Pub Date : 2024-03-01Epub Date: 2024-01-02DOI: 10.1097/JP9.0000000000000168
Saif Zaman, Fred Gorelick
Acute pancreatitis is a severe inflammatory disorder with limited treatment options. Improved understanding of disease mechanisms has led to new and potential therapies. Here we summarize what we view as some of the most promising new therapies for treating acute pancreatitis, emphasizing the rationale of specific treatments based on disease mechanisms. Targeted pharmacologic interventions are highlighted. We explore potential treatment benefits and risks concerning reducing acute injury, minimizing complications, and improving long-term outcomes. Mechanisms associated with acute pancreatitis initiation, perpetuation, and reconstitution are highlighted, along with potential therapeutic targets and how these relate to new treatments.
{"title":"Acute pancreatitis: pathogenesis and emerging therapies.","authors":"Saif Zaman, Fred Gorelick","doi":"10.1097/JP9.0000000000000168","DOIUrl":"10.1097/JP9.0000000000000168","url":null,"abstract":"<p><p>Acute pancreatitis is a severe inflammatory disorder with limited treatment options. Improved understanding of disease mechanisms has led to new and potential therapies. Here we summarize what we view as some of the most promising new therapies for treating acute pancreatitis, emphasizing the rationale of specific treatments based on disease mechanisms. Targeted pharmacologic interventions are highlighted. We explore potential treatment benefits and risks concerning reducing acute injury, minimizing complications, and improving long-term outcomes. Mechanisms associated with acute pancreatitis initiation, perpetuation, and reconstitution are highlighted, along with potential therapeutic targets and how these relate to new treatments.</p>","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"7 1","pages":"10-20"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140208469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/jp9.0000000000000174
C. Pang, Zhiyao Fan, Hanxiang Zhan
Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor, which is mostly solitary in the pancreas. Surgery-based comprehensive treatment with adjuvant chemotherapy is the currently advanced treatment modality, neoadjuvant chemotherapy has achieved satisfactory results, however, due to the high heterogeneity of PDAC, its sensitivity to chemotherapy is also different. A 66-year-old man presented with discomfort in the upper abdomen and Computed Tomography (CT) scans revealed two tumor lesions in the head and tail of the pancreas, respectively. Endoscopic ultrasonoraphy guided fine needle aspiration (EUS-FNA) was performed to clarify the pathology and the patient was recommended to undergo neoadjuvant therapy. Through five courses of neoadjuvant chemotherapy, the two tumors showed different treatment effects, and after evaluation, total pancreatectomy and splenectomy were provided to patients.We report a case of the one patient presenting with two pancreatic cancer lesions, who demonstrated different therapeutic responses after receiving neoadjuvant chemotherapy due to the heterogeneity of PDAC.
{"title":"Different response of two primary neoplastic lesions to neoadjuvant therapy: a case report","authors":"C. Pang, Zhiyao Fan, Hanxiang Zhan","doi":"10.1097/jp9.0000000000000174","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000174","url":null,"abstract":"Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor, which is mostly solitary in the pancreas. Surgery-based comprehensive treatment with adjuvant chemotherapy is the currently advanced treatment modality, neoadjuvant chemotherapy has achieved satisfactory results, however, due to the high heterogeneity of PDAC, its sensitivity to chemotherapy is also different. A 66-year-old man presented with discomfort in the upper abdomen and Computed Tomography (CT) scans revealed two tumor lesions in the head and tail of the pancreas, respectively. Endoscopic ultrasonoraphy guided fine needle aspiration (EUS-FNA) was performed to clarify the pathology and the patient was recommended to undergo neoadjuvant therapy. Through five courses of neoadjuvant chemotherapy, the two tumors showed different treatment effects, and after evaluation, total pancreatectomy and splenectomy were provided to patients.We report a case of the one patient presenting with two pancreatic cancer lesions, who demonstrated different therapeutic responses after receiving neoadjuvant chemotherapy due to the heterogeneity of PDAC.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"9 s2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140439209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pancreatic cancer is one of the most aggressive malignancies, a robust prognostic signature and novel biomarkers are urgently needed for accurate stratification of the patients and optimization of clinical decision-making. A list of bioinformatic analysis were applied in public dataset to construct an immune-related signature. Furthermore, the most pivotal gene in the signature was identified. The potential mechanism of the core gene function was revealed through GSEA, CIBERSORT, ESTIMATE, immunophenoscore algorithm, single cell analysis and functional experiment. An immune-related prognostic signature and associated nomogram were constructed and validated. Among the genes constituting the signature, IL1R2 was identified as the gene occupying the most paramount position in the risk signature. Meanwhile, Knockdown of IL1R2 significantly inhibited the proliferation, invasion and migration ability of pancreatic cancer cells. Additionally, high IL1R2 expression was associated with reduced CD8+ T cell infiltration in pancreatic cancer microenvironment, which may be due to high PD-L1 expression in cancer cells. Finally, the IPS algorithm proved that patients with high IL1R2 expression possessed a higher tumor mutation burden and a higher probability of benefiting from immunotherapy. In conclusion, our study constructed an efficient immune-related prognostic signature and identified the key role of IL1R2 in the development of pancreatic cancer, as well as its potential to serve as a biomarker for immunotherapy efficacy prediction for pancreatic cancer.
{"title":"Immune-related signature identifies IL1R2 as an immunological and prognostic biomarker in pancreatic cancer","authors":"Chengcheng Wang, Yuan Chen, Xinpeng Yin, Ruiyuan Xu, Rexiati Ruze, Jianlu Song, Chenglin Hu, Yupei Zhao","doi":"10.1097/jp9.0000000000000175","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000175","url":null,"abstract":"\u0000 \u0000 Pancreatic cancer is one of the most aggressive malignancies, a robust prognostic signature and novel biomarkers are urgently needed for accurate stratification of the patients and optimization of clinical decision-making.\u0000 \u0000 \u0000 \u0000 A list of bioinformatic analysis were applied in public dataset to construct an immune-related signature. Furthermore, the most pivotal gene in the signature was identified. The potential mechanism of the core gene function was revealed through GSEA, CIBERSORT, ESTIMATE, immunophenoscore algorithm, single cell analysis and functional experiment.\u0000 \u0000 \u0000 \u0000 An immune-related prognostic signature and associated nomogram were constructed and validated. Among the genes constituting the signature, IL1R2 was identified as the gene occupying the most paramount position in the risk signature. Meanwhile, Knockdown of IL1R2 significantly inhibited the proliferation, invasion and migration ability of pancreatic cancer cells. Additionally, high IL1R2 expression was associated with reduced CD8+ T cell infiltration in pancreatic cancer microenvironment, which may be due to high PD-L1 expression in cancer cells. Finally, the IPS algorithm proved that patients with high IL1R2 expression possessed a higher tumor mutation burden and a higher probability of benefiting from immunotherapy.\u0000 \u0000 \u0000 \u0000 In conclusion, our study constructed an efficient immune-related prognostic signature and identified the key role of IL1R2 in the development of pancreatic cancer, as well as its potential to serve as a biomarker for immunotherapy efficacy prediction for pancreatic cancer.\u0000","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"33 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-09DOI: 10.1097/jp9.0000000000000173
Gayathri Swaminathan, Toshie Saito, S. Husain
The ‘omics’ revolution has transformed the biomedical research landscape by equipping scientists with the ability to interrogate complex biological phenomenon and disease processes at an unprecedented level. The volume of ‘big’ data generated by the different omics studies such as genomics, transcriptomics, proteomics, and metabolomics has led to the concurrent development of computational tools to enable in silico analysis and aid data deconvolution. Considering the intensive resources and high costs required to generate and analyze big data, there has been centralized, collaborative efforts to make the data and analysis tools freely available as ‘Open Source’, to benefit the wider research community. Pancreatology research studies have contributed to this ‘big data rush’ and have additionally benefitted from utilizing the open source data as evidenced by the increasing number of new research findings and publications that stem from such data. In this review, we briefly introduce the evolution of open source omics data, data types, the ‘FAIR’ guiding principles for data management and reuse, and centralized platforms that enable free and fair data accessibility, availability, and provide tools for omics data analysis. We illustrate, through the case study of our own experience in mining pancreatitis omics data, the power of repurposing open source data to answer translationally relevant questions in pancreas research.
{"title":"Exploiting Open Source Omics Data to Advance Pancreas Research","authors":"Gayathri Swaminathan, Toshie Saito, S. Husain","doi":"10.1097/jp9.0000000000000173","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000173","url":null,"abstract":"The ‘omics’ revolution has transformed the biomedical research landscape by equipping scientists with the ability to interrogate complex biological phenomenon and disease processes at an unprecedented level. The volume of ‘big’ data generated by the different omics studies such as genomics, transcriptomics, proteomics, and metabolomics has led to the concurrent development of computational tools to enable in silico analysis and aid data deconvolution. Considering the intensive resources and high costs required to generate and analyze big data, there has been centralized, collaborative efforts to make the data and analysis tools freely available as ‘Open Source’, to benefit the wider research community. Pancreatology research studies have contributed to this ‘big data rush’ and have additionally benefitted from utilizing the open source data as evidenced by the increasing number of new research findings and publications that stem from such data. In this review, we briefly introduce the evolution of open source omics data, data types, the ‘FAIR’ guiding principles for data management and reuse, and centralized platforms that enable free and fair data accessibility, availability, and provide tools for omics data analysis. We illustrate, through the case study of our own experience in mining pancreatitis omics data, the power of repurposing open source data to answer translationally relevant questions in pancreas research.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139789517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-09DOI: 10.1097/jp9.0000000000000173
Gayathri Swaminathan, Toshie Saito, S. Husain
The ‘omics’ revolution has transformed the biomedical research landscape by equipping scientists with the ability to interrogate complex biological phenomenon and disease processes at an unprecedented level. The volume of ‘big’ data generated by the different omics studies such as genomics, transcriptomics, proteomics, and metabolomics has led to the concurrent development of computational tools to enable in silico analysis and aid data deconvolution. Considering the intensive resources and high costs required to generate and analyze big data, there has been centralized, collaborative efforts to make the data and analysis tools freely available as ‘Open Source’, to benefit the wider research community. Pancreatology research studies have contributed to this ‘big data rush’ and have additionally benefitted from utilizing the open source data as evidenced by the increasing number of new research findings and publications that stem from such data. In this review, we briefly introduce the evolution of open source omics data, data types, the ‘FAIR’ guiding principles for data management and reuse, and centralized platforms that enable free and fair data accessibility, availability, and provide tools for omics data analysis. We illustrate, through the case study of our own experience in mining pancreatitis omics data, the power of repurposing open source data to answer translationally relevant questions in pancreas research.
{"title":"Exploiting Open Source Omics Data to Advance Pancreas Research","authors":"Gayathri Swaminathan, Toshie Saito, S. Husain","doi":"10.1097/jp9.0000000000000173","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000173","url":null,"abstract":"The ‘omics’ revolution has transformed the biomedical research landscape by equipping scientists with the ability to interrogate complex biological phenomenon and disease processes at an unprecedented level. The volume of ‘big’ data generated by the different omics studies such as genomics, transcriptomics, proteomics, and metabolomics has led to the concurrent development of computational tools to enable in silico analysis and aid data deconvolution. Considering the intensive resources and high costs required to generate and analyze big data, there has been centralized, collaborative efforts to make the data and analysis tools freely available as ‘Open Source’, to benefit the wider research community. Pancreatology research studies have contributed to this ‘big data rush’ and have additionally benefitted from utilizing the open source data as evidenced by the increasing number of new research findings and publications that stem from such data. In this review, we briefly introduce the evolution of open source omics data, data types, the ‘FAIR’ guiding principles for data management and reuse, and centralized platforms that enable free and fair data accessibility, availability, and provide tools for omics data analysis. We illustrate, through the case study of our own experience in mining pancreatitis omics data, the power of repurposing open source data to answer translationally relevant questions in pancreas research.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139849408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-06DOI: 10.1097/jp9.0000000000000172
Sen Yang, Yuze Hua, Qiaofei Liu, Quan Liao
Patients with peritoneal metastatic pancreatic ductal adenocarcinoma (pmPDAC) with high-level serum carbohydrate antigens (CAs) always suffer extremely dismal prognosis, with a median survival of several months. Herein, we reported a case of pmPDAC with high serum CAs who had long-term clinical remission with normalization of CAs after chemoradiation. In November 2019, a 64-year-old male patient was admitted to our center with a solid mass measuring 2.8×2.5×2.0cm in the body of the pancreas near the celiac trunk. Positron emission tomography-computed tomography (PET-CT) revealed an SUVmax of 4.2. The serum CA 242 level exceeded 150.0 U/ml (normal range: 0-20 U/ml), and CA 19-9 was elevated at 975.2 U/ml (normal range: 0-34 U/ml). During laparotomy, the tumor was found to encircle the celiac trunk over 180 degrees, with several small peritoneal nodules in the lesser omental cavity. Pathological examination confirmed the diagnosis of pmPDAC. Next-generation sequencing revealed RAS G12V, EGFR mutation (-), low TMB (tumor mutation burden), and MSS (microsatellite stability). The patient underwent six cycles of the AG regimen (gemcitabine plus nab-paclitaxel), resulting in significant tumor shrinkage and a sharp decline in CAs. Partial remission was achieved. However, due to intolerant neurotoxicity, the AG regimen was discontinued. Subsequently, synchronous oral fluorouracil (S1) and radiation therapy were administered. Five months after radiation treatment, all CAs normalized. Oral S1 was continued for an additional three months. Eventually, all anti-cancer drugs were stopped. Computed tomography scans indicated that the tumor still surrounded the celiac trunk and common hepatic artery. After a thorough discussion, a wait-and-see strategy was adopted. Remarkably, 32 months after stopping anti-cancer medication, the patient remains in good health, with sustained normalization of CAs. At the last follow-up, he had lived for 50 months, and the normalization of the CAs was sustained for 36 months. Although he still suffers the risk of disease progression, it is a successful case of state-of-the-art chemoradiation for a dismal pmPDAC patient.
{"title":"Long-term Sustained Clinical Remission of Peritoneal Metastatic Pancreatic Ductal Adenocarcinoma After Sequential Chemoradiation Therapy: A Case Report","authors":"Sen Yang, Yuze Hua, Qiaofei Liu, Quan Liao","doi":"10.1097/jp9.0000000000000172","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000172","url":null,"abstract":"Patients with peritoneal metastatic pancreatic ductal adenocarcinoma (pmPDAC) with high-level serum carbohydrate antigens (CAs) always suffer extremely dismal prognosis, with a median survival of several months. Herein, we reported a case of pmPDAC with high serum CAs who had long-term clinical remission with normalization of CAs after chemoradiation. In November 2019, a 64-year-old male patient was admitted to our center with a solid mass measuring 2.8×2.5×2.0cm in the body of the pancreas near the celiac trunk. Positron emission tomography-computed tomography (PET-CT) revealed an SUVmax of 4.2. The serum CA 242 level exceeded 150.0 U/ml (normal range: 0-20 U/ml), and CA 19-9 was elevated at 975.2 U/ml (normal range: 0-34 U/ml). During laparotomy, the tumor was found to encircle the celiac trunk over 180 degrees, with several small peritoneal nodules in the lesser omental cavity. Pathological examination confirmed the diagnosis of pmPDAC. Next-generation sequencing revealed RAS G12V, EGFR mutation (-), low TMB (tumor mutation burden), and MSS (microsatellite stability). The patient underwent six cycles of the AG regimen (gemcitabine plus nab-paclitaxel), resulting in significant tumor shrinkage and a sharp decline in CAs. Partial remission was achieved. However, due to intolerant neurotoxicity, the AG regimen was discontinued. Subsequently, synchronous oral fluorouracil (S1) and radiation therapy were administered. Five months after radiation treatment, all CAs normalized. Oral S1 was continued for an additional three months. Eventually, all anti-cancer drugs were stopped. Computed tomography scans indicated that the tumor still surrounded the celiac trunk and common hepatic artery. After a thorough discussion, a wait-and-see strategy was adopted. Remarkably, 32 months after stopping anti-cancer medication, the patient remains in good health, with sustained normalization of CAs.\u0000 At the last follow-up, he had lived for 50 months, and the normalization of the CAs was sustained for 36 months. Although he still suffers the risk of disease progression, it is a successful case of state-of-the-art chemoradiation for a dismal pmPDAC patient.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"253 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139858459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-06DOI: 10.1097/jp9.0000000000000172
Sen Yang, Yuze Hua, Qiaofei Liu, Quan Liao
Patients with peritoneal metastatic pancreatic ductal adenocarcinoma (pmPDAC) with high-level serum carbohydrate antigens (CAs) always suffer extremely dismal prognosis, with a median survival of several months. Herein, we reported a case of pmPDAC with high serum CAs who had long-term clinical remission with normalization of CAs after chemoradiation. In November 2019, a 64-year-old male patient was admitted to our center with a solid mass measuring 2.8×2.5×2.0cm in the body of the pancreas near the celiac trunk. Positron emission tomography-computed tomography (PET-CT) revealed an SUVmax of 4.2. The serum CA 242 level exceeded 150.0 U/ml (normal range: 0-20 U/ml), and CA 19-9 was elevated at 975.2 U/ml (normal range: 0-34 U/ml). During laparotomy, the tumor was found to encircle the celiac trunk over 180 degrees, with several small peritoneal nodules in the lesser omental cavity. Pathological examination confirmed the diagnosis of pmPDAC. Next-generation sequencing revealed RAS G12V, EGFR mutation (-), low TMB (tumor mutation burden), and MSS (microsatellite stability). The patient underwent six cycles of the AG regimen (gemcitabine plus nab-paclitaxel), resulting in significant tumor shrinkage and a sharp decline in CAs. Partial remission was achieved. However, due to intolerant neurotoxicity, the AG regimen was discontinued. Subsequently, synchronous oral fluorouracil (S1) and radiation therapy were administered. Five months after radiation treatment, all CAs normalized. Oral S1 was continued for an additional three months. Eventually, all anti-cancer drugs were stopped. Computed tomography scans indicated that the tumor still surrounded the celiac trunk and common hepatic artery. After a thorough discussion, a wait-and-see strategy was adopted. Remarkably, 32 months after stopping anti-cancer medication, the patient remains in good health, with sustained normalization of CAs. At the last follow-up, he had lived for 50 months, and the normalization of the CAs was sustained for 36 months. Although he still suffers the risk of disease progression, it is a successful case of state-of-the-art chemoradiation for a dismal pmPDAC patient.
{"title":"Long-term Sustained Clinical Remission of Peritoneal Metastatic Pancreatic Ductal Adenocarcinoma After Sequential Chemoradiation Therapy: A Case Report","authors":"Sen Yang, Yuze Hua, Qiaofei Liu, Quan Liao","doi":"10.1097/jp9.0000000000000172","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000172","url":null,"abstract":"Patients with peritoneal metastatic pancreatic ductal adenocarcinoma (pmPDAC) with high-level serum carbohydrate antigens (CAs) always suffer extremely dismal prognosis, with a median survival of several months. Herein, we reported a case of pmPDAC with high serum CAs who had long-term clinical remission with normalization of CAs after chemoradiation. In November 2019, a 64-year-old male patient was admitted to our center with a solid mass measuring 2.8×2.5×2.0cm in the body of the pancreas near the celiac trunk. Positron emission tomography-computed tomography (PET-CT) revealed an SUVmax of 4.2. The serum CA 242 level exceeded 150.0 U/ml (normal range: 0-20 U/ml), and CA 19-9 was elevated at 975.2 U/ml (normal range: 0-34 U/ml). During laparotomy, the tumor was found to encircle the celiac trunk over 180 degrees, with several small peritoneal nodules in the lesser omental cavity. Pathological examination confirmed the diagnosis of pmPDAC. Next-generation sequencing revealed RAS G12V, EGFR mutation (-), low TMB (tumor mutation burden), and MSS (microsatellite stability). The patient underwent six cycles of the AG regimen (gemcitabine plus nab-paclitaxel), resulting in significant tumor shrinkage and a sharp decline in CAs. Partial remission was achieved. However, due to intolerant neurotoxicity, the AG regimen was discontinued. Subsequently, synchronous oral fluorouracil (S1) and radiation therapy were administered. Five months after radiation treatment, all CAs normalized. Oral S1 was continued for an additional three months. Eventually, all anti-cancer drugs were stopped. Computed tomography scans indicated that the tumor still surrounded the celiac trunk and common hepatic artery. After a thorough discussion, a wait-and-see strategy was adopted. Remarkably, 32 months after stopping anti-cancer medication, the patient remains in good health, with sustained normalization of CAs.\u0000 At the last follow-up, he had lived for 50 months, and the normalization of the CAs was sustained for 36 months. Although he still suffers the risk of disease progression, it is a successful case of state-of-the-art chemoradiation for a dismal pmPDAC patient.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"6 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139798693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-14DOI: 10.1097/jp9.0000000000000165
Parth S Patel, V. Akshintala
Endoscopic retrograde cholangiopancreatography (ERCP) has continued to develop over recent decades with regards to both indications for its use and improvements in technique. The most common complication is post- endoscopic retrograde cholangiopancreatography pancreatitis (PEP) with incidence rates being reported at ~10%. The exact mechanism of PEP is unknown but is likely multi-factorial with papillary edema contributing to the activation of the inflammatory cascade playing an important role. Selected risk factors include patient-related factors (female, sex, younger age, sphincter of Oddi dysfunction, and history of PEP) and procedure-related factors (difficult cannulation, multiple pancreatic duct guidewire passes, pancreatic acinarization, multiple pancreatic duct contrast injections and precut sphincterotomy). Several preventative prophylactic strategies have been posited; however, current guidelines recommend the use of rectal NSAIDs, aggressive IV fluid hydration and pancreatic duct stents. Appropriate patient selection and the use of non-invasive imaging modalities for diagnosis of pancreaticobiliary abnormalities is a key aspect in prevention. Future studies continue to explore various pharmacologic, procedure-related and combination strategies for prevention and will be important as the use of ERCP continues to grow.
{"title":"Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis – A Review","authors":"Parth S Patel, V. Akshintala","doi":"10.1097/jp9.0000000000000165","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000165","url":null,"abstract":"Endoscopic retrograde cholangiopancreatography (ERCP) has continued to develop over recent decades with regards to both indications for its use and improvements in technique. The most common complication is post- endoscopic retrograde cholangiopancreatography pancreatitis (PEP) with incidence rates being reported at ~10%. The exact mechanism of PEP is unknown but is likely multi-factorial with papillary edema contributing to the activation of the inflammatory cascade playing an important role. Selected risk factors include patient-related factors (female, sex, younger age, sphincter of Oddi dysfunction, and history of PEP) and procedure-related factors (difficult cannulation, multiple pancreatic duct guidewire passes, pancreatic acinarization, multiple pancreatic duct contrast injections and precut sphincterotomy). Several preventative prophylactic strategies have been posited; however, current guidelines recommend the use of rectal NSAIDs, aggressive IV fluid hydration and pancreatic duct stents. Appropriate patient selection and the use of non-invasive imaging modalities for diagnosis of pancreaticobiliary abnormalities is a key aspect in prevention. Future studies continue to explore various pharmacologic, procedure-related and combination strategies for prevention and will be important as the use of ERCP continues to grow.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"18 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139002829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-14DOI: 10.1097/jp9.0000000000000162
M. Bachand, Mohamed-Anas Chennouf, Mandy Malick, Annie Beaudoin
Long term surveillance of branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) remains controversial, particularly regarding cysts follow up > 5 years. The primary endpoint of this study was to assess the risk of malignant transformation of presumed BD-IPMN during follow-up and identify clinical and morphological predictors of malignancy. We performed a retrospective analysis of data from all patients with a presumed BD-IPMN diagnosis at the CIUSSS de l’Estrie CHUS, from 2004-2018. The final database included 380 patients with presumed BD-IPMN with a median follow up of 43,9 months (IQR 28,6-73,3 months). Mean age at diagnosis was 65,5 years [27-90], 159 patients (42,8%) were male and 17 patients (4,5%) underwent resection of their lesion during their surveillance period. In our cohort, 132 patients (34,7%) had a follow-up > 5 years. Overall risk of malignancy was 2.1% [0.9%-4.1%]. During follow-up, neoplastic transformation was observed in 2/132 patients (1,5%) surveilled > 5 years. Malignancy was significantly associated with cyst growth > 2,5 mm/year (57,1% vs 5,8% p < 0,001) dilated MPD (71,4% vs 4,9% p<0,001), solid component (71,4% vs 1,3% p<0,001), positive cytology (37,5% vs 0,5% p<0,001), development of high-risk stigmatas (87,5% vs 1,9% p <0,001) or worrisome features (87,5% vs 23,9% p<0,001) during follow up and symptoms of jaundice (25% vs 0,5% p=0,002) and abdominal pain (50% vs 9,4% p=0,005). While overall malignancy risk remains low in presumed BD-IPMN, continuous surveillance should be pursued after 5 years in surgically fit individuals, particularly in patients who develop our identified risk factors.
对分支导管内乳头状粘液瘤（BD-IPMN）的长期监测仍存在争议，尤其是对随访时间超过 5 年的囊肿。本研究的主要终点是评估随访期间假定的 BD-IPMN 恶性转化的风险，并确定恶变的临床和形态学预测因素。 我们对CIUSSS de l'Estrie CHUS在2004-2018年间诊断出的所有假定BD-IPMN患者的数据进行了回顾性分析。 最终数据库包括380名推测为BD-IPMN的患者，中位随访时间为43.9个月（IQR为28.6-73.3个月）。诊断时的平均年龄为 65.5 岁 [27-90]，159 名患者（42.8%）为男性，17 名患者（4.5%）在监测期间接受了病灶切除术。在我们的队列中，132 名患者（34.7%）的随访时间超过 5 年。恶性肿瘤的总体风险为 2.1% [0.9%-4.1%]。在随访期间，2/132 名（1.5%）随访时间超过 5 年的患者出现了肿瘤变。恶性肿瘤与囊肿生长速度大于 2.5 毫米/年（57.1% vs 5.8% p < 0.001）、MPD 扩张（71.4% vs 4.9% p < 0.001）、实性成分（71.4% vs 1.3% p < 0.001）、细胞学阳性（37.5% vs 0.5% p < 0、001）、随访期间出现高风险烙印（87.5% vs 1.9% p<0.001）或令人担忧的特征（87.5% vs 23.9% p<0.001）以及黄疸（25% vs 0.5% p=0.002）和腹痛（50% vs 9.4% p=0.005）症状。 虽然假定的 BD-IPMN 的总体恶性肿瘤风险仍然很低，但对于适合手术的患者，尤其是出现我们所确定的风险因素的患者，应在 5 年后继续进行监测。
{"title":"Branch-duct intraductal papillary mucinous neoplasm (BD-IPMN): a retrospective study on neoplastic risk after 5 years surveillance","authors":"M. Bachand, Mohamed-Anas Chennouf, Mandy Malick, Annie Beaudoin","doi":"10.1097/jp9.0000000000000162","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000162","url":null,"abstract":"\u0000 \u0000 Long term surveillance of branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) remains controversial, particularly regarding cysts follow up > 5 years. The primary endpoint of this study was to assess the risk of malignant transformation of presumed BD-IPMN during follow-up and identify clinical and morphological predictors of malignancy.\u0000 \u0000 \u0000 \u0000 We performed a retrospective analysis of data from all patients with a presumed BD-IPMN diagnosis at the CIUSSS de l’Estrie CHUS, from 2004-2018.\u0000 \u0000 \u0000 \u0000 The final database included 380 patients with presumed BD-IPMN with a median follow up of 43,9 months (IQR 28,6-73,3 months). Mean age at diagnosis was 65,5 years [27-90], 159 patients (42,8%) were male and 17 patients (4,5%) underwent resection of their lesion during their surveillance period. In our cohort, 132 patients (34,7%) had a follow-up > 5 years.\u0000 Overall risk of malignancy was 2.1% [0.9%-4.1%]. During follow-up, neoplastic transformation was observed in 2/132 patients (1,5%) surveilled > 5 years. Malignancy was significantly associated with cyst growth > 2,5 mm/year (57,1% vs 5,8% p < 0,001) dilated MPD (71,4% vs 4,9% p<0,001), solid component (71,4% vs 1,3% p<0,001), positive cytology (37,5% vs 0,5% p<0,001), development of high-risk stigmatas (87,5% vs 1,9% p <0,001) or worrisome features (87,5% vs 23,9% p<0,001) during follow up and symptoms of jaundice (25% vs 0,5% p=0,002) and abdominal pain (50% vs 9,4% p=0,005).\u0000 \u0000 \u0000 \u0000 While overall malignancy risk remains low in presumed BD-IPMN, continuous surveillance should be pursued after 5 years in surgically fit individuals, particularly in patients who develop our identified risk factors.\u0000","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"6 5‐6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138972469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic pancreatitis (CP) is a multifaceted disorder influenced by environmental and genetic factors, with smoking and alcohol consumption being major contributors. Recent developments encompass the advent of innovative transgenic models and the identification of susceptibility genes, shedding light on the genetic aspect of CP. The pathogenesis of this disease involves a complex interplay of pancreatic acinar cell dysfunction, inflammatory reactions, and fibrosis. Current research delves into understanding these molecular mechanisms. Pain, a pivotal symptom of CP, has been increasingly studied to develop effective therapeutic interventions. Diagnostic advancements, including endoscopic ultrasound, radiomics, and blood-based markers, have shown potential in enhancing early CP detection. Moreover, recent clinical trials have optimized treatment approaches, such as pancreatic stone fragmentation, stent placement, and decision-making between endoscopic and surgical procedures. Emerging therapies, including chemical pancreatectomy and gene therapy, present promising opportunities for improved CP management.
{"title":"A Comprehensive Review of Recent Advances in Chronic Pancreatitis","authors":"Shenghan Mao, Wen‐Bin Zou, Xiaotong Mao, Zhao-Shen Li, Zhuan Liao","doi":"10.1097/jp9.0000000000000161","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000161","url":null,"abstract":"Chronic pancreatitis (CP) is a multifaceted disorder influenced by environmental and genetic factors, with smoking and alcohol consumption being major contributors. Recent developments encompass the advent of innovative transgenic models and the identification of susceptibility genes, shedding light on the genetic aspect of CP. The pathogenesis of this disease involves a complex interplay of pancreatic acinar cell dysfunction, inflammatory reactions, and fibrosis. Current research delves into understanding these molecular mechanisms. Pain, a pivotal symptom of CP, has been increasingly studied to develop effective therapeutic interventions. Diagnostic advancements, including endoscopic ultrasound, radiomics, and blood-based markers, have shown potential in enhancing early CP detection. Moreover, recent clinical trials have optimized treatment approaches, such as pancreatic stone fragmentation, stent placement, and decision-making between endoscopic and surgical procedures. Emerging therapies, including chemical pancreatectomy and gene therapy, present promising opportunities for improved CP management.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139002751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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