Pancreatology最新文献

Background: Depression and anxiety are increasingly recognized as important comorbidities in gastrointestinal (GI) disorders, influencing disease burden and patient outcomes. However, their prevalence in pancreatitis, both in its acute (AP) and chronic (CP) forms, remains underexplored. This systematic review and meta-analysis aimed to quantify the burden of depressive and anxiety symptoms among patients with pancreatitis.

Methods: We conducted a systematic search (PROSPERO: CRD42023481739) across three databases: MEDLINE, Embase, and CENTRAL, to identify studies reporting on the prevalence of depression and anxiety symptoms in patients with AP or CP, as of November 10, 2023. The random-effects model was used to calculate the pooled proportion rate and pooled means of different anxiety/depression scores, along with 95 % confidence intervals (CI).

Results: In total, 44 studies were included. Anxiety was observed in 23 % (CI: 7 %-54 %) of the AP cases, and it was observed in 31 % (CI: 23 %-39 %) of the CP cases. Depressive symptoms were observed in 29 % (CI: 14 %-51 %) of the AP patients, while in CP cases, the prevalence was 39 % (CI: 30 %-48 %). The pooled single-mean analysis of psychological questionnaire data confirms clinically significant levels of both depressive and anxiety symptoms. Mean scores exceeded established cut-off points across all measures: CESD-10 (14.30 [CI: 6.69-21.92]), HADS-depression (8.23 [CI: 4.53-11.94]), SES (49.29 [CI: 44.01-54.57]), HADS-anxiety (8.67 [CI: 6.89-10.46]), and SAS (47.75 [CI: 35.05-60.45]). These findings indicate that many participants experienced symptom levels beyond the normative range. Overall, a low risk of bias was observed; however, several studies were identified as high risk due to reporting limitations.

Conclusions: Our findings reveal a notably high prevalence of depression and anxiety in pancreatitis, exceeding global averages and rates seen in other GI disorders. These findings warrant routine psychological screening, ongoing follow-up, and the integration of mental health professionals into multidisciplinary care teams are therefore warranted.

Background: Acute pancreatitis (AP) may develop in patients with cirrhosis of the liver due to higher prevalence of etiological factors such as alcoholism and gallstones in them. However, the data are limited regarding the clinical outcomes in patients with AP and underlying cirrhosis.

Methods: National Inpatient Sample (2016-2020) was reviewed to identify adult inpatients with AP. They were divided into three groups based on presence of cirrhosis. STATA was used to compare clinical outcomes and resource utilization using multivariate and propensity score-matched analyses.

Results: 1.38 million patients were admitted with AP, with 2.2 % and 2.1 % having compensated and decompensated cirrhosis respectively. Compared to non-cirrhotics, patients with decompensated cirrhosis had higher odds of mortality (OR 4.27,95 %C.I.:3.53-5.17,p = 0.001), length of stay (LOS) (1.9 days,95 %C.I.:1.69-2.10,p = 0.001) and total hospitalization charges (THC) (9544$,95 %C.I.:16,484-22,603,p = 0.001); worse secondary outcomes including AP-related: sepsis (OR 2.59,95 %C.I.:2.23-3.00,p-0.001), acute kidney injury (AKI) (OR 1.64,95 %C.I.:1.53-1.77,p = 0.001), shock (OR 2.8,95 %C.I.:2.23-3.51,p = 0.001), acute respiratory failure (OR 1.76,95 %C.I.:1.56-1.99,p = 0.001); and cirrhosis-related: gastrointestinal bleeding (OR 5.08,95 %C.I.:4.62-5.59,p = 0.001) and portal vein thrombosis (OR 9.22,95 %C.I.:8.22-10.36,p = 0.001). Patients with compensated cirrhosis had similar odds of mortality, lower LOS (-0.23 days,95 %C.I.: 0.34 to -0.12,p = 0.001) and THC (-2727$,95 %C.I.: 4091 to -1362,p = 0.001) but higher odds of gastrointestinal bleeding (OR 1.92,95 %C.I.:1.50-2.45,p = 0.001), blood transfusion requirements (OR 1.52,95 %C.I.:1.16-2.00,p = 0.002) and portal vein thrombosis (OR 1.93,95 %C.I.:1.53-2.44,p = 0.001).

Conclusion: Patients with decompensated cirrhosis had higher odds of mortality, higher healthcare resource utilization, and worse clinical outcomes compared to those without cirrhosis. Patients with compensated cirrhosis had higher odds of portal vein thrombosis, GI bleeding, and blood transfusion. Complications of portal hypertension are likely the primary drivers behind increased odds of mortality in cirrhotic patients with AP. Patients with decompensated cirrhosis also seem to be at a higher risk of complications due to AP.

Introduction: Intraductal papillary mucinous neoplasms (IPMN) are a common precancerous condition for pancreatic cancer. Obesity is an increasingly prevalent condition globally and has shown to contribute to carcinogenesis in pancreatic cancer. A potential effect of overweight and obesity on disease progression in IPMN is unexplored.

Methods: A systematic search of databases was performed up to April 2025. Inclusion criteria were original English studies reporting data on the prevalence of overweight and obesity in IPMN patients. Two independent reviewers performed study screening, data extraction and quality assessment using Covidence. Risk of bias assessment was done by using the Newcastle-Ottawa scale. Meta-analysis was performed of hazards ratios (HR) and odds ratios (OR) using a random-effects model with generic inverse variance method.

Results: After screening 695 studies a total of 15 cohort studies were included, entailing data on 6149 patients with IPMN. Four studies reported HR for progression of IPMN using different categories to report body-mass-index (BMI). The pooled HR for IPMN progression for obese versus normal-weight individuals was 1.87 (95 % confidence interval (CI) 1.42-2.45). Four studies reported OR for the association between obesity and malignancy in surgically treated IPMN patients. The pooled OR for malignancy was 2.48 (95 % CI 1.01-6.11).

Conclusions: This meta-analysis reveals that obesity and overweight may be associated with the risk of progression of IPMN, as well as to the likelihood of malignancy in patients undergoing surgery for IPMN. Surveillance programs should therefore take obesity into account as a potential risk factor for progression of IPMNs.

Background: Fluid resuscitation is critical in patients with acute pancreatitis (AP) but there is no consensus regarding the amount of fluid to be infused. This is primarily due to difficulty in assessing the fluid deficit accurately. Our objective was to measure the amount of fluid sequestration and intravascular plasma volume deficit by measuring fluid in various body compartments in patients with AP.

Methods: Patients with predicted severe AP presenting within 72 h of onset of pain were included prospectively. These patients underwent analysis of the body fluid composition (distribution of fluid in different compartments) by the Body Composition Monitor, a whole-body multifrequency bioimpedance analysis device. Total body water (TBW), intracellular fluid (ICF), and extracellular fluid (ECF) were measured. Intravascular plasma volume was measured objectively by ⁵¹Chromium radio-isotope labelled RBCs dilution method. Fluid sequestration in the interstitial compartment was calculated based on the fluid distribution.

Results: Twenty patients with predicted severe AP were included in the study [median age 37 years, 75 % male]. The median measured ECF was 13.8 (9.9-18.8) L [58.6 % increase], ICF was 16.3 (10.4-23.3) L [20.1 % decrease], and interstitial fluid volume was 12.7 (8.9-16.3) L [101 % increase] at 48 h after hospitalization. The median plasma volume was 1.4 (0.5-2.3) L at 48 h as compared to 2.4 (1.6-3.1) L at baseline i.e. 48.6 % decrease with a plasma volume deficit of 1.1 (0.4-2.0) L. Fluid sequestration was 2.5 (1.2-3.7) L as per bioimpedance method.

Conclusion: The objective measurement of fluid distribution in body compartments revealed a modest plasma volume deficit in AP, supporting the rationale behind moderate fluid therapy to replenish the plasma volume deficit, rather than the total fluid sequestered in the interstitium.

Background: Factor VII activating protease (FSAP) can be activated by damaged or necrotic cells and plays a role in coagulation and inflammation.

Methods: Patients who were consecutively admitted and diagnosed with acute pancreatitis (AP) were screened. Multivariate logistic regression analysis was performed to analyze the relationship between plasma FSAP levels and disease severity. Spearman analysis was employed to explore the relationship between plasma FSAP levels and inflammation and coagulation indicators. The outcomes of interest included new-onset venous thrombosis, abdominal infection, pancreatic necrosis, and organ failure during hospitalization. Patients were followed up for 1-3 months to observe the evolution of AP.

Results: A total of 61 patients were included. The plasma FSAP levels in the severe acute pancreatitis (SAP) group were significantly higher than those in non-SAP group [15.95 (11.23, 22.81) μg/mL versus 7.36 (5.40, 11.46) μg/mL, p < 0.001] and were significantly associated with inflammation (C-reactive protein and procalcitonin) and coagulation (D-dimer and antithrombin III). High plasma FSAP levels were independently associated with the risk of pancreatic necrosis [OR (95 % CI): 1.23 (1.01-1.50), p = 0.046], and organ failure [OR (95 % CI): 1.37 (1.04-1.81), p = 0.025] during hospitalization, but not with new-onset venous thrombosis and abdominal infection. Higher plasma FSAP levels were also associated with longer recovery time for oral feeding and worse prognosis.

Conclusion: Plasma FSAP level can serve as a biomarker of disease severity and prognosis in AP.

Background: EUS and MRCP are considered equivalent for pancreatic cancer screening. ASGE guidelines suggest that the choice between these modalities should be based upon patient preferences, however, there is limited data to help guide clinicians.

Methods: All consecutive patients undergoing pancreatic cancer screening who had undergone both EUS and MRCP between 2021 and 2024 were identified. We also selected a comparison cohort of patients undergoing pancreatic cyst surveillance. A survey to elicit patient preferences and experience regarding physical discomfort, anxiety, dread, convenience, reassurance and cancer worry was administered to both groups.

Results: Of 150 pancreatic cancer screening patients approached, 74 % agreed to participate. We compared mean response scores between EUS and MRCP and found patients favored EUS: less claustrophobia(p = 0.001), less dread(p = 0.02), more reassurance(p = 0.01), and more likely to recommend to family(p = 0.059). While 41.4 % reported no overall preference, 33.3 % preferred EUS and 25.2 % MRCP. Of 70/150(47 %) pancreatic cyst surveillance patients who responded, no difference in anxiety, dread or reassurance was noted between EUS and MRCP, but patients reported more claustrophobia with MRCP(p = 0.001). However, patients were more likely to recommend MRCP to family(p = 0.055). While 36.8 % reported no overall preference, 44.1 % preferred MRCP and 19.1 % EUS. Higher levels of cancer worry were reported by screening than cyst surveillance patients, but both groups reported that this rarely interfered with daily activities.

Conclusions: Almost 60 % of patients prefer one screening modality over the other, with a trend towards screening patients favoring EUS and cyst surveillance patients MRCP. These findings support a patient-centered individualized approach to pancreatic cancer screening.