Pancreatology最新文献

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.

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.