Pancreatology最新文献

英文中文

Role of bioimpedance spectroscopy analysis to assess hydration status in the early phase of acute pancreatitis 生物阻抗谱分析在评估急性胰腺炎早期水合状态中的作用。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-02-01 DOI: 10.1016/j.pan.2025.12.003

Morten Laksáfoss Lauritsen , Mikkel Parsberg Werge , Mirjana Cihoric , Henrik Løvendahl Jørgensen , Nicolai Bang Foss , John Gásdal Karstensen , Amer Hadi , Lise Lotte Gluud , Srdan Novovic

引用次数: 0

Analgesic phenotypes in acute pancreatitis: Clustering analysis of two prospective global cohort studies 急性胰腺炎镇痛表型：两项前瞻性全球队列研究的聚类分析。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-02-01 DOI: 10.1016/j.pan.2025.12.013

Chris Varghese , Cecilie Siggaard Knoph , Nejo Joseph , Stacey Culp , Enrique de-Madaria , John A. Windsor , Asbjørn Mohr Drewes , Georgios I. Papachristou , Sanjay Pandanaboyana , the PAINAP Collaborative and APPRENTICE Study Groups

Introduction

Pain management in acute pancreatitis (AP) is of critical therapeutic and prognostic significance. We aimed to identify patient phenotypes in AP based on pain management strategies and evaluate their prognostic impact.

Methods

Data from two major international prospective cohort studies of AP patients (PAINAP study, n = 2119 and APPRENTICE study, n = 1544) from 141 centers worldwide were collated. Demographic data and analgesic use (within 72 h of presentation) were used for latent class analysis of binary analgesic data. The number of clusters was determined by minimisation of Bayesian information criterion. Cluster assignment and AP outcomes were interrogated with multivariable mixed-effects logistic regression.

Results

Overall, 3469 patients (median age 52; 47 % female) were analysed. There were 1015 (29.2 %) patients that had moderately severe to severe AP. Within the first 72 h, 494 (14.2 %) patients received non-steroidal anti-inflammatory drugs (NSAIDs), 1410 (40.6 %) weak opioids, 1347 (14.2 %) strong opioids, and 48 (1.4 %) epidural analgesia. There were significant variations in analgesic prescribing patterns across centers (p < 0.001, interclass correlation coefficient 43.8 %). Latent class analysis identified 5 unique patient clusters: early NSAIDs use, minimal analgesic use, strong opioid use, early multimodal analgesia use, and early weak opioid use. The cluster characterized by early NSAIDs was associated with non-severe AP (adjusted odds ratio 0.64, 95 % confidence interval 0.44–0.93, p = 0.02), which could suggest that the use of NSAIDs was perhaps driven by milder pain severity.

Conclusion

Unique clusters in the management of pain in AP were identified, with associations to severity of AP. Substantial centre-level variations exist in the patterns of analgesic prescribing globally, contributing to variations in outcomes.

急性胰腺炎（AP）的疼痛管理具有重要的治疗和预后意义。我们旨在根据疼痛管理策略确定AP患者的表型，并评估其对预后的影响。方法：对来自全球141个中心的两项主要的AP患者国际前瞻性队列研究（PAINAP研究，n = 2119和APPRENTICE研究，n = 1544）的数据进行整理。人口统计学数据和镇痛药使用情况（就诊后72小时内）用于二元镇痛药数据的潜在分类分析。通过贝叶斯信息准则的最小化来确定聚类的数量。聚类分配和AP结果通过多变量混合效应逻辑回归进行询问。结果：总共分析了3469例患者（中位年龄52岁，47%为女性）。1015例（29.2%）患者有中重度到重度AP。在最初72小时内，494例（14.2%）患者使用非甾体类抗炎药（NSAIDs）， 1410例（40.6%）使用弱阿片类药物，1347例（14.2%）使用强阿片类药物，48例（1.4%）使用硬膜外镇痛。各中心镇痛药处方模式差异显著（p < 0.001，类间相关系数43.8%）。潜在分类分析确定了5个独特的患者群：早期使用非甾体抗炎药、少量使用镇痛药、强烈使用阿片类药物、早期使用多模式镇痛药和早期使用弱阿片类药物。以早期非甾体抗炎药为特征的组群与非严重AP相关（调整优势比0.64,95%可信区间0.44-0.93,p = 0.02），这可能表明非甾体抗炎药的使用可能是由较轻的疼痛严重程度驱动的。结论：确定了AP疼痛管理的独特集群，与AP的严重程度有关。全球镇痛处方模式存在实质性的中心水平差异，导致了结果的变化。

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引用次数: 0

Elevated circulating glycine levels are associated with reduced pancreatic cancer risk: A prospective cohort study based on the UK biobank 循环甘氨酸水平升高与胰腺癌风险降低相关：一项基于英国生物银行的前瞻性队列研究。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-02-01 DOI: 10.1016/j.pan.2025.12.015

Shuai Xiang , Yunlong Li , Yuxin Wang , Hongxu Nie , Chengfeng Wang , Xu Che , Yongxing Du

Background

Identifying biomarkers associated with pancreatic cancer (PC) development could facilitate early intervention and improve outcomes.

Methods

This study enrolled 206,363 participants, with 854 incident cases of PC were identified during follow-up. 168 metabolic biomarkers were measured by nuclear magnetic resonance spectroscopy, and the polygenic risk score (PRS) for PC constructed by 44 single nucleotide polymorphisms was calculated. Multivariate Cox regression analysis and multiple hypothesis testing were employed to evaluate the association between metabolites and PC risk. Stratified analyses and interaction tests were conducted to explore the effects of metabolites under different genetic backgrounds and lifestyle factors.

Results

After correction for multiple hypothesis testing, only plasma glycine levels showed a significant inverse correlation with PC risk (FDR-corrected P-value <0.05). High glycine levels were associated with a 21.4 % reduction in PC risk compared to low levels (HR: 0.786, 95 % CI: 0.657–0.940). PRS was positively associated with PC risk, with high PRS participants showing a 2.871-fold increased risk (95 % CI: 2.382–3.460). Glycine's protective effects were more pronounced in low PRS participants and never smokers. High glycine and low PRS participants demonstrated a 72.3 % reduction in PC risk compared to low glycine and high PRS participants (HR: 0.277, 95 % CI: 0.197–0.389). Notably, even among participants with the highest PRS, baseline plasma glycine levels were still significantly inversely associated with future PC risk.

Conclusion

Higher circulating glycine levels are associated with a reduced risk of PC, even in individuals with the highest genetic susceptibility. These findings suggest that higher circulating glycine levels may hold potential for PC prevention strategies, warranting further experimental validation of glycine supplementation in prospective trials.

背景：识别与胰腺癌（PC）发展相关的生物标志物可以促进早期干预和改善预后。方法：本研究纳入206,363名参与者，在随访期间发现854例PC事件。采用核磁共振波谱法测定168个代谢生物标志物，计算44个单核苷酸多态性构建的PC多基因风险评分（PRS）。采用多变量Cox回归分析和多假设检验来评估代谢物与PC风险的关系。通过分层分析和相互作用试验探讨不同遗传背景和生活方式因素对代谢物的影响。结果：经过多重假设检验校正后，只有血浆甘氨酸水平与PC风险呈显著负相关（fdr校正的p值）。结论：较高的循环甘氨酸水平与PC风险降低相关，即使在遗传易感性最高的个体中也是如此。这些发现表明，较高的循环甘氨酸水平可能具有预防PC策略的潜力，需要在前瞻性试验中进一步实验验证补充甘氨酸。

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引用次数: 0

Response to the Letter to Editor: Strengths and methodological considerations for predicting post-pancreatectomy acute pancreatitis 给编辑的回复：预测胰腺切除术后急性胰腺炎的优势和方法学考虑。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-02-01 DOI: 10.1016/j.pan.2025.12.022

Haoda Chen, Baiyong Shen

引用次数: 0

Genomic characterization and prognosis of pancreatic adenosquamous carcinoma 胰腺腺鳞癌的基因组特征和预后。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-02-01 DOI: 10.1016/j.pan.2025.12.018

Yingying Huang , Xiaoyan Chang , Jun Du , Shuai Zhang , Sha Wang , Xiang Wang , Chunmei Bai

Pancreatic adenosquamous carcinoma (PASC) is a highly rare and aggressive disease with poor prognosis. The median overall survival is less than one year. Aiming to identify the genomic characterization of the PASC, we conducted a retrospective analysis of the clinical characteristics and genomic alterations in 14 patients with PASC who underwent surgery at Beijing Hospital and Peking Union Medical College Hospital from 2010 to 2021. Genomic alterations were identified using targeted panel sequencing. We developed a PASC-specific signature to aid in the prognostic stratification of these patients. Our study revealed several genetic alterations potentially contributing to the development and progression of PASC, including TP53 mutations, MYC amplification, and CDKN2A deletion. Pathway enrichment analysis indicated that STK11 mutations, high tumor mutational burden (TMB-H), APC deletion, TERT/RICTOR amplification, and chromosomal instability (CIN-H) were significantly associated with altered pathways. Additionally, we confirmed the prognostic value of our PASC-specific signature through validation in an independent cohort of pancreatic ductal adenocarcinoma patients.

摘要胰腺腺鳞癌（PASC）是一种罕见且侵袭性疾病，预后较差。中位总生存期不到一年。为了确定PASC的基因组特征，我们对2010年至2021年在北京医院和北京协和医院接受手术的14例PASC患者的临床特征和基因组改变进行了回顾性分析。使用靶向小组测序确定基因组改变。我们开发了pasc特异性标记来帮助这些患者的预后分层。我们的研究揭示了几种可能促进PASC发生和进展的遗传改变，包括TP53突变、MYC扩增和CDKN2A缺失。通路富集分析表明，STK11突变、高肿瘤突变负荷（TMB-H）、APC缺失、TERT/RICTOR扩增和染色体不稳定性（CIN-H）与通路改变显著相关。此外，我们通过独立的胰腺导管腺癌患者队列验证，证实了pasc特异性标记的预后价值。

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引用次数: 0

Comparison of clinical features and pancreatic cancer risk between genetic mutations associated versus alcohol associated chronic pancreatitis 与酒精相关的慢性胰腺炎相关基因突变的临床特征和胰腺癌风险比较

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-02-01 DOI: 10.1016/j.pan.2025.10.011

Yoonchan Lee, Tae Jun Song, Sung Hyun Cho, Gunn Huh, Dongwook Oh, Dong-Wan Seo

Background/objectives

Genetic mutations associated chronic pancreatitis (GCP), caused by pathogenic variants in SPINK1, PRSS1, or CFTR, represents a distinct subset of chronic pancreatitis, whereas alcoholic chronic pancreatitis (ACP) is the predominant adult etiology. We compared the clinical course and pancreatic cancer risk between GCP and ACP.

Methods

This retrospective cohort included GCP patients from a prospective registry with genetic testing (2009–2023) and ACP patients from a clinical database (1989–2023). Propensity score matching (1:3) balanced age, sex, BMI, smoking, diabetes, and Cambridge grade, yielding 139 GCP and 309 ACP patients. Outcomes were assessed using Kaplan–Meier and Cox regression, and cancer incidence was calculated per person-years with Poisson regression.

Results

In the matched GCP cohort, mutation distribution was SPINK1 67.6 % (94/139), PRSS1 15.8 % (22/139), and CFTR 11.5 % (16/139). Compared with ACP, GCP patients had more frequent pancreatic pain (89.2 % vs 77.3 %, p = 0.005) and a younger mean age at onset (26.5 vs 40.6 years, p < 0.001). New-onset diabetes was more common (35.3 % vs 21.7 %, p = 0.004) but developed later (22.5 vs 12.7 years, p < 0.001). Pancreatic atrophy occurred less often and later in GCP. Pancreatic cancer incidence was higher in GCP (4.24 vs 0.40 per 1000 person-years; IRR 10.61, p = 0.031), with all cancers arising within 5 years of diagnosis, predominantly in SPINK1 gene mutation carriers.

Conclusions

GCP shows distinct trajectories and an elevated early pancreatic cancer risk, particularly in SPINK1 gene mutation carriers, supporting genotype-stratified surveillance.

背景/目的：基因突变相关的慢性胰腺炎（GCP），由SPINK1、PRSS1或CFTR的致病变异引起，代表了慢性胰腺炎的一个独特的亚群，而酒精性慢性胰腺炎（ACP）是主要的成人病因。我们比较GCP和ACP的临床病程和胰腺癌风险。方法：该回顾性队列包括前瞻性基因检测登记的GCP患者（2009-2023）和临床数据库中的ACP患者（1989-2023）。倾向评分匹配（1:3）平衡了年龄、性别、BMI、吸烟、糖尿病和剑桥分级，得到139例GCP和309例ACP患者。使用Kaplan-Meier和Cox回归评估结果，使用泊松回归计算每个人年的癌症发病率。结果：在匹配的GCP队列中，突变分布为SPINK1 67.6% (94/139), PRSS1 15.8% (22/139), CFTR 11.5%（16/139）。与ACP相比，GCP患者胰腺疼痛更频繁（89.2% vs 77.3%, p = 0.005），平均发病年龄更年轻（26.5 vs 40.6岁，p < 0.001）。新发糖尿病更为常见（35.3%对21.7%,p = 0.004），但发病较晚（22.5年对12.7年，p < 0.001）。GCP患者胰腺萎缩发生率较低且较晚。GCP患者的胰腺癌发病率更高（4.24 vs 0.40 / 1000人-年；IRR 10.61, p = 0.031），所有癌症均在5年内发生，主要发生在SPINK1基因突变携带者中。结论：GCP表现出明显的轨迹和早期胰腺癌风险升高，特别是在SPINK1基因突变携带者中，支持基因型分层监测。

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引用次数: 0

Correlation between immune biomarkers and surrogate markers of severity of Acute Pancreatitis in an HIV endemic region HIV流行地区急性胰腺炎严重程度的免疫生物标志物和替代标志物的相关性

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-02-01 DOI: 10.1016/j.pan.2025.11.014

F. Madela , K. Chiliza , X. Mfeka , K. Gopee , M. Marin , M. Kongstad , S. Ostrowski , M. Ghanizada , H. Kløverpris , S. Thomson , C. Aldous

Background

Acute pancreatitis (AP) varies in severity, and traditional severity stratifications often fail to predict its early course. In people living with HIV (PLWH), chronic immune dysregulation leads to aberrant cytokine responses which influence biomarker performance. We hypothesize that in regions with high prevalence of HIV infection, HIV status will influence the immune biomarker performance in the prediction of severity of AP.

Methodology

In this prospective case-control study conducted in KwaZulu-Natal, 144 adult patients with AP (29 % PLWH) were enrolled. Blood samples were collected within 24 h of admission, and plasma was isolated and cryopreserved before cytokine levels were quantified using a multiplex electrochemiluminescence assay. Clinical severity was assessed using revised Atlanta classification. Receiver operating characteristic analyses were performed to derive optimal biomarker thresholds based on Youden's index, with significance set at p < 0.01.

Results

In people without HIV, IL-6, TNF-α, IL-15, IL-17, and MCP-1 were significantly upregulated in severe AP, with IL-15 demonstrating the highest discriminative performance (AUC 0.917; optimal cut-off 3.79 pg/mL; sensitivity 94.1 %, specificity 72.9 %). In PLWH patients, TNF-α was the only cytokine significantly associated with AP severity (AUC 0.974; optimal cut-off 9.42 pg/mL; sensitivity 100 %, specificity 97.4 %), while IL-17 did not predict severity in PLWH. Across the combined cohort, cytokine thresholds were higher in PLWH.

Conclusion

Distinct immune signatures correlate with AP severity and are significantly influenced by HIV status. IL-15 outperformed IL-6, TNF-α, IL-17, and MCP-1 in people without HIV, whereas TNF-α was the only predictor of severity in PLWH. Higher thresholds for prediction of severity in PLWH underscore the need for HIV-specific biomarker thresholds and further research into tailored severity stratification, and development of immunomodulating therapies in AP.

背景：急性胰腺炎（AP）的严重程度不同，传统的严重程度分层往往不能预测其早期病程。在HIV感染者（PLWH）中，慢性免疫失调导致异常的细胞因子反应，从而影响生物标志物的表现。我们假设在HIV感染率高的地区，HIV感染状况会影响预测AP严重程度的免疫生物标志物的表现。方法：在夸祖鲁-纳塔尔省进行的这项前瞻性病例对照研究中，纳入了144名成年AP患者（29% PLWH）。入院24小时内采集血样，分离血浆并冷冻保存，然后用多重电化学发光法测定细胞因子水平。临床严重程度评估采用修订的亚特兰大分级。根据约登指数（Youden's index）进行受试者工作特征分析，得出最佳生物标志物阈值，显著性设置为p < 0.01。结果：在未感染HIV的人群中，IL-6、TNF-α、IL-15、IL-17和MCP-1在严重AP中显著上调，其中IL-15表现出最高的鉴别性能（AUC 0.917；最佳临界值3.79 pg/mL；敏感性94.1%，特异性72.9%）。在PLWH患者中，TNF-α是唯一与AP严重程度显著相关的细胞因子（AUC 0.974；最佳临界值9.42 pg/mL；敏感性100%，特异性97.4%），而IL-17不能预测PLWH的严重程度。在合并队列中，PLWH患者的细胞因子阈值更高。结论：不同的免疫特征与AP严重程度相关，并受HIV状态的显著影响。在没有HIV的人群中，IL-15的表现优于IL-6、TNF-α、IL-17和MCP-1，而TNF-α是PLWH严重程度的唯一预测因子。预测PLWH严重程度的更高阈值强调了对hiv特异性生物标志物阈值的需求，并进一步研究针对性的严重程度分层，以及开发AP免疫调节疗法。

{"title":"Correlation between immune biomarkers and surrogate markers of severity of Acute Pancreatitis in an HIV endemic region","authors":"F. Madela , K. Chiliza , X. Mfeka , K. Gopee , M. Marin , M. Kongstad , S. Ostrowski , M. Ghanizada , H. Kløverpris , S. Thomson , C. Aldous","doi":"10.1016/j.pan.2025.11.014","DOIUrl":"10.1016/j.pan.2025.11.014","url":null,"abstract":"<div><h3>Background</h3><div>Acute pancreatitis (AP) varies in severity, and traditional severity stratifications often fail to predict its early course. In people living with HIV (PLWH), chronic immune dysregulation leads to aberrant cytokine responses which influence biomarker performance. We hypothesize that in regions with high prevalence of HIV infection, HIV status will influence the immune biomarker performance in the prediction of severity of AP.</div></div><div><h3>Methodology</h3><div>In this prospective case-control study conducted in KwaZulu-Natal, 144 adult patients with AP (29 % PLWH) were enrolled. Blood samples were collected within 24 h of admission, and plasma was isolated and cryopreserved before cytokine levels were quantified using a multiplex electrochemiluminescence assay. Clinical severity was assessed using revised Atlanta classification. Receiver operating characteristic analyses were performed to derive optimal biomarker thresholds based on Youden's index, with significance set at p < 0.01.</div></div><div><h3>Results</h3><div>In people without HIV, IL-6, TNF-α, IL-15, IL-17, and MCP-1 were significantly upregulated in severe AP, with IL-15 demonstrating the highest discriminative performance (AUC 0.917; optimal cut-off 3.79 pg/mL; sensitivity 94.1 %, specificity 72.9 %). In PLWH patients, TNF-α was the only cytokine significantly associated with AP severity (AUC 0.974; optimal cut-off 9.42 pg/mL; sensitivity 100 %, specificity 97.4 %), while IL-17 did not predict severity in PLWH. Across the combined cohort, cytokine thresholds were higher in PLWH.</div></div><div><h3>Conclusion</h3><div>Distinct immune signatures correlate with AP severity and are significantly influenced by HIV status. IL-15 outperformed IL-6, TNF-α, IL-17, and MCP-1 in people without HIV, whereas TNF-α was the only predictor of severity in PLWH. Higher thresholds for prediction of severity in PLWH underscore the need for HIV-specific biomarker thresholds and further research into tailored severity stratification, and development of immunomodulating therapies in AP.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"26 1","pages":"Pages 34-39"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145637325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acute pancreatitis in relation to SARS-CoV-2 vaccination and infection: A nationwide cohort study in Sweden. 急性胰腺炎与SARS-CoV-2疫苗接种和感染的关系：瑞典的一项全国性队列研究

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-01-31 DOI: 10.1016/j.pan.2026.01.077

Karin Hedenmalm, Nicklas Pihlström, Per Lindemo, Mats Lindblad, Viktor Oskarsson, Omid Sadr-Azodi, Rickard Ljung

引用次数: 0

Spontaneous cysto-biliary communication in walled-off necrosis of the pancreas. 胰腺壁闭塞性坏死中自发的胆囊-胆道交通。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-01-26 DOI: 10.1016/j.pan.2026.01.075

Venkatesh Vaithiyam, Amit Bagrodia, Keval Vora, Nikhil Sirohi, Shrey Bhatt, Ujjwal Sonika, Ashok Dalal, Ajay Kumar, Siddharth Srivastava, Sanjeev Sachdeva

引用次数: 0

Accelerated focused open necrosectomy-based step-cross versus conventional step-up approach in infected necrotizing pancreatitis. 在感染性坏死性胰腺炎中，基于加速聚焦开放性坏死切除术的阶梯交叉与传统的阶梯交叉

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2026-01-26 DOI: 10.1016/j.pan.2026.01.073

Shuai Li, Wutao Wang, Kaiming Li, Minchun Bu, Jing Zhou, Bo Ye, Lu Ke, Zhihui Tong, Weiqin Li, Gang Li

Background: Infected necrotizing pancreatitis (INP) patients requiring open necrosectomy (ON) as part of the step-up approach generally face high postoperative mortality. Our center proposed the step-cross approach as a supplement, but supporting evidence remains limited. This study aimed to compare clinical outcomes between the step-cross and step-up approaches in INP patients.

Methods: This retrospective cohort study included adult INP patients admitted to our center from 2017 to 2022. The step-cross approach consisted of percutaneous catheter drainage, followed by accelerated focused ON and personalized drainage or debridement as needed. Propensity score matching (PSM) was used to adjust for confounders.

Results: Of 509 included patients (median age 46 [34-55] years, 67.6 % male), 454 (89.2 %) and 55 (10.8 %) underwent the step-up and step-cross approach respectively. Overall, 180-day mortality was 20.2 % (103/509): 83 (18.3 %) in the step-up group and 20 (36.4 %) in step-cross group. After PSM (53 matched pairs), 180-day mortality did not differ significantly (35.9 %vs 49.1 %, relative risk [RR] and 95 % confidence interval [CI] with the step-cross approach = 0.73 [0.46-1.15], P = 0.169), but the step-cross group was associated with lower CRRT duration (2 [0, 16] vs 15 [3.5, 22] days, P = 0.005) and fewer minimally invasive necrosectomy procedures. Complications, hospital stays and costs were comparable between groups.

Conclusions: The step-cross approach is a safe complementary strategy to the step-up approach, demonstrating trends toward lower mortality and reduced organ support requirements in selected INP patients. Nevertheless, these findings require validation through large-scale prospective studies.

背景：感染性坏死性胰腺炎（INP）患者需要开放性坏死性切除术（ON）作为升级方法的一部分，通常面临较高的术后死亡率。本中心建议采用阶梯交叉法作为补充，但支持证据仍然有限。本研究旨在比较INP患者的阶梯交叉和阶梯上升方法的临床结果。方法：本回顾性队列研究纳入了2017年至2022年在本中心就诊的成人INP患者。阶梯交叉入路包括经皮导管引流，随后加速聚焦ON和个性化引流或根据需要清创。倾向评分匹配（PSM）用于调整混杂因素。结果：509例纳入的患者（中位年龄46[34-55]岁，67.6%为男性）中，分别有454例（89.2%）和55例（10.8%）采用阶梯入路和阶梯交叉入路。总体而言，180天死亡率为20.2%(103/509)：阶梯组为83(18.3%)，阶梯交叉组为20（36.4%）。经PSM（53对配对）后，180天死亡率无显著差异（35.9% vs 49.1%，相对危险度[RR]和95%可信区间[CI]，阶梯交叉入路= 0.73 [0.46-1.15],P = 0.169），但阶梯交叉组CRRT持续时间较短（2 [0,16]vs 15[3.5, 22]天，P = 0.005），微创坏死切除手术较少。两组之间的并发症、住院时间和费用具有可比性。结论：阶梯式交叉方法是一种安全的补充策略，在选择的INP患者中显示出降低死亡率和减少器官支持需求的趋势。然而，这些发现需要通过大规模的前瞻性研究来验证。

{"title":"Accelerated focused open necrosectomy-based step-cross versus conventional step-up approach in infected necrotizing pancreatitis.","authors":"Shuai Li, Wutao Wang, Kaiming Li, Minchun Bu, Jing Zhou, Bo Ye, Lu Ke, Zhihui Tong, Weiqin Li, Gang Li","doi":"10.1016/j.pan.2026.01.073","DOIUrl":"https://doi.org/10.1016/j.pan.2026.01.073","url":null,"abstract":"<p><strong>Background: </strong>Infected necrotizing pancreatitis (INP) patients requiring open necrosectomy (ON) as part of the step-up approach generally face high postoperative mortality. Our center proposed the step-cross approach as a supplement, but supporting evidence remains limited. This study aimed to compare clinical outcomes between the step-cross and step-up approaches in INP patients.</p><p><strong>Methods: </strong>This retrospective cohort study included adult INP patients admitted to our center from 2017 to 2022. The step-cross approach consisted of percutaneous catheter drainage, followed by accelerated focused ON and personalized drainage or debridement as needed. Propensity score matching (PSM) was used to adjust for confounders.</p><p><strong>Results: </strong>Of 509 included patients (median age 46 [34-55] years, 67.6 % male), 454 (89.2 %) and 55 (10.8 %) underwent the step-up and step-cross approach respectively. Overall, 180-day mortality was 20.2 % (103/509): 83 (18.3 %) in the step-up group and 20 (36.4 %) in step-cross group. After PSM (53 matched pairs), 180-day mortality did not differ significantly (35.9 %vs 49.1 %, relative risk [RR] and 95 % confidence interval [CI] with the step-cross approach = 0.73 [0.46-1.15], P = 0.169), but the step-cross group was associated with lower CRRT duration (2 [0, 16] vs 15 [3.5, 22] days, P = 0.005) and fewer minimally invasive necrosectomy procedures. Complications, hospital stays and costs were comparable between groups.</p><p><strong>Conclusions: </strong>The step-cross approach is a safe complementary strategy to the step-up approach, demonstrating trends toward lower mortality and reduced organ support requirements in selected INP patients. Nevertheless, these findings require validation through large-scale prospective studies.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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