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Objectives: To develop and validate a radiomics nomogram based on a fully automated pancreas segmentation to assess pancreatic exocrine function. Furthermore, we aimed to compare the performance of the radiomics nomogram with the pancreatic flow output rate (PFR) and conclude on the replacement of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) by the radiomics nomogram for pancreatic exocrine function assessment. Methods: All participants underwent S-MRCP between April 2011 and December 2014 in this retrospective study. PFR was quantified using S-MRCP. Participants were divided into normal and pancreatic exocrine insufficiency (PEI) groups using the cut-off of 200 µg/L of fecal elastase-1. Two prediction models were developed including the clinical and non-enhanced T1-weighted imaging radiomics model. A multivariate logistic regression analysis was conducted to develop the prediction models. The models' performances were determined based on their discrimination, calibration, and clinical utility. Results: A total of 159 participants (mean age ± standard deviation, 45 years ± 14;119 men) included 85 normal and 74 PEI. All the participants were divided into a training set comprising 119 consecutive patients and an independent validation set comprising 40 consecutive patients. The radiomics score was an independent risk factor for PEI (odds ratio = 11.69; p < 0.001). In the validation set, the radiomics nomogram exhibited the highest performance (AUC, 0.92) in PEI prediction, whereas the clinical nomogram and PFR had AUCs of 0.79 and 0.78, respectively. Conclusion: The radiomics nomogram accurately predicted pancreatic exocrine function and outperformed pancreatic flow output rate on S-MRCP in patients with chronic pancreatitis. Key Points: • The clinical nomogram exhibited moderate performance in diagnosing pancreatic exocrine insufficiency. • The radiomics score was an independent risk factor for pancreatic exocrine insufficiency, and every point rise in the rad-score was associated with an 11.69-fold increase in pancreatic exocrine insufficiency risk. • The radiomics nomogram accurately predicted pancreatic exocrine function and outperformed the clinical model and pancreatic flow output rate quantified by secretin-enhanced magnetic resonance cholangiopancreatography on MRI in patients with chronic pancreatitis. [ABSTRACT FROM AUTHOR]

Background: Pain is a major problem in 90% of patients with chronic pancreatitis (CP). Studies evaluating response to antioxidants (AO) are conflicting and no pediatric studies are available. Aims: To evaluate markers of oxidative stress (OS), and efficacy and predictors of response to AO in improving pain in children with CP. Methods: Antioxidants were given to CP children for 6 months. Subjects were assessed at baseline and post-therapy for pain and markers of OS [serum thiobarbituric acid reactive substances (TBARS), superoxide dismutase (S-SOD)] and antioxidant levels [vitamin C, selenium, total antioxidant capacity-ferric reducing ability of plasma (FRAP)]. Matched healthy controls were assessed for OS and antioxidant levels. Good response was defined as ≥ 50% reduction in number of painful days/month. Results: 48 CP children (25 boys, age 13 years) and 14 controls were enrolled. 38/48 cases completed 6 months of therapy. CP cases had higher OS [TBARS (7.8 vs 5.2 nmol/mL; p < 0.001)] and lower antioxidant levels [FRAP (231 vs. 381.3 µmol/L; p = 0.003), vitamin C (0.646 vs. 0.780 mg/dL; p < 0.001)] than controls. Significant reduction in TBARS and S-SOD and increase in FRAP, vitamin C, and selenium occurred after 6 months. 10.5% cases had minor side effects. 26(68%) cases had a good response, with 9(24%) becoming pain-free. Subjects with severe ductal changes had lower median BMI (− 0.73 vs 0.10; p = 0.04) and responded less often than those with mild changes (17/29 vs 9/9; p = 0.036). Conclusion: CP children have higher OS than healthy controls. Antioxidant therapy is safe. Pain response is seen in 68% cases, less often in patients with severe ductal changes. [ABSTRACT FROM AUTHOR]

Chronic fibroinflammatory pancreatitis causes irreparable damage to the pancreatic parenchyma. This frequently results in food restrictions, painkiller addiction, and serious quality of life impairment in children. We observed a 13-year-old girl who had previously been hospitalized multiple times and had undergone acute pancreatitis arrived with excruciating abdominal pain and recurrent hematemesis. A chronic intra-pseudocyst bleed and an ampulla of Vater hemorrhage were discovered during an upper gastrointestinal endoscopy. A 3×2×1 cm pancreatic head pseudocyst was discovered on the magnetic resonance cholangiopancreatography, however the computed tomography scan revealed a pancreatic head pseudocyst, pancreatic duct stones, and substantial peripancreatic inflammation. The multidisciplinary team determined that Frey’s surgery was the most efficient method to minimize her suffering. No complications occurred during the healing phase following surgery, and two years later, neither recurrence bleeding nor abdominal pain appeared. In summary, Frey’s method is a secure and efficient intervention when applied by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Pancreatic stones are a common finding of chronic pancreatitis and may cause recurrent abdominal pain and pancreatitis. Pancreatic stones are often accompanied by stenosis of the pancreatic duct and are often impacted within the pancreatic duct, so it is not easy to remove the pancreatic stones using a basket. Until now, extracorporeal shock wave lithotripsy has been used, but it requires repeated procedures and the success rate is not very high. The recently developed SpyGlass™ DS II (Boston Scientific, Marlborough, MA, USA) has a 3.5 mm diameter that allows insertion into the dilated pancreatic duct, it is possible to remove the pancreatic stones using electrohydraulic lithotripsy (EHL) or laser lithotripsy while directly viewing the pancreatic stones. In this paper, we would like to introduce a method to remove multiple pancreatic stones larger than 10 mm using SpyGlass™ DS II with EHL. [ABSTRACT FROM AUTHOR]

Background/Aim. Chronic pancreatitis (CP) causes inflammatory changes in the tissue of the pancreas, resulting in irreversible tissue damage. Pain, endocrine, and exocrine pancreatic insufficiency develop, thereby reducing the quality of life (QoL) of patients. The aim of the study was to determine the significance of surgical treatment in improving the QoL of patients with CP. Methods. QoL assessment of 50 patients diagnosed with CP was per-formed using a certified Euro Quality of Life-5 Dimension-5 Level (EuroQol-5D-5L) Questionnaire translated into Serbian. According to the method of treatment, patients completed the questionnaire. Patients were divided into two groups (conservatively treated – CT and surgically treated – ST), and all comparisons were made between groups. Results. Patients in stage B of CP were divided into two groups of 25 patients. The mean age in the ST group was 48.56 ± 11.91, and in the CT group was 51.08 ± 11.61 (p = 0.452). The male/female ratio in the ST group was 18/7, and in the CT group was 22/3 (p = 0.289). Pain in the ST group was present in 23 patients, and in the CT group was present in 18 patients (p = 0.141). Loss of appetite in the ST group was present in 7 patients and in the CT group in 10 patients (p = 0.256). Weight loss in both groups was equal (p = 1.000). Based on the EuroQol-5D-5L Questionnaire, significant differences were found (p < 0.001) between groups in Mobility and Pain/Discomfort, in Anxiety/Depression (p = 0.003), in Self-care (p = 0.004), and in Usual activities (p = 0.008). Conclusion. CP significantly reduces the QoL of patients treated either conservatively or by surgical approach. This study showed that surgical treatment is more beneficial for the QoL of patients with CP than the conservative approach.

Objectives: To develop and validate a CT nomogram and a radiomics nomogram to differentiate mass-forming chronic pancreatitis (MFCP) from pancreatic ductal adenocarcinoma (PDAC) in patients with chronic pancreatitis (CP). Methods: In this retrospective study, the data of 138 patients with histopathologically diagnosed MFCP or PDAC treated at our institution were retrospectively analyzed. Two radiologists analyzed the original cross-sectional CT images based on predefined criteria. Image segmentation, feature extraction, and feature reduction and selection were used to create the radiomics model. The CT and radiomics models were developed using data from a training cohort of 103 consecutive patients. The models were validated in 35 consecutive patients. Multivariable logistic regression analysis was conducted to develop a model for the differential diagnosis of MFCP and PDAC and visualized as a nomogram. The nomograms' performances were determined based on their differentiating ability and clinical utility. Results: The mean age of patients was 53.7 years, 75.4% were male. The CT nomogram showed good differentiation between the two entities in the training (area under the curve [AUC], 0.87) and validation (AUC, 0.94) cohorts. The radiomics nomogram showed good differentiation in the training (AUC, 0.91) and validation (AUC, 0.93) cohorts. Decision curve analysis showed that patients could benefit from the CT and radiomics nomograms, if the threshold probability was 0.05–0.85 and > 0.05, respectively. Conclusions: The two nomograms reasonably accurately differentiated MFCP from PDAC in patients with CP and hold potential for refining the management of pancreatic masses in CP patients. Key Points: • A CT nomogram and a computed tomography-based radiomics nomogram reasonably accurately differentiated mass-forming chronic pancreatitis from pancreatic ductal adenocarcinoma in patients with chronic pancreatitis (CP). • The two nomograms can monitor the cancer risk in patients with CP and hold promise to optimize the management of pancreatic masses in patients with CP. [ABSTRACT FROM AUTHOR]

Pancreatic cancer can arise in the background of chronic pancreatitis (CP). The relative risks for pancreatic cancer in CP vary considerably according to other contributing factors such as disease duration, excess alcohol consumption, tobacco consumption, eating habits, physical activity, and late-onset diabetes. The incidence of pancreatic cancer is estimated to be about 10 per 105 per year, and the incidence and prevalence of CP are estimated to be 5-12 per 105 and 50 per 105 per year, respectively. The pooled relative risk estimates for pancreatic cancer in CP patients range from 2.7 to 13.3. Subsets of CP subjects with a family history of pancreatic cancer or those with newly developed diabetes over the age of 50 have a higher risk for pancreatic cancer. However, the prevalence of pancreatic cancer is not high enough to justify general screening of the adult CP population. Thus, it is necessary to select subsets of CP cohorts with a significantly high risk of pancreatic cancer. We need a better overall disease model that can define the interaction of multiple risk factors and their cumulative or potential effects on pancreatic cancer. [ABSTRACT FROM AUTHOR]

Given the paucity of interventions to treat pancreatitis, it is imperative to identify and intervene upon modifiable risk factors such as heavy alcohol use. Current trends indicate a concerning increase in alcohol misuse and alcohol-related disease since the onset of the coronavirus disease-2019 pandemic. 1 The incidence of pancreatitis associated with alcohol misuse has increased by approximately 3% annually from 1961 to 2016. 2 Alcohol recidivism may be the most important risk factor for pancreatitis recurrence and development of chronic pancreatitis in the United States. 3 Early identification of alcohol misuse as a modifiable risk factor is paramount to mitigating pancreatitis-related morbidity. However, blood ethanol and urine ethyl glucuronide levels may be low in symptomatic individuals because they clear rapidly and patients may abstain from drinking in the days before their clinical presentation. Patient self-report may underestimate the quantity of alcohol intake and falsely reassure the provider that this is not a contributing factor to the presentation. 4 ., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Pancreatic cancer is highly malignant with a low five-year survival rate, which is caused by the difficulties in early diagnosis. At present, there is still no standardized procedure for the early screening for pancreatic cancer in China. With reference to related research advances in China and globally, this consensus proposes 26 recommendations concerning the objective of early screening for pancreatic cancer, high-risk population, initial screening age, follow-up interval, screening items, and timing of operation, which finally forms Chinese consensus on the early screening and surveillance for pancreatic cancer in high-risk individuals. [ABSTRACT FROM AUTHOR]