. [ABSTRACT FROM AUTHOR]

Objective. Serum leptin and adiponectin determinations have been proposed as markers for distinguishing pancreatic cancer and chronic pancreatitis from autoimmune pancreatitis; however, no studies exist in patients with autoimmune pancreatitis and in those with intraductal papillary mucinous tumors of the pancreas. The aim of this paper was to evaluate the circulating concentrations of receptor for advanced glycation end products (RAGE), leptin and adiponectin in patients with chronic pancreatic diseases. Material and methods. Seventy-five consecutive patients with chronic pancreatic diseases (47 males, 28 females; mean age 67.0 ± 13.2 years; range 37–97 years) were studied: six (8.0%) had autoimmune pancreatitis, 23 (30.7%) had chronic pancreatitis, 34 (45.3%) had pancreatic cancer and the remaining 12 (16.0%) had intraductal papillary mutinous tumors of the pancreas. Leptin, adiponectin and RAGE were determined in serum using commercially available kits. The leptin concentrations were normalized to the lower and upper reference limits because of the different gender reference ranges. Results. Normalized leptin concentrations were significantly lower in chronic pancreatitis patients (0.53 ± 1.28; p = 0.008) and in those with pancreatic cancer (0.12 ± 0.33; p < 0.001) compared to the overall population (0.58 ± 1.23), whereas autoimmune pancreatitis patients had significantly higher concentrations of this protein (2.18 ± 2.56; p = 0.004) compared to the overall population. RAGE and adiponectin concentrations were similar among the four groups of patients studied. Among the clinical variables considered, only pain was significantly related to leptin concentrations (patients with pain 0.18 ± 0.54, patients without pain 1.07 ± 1.64; p = 0.001). Conclusion. Serum leptin seems to be a good serum marker for differentiating autoimmune pancreatitis patients from those with chronic pancreatitis and pancreatic cancer. [ABSTRACT FROM AUTHOR]

We report four patients with pancreatic fistulas that failed to respond to conservative treatment. The fistulas were closed by endoscopic injection of N-butyl-2-cyanoacrylate (Histoacryl) diluted with an oily contrast agent (Lipiodol). A literature review revealed 32 similar cases in which endoscopic treatment with fibrin sealants ( n = 11) or cyanoacrylate ( n = 21) was used to close the fistulas. Based on our own experience and the literature review, we conclude that endoscopic sealing of pancreatic fistulas can be performed safely and effectively by experienced endoscopists in a tertiary centre. The procedure seems useful in the management of complicated pancreatic fistulas which do not respond to conservative treatment and may obviate the need for surgery. [ABSTRACT FROM AUTHOR]

Background. Autoimmune pancreatitis (AIP) is a relatively newly recognized type of pancreatitis that is characterized by diffuse or focal swelling of the pancreas due to lymphoplasmacytic infiltration and fibrosis of the pancreatic parenchyma. Material and methods. A PubMed literature search was performed using the keywords “autoimmune pancreatitis”. Sometimes, bibliographies were cross-referenced and related article searches were performed once an article of interest was identified. Results. Pathologically, AIP shows narrowing of the pancreatic ducts and the intrapancreatic portion of the common bile duct. Obstructive jaundice is a common symptom at presentation, and pancreatic cancer represents an important clinical differential diagnosis. In late stages of the disease, the normal pancreatic parenchyma is often replaced by large amounts of fibrosis. Histologically, there seem to be two subtypes of the disease–one showing infiltration with IgG4-positive plasma cells but lacking granulocytic epithelial lesions (GELs), the other showing GELs but lacking strong IgG4 positivity. AIP is in at least some instances the pancreatic manifestation of a clinicopathological entity of IgG4-related systemic sclerosing disease. On the basis of pancreatic imaging, together with serological measurement of IgG4 and evaluation of other organ involvement, many AIP patients can be identified. The remaining patients require further diagnostic work-up. In these patients, pancreatic core needle biopsy and, as AIP responds to steroid treatment, also a trial with steroids, can help to differentiate AIP from pancreatic cancer. Outlook and discussion. This review presents the pathological, radiologic and laboratory findings of AIP. Moreover, the treatment and pathogenesis are discussed. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the efficacy of continuous high-volume hemofiltration for the treatment of severe acute pancreatitis patients and the impact of acute physiology and chronic health evaluation (APACHE) II score on the efficacy of high-volume hemofiltration. Material and methods. A total of 63 patients diagnosed with severe acute pancreatitis between January 2005 and July 2007 were retrospectively analyzed: 34 accepted adjunctive continuous high-volume hemofiltration (HVHF group); and 29 only accepted conventional recommended treatments (control group). Results. There were no differences in physiological characteristics between the two groups when entering the intensive care unit. After treatment, the percentages of patients successfully weaned from mechanical ventilation ( p == 0.004) and who experienced renal function recovery ( p == 0.046) were significantly higher in the HVHF group than in the control group. The 28-day survival rate was 91.2% in the HVHF group, compared with 65.5% in the control group ( p == 0.014). For patients with APACHE II scores > 15, survival was significant higher in the HVHF group than in the control group (87.5% vs 50%; p == 0.044). No difference in survival was found in patients with APACHE II scores ≤≤ 15 between the two groups (94.4% vs 76.5%; p == 0.177). After HVHF therapy, APACHE II score, body temperature, urine volume and laboratory indices, including serum creatinine, base excess and blood calcium, were significantly improved. Conclusions. Adjunctive continuous HVHF was beneficial for the survival of severe acute pancreatitis patients. Survival improvement was significant in patients with APACHE II score > 15. [ABSTRACT FROM AUTHOR]

Objective . Experimental studies have shown that pancreatic activation of polyamine catabolism occurs during the early stage of acute pancreatitis. Changes in pancreatic polyamines are reflected in the red blood cell (RBC) polyamine contents, correlating with the extent of pancreatic necrosis. The aim of this human study was to examine the changes in polyamine levels in the RBCs of patients with acute pancreatitis. Material and methods . Twenty-four patients with acute pancreatitis (7 alcoholic, 10 gallstone and 7 of unknown etiology) were recruited in the study. Eighteen patients with non-pancreatic acute abdominal diseases were included as controls, and 6 volunteers were studied as references. Blood samples were collected on admission and during hospitalization to assess polyamine levels. After clinical recovery, the patients revisited the clinic, and RBC polyamine levels were measured again. For comparison, plasma interleukin-6 (IL-6), IL-10 and C-reactive protein (CRP) were measured. Results . In acute pancreatitis patients, there was no difference in RBC polyamine levels on admission compared with those in controls or in volunteers. Putrescine levels on admission were higher in patients with pancreatic necrosis than in patients without necrosis, but there was no difference in spermidine and spermine levels. Patients with pancreatitis of unknown etiology had significantly higher levels of polyamines on admission and throughout hospitalization, but they also had more necrosis, which explained the difference in multivariate analysis. Spermidine and spermine levels increased after clinical recovery. RBC putrescine correlated with IL-6 and IL-10, and spermine correlated with CRP. Conclusions . The results of this study suggest that RBC polyamines change in human acute pancreatitis in several respects, as has been previously observed in experimental pancreatitis. [ABSTRACT FROM AUTHOR]

Objective. Prospectively to evaluate patients with chronic asymptomatic pancreatic hyperenzymemia in order to identify possible pancreatic and non-pancreatic diseases. Material and methods. Seventy-five asymptomatic subjects with long-standing pancreatic hyperenzymemia (45 M, 30 F; mean age±SD 51.5±16.0 years, range 19-78 years, mean duration±SD of pancreatic hyperenzymemia 14.7±7.0 months, range 7-34 months) and normal ultrasonographic evaluation were included in this study. The subjects enrolled were carefully interviewed and prospectively evaluated. All patients underwent blood screening. An additional abdominal ultrasound was also carried out and, if considered necessary, other imaging and endoscopic evaluation procedures were used. Results. The follow-up of the patients after enrolment in the study was 3.3±1.8 years (mean±SD). In 38 patients (50.7%), pancreatic or extrapancreatic disease was diagnosed: 20 patients had chronic pancreatitis, 1 had autoimmune chronic pancreatitis, 1 had a benign cyst of the pancreas, 2 had serous cystadenomas, 5 had an intraductal papillary mucinous tumor of the pancreas, 3 had a ductal pancreatic adenocarcinoma, 4 patients had chronic viral hepatitis, and 2 had Crohn's disease. In 37 subjects (49.3%), no pancreatic or extrapancreatic diseases were found (3 subjects had macroamylasemia, 3 had familial hyperenzymemia, 31 had chronic non-pathological pancreatic hyperenzymemia). Conclusions. Subjects having an increase of either amylase or lipase serum levels should undergo a thorough diagnostic work-up prior to establishing the existence of chronic non-pathological pancreatic hyperenzymemia. [ABSTRACT FROM AUTHOR]

Objective. There are no recommendations on how to proceed in patients with increased pancreatic enzyme activities but non-pancreatic diseases. The objective of this study was to investigate prospectively in a general medical hospital the incidence, causes and clinical impact of hyperamylasaemia and/or hyperlipasaemia in these patients. Material and methods. During a 4-month period in 2004, amylase and lipase activities were measured in all patients (n, 1765) admitted to the Department of Internal Medicine of the Municipal Clinic of Luneburg, Germany. Patients with increased enzyme activities underwent abdominal ultrasonography and, if inconclusive, other imaging procedures. Results. Amylase and/or lipase activities were increased in 140 (8%) patients with non-pancreatic diseases: amylase in 29 cases (21%) and 1 case (1%)<3 and>3 times the upper limit of normal, respectively, lipase in 120 cases (86%) and 6 cases (4%)<3 and>3 times, respectively. In 53 (38%) patients no further imaging studies could be performed. In the remaining 87 patients amylase was increased in 18 patients (21%) and lipase in 3 patients (3%). The pancreas was normal on imaging procedures in 77 (89%) patients and abnormal in 10 (11%) (chronic pancreatitis: 4, small cystic lesions: 6). The cystic lesions were mostly located in the pancreas head, probably corresponding to branch-duct intraductal papillary mucinous neoplasm. Conclusions. Increased pancreatic enzyme activities occur in 8% of hospitalized patients with non-pancreatic diseases, but pancreatic abnormalities will be found in only a few (11%), which are unlikely to need further investigation or therapy. Therefore, routine analysis of amylase or lipase activities in patients with non-pancreatic diseases is not indicated. [ABSTRACT FROM AUTHOR]

The article presents information on familial pancreatic cancer (FPC). FPC is inherited as an autosomal dominant disease with involvement of different genes and modifying genes. It is believed that tobacco smoking could be responsible for 14% of all pancreatic cancer cases. Cystic fibrosis gives a 32% higher risk of pancreatic cancer. Chronic pancreatitis is responsible for 5% of the pancreatic cancer cases.

Objective. Infected pancreatic necrosis is the main cause of death in patients with acute pancreatitis, and therefore its early prediction is of utmost importance. Endogenous cortisol metabolism plays a basic role both in the course of acute pancreatitis and in the process of infection. The purpose of this study was to analyze corticosteroid-binding globulin (CBG), total cortisol, calculated free cortisol and adrenocorticotropic hormone as potential early predictors in order to differentiate between infected pancreatic necrosis and sterile pancreatic necrosis in patients with acute pancreatitis. Material and methods. Serum levels of CBG, total cortisol, calculated free cortisol, and plasma levels of adrenocorticotropic hormone were determined in 109 consecutive patients with acute pancreatitis. C-reactive protein was measured as the control parameter. Thirty-five patients developed necrotizing pancreatitis and 10 developed infection of the necrosis. Blood was monitored for 6 days after the onset of pain; 30 healthy individuals served as controls. Results. Of all parameters only CBG showed a significant difference (p=0.0318) in its peak levels measured in the first 48 h in patients with sterile (26.5 µg/ml, range 21.3-34.7) and infected (16.0 µg/ml, range 15.2-25.0) necrosis at a cut-off level of 16.8 µg/ml. That difference was further preserved for the first 6 days after onset of pain. Conclusions. In our group of patients, a decreased CBG level below 16.8 µg/ml within the initial 48 h of acute pancreatitis was an early predictor of later infected pancreatic necrosis, with a positive predictive value of 100% and a negative predictive value of 87.5%. [ABSTRACT FROM AUTHOR]

Objective. Obesity is a known risk factor for severe acute pancreatitis (AP), but the mechanism by which it affects the severity of AP is not fully understood. The main objective of this study was to investigate the relationship between obesity and inflammatory markers in AP. Material and methods. Thirty patients with AP who developed organ failure (Group I) and 87 patients with AP who survived without organ failure (Group II) were studied. Patients' height and weight were measured at admission for calculation of body mass index (BMI). Blood samples were taken at admission for measurement of plasma interleukin (IL)-1β, IL-6, IL-10, IL-1 receptor antagonist, procalcitonin, C-reactive protein (CRP) and monocyte human leucocyte antigen (HLA)-DR expression. Results. Group I patients had higher BMI values (median 26.2 kg/m2) than Group II patients (25.2 kg/m2), p=0.033. Both CRP values and monocyte HLA-DR expression showed a significant correlation with BMI (Spearman's rank correlation r=0.32, p=0.003 and r=-0.33, p=0.002, respectively). The correlation between BMI and monocyte HLA-DR expression was significant in Group II patients (r=-0.34, p=0.002) but not in Group I patients (r=-0.02, p>0.05). There was no correlation between BMI and IL-1β, IL-6, IL-10, IL-1 receptor antagonist or procalcitonin. Conclusions. BMI did not affect either pro-inflammatory or anti-inflammatory cytokine levels in early AP. However, in patients with mild AP, BMI correlated positively with CRP levels and inversely with monocyte HLA-DR expression, which might reflect an amplified inflammatory response in these patients. Taken together, acute inflammatory response in AP, which ultimately determines the severity of AP, was little affected by BMI. [ABSTRACT FROM AUTHOR]

Objective. Fine-needle aspiration (FNA) is the procedure of choice for accurate diagnosis of infected necrosis. However, invasive procedures increase the risk of secondary pancreatic infection and the timing of FNA is still a matter for debate. Our objective was to assess the value of routine clinical tests to determine the minimal risk for infected necrosis, thereby optimizing timing and selection of patients for image-guided FNA. Material and methods. This prospective, non-randomized study comprised 90 patients with acute necrotizing pancreatitis. The data of 52 patients were used for discriminant function analysis to determine the differences between patients with infected necrosis and those with sterile necrosis. Cut-off points for variables were established using receiver operating characteristic (ROC) curve analysis and logistic regression was performed to determine the risk of infected necrosis. The clinical relevance of the defined diagnostic system was prospectively tested in a further 38 consecutive patients with acute necrotizing pancreatitis (ANP). Results. Discriminant function analysis showed that C-reactive protein (CRP) and white blood cell (WBC) values were significant discriminators between patients with sterile necrosis and those with infected necrosis. Cut-off values of 81 mg/l for CRP and 13×109/l for WBC were established. The predicted risk for infected necrosis is approx. 1.4% if both tests are below the defined cut-off values. Consequently, we found FNA unnecessary in this subset of patients, unless otherwise indicated, as this invasive procedure per se carries a certain risk of bacterial contamination. Conclusions. Routine clinical tests are helpful in diagnosing the development of infected necrosis. Based on the application of classification functions, the timing and selection of patients for image-guided FNA can be optimized. [ABSTRACT FROM AUTHOR]

Objective . Surgery is the traditional treatment for symptomatic pancreatic pseudocysts and abscesses, but morbidity and mortality are still too high. Minimally invasive approaches have been encouraged. The aim of this study was to evaluate the results of the endoscopic-ultrasound-guided (EUS) endoscopic transmural drainage of these pancreatic collections. Material and methods . In this retrospective review of consecutive cases from a single referral centre, cystogastrostomy and cystoduodenostomy were created with an interventional linear echoendoscope under endosonographic and fluoroscopic control by the endoscopic insertion of straight or double pigtail stents. Results . Fifty-one symptomatic patients (33 men; mean age 58 years) were submitted to 62 procedures from January 2003 to December 2005. EUS-guided drainage was successful in 48 (94%) patients. Only three patients needed surgery. There were two procedure-related complications managed clinically. During a mean follow-up of 39 weeks, recurrence due to migration or obstruction of the stent was 17.7%. All these cases were submitted to a new session of endoscopic drainage. There was no mortality. Complications were more frequent in patients with a recent episode of acute pancreatitis (38.5% versus 10%; p=0.083). The endoscopic approach was not more hazardous for abscesses in regard to complications rate (19% versus 16.6%; p>0.05). In abscesses, a nasocystic drain did not decrease the complications rate (27% versus 13%; p=0.619), but the placement of 2 stents did decrease this rate (18% versus 20%; p>0.05), although increased it in pseudocysts (40% versus 13%; p=0.185). Conclusions . Endoscopic transmural drainage is a minimally invasive, effective and safe approach in the management of pancreatic pseudocysts and abscesses. [ABSTRACT FROM AUTHOR]

This is the first report of a case of biliopancreatic fistula complicating a pancreatic pseudocyst diagnosed correctly by transabdominal ultrasound. The diagnosis was confirmed by magnetic resonance and endoscopic retrograde cholangiopancreatography. The fistula was treated successfully with biliary stenting. The clinical and imaging features of this exceptional complication are presented along with a brief review of the topic. [ABSTRACT FROM AUTHOR]

Objective. Stents have been used to relieve pancreatic duct stricture and upstream dilatation. However, many of these stents are straight-type stents originally manufactured for biliary use. A plastic stent that was developed for use in the pancreatic duct was used in this study and its usefulness investigated. Material and methods. The stent (s-type stent: 10&ThickSpace;Fr in diameter) has two alternate flexions and the shape resembles the tilde mark “&nvsim;” in appearance. After obtaining informed consent, stents were placed in 20 patients with abdominal pain caused by chronic pancreatitis and stricture of the distal main pancreatic duct. The stents were removed according to the clinical manifestations and replaced with new ones if the stricture persisted. Results. In total, 33 stents were placed in 20 patients. Pain relief was attained in 19 patients (95%). The stricture improved after one stenting in 8 patients (40%). Owing to persistent stricture, the stenting was repeated in 11 patients. The 50% stent indwelling period was 369.0 days. No proximal or distal migration of the stent occurred and there were no serious complications. Conclusions. In view of its long durability as a stent and no migration, the s-stent is safe and useful for the management of pancreatic ductal strictures in patients with chronic pancreatitis. [ABSTRACT FROM AUTHOR]

The article presents an analysis of previous research and literature on the clinical and experimental evidence of pancreatitis-associated liver injury (PALI). Focus was also made on the influence of PALI in the development of other extrapancreatic organ dysfunctions, the pattern of liver cell injury and death, the role of cytokines, the function of pancreatitis-associated ascitic fluid, and changes in liver metabolism.

Objective. The aim of this study was to compare long-term recurrence and death rates after a first episode of acute pancreatitis in patients with and without gallstones. Additionally, it was of interest to find out if there were factors predictive of readmission or death. Material and methods. Over a period of 3 years (1995 to 1998), 155 patients admitted with a first attack of acute pancreatitis were included in the study. They followed a specific protocol (ultrasound within 24 h, laboratory tests, Ranson scoring and patients with severe pancreatitis computed tomography scans). In gallstones, pancreatitis, either ERCP or cholecystectomy, was performed at admission or in the case of the latter within 4 weeks. A follow-up was done in January 2002. Results. Forty-one percent of the patients without gallstones were readmitted to hospital during the period of follow-up compared to 10% in the group of patients with gallstones. Using multivariate analysis, no factors were significantly predictive of readmission. Conclusions. We found an identical mortality rate of 15% in the two groups, the only predictive factor being age. [ABSTRACT FROM AUTHOR]

Objective The prevalence and main determinants of exocrine pancreatic insufficiency were investigated in a large population-based sample of older adults by measuring pancreatic elastase-1 in stool. Material and methods The study comprised 914 participants aged 50 to 75 years recruited by their general practitioner during a general health examination. All participants and their physicians were asked to fill out a standardized questionnaire which contained information on socio-demographic and lifestyle factors as well as medical history. Native stool was examined for pancreatic elastase-1 with a commercially available ELISA (ScheBo® Tech, Giessen, Germany). Results Overall, 524 women and 390 men aged 50 to 75 years (mean age 61.9 years) were included in the analysis. In total, 105 (11.5%) of the 914 subjects showed signs of exocrine pancreatic insufficiency (EPI) with =200 µ g elastase-1/g stool, and 47 (5.1%) subjects showed signs of a severe exocrine pancreatic insufficiency (SEPI, <100 µ g elastase-1/g stool). There was a clear increase in EPI with age. Patients taking angiotensin-converting enzyme (ACE) inhibitors had a lower prevalence than subjects without this medication; these associations persisted after adjustment for covariates. Conclusions Prevalence of EPI increases with age and seems to be tentatively higher in men than in women. However, smoking seems to be an independent risk factor for EPI and SEPI whereas ACE-inhibitor intake might be a protective factor. The latter finding may even point to new options in the treatment of chronic pancreatitis. [ABSTRACT FROM AUTHOR]

Background: Although many patients with autoimmune pancreatitis undergo steroid therapy, detailed evaluation of morphological changes in the pancreas and bile duct following therapy has not been performed in this disease. In this study serological and morphological changes occurring during steroid treatment of autoimmune pancreatitis are comparatively examined. Methods: Ten patients with autoimmune pancreatitis were treated with corticosteroids. Morphological findings were: pancreatic enlargement ( n = 9), irregular narrowing of the main pancreatic duct ( n = 10), and biliary stenosis ( n = 9). An initial dose of prednisolone was 40-30 mg/day, and this was tapered by 5 mg every 1-2 weeks. All patients underwent ultrasound and serological testing 1-2 weeks after commencing medication, followed by weekly serological testing and by CT and endoscopic retrograde cholangiopancreatography after1-2 months. Radiological and serological changes were compared. Results: All 10 patients were responsive to steroid therapy. Pancreatic size normalized within 1 month; however, irregularity of the pancreatic duct remained in 6 patients. Rigidity or lateral deformity of the bile duct remained in 3 patients and biliary stenosis persisted in 5. Four patients in whom elevated serum IgG4 failed to normalize also showed incomplete morphological improvement. Three patients with complete improvement of the pancreatic duct stopped medication, but recurrence of pancreatitis did not occur. Conclusions: Although steroid therapy was morphologically and serologically effective in patients with autoimmune pancreatitis, cholangiopancreatographic abnormalities remained in many patients. Morphological improvement on cholangiopancreatography and normalization of serum IgG4 after steroid therapy appeared to be good indicators for discontinuing medication in patients with autoimmune pancreatitis. [ABSTRACT FROM AUTHOR]

Examines the state of insufficiency of exocrine in acute pancreatitis. Pathophysiology of acute pancreatitis; Identification of the most important function of the exocrine pancreas which is the secretion of enzymes and fluid into the gut to digest nutrients; Exocrine pancreatic function during the acute phase of acute pancreatitis.

Background: It is not known whether initial endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) is more cost effective than endoscopic retrograde cholangiopancreatography (ERCP). Methods: A cost-effectiveness analysis of EUS, MRCP and ERCP was performed on 163 patients. The effectiveness of an investigation was defined as the percentage of patients with no need for further evaluation after the investigation in question had been performed. Costs were assumed from the budget-holder's point of view. Results: MRCP, EUS and ERCP had a total accuracy of 0.91, 0.93 and 0.92, respectively. Eighty-four (52%) patients needed endoscopic therapy in combination with ERCP, giving an effectiveness of MRCP, EUS, and ERCP of 0.44, 0.45 and 0.92, respectively. The cost-effectiveness of MRCP, EUS, and ERCP was 6622, 7353 and 4246 Danish Kroner (DKK) per fully investigated and treated patient (1 DKK = 0.14 EUR). Conclusion: Within a patient population with a probability of therapeutic ERCP in 50% of the patients, ERCP was the most cost-effective strategy. [ABSTRACT FROM AUTHOR]

Background: Cytokines are markers of acute pancreatic inflammation and essential for distant organ injury, but they also stimulate pancreatic fibrogenesis and are thus involved in the progression from acute pancreatitis to chronic pancreatic injury and fibrosis. The aim of this study was to evaluate the circulating levels of IL-6, MCP-1, TGF-β1, IGF-1 and IGFBP-3 in patients with alcoholic chronic pancreatitis (CP). Methods: Twelve male patients with severe CP and 11 matched controls ingested 40 g alcohol. Plasma cytokine concentrations were measured for 24 h and assessed by sandwich ELISA techniques. Results: IL-6 was higher in CP at fasting and 1, 4 and 24 h after alcohol intake ( P < 0.04), and a significantly greater rise was found at 1 h compared to pre-stimulatory conditions and controls ( P < 0.01). MCP-1 plasma levels in CP were significantly decreased at 1 h ( P < 0.01) and 4 h ( P < 0.001) compared to pre-stimulatory levels and controls, and a variance analysis showed significantly ( P < 0.001) lower post-stimulatory levels at 1 h and 4 h both in CP and in controls. Alcohol consumption (40 g), however, did not influence plasma levels of TGF-1β, IGF-1 or IGFBP-3 in either of the two groups at the time frame applied. Conclusions: Acute alcohol intake induces a rise in the plasma levels of IL-6 in CP as compared to controls. The low circulating concentrations of MCP-1 1 and 4 h following alcohol consumption might possibly reflect that this mediator acts locally via autocrine mechanisms. [ABSTRACT FROM AUTHOR]

Studies endoscopic management of chronic and non-biliary recurrent pancreatis. Role of endoscopic techniques in affording immediate symptom relief from disease progression; Focus of the therapy to remove ductal obstruction and at accomplishing relief of pancreatic tissue pressures; Overview of endoscopic procedures; Offer of guidance to endoscopic therapy; Data compilation to assess success, complication and outcomes.

Background: To observe outcome in a cohort of patients with severe acute pancreatitis receiving multiple anti-oxidant therapy. Methods: An observational study was carried out in 46 consecutive patients with acute pancreatitis fulfilling current Atlanta consensus criteria for severe disease. All patients received multiple anti-oxidant therapy based on intravenous selenium, N-acetylcysteine and ascorbic acid plus β-carotene and α-tocopherol delivered via nasogastric tube. Principal outcomes were the effect of anti-oxidant supplementation on anti-oxidant levels, morbidity and mortality in patients on anti-oxidant therapy, case-control analysis of observed survival compared to predicted survival derived from logistic organ dysfunction score (LODS), logistic regression analysis of factors influencing outcome and side effect profile of anti-oxidant therapy. Results: Paired baseline and post-supplementation data were available for 25 patients and revealed that anti-oxidant supplementation restored vitamin C ( P = 0.003) and selenium ( P = 0.028) toward normal. In univariate survival analysis, patient survival to discharge was best predicted by admission APACHE-II score with relative risk of death increasing 12.6% for each unit increase (95% CI 6.0% to 19.6%). The mean LODS calculated on admission to hospital was 3.7 (standard error of the mean 4.1) giving a predicted mortality for the cohort of 21%. The observed in-hospital mortality was 43%. Conclusions: Case-control analyses do not appear to demonstrate any benefit from the multiple anti-oxidant combination of selenium, N-acetylcysteine and ascorbic acid in severe acute pancreatitis. [ABSTRACT FROM AUTHOR]

Characterizes cartilage oligomeric matrix protein (COMP) messenger RNA and protein expression in the normal pancreas, chronic pancreatitis (CP) and pancreatic cancer tissues. Preferential expression of COMP in degenerating acinar cells in CP and in CP-like areas in pancreatic cancer, suggesting a potential role of the gene in the course o acinar cell degeneration and dedifferentiation.

Background: Gut hypoperfusion has a major role in the pathogenesis of multiple organ failure, which is the main cause of death in severe acute pancreatitis. The effects of experimental acute pancreatitis on splanchnic and pancreatic perfusion and oxygenation were studied to find out whether gut hypoperfusion occurs already at the same time as changes in pancreatic perfusion. Methods: Twenty-four domestic pigs weighing 21-27 kg were randomized to severe or mild acute pancreatitis or control groups. Eight anaesthetize d and mechanically ventilated pigs were intraductally infused with taurocholic acid to induce severe acute pancreatitis and eight received intraductal saline to induce mild acute pancreatitis. Eight pigs served as controls. Results: Intraductally infused taurocholic acid rapidly induced severe necrotizing acute pancreatitis as assessed macroscopically and histologically. Histological changes of mild acute pancreatitis were seen in animals after intraductal saline infusion. After the induction, pancreatic tissue oxygen tension decreased promptly in severe acute pancreatitis and increased in mild acute pancreatitis. Laser-Doppler red cell flux decreased in severe acute pancreatitis. Gut pH gap and pCO[sub 2] gap decreased in 2 h after the induction of severe acute pancreatitis. Central haemodynamics were fairly stable throughout the study period in all groups. Conclusion: In experimental severe acute pancreatitis, splanchnic malperfusion seems to begin with pancreatic hypoperfusion before disturbances in gut microcirculation. [ABSTRACT FROM AUTHOR]

Background: Activation of the receptor c-met stimulates motility, mitosis, morphogenesis, processes involved in organ regeneration, or progression of malignancies. In the present study we investigated the expression of c-met protein in the regenerating pancreas and characterized the influence of cytokines on c-met expression. Methods: Acute pancreatitis was induced in rats by cerulein injection. Rat acini and rat and human pancreatic cancer cells were stimulated with interleukin-1α (IL-1α), IL-6, tumor necrosis factor-α (TNF-α) or transforming growth factor-β1 (TGF-β1). C-met expression was analyzed by means of Western blotting and localization in pancreatic tissue by immunohistochemistry. Results: C-met protein expression was significantly upregulated in the regenerating pancreas and localized in areas of regenerating tissue. Stimulation with cytokines resulted in a two- to threefold increase of c-met expression in vitro. Conclusion: Enhanced c-met expression after acute pancreatitis suggests that HGF/met has an important role in pancreatic regeneration, which is probably mediated by cytokines. This regulatory mechanism is also of importance in pancreatic cancer. [ABSTRACT FROM AUTHOR]

Examines the influence of pancreatic diseases on splenic-vein thrombosis (SVT). Medical complications of SVT; Etiology of SVT; Role of splenectomy on patient with asymptomatic SVT; Association of bleeding gastric varices clinical syndrome with SVT.

The article presents views and insights of the author concerning the compliance with guidelines for the management of acute pancreatitis. Guidelines in acute pancreatitis have been produced by national societies, by international societies, and simply by groups of interested pancreatologists. According to the author, guidelines should be commissioned by existing societies and be based on as high a level of evidence as possible, with grade of recommendation stated clearly.

An unusual pancreatobiliary fistula occurred as a complication of chronic pancreatitis. Endoscopic papillotomy was performed and a plastic endoprosthesis was inserted into the main pancreatic duct. The pancreatic stenting led to the closure of the fistula and no additional surgical treatment was necessary. [ABSTRACT FROM AUTHOR]

The article focuses on a study regarding gastrointestinal motility in acute pancreatitis. It mentions that the study reveals the high prevalence of dysmotility-related symptoms in patients with acute pancreatitis with the help of Gastroparesis Cardinal Symptom Index (GCSI). It also mentions that gastrointestinal symptoms are limited and similar in character in acute or chronic states of dysmotility.

A letter to the editor is presented in response to the article "Multidisciplinary management of pancreatic neuroendocrine tumors - the importance of an aggressive surgical approach" by K. Oberg in the previous issue.

A correction to the article "Murugaian et al., Novel mutations in calcium sensing receptor gene in tropical chronic pancreatitis in India" is presented.

A letter to the editor is presented in response to the article "Benign pancreatic hyperenzymemia: a pediatric experience," published in a previous issue.