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1. Discharge protocol in acute pancreatitis: an international survey and cohort analysis

Author

Rita Nagy, Klementina Ocskay, Zoltán Sipos, Andrea Szentesi, Áron Vincze, László Czakó, Ferenc Izbéki, Natalia V. Shirinskaya, Vladimir L. Poluektov, Alexandr N. Zolotov, Yin Zhu, Liang Xia, Wenhua He, Robert Sutton, Peter Szatmary, Rajarshi Mukherjee, Isobel Saffron Burridge, Emma Wauchope, Elsa Francisco, David Aparicio, Bruno Pinto, António Gomes, Vitor Nunes, Vasile Marcel Tantau, Emanuela Denisa Sagau, Alina Ioana Tantau, Andra Iulia Suceveanu, Cristina Tocia, Andrei Dumitru, Elizabeth Pando, Piero Alberti, Arturo Cirera, Xavier Molero, Hong Sik Lee, Min Kyu Jung, Eui Joo Kim, Sanghyub Lee, María Lourdes Ruiz Rebollo, Reyes Busta Nistal, Sandra Izquierdo Santervas, Dusan Lesko, Marek Soltes, Jozef Radonak, Hubert Zatorski, Ewa Małecka-Panas, Adam Fabisiak, M. Susak Yaroslav, V. Maksymenko Mykhailo, A. Tkachenko Olekcandr, Giedrius Barauskas, Vytautas Simanaitis, Povilas Ignatavicius, Mariana Jinga, Vasile-Daniel Balaban, Cristina Patoni, Liang Gong, Kai Song, Yunlong Li, T. Cúrdia Gonçalves, Marta Freitas, Vítor Macedo, Marlies Vornhuelz, Sarah Klauss, Georg Beyer, Aydin Seref Koksal, Mukaddes Tozlu, Ahmet Tarik Eminler, Nuria Torres Monclús, Eva Pijoan Comas, Juan Armando Rodriguez Oballe, Łukasz Nawacki, Stanisław Głuszek, Alberto Rama-Fernández, Marco Galego, Daniel de la Iglesia, Umut Emre Aykut, Deniz Güney Duman, Rahmi Aslan, Adriana Gherbon, Lihui Deng, Wei Huang, Qing Xia, Goran Poropat, Anja Radovan, Luka Vranić, Claudio Ricci, Carlo Ingaldi, Riccardo Casadei, Ionut Negoi, Cezar Ciubotaru, Florin Mihail Iordache, Gabriel Constantinescu, Vasile Sandru, Engin Altintas, Hatice Rizaoglu Balci, Júlio Constantino, Débora Aveiro, Jorge Pereira, Suleyman Gunay, Seda Misirlioglu Sucan, Oleksiy Dronov, Inna Kovalska, Nikhil Bush, Surinder Singh Rana, Serge Chooklin, Serhii Chuklin, Ionut Adrian Saizu, Cristian Gheorghe, Philipp Göltl, Michael Hirth, Radu Bogdan Mateescu, Geanina Papuc, Georgi Angelov Minkov, Emil Tihomirov Enchev, Laura Mastrangelo, Elio Jovine, Weiwei Chen, Quping Zhu, Anita Gąsiorowska, Natalia Fabisiak, Mihailo Bezmarevic, Andrey Litvin, Martina Cattani Mottes, Eun Kwang Choi, Peter Bánovčin, Lenka Nosáková, Mila Dimitrova Kovacheva-Slavova, Ali Kchaou, Ahmed Tlili, Marco V. Marino, Katarzyna Kusnierz, Artautas Mickevicius, Marcus Hollenbach, Pavol Molcan, Orestis Ioannidis, Mark Valerievich Tokarev, Ali Tüzün Ince, Ivan Albertovich Semenenko, Shamil Galeev, Elena Ramírez-Maldonado, Ville Sallinen, Petr Pencik, Judit Bajor, Patricia Sarlós, Roland Hágendorn, Szilárd Gódi, Imre Szabó, József Czimmer, Gabriella Pár, Anita Illés, Nándor Faluhelyi, Péter Kanizsai, Tamás Nagy, Alexandra Mikó, Balázs Németh, József Hamvas, Barnabás Bod, Márta Varga, Imola Török, János Novák, Árpád Patai, János Sümegi, Csaba Góg, Mária Papp, Bálint Erőss, Szilárd Váncsa, Brigitta Teutsch, Katalin Márta, Péter Jenő Hegyi, Tamás Tornai, Balázs Lázár, Tamás Hussein, Dorottya Tarján, Mónika Lipp, Beáta Kovács, Orsolya Urbán, Emese Fürst, Edina Tari, Ibolya Kocsis, Pál Maurovich-Horvát, Balázs Tihanyi, Orsolya Eperjesi, Zita Kormos, Pál Ákos Deák, Andrea Párniczky, and Péter Hegyi

Subjects
Medicine, Science
Abstract

Abstract There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p

Published
2023
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2. Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality

Author

Klementina Ocskay, Zsófia Vinkó, Dávid Németh, László Szabó, Judit Bajor, Szilárd Gódi, Patrícia Sarlós, László Czakó, Ferenc Izbéki, József Hamvas, Mária Papp, Márta Varga, Imola Török, Artautas Mickevicius, Ville Sallinen, Elena Ramirez Maldonado, Shamil Galeev, Alexandra Mikó, Bálint Erőss, Marcell Imrei, Péter Jenő Hegyi, Nándor Faluhelyi, Orsolya Farkas, Péter Kanizsai, Attila Miseta, Tamás Nagy, Roland Hágendorn, Zsolt Márton, Zsolt Szakács, Andrea Szentesi, Péter Hegyi, and Andrea Párniczky

Subjects
Medicine, Science
Abstract

Abstract The incidence and medical costs of acute pancreatitis (AP) are on the rise, and severe cases still have a 30% mortality rate. We aimed to evaluate hypoalbuminemia as a risk factor and the prognostic value of human serum albumin in AP. Data from 2461 patients were extracted from the international, prospective, multicentre AP registry operated by the Hungarian Pancreatic Study Group. Data from patients with albumin measurement in the first 48 h (n = 1149) and anytime during hospitalization (n = 1272) were analysed. Multivariate binary logistic regression and Receiver Operator Characteristic curve analysis were used. The prevalence of hypoalbuminemia (

Published
2021
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3. EASY‐APP: An artificial intelligence model and application for early and easy prediction of severity in acute pancreatitis

Author

Balázs Kui, József Pintér, Roland Molontay, Marcell Nagy, Nelli Farkas, Noémi Gede, Áron Vincze, Judit Bajor, Szilárd Gódi, József Czimmer, Imre Szabó, Anita Illés, Patrícia Sarlós, Roland Hágendorn, Gabriella Pár, Mária Papp, Zsuzsanna Vitális, György Kovács, Eszter Fehér, Ildikó Földi, Ferenc Izbéki, László Gajdán, Roland Fejes, Balázs Csaba Németh, Imola Török, Hunor Farkas, Artautas Mickevicius, Ville Sallinen, Shamil Galeev, Elena Ramírez‐Maldonado, Andrea Párniczky, Bálint Erőss, Péter Jenő Hegyi, Katalin Márta, Szilárd Váncsa, Robert Sutton, Peter Szatmary, Diane Latawiec, Chris Halloran, Enrique de‐Madaria, Elizabeth Pando, Piero Alberti, Maria José Gómez‐Jurado, Alina Tantau, Andrea Szentesi, Péter Hegyi, and the Hungarian Pancreatic Study Group

Subjects
acute pancreatitis, artificial intelligence, severity prediction, Medicine (General), R5-920
Abstract

Abstract Background Acute pancreatitis (AP) is a potentially severe or even fatal inflammation of the pancreas. Early identification of patients at high risk for developing a severe course of the disease is crucial for preventing organ failure and death. Most of the former predictive scores require many parameters or at least 24 h to predict the severity; therefore, the early therapeutic window is often missed. Methods The early achievable severity index (EASY) is a multicentre, multinational, prospective and observational study (ISRCTN10525246). The predictions were made using machine learning models. We used the scikit‐learn, xgboost and catboost Python packages for modelling. We evaluated our models using fourfold cross‐validation, and the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and accuracy metrics were calculated on the union of the test sets of the cross‐validation. The most critical factors and their contribution to the prediction were identified using a modern tool of explainable artificial intelligence called SHapley Additive exPlanations (SHAP). Results The prediction model was based on an international cohort of 1184 patients and a validation cohort of 3543 patients. The best performing model was an XGBoost classifier with an average AUC score of 0.81 ± 0.033 and an accuracy of 89.1%, and the model improved with experience. The six most influential features were the respiratory rate, body temperature, abdominal muscular reflex, gender, age and glucose level. Using the XGBoost machine learning algorithm for prediction, the SHAP values for the explanation and the bootstrapping method to estimate confidence, we developed a free and easy‐to‐use web application in the Streamlit Python‐based framework (http://easy‐app.org/). Conclusions The EASY prediction score is a practical tool for identifying patients at high risk for severe AP within hours of hospital admission. The web application is available for clinicians and contributes to the improvement of the model.

Published
2022
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4. Initial Renal Function (eGFR) Is a Prognostic Marker of Severe Acute Pancreatitis: A Cohort-Analysis of 1,224 Prospectively Collected Cases

Author

Pál Tod, Nelli Farkas, Dávid Németh, Gábor Szénási, Áron Vincze, Roland Hágendorn, László Czakó, Dóra Illés, Ferenc Izbéki, Veronika Dunás-Varga, Mária Papp, József Hamvas, Márta Varga, Katalin Gombos, Tamás Nagy, Zsolt Márton, Nándor Faluhelyi, Imola Török, Ali Tüzün Ince, Shamil Galeev, Péter Jenő Hegyi, Andrea Szentesi, Andrea Párniczky, Zsolt Szakács, Péter Hegyi, and Péter Hamar

Subjects
AP severity and mortality, renal dysfunction, CKD-EPI, EGFR, human retrospective cohort, Medicine (General), R5-920
Abstract

Background: Acute pancreatitis (AP) is a life-threatening disease. We aimed to explore the prognostic relevance of renal function based on estimated glomerular filtration rate (eGFR).Methods: A prospective registry of AP patients was established by the Hungarian Pancreatic Study Group. Data of 1,224 consecutive patients were collected between 2012 and 2017. Patients were divided into 3 groups according to their eGFR measured within 24 h of hospitalization: normal renal function: >90 mL/min, mild to moderate renal functional impairment: 30–90 mL/min and severe renal dysfunction:

Published
2021
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5. A Multicenter, International Cohort Analysis of 1435 Cases to Support Clinical Trial Design in Acute Pancreatitis

Author

Nelli Farkas, Lilla Hanák, Alexandra Mikó, Judit Bajor, Patrícia Sarlós, József Czimmer, Áron Vincze, Szilárd Gódi, Dániel Pécsi, Péter Varjú, Katalin Márta, Péter Jenő Hegyi, Bálint Erőss, Zsolt Szakács, Tamás Takács, László Czakó, Balázs Németh, Dóra Illés, Balázs Kui, Erika Darvasi, Ferenc Izbéki, Adrienn Halász, Veronika Dunás-Varga, László Gajdán, József Hamvas, Mária Papp, Ildikó Földi, Krisztina Eszter Fehér, Márta Varga, Klára Csefkó, Imola Török, Farkas Hunor-Pál, Artautas Mickevicius, Elena Ramirez Maldonado, Ville Sallinen, János Novák, Ali Tüzün Ince, Shamil Galeev, Barnabás Bod, János Sümegi, Petr Pencik, Attila Szepes, Andrea Szentesi, Andrea Párniczky, and Péter Hegyi

Subjects
acute pancreatitis, C-reactive protein, white blood cell, trial design, sample size calculation, Physiology, QP1-981
Abstract

BackgroundC-reactive protein level (CRP) and white blood cell count (WBC) have been variably used in clinical trials on acute pancreatitis (AP). We assessed their potential role.MethodsFirst, we investigated studies which have used CRP or WBC, to describe their current role in trials on AP. Second, we extracted the data of 1435 episodes of AP from our registry. CRP and WBC on admission, within 24 h from the onset of pain and their highest values were analyzed. Descriptive statistical tools as Kruskal–Wallis, Mann–Whitney U, Levene’s F tests, Receiver Operating Characteristic (ROC) curve analysis and AUC (Area Under the Curve) with 95% confidence interval (CI) were performed.ResultsOur literature review showed extreme variability of CRP used as an inclusion criterion or as a primary outcome or both in past and current trials on AP. In our cohort, CRP levels on admission poorly predicted mortality and severe cases of AP; AUC: 0.669 (CI:0.569–0.770); AUC:0.681 (CI: 0.601–0.761), respectively. CRP levels measured within 24 h from the onset of pain failed to predict mortality or severity; AUC: 0.741 (CI:0.627–0.854); AUC:0.690 (CI:0.586–0.793), respectively. The highest CRP during hospitalization had equally poor predictive accuracy for mortality and severity AUC:0.656 (CI:0.544–0.768); AUC:0.705 (CI:0.640–0.769) respectively. CRP within 24 h from the onset of pain used as an inclusion criterion markedly increased the combined event rate of mortality and severe AP (13% for CRP > 25 mg/l and 28% for CRP > 200 mg/l).ConclusionCRP within 24 h from the onset of pain as an inclusion criterion elevates event rates and reduces the number of patients required in trials on AP.

Published
2019
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6. Inflammatory bowel disease does not alter the clinical features and the management of acute pancreatitis: A prospective, multicentre, exact-matched cohort analysis

Author

Dóra Dohos, Nelli Farkas, Alex Váradi, Bálint Erőss, Andrea Párniczky, Andrea Szentesi, Péter Hegyi, Patrícia Sarlós, László Czakó, Eszter Boros, Tamás Hussein, Katalin Márta, Katalin Borka, Attila Doros, Nóra Hosszúfalusi, László Zubek, Zsolt Molnár, Szilárd Váncsa, Rita Nagy, Stefania Bunduc, Mária Földi, Nándor Faluhelyi, Orsolya Farkas, Áron Vincze, Balázs Kui, Ferenc Izbéki, József Hamvas, Mária Papp, Márta Varga, Imola Török, Artautas Mickevicius, Elena Ramirez Maldonado, Ville Sallinen, Ali Tüzün Ince, Shamil Galeev, Goran Poropat, Davor Stimac, Andrey Litvin, Imanta Ozola-Zalite, Aldis Pukitis, Kristina Zadorozhna, Tibor Gyökeres, and İNCE, ALİ TÜZÜN

Subjects
Hepatology, Endocrinology, Diabetes and Metabolism, Gastroenterology, Inflammatory Bowel Diseases, Prognosis, Severity of Illness Index, Anti-Bacterial Agents, Cohort Studies, Pancreatitis, Acute Disease, Acute pancreatitis, Inflammatory bowel disease, Antibiotics, Disease management, Humans, Prospective Studies, 03.02. Klinikai orvostan
Abstract

© 2022 The AuthorsObjective and aims: Acute pancreatitis in inflammatory bowel disease occurs mainly as an extraintestinal manifestation or a side effect of medications. We aimed to investigate the prognostic factors and severity indicators of acute pancreatitis and the treatment of patients with both diseases. Design: We performed a matched case-control registry analysis of a multicentre, prospective, international acute pancreatitis registry. Patients with both diseases were matched to patients with acute pancreatitis only in a 1:3 ratio by age and gender. Subgroup analyses were also carried out based on disease type, activity, and treatment of inflammatory bowel disease. Results: No difference in prognostic factors (laboratory parameters, bedside index of severity in acute pancreatitis, imaging results) and outcomes of acute pancreatitis (length of hospitalization, severity, and local or systemic complications) were detected between groups. Significantly lower analgesic use was observed in the inflammatory bowel disease population. Antibiotic use during acute pancreatitis was significantly more common in the immunosuppressed group than in the non-immunosuppressed group (p = 0.017). However, none of the prognostic parameters or the severity indicators showed a significant difference between any subgroup of patients with inflammatory bowel disease. Conclusion: No significant differences in the prognosis and severity of acute pancreatitis could be detected between patients with both diseases and with pancreatitis only. The need for different acute pancreatitis management is not justified in the coexistence of inflammatory bowel disease, and antibiotic overuse should be avoided.

Published
2022
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7. Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases

Author

János Novák, Dániel Pécsi, Bálint Erőss, Ville Sallinen, Klára Csefkó, Patrícia Sarlós, Lilla Hanák, Áron Vincze, Ali Tüzün Ince, János Sümegi, Artautas Mickevicius, László Gajdán, Dóra Illés, Ildikó Földi, Balázs Németh, Péter Varjú, Elena Ramirez Maldonado, József Czimmer, Szilárd Gódi, Petr Pencik, Zsolt Dubravcsik, Balázs Kui, Márta Varga, László Czakó, Hunor Farkas, Péter Hegyi, Imola Török, Judit Bajor, Nelli Farkas, Péter Jenő Hegyi, Katalin Márta, Andrea Párniczky, Alexandra Mikó, Dóra Mosztbacher, Tamás Takács, Andrea Szentesi, Krisztina Fehér, Mária Papp, József Hamvas, Ferenc Izbéki, Adrienn Halász, Barnabás Bod, Erika Darvasi, Zsolt Szakács, Shamil Galeev, İNCE, ALİ TÜZÜN, HUS Abdominal Center, Department of Anatomy, University of Helsinki, Helsinki University Hospital Area, and IV kirurgian klinikka

Subjects
Male, Internationality, Etiology, ALCOHOL-CONSUMPTION, Endocrinology, Diabetes and Metabolism, Gastroenterology, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Medicine, Prospective Studies, Triglyceride Measurement, HYPERLIPIDEMIA, Aged, 80 and over, Hypertriglyceridemia, ISSUES, Incidence (epidemiology), Cohort, Middle Aged, 3. Good health, ELEVATED SERUM TRIGLYCERIDES, 030220 oncology & carcinogenesis, Acute pancreatitis, Female, 030211 gastroenterology & hepatology, Cohort study, Adult, medicine.medical_specialty, Adolescent, Severity, Young Adult, 03 medical and health sciences, Internal medicine, Diabetes mellitus, Humans, Aged, ATLANTA CLASSIFICATION, Hepatology, Triglyceride, business.industry, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, Pancreatitis, chemistry, 3121 General medicine, internal medicine and other clinical medicine, LIPASE, business, AMYLASE
Abstract

BACKGROUND: Hypertriglyceridemia is the third most common cause of acute pancreatitis (AP). It has been shown that hypertriglyceridemia aggravates the severity and related complications of AP; however, detailed analyses of large cohorts are contradictory. Our aim was to investigate the dose-dependent effect of hypertriglyceridemia on AP. METHODS: AP patients over 18 years old who underwent triglyceride measurement within the initial three days were included into our cohort analysis from a prospective international, multicenter AP registry operated by the Hungarian Pancreatic Study Group. Data on 716 AP cases were analyzed. Six groups were created based on the highest triglyceride level (

Published
2020
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8. Hypoalbuminemia, An Independent Risk Factor for Severity and Mortality Affects One Third of Patients in Acute Pancreatitis: Multicenter Prospective International Cohort Analysis

Author

Klementina Ocskay, Zsófia Vinkó, Dávid Németh, László Szabó, Judit Bajor, Szilárd Gódi, Patrícia Sarlós, László Czakó, Ferenc Izbéki, József Hamvas, Mária Papp, Márta Varga, Imola Török, Artautas Mickevicius, Ville Sallinen, Elena Ramirez Maldonado, Shamil Galeev, Alexandra Mikó, Bálint Erőss, Marcell Imrei, Péter Jenő Hegyi, Nándor Faluhelyi, Orsolya Farkas, Péter Kanizsai, Attila Miseta, Tamás Nagy, Roland Hágendorn, Zsolt Márton, Zsolt Szakács, Andrea Szentesi, Péter Hegyi, Andrea Párniczky, and Hungarian Pancreatic Study Group

Subjects
medicine.medical_specialty, Text mining, business.industry, Internal medicine, medicine, Acute pancreatitis, Hypoalbuminemia, Risk factor, business, medicine.disease, Cohort study
Abstract

Introduction The incidence and medical costs of acute pancreatitis (AP) are on the rise, and severe cases still have a 30% mortality rate. We aimed to evaluate hypoalbuminemia as a risk factor and the prognostic value of human serum albumin in AP. Methods Data of 2461 patients were extracted from the international, prospective, multicenter AP registry of the Hungarian Pancreatic Study Group. Data of patients with albumin measurement in the first 48 hours (n=1149) and anytime during hospitalization (n=1272) was analyzed. Multivariate binary logistic regression and Receiver Operator Characteristic curve analysis were used. Results The prevalence of hypoalbuminemia (Conclusion Hypoalbuminemia is an independent risk factor of severity and mortality in AP, and it shows a dose-dependent relationship with local complications, organ failure, and length of stay.

Published
2021
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9. Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors – a multi-institutional study

Author

Ville Sallinen, Stuart Robinson, Oskar Franklin, Francesca Muffatti, Bertrand Dousset, Shamil Galeev, Anne Antila, Dominik Wiese, Zahar Kovalenko, Alain Sauvanet, Falconi Massimo, Philippe Ruszniewski, G.O. Ceyhan, Nicolas Regenet, Detlef K. Bartsch, Tessa T. Y. Le Large, Francesco Panzuto, Stefano Partelli, Bjørn Edwin, Sven-Petter Haugvik, Elke Tieftrunk, Emma Martínez-Moneo, Sébastien Gaujoux, Pertti Panula / Principal Investigator, Clinicum, IV kirurgian klinikka, Department of Surgery, University of Helsinki, HUS Abdominal Center, CCA - Cancer Treatment and quality of life, Medical oncology laboratory, Sallinen, V. J., Le Large, T. T. Y., Tieftrunk, E., Galeev, S., Kovalenko, Z., Haugvik, S. -P., Antila, A., Franklin, O., Martinez-Moneo, E., Robinson, S. M., Panzuto, F., Regenet, N., Muffatti, F., Partelli, S., Wiese, D., Ruszniewski, P., Dousset, B., Edwin, B., Bartsch, D. K., Sauvanet, A., Massimo, F., Ceyhan, G. O., Gaujoux, S., CCA - Cancer Treatment and Quality of Life, AGEM - Re-generation and cancer of the digestive system, and Graduate School

Subjects
Pancreatic Duct, Male, Pathology, Time Factors, Databases, Factual, 030230 surgery, Neuroendocrine tumors, surgery, 0302 clinical medicine, Retrospective Studie, Risk Factors, pancreatic endocrine tumors, Gastroenterology, Pancreatic Neoplasm, Bile Duct, Middle Aged, FISTULA, 3. Good health, Tumor Burden, ddc, Europe, Neuroendocrine Tumors, 030220 oncology & carcinogenesis, ENDOCRINE TUMORS, PANCREATICODUODENECTOMY, SURVIVAL, Female, Neuroendocrine Tumor, Human, Dilatation, Pathologic, NEOPLASMS, medicine.medical_specialty, Time Factor, UNITED-STATES, Gastroenterology and Hepatology, Disease-Free Survival, prognosis, Pancreaticoduodenectomy, 03 medical and health sciences, Pancreatectomy, medicine, Gastroenterologi, SINGLE INSTITUTION, MANAGEMENT, Humans, Aged, Retrospective Studies, Hepatology, business.industry, Risk Factor, MORTALITY, Pancreatic Ducts, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, 3 DECADES, Pancreatic Neoplasms, 3121 General medicine, internal medicine and other clinical medicine, Bile Ducts, Neoplasm Grading, Neoplasm Recurrence, Local, business
Abstract

Background: Malignant potential of small (

Published
2018
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10. Diagnosis and treatment in chronic pancreatitis: an international survey and case vignette study

Author

Yama Issa, Hjalmar C. van Santvoort, Paul Fockens, Marc G. Besselink, Thomas L. Bollen, Marco J. Bruno, Marja A. Boermeester, Frank G. Moody, Claude Bertrand, Colin Johnson, Aude van Lander, Ross Carter, John B. Conneely, Frederik Berrevoet, Donzília Sousa Silva, Zong-Fang Li, Philippe Lévy, Kofi Oppong, Timothy B. Gardner, C. Mel Wilcox, Jeremy French, Michael Steer, Edward L. Bradley, Peter Layer, Bertrand Napoleon, Jorge Antonio Mosquera, D.J. Gouma, Roland Andersson, Antonio Manzelli, J.M. Klaase, Massimo Falconi, Enrique de-Madaria, Riccardo Casadei, Giuseppe Malleo, Raffaele Pezzilli, Ewa Malecka-Panas, Matthias Lohr, Julia Mayerle, Erik A.J. Rauws, Martin L. Freeman, Affirul Chairil Ariffin, Bhavin Vasavada, Paul Bo-San Lai, Jose Luis Beristain-Hernandez, Álvarez Juan, Haralds Plaudis, Dionisios Vrochides, Vincenzo Neri, Vimalraj Velayutham, Aleksey Andrianov, Joan Figueras, Kjetil Soreide, Aliaksei Shcherba, Mahir Gachabayov, Roger G. Keith, Georgios Tsoulfas, Michael Anthony Fink, Stefano Crippa, Mehrdad Nikfarjam, Dibyajyoti Bora, Rajendra Desai, Marcello Donati, Jan Jin Bong, Emma Martínez Moneo, Gareth Morris-Stiff, Ahmet Coker, Alexandre Prado de Resende, Suryabhan Sakhahari Bhalerao, Sadiq S. Sikora, Dezső Kelemen, László Czakó, Hariharan Ramesh, Oleg Rummo, Aliaksei Fedaruk, Alexey Hlinnik, Madhusudhan Chinthakindi, Traian Dumitrascu, Vyacheslav Egorov, Vincent Bettschart, Michele Molinari, E. Aldana D. Guillermo, Susan L. Orloff, Daniel Vasilev Kostov, Laurent Sulpice, Brett Knowles, Yasutoshi Kimura, Gabriele Marangoni, Rajeev Joshi, Tibor Gyökeres, null Bedin, V. Vladimir, Arpad Ivanecz, Adelmo Antonucci, Jones A.O. Omoshoro-Jones, Richard Nakache, Marco Del Chiaro, Marianne Johnstone, Tomoaki Saito, Gianpaolo Balzano, Serge Chooklin, Piero Boraschi, Walter Park, Pedro Nuno Valente Reis Pereira, Nico Pagano, Pavlos Lykoudis, Lars Ivo Partecke, Aliaksandr Siatkouski, Rosa Jorba Martín, Yasunari Kawabata, Luís Carvalho Lourenço, Carlos Marra-Lopez, Jun Kyu Lee, Nils Habbe, Robert C. Verdonk, Yliya Rabotyagova, Rupjyoti Talukdar, Luca Frulloni, Shamil Galeev, Zoltán Berger, Takeo Yasuda, Thilo Hackert, Ziyovuddin Saatov, Dimitri Aristotle Raptis, Jaume Boadas, Francesco Vitali, Livia Archibugi, Miroslav Ryska, Balazs Tihanyi, Vikesh K. Singh, Atsushi Masamune, Paul Yeaton, Kerrington D. Smith, Shrey Modi, Laura Cosen-Binker, Savio George Barreto, Eugenio Morandi, Sergio Valeri, Cintia Yoko Morioka, Luis F. Lara, Yoshifumi Takeyama, Frank G. Gress, Young-Dong Yu, Ezio Gaia, Sorin Traian Barbu, Ali Tüzün İnce, Akkraporn Deeprasertvit, Yu-Ting Chang, Stephen Olusola Abiola, Sabite Kacar, Peter Muscarella, Henri Braat, Samuel Han, Ali A. Aghdassi, Jean-Louis Frossard, Jill P. Smith, M.P. Schwartz, H.M. van Dullemen, N.G. Venneman, B.W.M. Spanier, Sjoerd Kuiken, Erwin van Geenen, Greg Beilman, Georgios Papachristou, Oscar Chapa Azuela, P. van der Schaar, Nevin Oruc, Marie-Paule Anten, William H. Nealon, Jesús García-Cano, Manol Jovani, Ziad Melki, Mustafa Mohammed Ahmed Ibrahim, M.U. Awajdarip, Mohammad Azam, K.G. Sabu, Igor Ermolaev, Shiran Shetty, Belei Oana, Juris Pokrotnieks, Malgorzata Lazuchiewicz-Kot, Riadh Bouali, Marek Winiarski, Marcus Schmitt, Mihai Rimbas, Alexander Meining, Bories Erwan, Peter N. Meier, Rainer Schoefl, Ahmed Youssef Altonbary, Igor Marsteller, Ingo Wallstabe, Skerdi Prifti, Arnaud Lemmers, M. Horvath, Ajay Kumar, Joseph J. Palermo, Issa, Y., van Santvoort, H. C., Fockens, P., Besselink, M. 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F., Takeyama, Y., Gress, F. G., Yu, Y. -D., Gaia, E., Barbu, S. T., Ince, A. T., Deeprasertvit, A., Chang, Y. -T., Abiola, S. O., Kacar, S., Muscarella, P., Braat, H., Han, S., Aghdassi, A. A., Frossard, J. -L., Smith, J. P., Schwartz, M. P., van Dullemen, H. M., Venneman, N. G., Spanier, B. W. M., Kuiken, S., van Geenen, E., Beilman, G., Papachristou, G., Chapa Azuela, O., van der Schaar, P., Oruc, N., Anten, M. -P., Nealon, W. H., Garcia-Cano, J., Jovani, M., Melki, Z., Ibrahim, M. M. A., Awajdarip, M. U., Azam, M., Sabu, K. G., Ermolaev, I., Shetty, S., Oana, B., Pokrotnieks, J., Lazuchiewicz-Kot, M., Bouali, R., Winiarski, M., Schmitt, M., Rimbas, M., Meining, A., Erwan, B., Meier, P. N., Schoefl, R., Altonbary, A. Y., Marsteller, I., Wallstabe, I., Prifti, S., Lemmers, A., Horvath, M., Kumar, A., Palermo, J. J., Surgery, Amsterdam institute for Infection and Immunity, Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, CCA - Cancer Treatment and Quality of Life, CCA - Imaging and biomarkers, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, Cancer Center Amsterdam, APH - Methodology, AII - Infectious diseases, Issa, Yama, van Santvoort, Hjalmar C., Fockens, Paul, Besselink, Marc G., Bollen, Thomas L., Bruno, Marco J., Boermeester, Marja A., Moody, Frank G., Bertrand, Claude, Johnson, Colin, van Lander, Aude, Carter, Ro, Conneely, John B., Berrevoet, Frederik, Sousa Silva, Donzã­lia, Zong-Fang, Li, Lã©vy, Philippe, Oppong, Kofi, Gardner, Timothy B., Wilcox, C. 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J., Freeman, Martin L., Ariffin, Affirul Chairil, Vasavada, Bhavin, Lai, Paul Bo-San, Beristain-Hernandez, Jose Lui, Juan, à lvarez, Plaudis, Harald, Vrochides, Dionisio, Neri, Vincenzo, Velayutham, Vimalraj, Andrianov, Aleksey, Figueras, Joan, Soreide, Kjetil, Shcherba, Aliaksei, Gachabayov, Mahir, Keith, Roger G., Tsoulfas, Georgio, Fink, Michael Anthony, Crippa, Stefano, Nikfarjam, Mehrdad, Bora, Dibyajyoti, Desai, Rajendra, Donati, Marcello, Bong, Jan Jin, Martínez Moneo, Emma, Morris-Stiff, Gareth, Coker, Ahmet, de Resende, Alexandre Prado, Bhalerao, Suryabhan Sakhahari, Sikora, Sadiq S., Kelemen, Dezså, Czakã³, Lã¡szlã³, Ramesh, Hariharan, Rummo, Oleg, Fedaruk, Aliaksei, Hlinnik, Alexey, Chinthakindi, Madhusudhan, Dumitrascu, Traian, Egorov, Vyacheslav, Bettschart, Vincent, Molinari, Michele, Guillermo, E. 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O., Nakache, Richard, Del Chiaro, Marco, Johnstone, Marianne, Saito, Tomoaki, Balzano, Gianpaolo, Chooklin, Serge, Boraschi, Piero, Park, Walter, Pereira, Pedro Nuno Valente Rei, Pagano, Nico, Lykoudis, Pavlo, Partecke, Lars Ivo, Siatkouski, Aliaksandr, Martã­n, Rosa Jorba, Kawabata, Yasunari, Lourenã§o, Luís Carvalho, Marra-Lopez, Carlo, Lee, Jun Kyu, Habbe, Nil, Verdonk, Robert C., Rabotyagova, Yliya, Talukdar, Rupjyoti, Frulloni, Luca, Galeev, Shamil, Berger, Zoltã¡n, Yasuda, Takeo, Hackert, Thilo, Saatov, Ziyovuddin, Raptis, Dimitri Aristotle, Boadas, Jaume, Vitali, Francesco, Archibugi, Livia, Ryska, Miroslav, Tihanyi, Balaz, Singh, Vikesh K., Masamune, Atsushi, Yeaton, Paul, Smith, Kerrington D., Modi, Shrey, Cosen-Binker, Laura, Barreto, Savio George, Morandi, Eugenio, Valeri, Sergio, Morioka, Cintia Yoko, Lara, Luis F., Takeyama, Yoshifumi, Gress, Frank G., Young-Dong, Yu, Gaia, Ezio, Barbu, Sorin Traian, Ä°nce, Ali Tüzün, Deeprasertvit, Akkraporn, Chang, Yu-Ting, Abiola, Stephen Olusola, Kacar, Sabite, Muscarella, Peter, Braat, Henri, Han, Samuel, Aghdassi, Ali A., Frossard, Jean-Loui, Smith, Jill P., Kuiken, Sjoerd, van Geenen, Erwin, Beilman, Greg, Papachristou, Georgio, Chapa Azuela, Oscar, Oruc, Nevin, Anten, Marie-Paule, Nealon, William H., García-Cano, Jesãº, Jovani, Manol, Melki, Ziad, Ibrahim, Mustafa Mohammed Ahmed, Azam, Mohammad, Ermolaev, Igor, Shetty, Shiran, Oana, Belei, Pokrotnieks, Juri, Lazuchiewicz-Kot, Malgorzata, Bouali, Riadh, Winiarski, Marek, Schmitt, Marcu, Rimbas, Mihai, Meining, Alexander, Erwan, Borie, Meier, Peter N., Schoefl, Rainer, Altonbary, Ahmed Youssef, Marsteller, Igor, Wallstabe, Ingo, Prifti, Skerdi, Lemmers, Arnaud, Kumar, Ajay, Palermo, Joseph J., and Gastroenterology & Hepatology

Subjects
Endoscopic ultrasound, medicine.medical_treatment, Islets of Langerhans Transplantation, Practice Patterns, Diagnosis, treatment, chronic pancreatitis, survey, Bioinformatics, 0302 clinical medicine, Risk Factors, Lithotripsy, Diagnosis, 03.02. Klinikai orvostan, Endoscopy, Digestive System, Chronic, Practice Patterns, Physicians', Tomography, Digestive System Surgical Procedures, treatment, medicine.diagnostic_test, Gastroenterology, Magnetic Resonance Imaging, X-Ray Computed, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Predictive value of tests, Pancreatectomy, 030211 gastroenterology & hepatology, Autologous, medicine.medical_specialty, Clinical Decision-Making, Transplantation, Autologous, Decision Support Techniques, chronic pancreatitis, 03 medical and health sciences, Predictive Value of Tests, Pancreatitis, Chronic, medicine, Humans, survey, Pancreatic duct, Transplantation, Physicians', Hepatology, business.industry, General surgery, Gastroenterologists, Endoscopy, Magnetic resonance imaging, medicine.disease, Pancreatitis, Health Care Surveys, Tomography, X-Ray Computed, business, Digestive System
Abstract

Background The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research. Methods An online survey, including questions regarding the diagnosis and treatment of CP and several controversial clinical case vignettes, was send by e-mail to members of various international pancreatic associations: IHPBA, APA, EPC, ESGE and DPSG. Results A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Buchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic ± ESWL treatment and 29% preferred initial surgical treatment. Conclusion Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged.

Published
2017
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11. Surveillance strategy for small asymptomatic non-functional pancreatic neuroendocrine tumors - a systematic review and meta-analysis

Author

Tessa Y S Le Large, Güralp O. Ceyhan, Ville Sallinen, Shamil Galeev, Raphael L. C. Araujo, Elke Tieftrunk, Sébastien Gaujoux, and Zahar Kovalenko

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, MEDLINE, 030230 surgery, Cochrane Library, Neuroendocrine tumors, Asymptomatic, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Internal medicine, medicine, Humans, Watchful Waiting, Aged, Hepatology, business.industry, Patient Selection, Gastroenterology, Evidence-based medicine, Middle Aged, medicine.disease, Prognosis, 3. Good health, Surgery, Tumor Burden, Pancreatic Neoplasms, Neuroendocrine Tumors, 030220 oncology & carcinogenesis, Meta-analysis, Predictive value of tests, Disease Progression, Female, medicine.symptom, business, Watchful waiting
Abstract

Background Non-functional pancreatic neuroendocrine tumors (NF-PNET) are rare neoplasms being increasingly diagnosed. Surgical treatment or expectant management are both suggested for small NF-PNETs. The aim of this study was to evaluate the outcome of surveillance strategy for small NF-PNETs. Methods A systematic search was performed up to March 2016 in MEDLINE, EMBASE and the Cochrane Library according to the PRISMA guidelines. Data was pooled using the random-effects model. Results Nine articles including 344 patients with sporadic and 64 patients with MEN1 related NF-PNET were selected. Tumor growth was observed in 22% and 52%, development of metastases were reported on 0% and 9%, and rate of secondary surgical resection was 12% and 25% in patients with sporadic or MEN1 related NF-PNETs, respectively. All metastases (1 distant, 4 nodal) were reported by a single study in patients with MEN1. Reason for secondary surgery was tumor growth in half of patients undergoing surgery. Discussion Expectant management of small asymptomatic, sporadic, NF-PNETs could be a reasonable option in highly selected patients. However, the level of evidence is low and longer follow-up is needed to identify patients could benefit from upfront surgery instead of expectant treatment.

Published
2016
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