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Some patients with chronic pancreatitis experience pancreatic duct obstruction caused by stones, which may contribute to chronic abdominal pain. Although relieving this obstruction through a procedure known as extracorporeal shock-wave lithotripsy could potentially alleviate the pain, there is no high-quality evidence demonstrating the benefit of such intervention. The objective of this randomized, sham-controlled trial was to assess the efficacy and safety of pancreatic duct decompression through lithotripsy and endoscopic retrograde pancreatography. Visual Abstract. Extracorporeal Shock-Wave Lithotripsy and Endoscopy for the Treatment of Pain in Chronic Pancreatitis: Some patients with chronic pancreatitis experience pancreatic duct obstruction caused by stones, which may contribute to chronic abdominal pain. Although relieving this obstruction through a procedure known as extracorporeal shock-wave lithotripsy could potentially alleviate the pain, there is no high-quality evidence demonstrating the benefit of such intervention. The objective of this randomized, sham-controlled trial was to assess the efficacy and safety of pancreatic duct decompression through lithotripsy and endoscopic retrograde pancreatography. Background: No randomized controlled trials have substantiated endoscopic decompression of the pancreatic duct in patients with painful chronic pancreatitis. Objective: To investigate the pain-relieving effect of pancreatic duct decompression in patients with chronic pancreatitis and intraductal stones. Design: 24-week, parallel-group, randomized controlled trial (ClinicalTrials.gov: NCT03966781) Setting: Asian Institute of Gastroenterology in India from February 2021 to July 2022. Participants: 106 patients with chronic pancreatitis. Intervention: Combined extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde pancreatography (ERP) compared with sham procedures. Measurements: The primary end point was pain relief on a 0- to 10-point visual analog scale (VAS) at 12 weeks. Secondary outcomes were assessed after 12 and 24 weeks and included 30% pain relief, opioid use, pain-free days, questionaries, and complications to interventions. Results: 52 patients in the ESWL/ERP group and 54 in the sham group were included. At 12 weeks, the ESWL/ERP group showed better pain relief compared with the sham group (mean difference in change, −0.7 [95% CI, −1.3 to 0] on the VAS; P  = 0.039). The difference between groups was not sustained at the 24-week follow-up, and no differences were seen for 30% pain relief at 12- or 24-week follow-up. The number of pain-free days was increased (median difference, 16.2 days [CI, 3.9 to 28.5 days]), and the number of days using opioids was reduced (median difference, −5.4 days [CI, −9.9 to −0.9 days]) in the ESWL/ERP group compared with the sham group at 12-week follow-up. Safety outcomes were similar between groups. Limitation: Single-center study and limited duration of follow-up. Conclusion: In patients with chronic pancreatitis and intraductal stones, ESWL with ERP provided modest short-term pain relief. Primary Funding Source: Asian Institute of Gastroenterology and Aalborg University Hospital. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic Fluid Collections (PFCs) are accumulations of pancreatic fluid or debris contained within a granulation tissue wall. Unlike true cysts, they arise as complications of various conditions like acute pancreatitis, abdominal trauma, pancreatic surgery, or chronic pancreatic duct obstruction. While smaller PFCs (under 4 cm) often resolve on their own without intervention, larger collections exceeding 6 cm or those causing symptoms like infection or bile duct obstruction have significantly lower rates of spontaneous resolution. In such cases, drainage intervention is typically recommended. Aim: To assess the treatment effectiveness of Percutaneous Catheter Drainage (PCD) for PFCs using ultrasound guidance. Materials and Methods: A prospective interventional study was conducted in the Department of Radiodiagnosis, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India, from September 2021 to August 2022. The study focused on patients (N=73) with PFC as a complication of acute pancreatitis necessitating ultrasound-guided PCD. The study outcomes were clinical effectiveness, reinterventions, and mortality rates. Additionally, authors investigated the impact of various drainage factors, such as indication, PFC type, location relative to the pancreas, PFC size, Modified Computed Tomography (CT) Severity Index (CTSI), duration between symptom onset and PCD initiation, total catheter dwell time, and duration between symptom onset and reintervention. Statistical analyses employed International Business Machine (IBM) Statistical Packages for Social Sciences (SPSS) Statistics. Descriptive statistics and independent samples t-test for continuous variables; Chi-square test for categorical data (p<0.05). Results: In present study, the mean age of the subjects was 47 years. PCD in terms of clinical success was 63% (n=46) and clinical failure was 37% (n=27). Open necrosectomy was performed on 15 patients (20.5%) and open cystogastrostomy was performed on 11 patients (15.1%). Conclusion: The utilisation of ultrasound-guided PCD for PFCs represents a technique associated with relatively low morbidity and mortality rates. This approach can serve as either definitive treatment or a transitional measure before resorting to open surgery. [ABSTRACT FROM AUTHOR]

A major shift in the approach to the management of pancreatic ductal adenocarcinomas (PDACs) has been the recognition of the systemic nature of the disease even in clinically and radiologically limited disease stages. The recalcitrant nature of PDAC is intrinsically related to the lack of therapeutic targets and dense surrounding stroma that limits the activity of currently available chemotherapeutic options. However, research is increasingly focusing on intensifying systemic management options in PDAC, resulting in gradual improvements in survival. Currently effective chemotherapeutic regimens like modified 5-fluorouracil-leucovorin-irinotecan-oxaliplatin and gemcitabine-nab-paclitaxel have improved outcomes in resectable and advanced PDAC. An increasing use of these regimens has also resulted in greater conversion of borderline resectable and locally advanced cancers to resection, though the most effective approach in this subgroup is yet to be identified. The current review presents an outline of the basic systemic nature of PDAC and current options of systemic therapy, predominantly chemotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic Ductal Disruption (PDD) may remain a localised collection to form pseudocyst or dissect into adjacent organs or rupture freely into the peritoneal cavity or pleural cavity resulting in massive or high-volume ascites or pleural effusions. The management of pseudocyst is well known among general and gastrosurgeons, but ascites and plural effusion remain difficult decisions. Depending on the availability of resources total parenteral nutrition, octreotide, pancreatic duct stenting are used with varying success. There are no guidelines as to which intervention is preferable in different clinical scenarios. Aim: To audit the clinical characters and management of patients with pancreatic ascites and pleural effusion. Materials and Methods: This study was done at the Department of Surgical Gastroenterology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India. Fifty two patients with pancreatic ascites or pancreatico pleural fistula in the background of chronic pancreatitis satisfying both inclusion and exclusion criteria were identified and studied from the prospectively maintained database of patients with chronic pancreatitis in the period from September 2010 to September 2020. The patients were classified as conservatively managed, endoscopic main pancreatic duct stenting or surgery. Statistical analysis was done using windows excel. The results were expressed as percentage, mean and Standard Deviation (SD). Results: Five patients with ascites and two patients with pleural effusion responded completely to conservative measures (13.4%). In one of them ascites recurred at two months and one had left pleural effusion recurrence at one month. Fifteen patients died while on conservative management (68.2% mortality). Among eight patients undergoing endoscopic pancreatic duct stenting, ascites/pleural effusion resolved in six (75% success rate) and remained asymptomatic during mean follow-up of 12 months. Two patients who were not improving after stenting were lost to follow-up. Twenty-two patients underwent surgery namely lateral pancreatojejunostomy with resolution of symptoms. Two patients undergoing surgery died in postoperative period due to sepsis and chest infection (9% mortality). At a mean follow-up of 14 months they remained symptom free. Conclusion: Conservative management alone has high mortality. Early aggressive management can aim to stop leak either by pancreatic duct stenting or surgical lateral pancreatojejunostomy will help reduce mortality and morbidity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate spectrum, efficacy and safety of Endoscopic retrograde cholangiopancreatography (ERCP) in pediatric population. Methods: Retrospective case record review of pediatric patients (age ≤15 y) undergoing ERCP between January 2011 to June 2015 at a tertiary care referral hospital in New Delhi, India. The Indications for ERCP, cannulation success rate, procedure success rate and complications were recorded. Results: The mean (SD) age of the participants were 11.5 (3) years. 164 ERCP procedures were done in 126 patients (67 males). All procedures were done under conscious sedation. The common indications for ERCP were choledocholithiasis (50, 30.5%), chronic calcific pancreatitis (38,23.2%), main pancreatic duct injury with leak (21,12.8%), and bile leak (12,7.3%). The cannulation success rate was 90.4% (114 out of 126), while procedural success rate was 86% (141 out of 164). Overall 8 complications were encountered; all were successfully managed conservatively. Conclusions: ERCP in children can be successfully performed at centers with such expertise. [ABSTRACT FROM AUTHOR]

Hepatopancreatic parvovirus (HPV) infects Penaeus monodon and causes mortality in the larval stages. Further, it has been implicated in the growth retardation in cultured P. monodon . Though different geographical isolates of HPV show large sequence variations, a sensitive PCR assay specific to Indian isolate has not yet been reported. Here, we developed a sensitive SYBR Green-based and TaqMan real-time PCR for the detection and quantification of the virus. A 441-bp PCR amplicon was cloned in pTZ57 R/T vector and the plasmid copy number was estimated. A 10-fold serial dilution of the plasmid DNA from 1 × 10 9 copies to 1 copy was prepared and used as the standard. The primers were tested initially using the standard on a conventional PCR format to determine the linearity of detection. The standards were further tested on real-time PCR format using SYBR Green and TaqMan chemistry and standard curves were generated based on the Ct values from three well replicates for each dilution. The assays were found to be sensitive, specific and reproducible with a wide dynamic range (1 × 10 9 to 10 copies) with coefficient of regression ( R 2 ) > 0.99, calculated average slope −3.196 for SYBR Green assay whereas, for TaqMan assay it was >0.99 and −3.367, respectively. The intra- and inter-assay variance of the Ct values ranged from 0.26% to 0.94% and 0.12% to 0.81%, respectively, for SYBR Green assay, and the inter-assay variance of the Ct values for TaqMan assay ranged from 0.07% to 1.93%. The specificity of the assays was proved by testing other DNA viruses of shrimp such as WSSV, IHHNV and MBV. Standardized assays were further tested to detect and quantify HPV in the post-larvae of P. monodon . The result was further compared with conventional PCR to test the reproducibility of the test. The assay was also used to screen Litopeneaus vannamei , Macrobrachium rosenbergii and Scylla serrata for HPV. [ABSTRACT FROM AUTHOR]

Aim: To assess the effectiveness of longitudinal pancreatico-gastrostomy (LPG) in relieving intractable abdominal pain in patients of chronic pancreatitis (CP) with dilated main pancreatic duct (MPD). Materials and Methods: This prospective study was conducted from 1997-2005 at two university-affiliated hospitals in India. Ductal decompression by LPG was performed in 30 patients (26 males, 4 females) suffering from intractable pain due to CP. The operative outcomes were classified as satisfactory and unsatisfactory according to whether the patients were completely / almost completely relieved of pain or continued to be troubled by pain. Main outcome measures: The main outcome measures were pain-relief, postoperative morbidity, and mortality. Results: There was no postoperative mortality. Morbidity included pancreatic fistula in one patient, which closed spontaneously, gastric hemorrhage in two, prolonged ileus in one and wound infection in another. Twenty eight patients (93%) patients could be followed up till the end, the mean follow-up period being 23.8 (range 3-96) months. Operative result was satisfactory (no pain or mild pain) in 23 (82%) and unsatisfactory (moderate to severe pain) in 5 (18%) patients. Complete pain relief was seen in 14 (50%) patients. The functional results, in terms of pain relief, were better in patients who had abstained from alcohol postoperatively. Conclusion: LPG is a good operative procedure to relieve intractable pain in patients of CP with an MPD diameter of at least 7 mm. [ABSTRACT FROM AUTHOR]

Intestinal infestation of humans by Ascaris lumbricoides is endemic in India. The usual habitat of the adult worm is the jejunum. Hepatopancreatic ascariasis (HPA) is designated to a rare group of diseases caused by lodgement of adult worms in the bile or pancreatic ducts. This short report illustrates four rare cases of patients with HPA. [ABSTRACT FROM AUTHOR]

Background: Pain is the primary symptom of chronic pancreatitis (CP) and remains a considerable therapeutic challenge. In patients with obstruction of the pancreatic duct, including stones and strictures, endoscopic treatment with or without preceding extracorporeal shock wave lithotripsy (ESWL) has been used for pancreatic duct decompression. The rationale for these procedures is based on the assumption that obstruction of the pancreatic duct leads to ductal hypertension and pain. However, clinical pain symptoms correlate poorly with pancreatic duct morphology, and the evidence for pancreatic duct decompression as an effective treatment for pain is based on case series and comparison between different procedures. No randomized, prospective, sham-controlled trials are currently available. The SCHOKE (Extracorporeal Shock Wave Lithotripsy and Endotherapy for Pain in Chronic Pancreatitis) trial is a randomized, sham-controlled trial designed to determine if pancreatic duct decompression is an effective treatment for pain in patients with CP.Methods: The SCHOKE trial is a randomized, single-blind, parallel-group, sham-controlled trial designed to evaluate the effect of combined ESWL and endoscopic treatment for pain in patients with CP. In total, 106 adult patients with painful CP and pancreatic duct obstruction will be randomized to combined ESWL and subsequent endoscopic treatment or corresponding sham procedures. The primary outcome is pain relief during the 3-month postrandomization period as documented in a pain diary. Secondary outcomes include quality of life and functional scores, patient global impression of change, change in use of analgesics, frequency of hospitalization, and complications. Standard follow-up is at 3 and 6 months after randomization. In an experimental substudy, quantitative sensory testing obtained before and after intervention will be used to obtain information on central pain processing and to develop models for prediction of treatment outcome.Discussion: The SCHOKE trial investigates if pancreatic duct decompression, obtained by combined ESWL and endoscopic treatment, is effective for pain treatment in patients with CP.Trial Registration: ClinicalTrials.gov, NCT03966781. Registered on May 25, 2019. Protocol date and version identifier: March 1, 2020; version 3.0.Sponsor: Rupjyoti Talukdar, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India. [ABSTRACT FROM AUTHOR]