Pub Date : 2026-02-01DOI: 10.1016/j.pan.2025.12.022
Haoda Chen, Baiyong Shen
{"title":"Response to the Letter to Editor: Strengths and methodological considerations for predicting post-pancreatectomy acute pancreatitis","authors":"Haoda Chen, Baiyong Shen","doi":"10.1016/j.pan.2025.12.022","DOIUrl":"10.1016/j.pan.2025.12.022","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"26 1","pages":"Page 185"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145864533","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}
Pub Date : 2026-02-01DOI: 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.
{"title":"Genomic characterization and prognosis of pancreatic adenosquamous carcinoma","authors":"Yingying Huang , Xiaoyan Chang , Jun Du , Shuai Zhang , Sha Wang , Xiang Wang , Chunmei Bai","doi":"10.1016/j.pan.2025.12.018","DOIUrl":"10.1016/j.pan.2025.12.018","url":null,"abstract":"<div><div>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 <em>TP53</em> mutations, <em>MYC</em> amplification, and <em>CDKN2A</em> deletion. Pathway enrichment analysis indicated that <em>STK11</em> mutations, high tumor mutational burden (TMB-H), <em>APC</em> deletion, <em>TERT</em>/<em>RICTOR</em> 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.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"26 1","pages":"Pages 138-145"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145857461","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}
Pub Date : 2026-02-01DOI: 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。
{"title":"Comparison of clinical features and pancreatic cancer risk between genetic mutations associated versus alcohol associated chronic pancreatitis","authors":"Yoonchan Lee, Tae Jun Song, Sung Hyun Cho, Gunn Huh, Dongwook Oh, Dong-Wan Seo","doi":"10.1016/j.pan.2025.10.011","DOIUrl":"10.1016/j.pan.2025.10.011","url":null,"abstract":"<div><h3>Background/objectives</h3><div>Genetic mutations associated chronic pancreatitis (GCP), caused by pathogenic variants in <em>SPINK1</em>, <em>PRSS1</em>, or <em>CFTR</em>, 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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>In the matched GCP cohort, mutation distribution was <em>SPINK1</em> 67.6 % (94/139), <em>PRSS1</em> 15.8 % (22/139), and <em>CFTR</em> 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 <em>SPINK1</em> gene mutation carriers.</div></div><div><h3>Conclusions</h3><div>GCP shows distinct trajectories and an elevated early pancreatic cancer risk, particularly in <em>SPINK1</em> gene mutation carriers, supporting genotype-stratified surveillance.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"26 1","pages":"Pages 27-33"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459375","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}
Pub Date : 2026-02-01DOI: 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.
{"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}
Background: Pancreaticoduodenectomy (PD) presents a surgical challenge, and its feasibility in patients on dialysis is debated due to concerns over heightened perioperative risks. This study employs the NSQIP pancreatectomy database to investigate the impact of dialysis on PD-specific postoperative complications.
Methods: The NSQIP pancreatectomy targeted user file spanning 2014 to 2023 was used to identify patients undergoing a PD. Patients on dialysis were matched 1:3 to patients not receiving dialysis. Comparative analysis evaluated morbidity, mortality, and PD-specific complications.
Results: Among 43,565 patients who underwent a PD, 123 patients were on dialysis. Even after matching, dialysis patients displayed higher rates of complications, re-intubation, cardiac arrest, and bleeding (p < 0.001); furthermore, 30-day mortality was higher in the dialysis group (8.1% vs 3.0%, p = 0.014). However, rates of clinically relevant postoperative pancreatic fistula, delayed gastric emptying, and indwelling drain on POD 30 did not differ.
Conclusions: Although dialysis patients undergoing PD face increased risks of mortality and complications, PD-specific complications were not affected. These findings offer valuable insights for patient counseling and surgeon awareness.
背景：胰十二指肠切除术（PD）提出了一个手术挑战，由于担心透析患者的围手术期风险增加，其可行性一直存在争议。本研究采用NSQIP胰腺切除术数据库，探讨透析对pd特异性术后并发症的影响。方法：2014年至2023年NSQIP胰腺切除术目标用户文件用于识别PD患者。接受透析的患者与未接受透析的患者的比例为1:3。比较分析评估了发病率、死亡率和pd特异性并发症。结果：在43,565例PD患者中，123例患者接受透析治疗。即使配对后，透析患者的并发症、再插管、心脏骤停和出血发生率也较高（p < 0.001）；此外，透析组的30天死亡率更高（8.1% vs 3.0%, p = 0.014）。然而，临床相关的术后胰瘘、胃排空延迟和pod30留置引流的发生率没有差异。结论：虽然透析患者接受PD后死亡率和并发症的风险增加，但PD特异性并发症不受影响。这些发现为患者咨询和外科医生意识提供了有价值的见解。
{"title":"Comparative outcomes analysis of Whipple procedure in dialysis-dependent patients: A propensity-matched study using NSQIP data.","authors":"Genia Dubrovsky, Jiage Qian, Sebastiaan Ceuppens, Asmita Chopra, Geoffrey R Nunns, Samer AlMasri, Ibrahim Nassour, Aatur Singhi, Kenneth Lee, Amer Zureikat, Alessandro Paniccia","doi":"10.1016/j.pan.2026.01.078","DOIUrl":"https://doi.org/10.1016/j.pan.2026.01.078","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticoduodenectomy (PD) presents a surgical challenge, and its feasibility in patients on dialysis is debated due to concerns over heightened perioperative risks. This study employs the NSQIP pancreatectomy database to investigate the impact of dialysis on PD-specific postoperative complications.</p><p><strong>Methods: </strong>The NSQIP pancreatectomy targeted user file spanning 2014 to 2023 was used to identify patients undergoing a PD. Patients on dialysis were matched 1:3 to patients not receiving dialysis. Comparative analysis evaluated morbidity, mortality, and PD-specific complications.</p><p><strong>Results: </strong>Among 43,565 patients who underwent a PD, 123 patients were on dialysis. Even after matching, dialysis patients displayed higher rates of complications, re-intubation, cardiac arrest, and bleeding (p < 0.001); furthermore, 30-day mortality was higher in the dialysis group (8.1% vs 3.0%, p = 0.014). However, rates of clinically relevant postoperative pancreatic fistula, delayed gastric emptying, and indwelling drain on POD 30 did not differ.</p><p><strong>Conclusions: </strong>Although dialysis patients undergoing PD face increased risks of mortality and complications, PD-specific complications were not affected. These findings offer valuable insights for patient counseling and surgeon awareness.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166170","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}
Pub Date : 2026-01-31DOI: 10.1016/j.pan.2026.01.077
Karin Hedenmalm, Nicklas Pihlström, Per Lindemo, Mats Lindblad, Viktor Oskarsson, Omid Sadr-Azodi, Rickard Ljung
{"title":"Acute pancreatitis in relation to SARS-CoV-2 vaccination and infection: A nationwide cohort study in Sweden.","authors":"Karin Hedenmalm, Nicklas Pihlström, Per Lindemo, Mats Lindblad, Viktor Oskarsson, Omid Sadr-Azodi, Rickard Ljung","doi":"10.1016/j.pan.2026.01.077","DOIUrl":"https://doi.org/10.1016/j.pan.2026.01.077","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137808","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}
Pub Date : 2026-01-26DOI: 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.
{"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}
Pub Date : 2026-01-24DOI: 10.1016/j.pan.2026.01.003
Yan Zhang, Shaolong Hao, Fang Nie, Hao Sun, Wenxiu Zhang, Lang Ji, Jiahui Qi, Ziyu Zhang, Wei Han
{"title":"Reply to the Letter to Editor regarding the role of circular RNA circ0001415 in acute pancreatitis.","authors":"Yan Zhang, Shaolong Hao, Fang Nie, Hao Sun, Wenxiu Zhang, Lang Ji, Jiahui Qi, Ziyu Zhang, Wei Han","doi":"10.1016/j.pan.2026.01.003","DOIUrl":"https://doi.org/10.1016/j.pan.2026.01.003","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166237","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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