Pancreatology最新文献

英文中文

Impact of pancreatic steatosis on risk of Post-ERCP pancreatitis: Systematic review and meta-analysis 胰腺脂肪变性对ercp后胰腺炎风险的影响：系统回顾和荟萃分析。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-12-01 DOI: 10.1016/j.pan.2025.10.013

Mohamad Khaled Almujarkesh , Tareq Alsaleh , Amna Malik , Baha Fawwaz , Vishwas Vanar , Maham Hayat , Deepanshu Jain , Natalie Cosgrove , Dennis Yang , Muhammad K. Hasan , Ashok Saluja , Kambiz Kadkhodayan , Mustafa A. Arain , John George

Background

Pancreatic steatosis (PS) is characterized by fat accumulation within the pancreas. Although several risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) have been identified, the role of pancreatic steatosis (PS) remains inadequately explored.

Methods

We conducted a systematic review and meta-analysis to evaluate the association between PS and PEP. Multiple databases were searched through June 2025. Studies comparing PEP incidence with and without PS were included. The primary outcome was the incidence of PEP, and the secondary outcome was PEP severity. A random-effects model was utilized, and effect estimates were expressed as odds ratios (OR) and 95 % confidence interval (CI). Heterogeneity was assessed using the I² statistic.

Results

Five eligible studies with 2197 patients (mean age 69.7 years, 51.1 % female) were included. Patients with PS had significantly higher odds of PEP (OR 3.67; 95 % CI 2.29–5.90; I² = 26 %). On subgroup analysis, PS was consistently associated with significantly higher PEP odds. This included studies in East Asia (OR 2.79; 95 % CI 1.77–4.40; I² = 0 %) and Europe (OR 6.68; 95 % CI 3.10–14.43; I² = 0 %), retrospective studies (OR 4.44; 95 % CI 2.67–7.36; I² = 0 %), and studies not utilizing rectal non-steroidal anti-inflammatory drugs (OR 2.79; 95 % CI 1.77–4.40; I² = 0 %). There was a non-significant trend toward increased odds of severe PEP with PS (OR 2.17, 95 % CI 0.65–7.25; I² = 0 %)

Conclusions

PS appears to be a significant risk factor for the PEP and may help improve risk stratification before ERCP. Nevertheless, further large-scale prospective studies are needed to validate our results.

背景：胰腺脂肪变性（PS）以胰腺内脂肪堆积为特征。虽然内镜逆行胰胆管造影（ERCP）后胰腺炎（PEP）的几个危险因素已经确定，但胰腺脂肪变性（PS）的作用仍未充分探讨。方法：我们通过系统回顾和荟萃分析来评估PS和PEP之间的关系。到2025年6月，他们搜索了多个数据库。比较有和没有PS的PEP发生率的研究被纳入。主要结局是PEP的发生率，次要结局是PEP的严重程度。采用随机效应模型，效应估计用比值比（OR）和95%置信区间（CI）表示。采用I2统计量评估异质性。结果：纳入5项符合条件的研究，共2197例患者（平均年龄69.7岁，女性51.1%）。PS患者发生PEP的几率明显更高（OR 3.67; 95% CI 2.29-5.90; I2 = 26%）。在亚组分析中，PS与PEP的发生率一致。这包括东亚的研究（OR 2.79; 95% CI 1.77-4.40; I2 = 0%）和欧洲的研究（OR 6.68; 95% CI 3.10-14.43; I2 = 0%），回顾性研究（OR 4.44; 95% CI 2.67-7.36; I2 = 0%），以及不使用直肠非甾体抗炎药的研究（OR 2.79; 95% CI 1.77-4.40; I2 = 0%）。重度PEP合并PS的发生率增加趋势不显著（OR 2.17, 95% CI 0.65-7.25; I2 = 0%）。结论：PS似乎是PEP的一个重要危险因素，可能有助于改善ERCP前的风险分层。然而，需要进一步的大规模前瞻性研究来验证我们的结果。

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引用次数: 0

Diagnostic accuracy and Patient Derived Organoid (PDO) yield of 19G vs 22G Franseen needles for EUS-Guided biopsy in solid pancreatic lesions: A prospective comparative study 19G与22G Franseen针在eus引导下胰腺实体病变活检中的诊断准确性和患者衍生类器官（PDO）产量：一项前瞻性比较研究

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-12-01 DOI: 10.1016/j.pan.2025.09.001

Sarah Klauss , Yonggan Xue , Ahmed Alnatsha , Prince Allawadhi , Ujjwal M. Mahajan , Elisabetta Goni , Marlies Vornhülz , Simon Sirtl , Christian Schulz , Mark op den Winkel , Jörg Schirra , Steffen Ormanns , Michal Zorniak , Julia Mayerle , Georg Beyer

Background/objectives

Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is the standard procedure for conducting histological assessment of solid pancreatic lesions and obtaining tissue cores for generating patient-derived organoids (PDOs) in unresectable patients. The aim of this single-institution, prospective, comparative study was to investigate whether the use of the larger 19-gauge (G) FNB needle improves diagnostic performance and PDO establishment rate compared to the 22G FNB needle.

Methods

Patients with suspected solid pancreatic lesions on imaging were prospectively recruited between April 2019 and April 2022. Diagnostic EUS-FNB was performed with both needles in every patient. The primary endpoint was the diagnostic accuracy of the samples and the secondary endpoint the rate of successful PDO generation for which additional samples were obtained with both needles in a subset of twenty patients with high probability for pancreatic cancer.

Results

Of the 119 enrolled patients, eighty-five patients underwent EUS-FNB with both needle sizes. The overall diagnostic accuracy and the sensitivity for malignancy were similar for both needles. The sensitivity for pancreatic ductal adenocarcinoma (PDAC) was 83.3 % for the 22G and 76.7 % for the 19G needle (p = .46). Of the 20 patients with PDO sampling, 10 PDOs were established from 19G samples, 11 from 22G samples and 8 from both needle sizes (p = .99). The overall PDO success rate, regardless of needle size, was 60 %.

Conclusions

Compared to 22G, the 19G- FNB needle did not provide higher diagnostic accuracy or PDO yield, suggesting no need for larger needle sizes for PDO generation.

背景/目的：内镜下超声引导下细针活检（EUS-FNB）是对实体胰腺病变进行组织学评估和获得组织核心以生成不可切除患者源性类器官（PDOs）的标准程序。这项单机构、前瞻性、比较研究的目的是探讨与22G FNB针相比，使用更大的19号(G) FNB针是否能提高诊断性能和PDO建立率。方法：前瞻性招募2019年4月至2022年4月期间影像学上疑似胰腺实性病变的患者。诊断性EUS-FNB均采用双针。主要终点是样本的诊断准确性，次要终点是在20名高概率胰腺癌患者中使用两种针获得额外样本的PDO生成成功率。结果：在119名入组患者中，85名患者接受了两种针头大小的EUS-FNB。两种针的总体诊断准确性和对恶性肿瘤的敏感性相似。22G针对胰腺导管腺癌（PDAC）的敏感性为83.3%，19G针为76.7% （p = 0.46）。在20例PDO采样患者中，10例PDO来自19G样本，11例来自22G样本，8例来自两种针头尺寸（p = 0.99）。无论针头大小，PDO的总成功率为60%。结论：与22G相比，19G- FNB针头没有提供更高的诊断准确性和PDO产率，提示不需要更大的针头来产生PDO。

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引用次数: 0

Proceeding with liver transplantation in acute non-necrotizing pancreatitis: A 10-year propensity-matched cohort study 急性非坏死性胰腺炎进行肝移植：一项10年倾向匹配队列研究。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-12-01 DOI: 10.1016/j.pan.2025.11.005

Sameer Rao , Niwen Kong , Manas Gunani , Amir Gougol , Ravi Vachhani , Richard K. Sterling , Nikki Duong

引用次数: 0

Mapping of lymph node metastasis in nonfunctional pancreatic neuroendocrine tumors: A retrospective analysis of 455 patients 无功能胰腺神经内分泌肿瘤淋巴结转移的定位：回顾性分析455例患者。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-12-01 DOI: 10.1016/j.pan.2025.11.003

Fei Wang , Wei Tang , Chenjie Zhou , Zheng Li , Jie Chen , Xiaowu Xu , Xianjun Yu , Shunrong Ji

Background/objectives

Radical surgery is the standard treatment for resectable pancreatic neuroendocrine tumors (pNETs), but the necessity and extent of lymphadenectomy remain controversial. This study aimed to identify the optimal extent of lymph node dissection based on metastasis incidence.

Methods

A retrospective review of 955 patients treated at Shanghai Cancer Center, Fudan University, identified 455 patients who underwent lymph node dissection.

Results

For tumors ≤2 cm, lymph node metastases were observed at stations 13 & 17 (6.25 %) for tumors in the pancreatic head, and at station 8 (5.71 %) and stations 11 & 18 (4.62 %) for tumors in the body-tail. For tumors 2–4 cm, stations 13 & 17 (20.27 %) and station 14 (12.25 %) were most frequently positive in the head group, while station 11 & 18 (17.20 %) and station 14 (13.64 %) were positive in the body-tail group. For tumors ≥4 cm in the body-tail group, metastases were highest at stations 11 & 18 (24.00 %), station 8 (22.73 %), and station 10 (14.29 %). Insufficient data prevented analysis of tumors ≥4 cm in the head group. Subgroup analyses by tumor grade were also conducted.

Conclusions

Lymph node metastases are uncommon in pNETs <2 cm, supporting observation with close follow-up as an alternative to routine surgery. For tumors >2 cm, lymphadenectomy should be tailored to metastasis risk at specific stations.

背景/目的：根治性手术是可切除胰腺神经内分泌肿瘤（pNETs）的标准治疗方法，但淋巴结切除术的必要性和范围仍存在争议。本研究旨在根据转移发生率确定最佳淋巴结清扫程度。方法：回顾性分析955例在复旦大学上海肿瘤中心接受治疗的患者，其中455例接受了淋巴结清扫。结果：对于≤2 cm的肿瘤，位于胰头的肿瘤在第13、17位（6.25%）有淋巴结转移，位于体尾的肿瘤在第8位（5.71%）和第11、18位（4.62%）有淋巴结转移。2 ~ 4 cm肿瘤，头组以13、17站（20.27%）和14站（12.25%）阳性最多，体尾组以11、18站（17.20%）和14站（13.64%）阳性最多。对于≥4 cm的体尾组肿瘤，11、18站（24.00%）、8站（22.73%）和10站（14.29%）转移率最高。由于资料不足，无法对头部组≥4 cm的肿瘤进行分析。按肿瘤分级进行亚组分析。结论：淋巴结转移在2 cm的pNETs中并不常见，淋巴结切除术应根据特定部位的转移风险进行调整。

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引用次数: 0

Prevalence, clinicopathological features, and prognosis of diabetes in pancreatic cancer: A single-center retrospective cohort study of 1620 patients 糖尿病在胰腺癌中的患病率、临床病理特征和预后：一项1620例患者的单中心回顾性队列研究

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-12-01 DOI: 10.1016/j.pan.2025.11.004

Yunlong Li , Shuai Xiang , Wenhui Zhong , Shunda Wang , Shuisheng Zhang , Jianwei Zhang , Yongxing Du , Chengfeng Wang , Xu Che

Background

The interplay between pancreatic cancer (PC) and diabetes mellitus (DM) is complex, and may differ between new-onset DM (NODM) and long-standing DM (LSDM). We compared clinical features and prognosis across non-DM, NODM, and LSDM groups.

Methods

We retrospectively analyzed 1620 PC patients treated at the National Cancer Center (2008–2018). Patients were classified as non-DM, NODM (≤2 years), and LSDM (>2 years). Survival outcomes were assessed by Kaplan–Meier and Cox regression analyses, and mediation analysis was applied to evaluate indirect effects.

Results

Of 1620 patients, 536 (33.1 %) had DM, including 287 (53.4 % of DM) with NODM. NODM was associated with higher jaundice prevalence and elevated liver function markers; LSDM patients were older, had a greater prevalence of hypertension, and showed lower M stage. Non-DM patients had lower CA19-9, CA242, and CEA than both DM groups. Overall survival was significantly worse in NODM than in LSDM and non-DM. In curatively resected patients, DM status (non-DM/NODM/LSDM) independently predicted OS in multivariable models. Mediation analysis indicated total bilirubin accounted for 9.8 % of the adverse association between NODM and OS (ACME −0.46, 95 % CI −1.04 to −0.09; p = 0.008).

Conclusion

DM is common in PC and associates with distinct clinicopathological profiles. NODM is linked to jaundice and poorer survival, while DM status serves as an independent prognostic factor in the curative-surgery subgroup, with part of NODM's adverse effect operating through bilirubin.

背景：胰腺癌（PC）与糖尿病（DM）之间的相互作用是复杂的，并且在新发糖尿病（NODM）和长期糖尿病（LSDM）之间可能存在差异。我们比较了非dm、NODM和LSDM组的临床特征和预后。方法：回顾性分析2008-2018年在国家癌症中心治疗的1620例PC患者。患者分为非dm、NODM（≤2年）和LSDM（≤2年）。生存结局采用Kaplan-Meier和Cox回归分析评估，间接影响采用中介分析评估。结果：1620例患者中，536例（33.1%）为DM，其中287例（53.4%）为NODM。NODM与较高的黄疸患病率和肝功能指标升高有关；LSDM患者年龄较大，高血压患病率较高，M期较低。非糖尿病患者的CA19-9、CA242和CEA均低于两组。NODM患者的总生存率明显低于LSDM和非dm患者。在治疗性切除的患者中，在多变量模型中，DM状态（非DM/NODM/LSDM）独立预测OS。中介分析表明，总胆红素占NODM和OS之间不良关联的9.8% （ACME -0.46, 95% CI -1.04 ~ -0.09; p = 0.008）。结论：糖尿病在PC中很常见，且具有独特的临床病理特征。NODM与黄疸和较差的生存率有关，而在治疗手术亚组中，DM状态是一个独立的预后因素，部分NODM的不良反应通过胆红素起作用。

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引用次数: 0

Cost-effectiveness of biodegradable pancreatic stents in post-ERCP pancreatitis prophylaxis. 可生物降解胰腺支架在ercp后胰腺炎预防中的成本-效果。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-12-01 DOI: 10.1016/j.pan.2025.11.022

Abdullah Abbasi, Raheel Anjum, Pavit Tewatia, Shyam Menon

Background: Biodegradable biliopancreatic stents (BDS) are commercially available alternatives to conventional stents. While these offer potential economic benefits-such as eliminating the need for follow-up imaging or endoscopic procedures to retrieve retained stents-they have not been evaluated in a cost-effectiveness model. We aimed to develop a health economic model comparing conventional pancreatic stents (PS) with BDS for the prophylaxis of post-ERCP pancreatitis (PEP).

Methods: Data on pancreatic stents used for PEP and follow-up outcomes were extracted from the endoscopy database at The Royal Wolverhampton NHS Trust, United Kingdom, to develop a cost-benefit decision analysis model. Healthcare-associated quality of life data were sourced from the literature to derive utility values for the model. Complications related to retained stents were incorporated. Deterministic and probabilistic sensitivity analyses were performed. Incremental cost-effectiveness ratios (ICERs) were calculated using a willingness-to-pay (WTP) threshold of £30,000.

Results: Deterministic analysis demonstrated that using BDS for PEP prophylaxis was cost-effective compared to conventional PS (£656.12, 0.98 QALY for BDS vs. £377.59, 0.95 QALY for PS), yielding an ICER of £9316.70. Probabilistic sensitivity analysis similarly confirmed the cost-effectiveness of BDS over PS, with BDS being cost-effective at £666.67 for 0.98 QALY versus £373.68 for 0.95 QALY for PS. Threshold analysis identified a cost threshold of £353.37 for BDS to remain cost-effective.

Conclusion: BDS for PEP prophylaxis is cost effective compared to conventional PS, avoiding the need for follow-up imaging and repeat procedures for stent removal.

背景：生物可降解胆管支架（BDS）是传统支架的商业替代品。虽然这些技术提供了潜在的经济效益，例如无需后续成像或内窥镜手术来取出保留的支架，但它们尚未在成本效益模型中进行评估。我们的目的是建立一个健康经济模型，比较传统胰腺支架（PS）和BDS对ercp后胰腺炎（PEP）的预防作用。方法：从英国皇家伍尔弗汉普顿NHS信托基金会的内窥镜数据库中提取用于PEP的胰腺支架数据和随访结果，以建立成本效益决策分析模型。从文献中获取与医疗保健相关的生活质量数据，以得出模型的实用价值。留置支架相关并发症纳入研究。进行了确定性和概率敏感性分析。增量成本效益比（ICERs）是使用支付意愿（WTP）阈值30,000英镑来计算的。结果：确定性分析表明，与传统PS相比，使用BDS进行PEP预防具有成本效益（BDS为656.12英镑，质量aly为0.98；BDS为377.59英镑，质量aly为0.95），ICER为9316.70英镑。概率敏感性分析同样证实了BDS相对于PS的成本效益，BDS的成本效益为0.98 QALY为666.67英镑，而PS的成本效益为0.95 QALY为373.68英镑。阈值分析确定了BDS保持成本效益的成本阈值为353.37英镑。结论：与传统PS相比，BDS预防PEP具有成本效益，避免了后续影像学检查和重复支架取出手术的需要。

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引用次数: 0

Reevaluating rifaximin prophylaxis in severe acute pancreatitis: A call for methodological refinement and microbiome-centric endpoints. 重新评估利福昔明预防严重急性胰腺炎：呼吁改进方法和以微生物组为中心的终点。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-11-21 DOI: 10.1016/j.pan.2025.11.012

Parth Aphale, Himanshu Shekhar, Shashank Dokania

引用次数: 0

Methodological Considerations Regarding "Prognostic impact of serum triglycerides in acute pancreatitis". 关于“血清甘油三酯对急性胰腺炎预后的影响”的方法学考虑。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-11-12 DOI: 10.1016/j.pan.2025.11.008

Wenhua Zhou, Liuying Li, Xia Zhou

引用次数: 0

Event timing inaccuracies in a retrospective study of low-dose aspirin and acute pancreatitis. 低剂量阿司匹林与急性胰腺炎回顾性研究中的事件时间不准确。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-11-12 DOI: 10.1016/j.pan.2025.11.006

Hung-Da Chen, Joshua Wang

引用次数: 0

Prognostic impact of serum triglycerides in acute pancreatitis: Evidence from multi-center cohort study using a common data model 血清甘油三酯对急性胰腺炎预后的影响：来自使用通用数据模型的多中心队列研究的证据。

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology

Pub Date : 2025-11-01 DOI: 10.1016/j.pan.2025.09.032

Da Hee Park , Seung In Seo , Jin Gu Kang , Woon Geon Shin , Jinseob Kim , Kyong Joo Lee , Se Woo Park

Background and aims

Hypertriglyceridemia (HTG) is a risk factor for acute pancreatitis (AP); however its association with increased AP severity remains unclear. This study aimed to investigate the association between HTG levels and severity of AP.

Design

This study analyzed data from 10 Korean hospital databases converted to a common data model from 2004 to 2019. Hospitalized patients with AP were divided into two groups based on their serum triglyceride (TG) levels: a high TG (HiTG) group (serum TG: >500 mg/dL) and a low TG (LoTG) group (TG: ≤500 mg/dL). Subgroup analyses were performed based on age and sex.

Results

A total of 5644 AP patients were included in the study, with 534 and 5110 patients in the HiTG and LoTG groups, respectively. An increasing trend was observed in the number of patients with pancreatitis (p < 0.001 for trend), including those with HTG-associated pancreatitis. The HiTG group showed a male predominance (74.9 %), and 34.4 % of patients were between the ages of 30 and 39 years. The HiTG group showed significantly higher C-reactive protein (CRP) elevation rates (30.8 % vs. 10.6 %, P < 0.001) requiring intensive care unit (ICU) admission (12.8 % vs. 9.3 %, P = 0.050) than the LoTG group. Age-based subgroup analysis revealed that the HiTG group had significantly higher CRP levels, ICU management, and 30-day mortality in patients aged <60 years.

Conclusion

HTG is associated with a higher risk of developing severe AP. Younger patients (<60 years) with HTG may be vulnerable to a more severe disease course.

背景和目的：高甘油三酯血症（HTG）是急性胰腺炎（AP）的危险因素；然而，其与急性脑卒中严重程度增加的关系尚不清楚。本研究旨在探讨HTG水平与ap严重程度之间的关系。设计：本研究分析了从2004年至2019年转换为通用数据模型的10家韩国医院数据库的数据。根据住院AP患者的血清甘油三酯（TG）水平分为两组：高TG （HiTG）组（血清TG: bb0 500 mg/dL）和低TG （LoTG）组（TG:≤500 mg/dL）。根据年龄和性别进行亚组分析。结果：共纳入AP患者5644例，其中HiTG组534例，LoTG组5110例。胰腺炎患者数量呈增加趋势（p < 0.001），包括htg相关性胰腺炎患者。HiTG组以男性为主（74.9%），34.4%的患者年龄在30 ~ 39岁之间。HiTG组c -反应蛋白（CRP）升高率（30.8%比10.6%,P < 0.001）需要入住重症监护病房（ICU）（12.8%比9.3%,P = 0.050）显著高于LoTG组。基于年龄的亚组分析显示，HiTG组在老年患者中CRP水平、ICU管理和30天死亡率均显著升高。结论：HTG与发生严重AP的风险较高相关。

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