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10. Machine learning approach in the STARK international study: gradient boosting outperforms logistic regression to predict post- ERCP pancreatitis

Author

Archibugi, Livia, Ciarfaglia, G, Cárdenas-Jaén, Karina, Poropat, Goran, Korpela, Taija, Maisonneuve, Patrick, Aparicio Tormo, JR, Casella y Casellas, JA, Arcidiacono, Paolo Giorgio, Mariani, A, Štimac, Davor, Hauser, Goran, Udd, M, Kylänpää, L, Rainio, M, Di Giulio, E, Vanella, G, Löhr, Matthias, Valente, Roberto, Arnelo, U, Fagerstrom, N, de Pretis, Nicolo, Gabbrielli, A, Brozzi, L, Capurso, Gabriele, and de-Madaria, Enrique

Subjects
education, Machine learning, pancreatitis, ERCP
Abstract

Introduction: Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis (PEP) is ERCP most frequent complication. Predicting PEP risk can be determinant in reducing its incidence and managing patients appropriately, however, studies conducted so far identified single risk factors with standard statistical approaches, with limited accuracy. Aims & Methods: The aim was to build and evaluate performances of machine learning models to predict PEP probability and identify relevant features. The “STARK project” is an international, multicenter, prospective cohort study focused on PEP-associated factors. Data were randomly split in training (80%) and test set (20%). Models used to predict PEP probability were: gradient boosting (GB) and logistic regression (LR). On the training set, a 10-split random cross-validation (CV) was applied to optimize parameters to obtain the best mean Area Under the Receiver Operating Characteristics Curve (AUC of ROC). Afterwards, the model was re-trained on the whole training set with the best parameters and then applied on the test set. Results: 1, 150 patients were included. 70 (6.1%) patients developed PEP. GB model AUC in CV was 0.7±0.076 (95% CI 0.64-0.76), LR model 0.585±0.068 (95% CI 0.53-0.63) (p-value=0.012). AUC in test for GB model was 0.671. Most relevant variables for PEP prediction were: total bilirubin, age, body mass index, procedure time, alcohol units/day, previous sphincterotomy, biliary cannulation attempts and use of Ringer’s solution. Conclusion: This is the first study applying machine learning techniques for PEP prediction, with GB significantly outperforming LR model. Relevant variables were mostly pre-procedural except for procedure time, biliary cannulation attempts and Ringer’s solution use.

Published
2020

15. Machine Learning approach to predict Post-ERCP Pancreatitis in the STARK international multicenter prospective cohort study

Author

Archibugi, L., primary, Ciarfaglia, G., additional, Cárdenas-Jaén, K., additional, Poropat, G., additional, Korpela, T., additional, Maisonneuve, P., additional, Aparicio, J., additional, Casellas, J., additional, Arcidiacono, P., additional, Mariani, A., additional, Stimac, D., additional, Hauser, G., additional, Udd, M., additional, Kylänpää, L., additional, Rainio, M., additional, Di Giulio, E., additional, Vanella, G., additional, Lohr, M., additional, Valente, R., additional, Arnelo, U., additional, De Pretis, N., additional, Gabbrielli, A., additional, Brozzi, L., additional, De-Madaria, E., additional, and Capurso, G., additional

Published
2020
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17. STARK STUDY: MACHINE LEARNING APPROACH TO PREDICT POST-ERCP PANCREATITIS IN AN INTERNATIONAL MULTICENTER PROSPECTIVE COHORT STUDY

Author

Archibugi, L, additional, Ciarfaglia, G, additional, Cárdenas-Jaén, K, additional, Poropat, G, additional, Korpela, T, additional, Maisonneuve, P, additional, Aparicio, JR, additional, Casellas, JA, additional, Arcidiacono, PG, additional, Mariani, A, additional, Stimac, D, additional, Hauser, G, additional, Udd, M, additional, Kylänpää, L, additional, Rainio, M, additional, Giulio, ED, additional, Vanella, G, additional, Lohr, M, additional, Valente, R, additional, Arnelo, U, additional, Pretis, ND, additional, Gabbrielli, A, additional, Brozzi, L, additional, De-Madaria, E, additional, and Capurso, G, additional

Published
2020
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24. European evidence-based guidelines on pancreatic cystic neoplasms

Author

Del Chiaro M, Besselink M, Scholten L, Bruno M, Cahen D, Gress T, van Hooft J, Lerch M, Mayerle J, Hackert T, Satoi S, Zerbi A, Cunningham D, De Angelis C, Giovanni M, DE MADARIA E, Hegyi P, Rosendahl J, Friess H, Manfredi R, Levy P, Real F, Sauvanet A, Abu Hilal M, Marchegiani G, Esposito I, Ghaneh P, Engelbrecht M, Fockens P, van Huijgevoort N, Wolfgang C, Bassi C, Gubergrits N, Verbeke C, Kloppel G, Scarpa A, Zamboni G, Lennon A, Sund M, Kartalis N, Grenacher L, Falconi M, Arnelo U, Kopchak K, Oppong K, McKay C, Hauge T, Conlon K, Adham M, Ceyhan G, Salvia R, Dervenis C, Allen P, Paye F, Bartsch D, Lohr M, Mutignani M, Laukkarinen J, Schulick R, Valente R, Seufferlein T, Capurso G, Siriwardena A, Neoptolemos J, Pukitis A, Segersvard R, Aghdassi A, Andrianello S, Bossuyt P, Bulow R, Cardenas-Jaen K, Cortegoso P, Fontana M, Haeberle L, Heckler M, Litvin A, Mann K, Michalski C, Michl P, Nappo G, Perri G, Persson S, Scheufele F, Sclafani F, Schmidt M, Venezia L, Volker F, Vullierm M, Wusten L, and European Study Grp Cystic Tum

Abstract

Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring < 40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter >= 40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule > 5 mm, and MPD diameter > 10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.

Published
2018

25. Chronic use of statins and acetylsalicylic acid and incidence of post-ERCP acute pancreatitis. Data from the STARK project, a prospective international, multicenter, cohort study

Author

Cárdenas Jáen, K., primary, Archibugi, L., additional, Poropat, G., additional, Korpela, T., additional, Capurso, G., additional, Maisonneuve, P., additional, Aparicio, J.R., additional, Casellas, J.A., additional, Arcidiacono, P.G., additional, Mariani, A., additional, Stimac, D., additional, Hauser, G., additional, Udd, M., additional, Kylänpää, L., additional, Rainio, M., additional, Di Giulio, E., additional, Vanella, G., additional, Lohr, M., additional, Valente, R., additional, Arnelo, U., additional, De Pretis, N., additional, and de Madaria, E., additional

Published
2019
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30. European evidence-based guidelines on pancreatic cystic neoplasms

Author

Del Chiaro, M. (Marco), Besselink, M.G. (Marc), Scholten, L. (Lianne), Bruno, M.J. (Marco), Cahen, D.L. (Djuna), Gress, T. (Thomas), Hooft, J.E. (Jeanin) van, Lerch, M. (M.), Mayerle, J. (Julia), Hackert, T. (Thilo), Satoi, S. (Sohei), Zerbi, A. (Alessandro), Cunningham, D. (David), Angelis, C. (Claudio) de, Giovannini, M. (Marc), de-Madaria, E. (Enrique), Hegyi, P. (Peter), Rosendahl, J. (Jonas), Friess, H., Manfredi, R. (Riccardo), Lévy, P. (Philippe), Real, F.X. (Francisco), Sauvanet, A., Abu Hilal, M., Marchegiani, G. (Giovanni), Esposito, I. (I.), Ghaneh, P. (P.), Engelbrecht, M.R.W. (Marc R.W.), Fockens, P. (Paul), van Huijgevoort, N.C.M. (Nadine C.M.), Wolfgang, C.L. (Christopher L.), Bassi, C. (Claudio), Gubergrits, N.B. (Natalya B.), Verbeke, C. (Caroline), Kloppel, G. (Günter), Scarpa, A. (Aldo), Zamboni, W.C., Lennon, A.M. (Anne Marie), Sund, R. (Reijo), Kartalis, N. (Nikolaos), Grenacher, L. (Lars), Falconi, M. (Massimo), Arnelo, U. (U.), Kopchak, K.V. (Kostantin V.), Oppong, K. (K.), McKay, C. (Colin), Hauge, A.W. (Anne Werner), Conlon, K. (Kevin), Adham, I.M., Ceyhan, G.O. (Güralp O.), Salvia, R. (Roberto), Dervenis, C. (Christos), Allen, P.J. (Peter), Paye, F. (François), Bartsch, D.K. (Detlef), Löhr, M. (M.), Mutignani, M. (Massimiliano), Laukkarinen, J. (Johanna), Schulick, R. (Richard), Valente, R. (Roberto), Seufferlein, T. (Thomas), Capurso, G. (Gabriele), Siriwardena, A. (Ajith), Neoptolemos, J.P. (John), Pukitis, A.P. (A.), Segersvärd, R. (Ralf), Aghdassi, A. (A.), Andrianello, S. (S.), Bossuyt, P.M.M. (Patrick), Bülow, R. (R.), Cárdenas-Jaén, K. (K.), Cortegoso, P. (P.), Fontana, M. (M.), Haeberle, L. (L.), Heckler, M. (M.), Litvin, A. (Andrey), Mann, K. (K.), Michalski, C. (C.), Michl, P. (P.), Nappo, G. (G.), Perri, G. (G.), Persson, S. (S.), Scheufele, F. (F.), Sclafani, F. (F.), Schmidt, M. (M.), Venezia, L. (L.), Volker, F. (F.), Vullierm, M.-P. (M. P.), Wüsten, L. (L.), Del Chiaro, M. (Marco), Besselink, M.G. (Marc), Scholten, L. (Lianne), Bruno, M.J. (Marco), Cahen, D.L. (Djuna), Gress, T. (Thomas), Hooft, J.E. (Jeanin) van, Lerch, M. (M.), Mayerle, J. (Julia), Hackert, T. (Thilo), Satoi, S. (Sohei), Zerbi, A. (Alessandro), Cunningham, D. (David), Angelis, C. (Claudio) de, Giovannini, M. (Marc), de-Madaria, E. (Enrique), Hegyi, P. (Peter), Rosendahl, J. (Jonas), Friess, H., Manfredi, R. (Riccardo), Lévy, P. (Philippe), Real, F.X. (Francisco), Sauvanet, A., Abu Hilal, M., Marchegiani, G. (Giovanni), Esposito, I. (I.), Ghaneh, P. (P.), Engelbrecht, M.R.W. (Marc R.W.), Fockens, P. (Paul), van Huijgevoort, N.C.M. (Nadine C.M.), Wolfgang, C.L. (Christopher L.), Bassi, C. (Claudio), Gubergrits, N.B. (Natalya B.), Verbeke, C. (Caroline), Kloppel, G. (Günter), Scarpa, A. (Aldo), Zamboni, W.C., Lennon, A.M. (Anne Marie), Sund, R. (Reijo), Kartalis, N. (Nikolaos), Grenacher, L. (Lars), Falconi, M. (Massimo), Arnelo, U. (U.), Kopchak, K.V. (Kostantin V.), Oppong, K. (K.), McKay, C. (Colin), Hauge, A.W. (Anne Werner), Conlon, K. (Kevin), Adham, I.M., Ceyhan, G.O. (Güralp O.), Salvia, R. (Roberto), Dervenis, C. (Christos), Allen, P.J. (Peter), Paye, F. (François), Bartsch, D.K. (Detlef), Löhr, M. (M.), Mutignani, M. (Massimiliano), Laukkarinen, J. (Johanna), Schulick, R. (Richard), Valente, R. (Roberto), Seufferlein, T. (Thomas), Capurso, G. (Gabriele), Siriwardena, A. (Ajith), Neoptolemos, J.P. (John), Pukitis, A.P. (A.), Segersvärd, R. (Ralf), Aghdassi, A. (A.), Andrianello, S. (S.), Bossuyt, P.M.M. (Patrick), Bülow, R. (R.), Cárdenas-Jaén, K. (K.), Cortegoso, P. (P.), Fontana, M. (M.), Haeberle, L. (L.), Heckler, M. (M.), Litvin, A. (Andrey), Mann, K. (K.), Michalski, C. (C.), Michl, P. (P.), Nappo, G. (G.), Perri, G. (G.), Persson, S. (S.), Scheufele, F. (F.), Sclafani, F. (F.), Schmidt, M. (M.), Venezia, L. (L.), Volker, F. (F.), Vullierm, M.-P. (M. P.), and Wüsten, L. (L.)

Abstract

Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gas

Published
2018
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31. European evidence-based guidelines on pancreatic cystic neoplasms

Author

Del Chiaro, M, Besselink, MG, Scholten, L, Bruno, Marco, Cahen, Djuna, Gress, TM, van Hooft, JE, Lerch, MM, Mayerle, J, Hackert, T, Satoi, S, Zerbi, A, Cunningham, D, De Angelis, C, Giovannini, M, de-Madaria, E, Hegyi, P, Rosendahl, J, Friess, H, Manfredi, R, Levy, P, Real, FX, Sauvanet, A, Abu Hilal, M, Marchegiani, G, Esposito, I, Ghaneh, P, Engelbrecht, MRW, Fockens, P, van Huijgevoort, NCM, Wolfgang, C, Bassi, C, Gubergrits, NB, Verbeke, C, Kloppel, G, Scarpa, A, Zamboni, G, Lennon, AM, Sund, M, Kartalis, N, Grenacher, L, Falconi, M, Arnelo, U, Kopchak, KV, Oppong, K, McKay, C, Hauge, T, Conlon, K, Adham, M, Ceyhan, GO, Salvia, R, Dervenis, C, Allen, P, Paye, F, Bartsch, DK, Lohr, M, Mutignani, M, Laukkarinen, J, Schulick, R, Valente, R, Seufferlein, T, Capurso, G, Siriwardena, A, Neoptolemos, JP, Pukitis, A, Segersvard, R, Aghdassi, A, Andrianello, S, Bossuyt, P, Bulow, R, Cardenas-Jaen, K, Cortegoso, P, Fontana, M, Haeberle, L, Heckler, M, Litvin, A, Mann, K, Michalski, C, Michl, P, Nappo, G, Di Perri, G, Persson, S, Scheufele, F, Sclafani, F, Schmidt, M, Venezia, L, Volker, F, Vullierm, MP, Wusten, L, Del Chiaro, M, Besselink, MG, Scholten, L, Bruno, Marco, Cahen, Djuna, Gress, TM, van Hooft, JE, Lerch, MM, Mayerle, J, Hackert, T, Satoi, S, Zerbi, A, Cunningham, D, De Angelis, C, Giovannini, M, de-Madaria, E, Hegyi, P, Rosendahl, J, Friess, H, Manfredi, R, Levy, P, Real, FX, Sauvanet, A, Abu Hilal, M, Marchegiani, G, Esposito, I, Ghaneh, P, Engelbrecht, MRW, Fockens, P, van Huijgevoort, NCM, Wolfgang, C, Bassi, C, Gubergrits, NB, Verbeke, C, Kloppel, G, Scarpa, A, Zamboni, G, Lennon, AM, Sund, M, Kartalis, N, Grenacher, L, Falconi, M, Arnelo, U, Kopchak, KV, Oppong, K, McKay, C, Hauge, T, Conlon, K, Adham, M, Ceyhan, GO, Salvia, R, Dervenis, C, Allen, P, Paye, F, Bartsch, DK, Lohr, M, Mutignani, M, Laukkarinen, J, Schulick, R, Valente, R, Seufferlein, T, Capurso, G, Siriwardena, A, Neoptolemos, JP, Pukitis, A, Segersvard, R, Aghdassi, A, Andrianello, S, Bossuyt, P, Bulow, R, Cardenas-Jaen, K, Cortegoso, P, Fontana, M, Haeberle, L, Heckler, M, Litvin, A, Mann, K, Michalski, C, Michl, P, Nappo, G, Di Perri, G, Persson, S, Scheufele, F, Sclafani, F, Schmidt, M, Venezia, L, Volker, F, Vullierm, MP, and Wusten, L

Published
2018

32. European evidence-based guidelines on pancreatic cystic neoplasms

Author

Del Chiaro, M., Besselink, M. G., Scholten, L., Bruno, M. J., Cahen, D. L., Gress, T. M., van Hooft, J. E., Lerch, M. M., Mayerle, J., Hackert, T., Satoi, S., Zerbi, A., Cunningham, D., De Angelis, Claudio, Giovannini, Massimo, de-Madaria, E., Hegyi, P., Rosendahl, J., Friess, H., Manfredi, Riccardo, Levy, P., Real, F. X., Sauvanet, A., Hilal, M. A., Marchegiani, G., Esposito, I., Ghaneh, P., Engelbrecht, M. R. W., Fockens, P., van Huijgevoort, N. C. M., Wolfgang, C., Bassi, C., Gubergrits, N. B., Verbeke, C., Kloppel, G., Scarpa, A., Zamboni, G., Lennon, A. M., Sund, M., Kartalis, N., Grenacher, L., Falconi, M., Arnelo, U., Kopchak, K. V., Oppong, K., Mckay, C., Hauge, T., Conlon, K., Adham, M., Ceyhan, G. O., Salvia, R., Dervenis, C., Allen, P., Paye, F., Bartsch, D. K., Lohr, M., Mutignani, Massimiliano, Laukkarinen, J., Schulick, R., Valente, R., Seufferlein, T., Capurso, G., Siriwardena, A., Neoptolemos, J. P., Pukitis, A., Segersvard, R., Aghdassi, A., Andrianello, S., Bossuyt, P., Bulow, R., Cardenas-Jaen, K., Cortegoso, P., Fontana, Tecla Maria, Haeberle, L., Heckler, M., Litvin, A., Mann, K., Michalski, C., Michl, P., Nappo, G., Perri, Gianluigi, Persson, S., Scheufele, F., Sclafani, F., Schmidt, M., Venezia, L., Volker, F., Vullierm, M. -P., Wusten, L., De Angelis C., Giovannini M., Manfredi R. (ORCID:0000-0002-4972-9500), Mutignani M. (ORCID:0000-0002-1272-4888), Fontana M., Perri G., Del Chiaro, M., Besselink, M. G., Scholten, L., Bruno, M. J., Cahen, D. L., Gress, T. M., van Hooft, J. E., Lerch, M. M., Mayerle, J., Hackert, T., Satoi, S., Zerbi, A., Cunningham, D., De Angelis, Claudio, Giovannini, Massimo, de-Madaria, E., Hegyi, P., Rosendahl, J., Friess, H., Manfredi, Riccardo, Levy, P., Real, F. X., Sauvanet, A., Hilal, M. A., Marchegiani, G., Esposito, I., Ghaneh, P., Engelbrecht, M. R. W., Fockens, P., van Huijgevoort, N. C. M., Wolfgang, C., Bassi, C., Gubergrits, N. B., Verbeke, C., Kloppel, G., Scarpa, A., Zamboni, G., Lennon, A. M., Sund, M., Kartalis, N., Grenacher, L., Falconi, M., Arnelo, U., Kopchak, K. V., Oppong, K., Mckay, C., Hauge, T., Conlon, K., Adham, M., Ceyhan, G. O., Salvia, R., Dervenis, C., Allen, P., Paye, F., Bartsch, D. K., Lohr, M., Mutignani, Massimiliano, Laukkarinen, J., Schulick, R., Valente, R., Seufferlein, T., Capurso, G., Siriwardena, A., Neoptolemos, J. P., Pukitis, A., Segersvard, R., Aghdassi, A., Andrianello, S., Bossuyt, P., Bulow, R., Cardenas-Jaen, K., Cortegoso, P., Fontana, Tecla Maria, Haeberle, L., Heckler, M., Litvin, A., Mann, K., Michalski, C., Michl, P., Nappo, G., Perri, Gianluigi, Persson, S., Scheufele, F., Sclafani, F., Schmidt, M., Venezia, L., Volker, F., Vullierm, M. -P., Wusten, L., De Angelis C., Giovannini M., Manfredi R. (ORCID:0000-0002-4972-9500), Mutignani M. (ORCID:0000-0002-1272-4888), Fontana M., and Perri G.

Abstract

Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.

Published
2018

34. Endoscopic classification of the papilla of Vater. Results of an inter- and intraobserver agreement study.

Author

Haraldsson, E, Lundell, L, Swahn, F, Enochsson, Lars, Löhr, J M, Arnelo, U, Haraldsson, E, Lundell, L, Swahn, F, Enochsson, Lars, Löhr, J M, and Arnelo, U

Abstract

BACKGROUND: Many endoscopists acknowledge that the appearance of the papilla of Vater seems to affect biliary cannulation. To assess the association between the macroscopic appearance of the papilla and biliary cannulation and other related clinical issues, a system is needed to define the appearance of the papilla. OBJECTIVE: The purpose of this study was to validate an endoscopic classification of the papilla of Vater by assessing the interobserver and intraobserver agreements among endoscopist with varying experience. METHODS: An endoscopic classification, based on pictures captured from 140 different papillae, containing four types of papillae was proposed. The four types are (a) Type 1: regular papilla, no distinctive features, 'classic appearance'; (b) Type 2: small papilla, often flat, with a diameter ≤ 3 mm (approximately 9 Fr); (c) Type 3: protruding or pendulous papilla, a papilla that is standing out, protruding or bulging into the duodenal lumen or sometimes hanging down, pendulous with the orifice oriented caudally; and (d) Type 4: creased or ridged papilla, where the ductal mucosa seems to extend distally, rather out of the papillary orifice, either on a ridge or in a crease. To assess the level of interobserver agreement, a web-based survey was sent out to 18 endoscopists, containing 50 sets of still images of the papilla, distributed between the four different types. Three months later a follow-up survey, with images from the first survey was sent to the same endoscopists. RESULTS: Interobserver agreement was substantial (κ = 0.62, 95% confidence interval (CI) 0.58-0.65) and were similar for both experts and non-experts. The intraobserver agreement assessed with the second survey was also substantial (κ = 0.66, 95% CI 0.59-0.72). CONCLUSION: The proposed endoscopic classification of the papilla of Vater seems to be easy to use, irrespective of the level of experience of the endoscopist. It carries a substantial inter- and intraobserver agreement and

Published
2017
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36. T03.01.2 STARK STUDY: MACHINE LEARNING APPROACH TO PREDICT POST-ERCP PANCREATITIS IN AN INTERNATIONAL MULTICENTER PROSPECTIVE COHORT STUDY

Author

Archibugi, L., Ciarfaglia, G., Cárdenas-Jaén, K., Poropat, G., Korpela, T., Maisonneuve, P., Aparicio, J.R., Casellas, J.A., Arcidiacono, P.G., Mariani, A., Stimac, D., Hauser, G., Udd, M., Kylänpää, L., Rainio, M., Di Giulio, E., Vanella, G., Lohr, M., Valente, R., Arnelo, U., De Pretis, N., Gabbrielli, A., Brozzi, L., De-Madaria, E., and Capurso, G.

Published
2020
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37. Multicenter randomized trial comparing short-term stenting versus balloon dilatation for dominant strictures in primary sclerosing cholangitis

Author

Ponsioen, C., primary, Arnelo, U., additional, Bergquist, A., additional, Rauws, E., additional, Paulsen, V., additional, Cantu, P., additional, Parzanese, I., additional, de Vries, E., additional, Said, K., additional, Chazouilleres, O., additional, Kemgang, A., additional, Desaint, B., additional, Farkkila, M., additional, Van der Merwe, S., additional, Van Steenbergen, W., additional, Marschall, H.-U., additional, Stotzer, P.-O., additional, Thorburn, D., additional, Pereira, S., additional, and Aabakken, L., additional

Published
2017
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38. Conservative Treatment of Chronic Pancreatitis: A Practical Approach

Author

Laukkarinen, Johanna, Puolakkainen, Pauli, Valente, R., Waldthaler, A., Scandavini, C. M., Vujasinovic, M., Del Chiaro, M., Arnelo, U., and Löhr, J.-M.

Abstract

Background: Chronic pancreatitis is a long-standing, inflammatory condition of the pancreas that leads to the progressive damage and loss of function of pancreatic parenchyma and to the development of possible locoregional and systemic medical complications.Materials and methods: In this review, we tried to summarize the current evidence on non-surgical treatment trying to suggest a practical approach to the management of chronic pancreatitis.Results: Besides the unclear pathophysiological mechanism and a poorly unknown epidemiology, chronic pancreatitis is a complex syndrome that displays different possible challenges for physicians. Despite being traditionally considered as a benign disease, chronic pancreatitis encompasses 10-year mortality rates which are superior to the ones reported for some of the most common cancers.Conclusions: Chronic pancreatitis encompasses the management of multiple and complex medical co-morbidities that needs to be understood and addressed in a multidisciplinary specialist context.

Published
2020
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41. Impact of Pancreatic Gland Volume on Fistula Formation After Pancreatic Tail Resection

Author

Frozanpor, F., Albiin, N., Linder, S., Ralf Segersvärd, Lundell, L., and Arnelo, U.

Subjects
Pancreatectomy, Pancreatic Fistula, Surgical Stapling
Abstract

Context Resection of the body and tail of the pancreas (distal pancreatectomy) is associated with high postoperative morbidity, most of which is due to leakage from the pancreatic transection surface. Objective The aim of the current study was to analyze factors which may affect the risk of pancreatic fistula formation. Patients All consecutive distal pancreatectomies prospectively registered in our hospital database from 1999 to 2007 were included. Clinically relevant pancreatic fistula grades B and C, defined according to the International Study Group on Pancreatic Fistula (ISGPF) definition were assessed. Main outcome measures The impact of patient, tumor, surgery, and radiology-related factors on the risk of pancreatic fistula formation were assessed by univariate and multivariate analyses. Results A distal pancreatectomy was performed in 51 patients (median age: 59 years; range: 26-76 years), 22 of whom had malignant and 29 benign or premalignant disease. Pancreatic fistulas were diagnosed in 17 (33.3%) of the patients. An additional three patients had a local abscess without apparent but assumed pancreatic leakage. Multivariate analysis showed that pancreatic fistulas occurred more frequently after hand suturing of the transection area versus the use of a stapler (69.2% vs. 21.1%; OR: 40.4, 95% CI: 3.36-486; P=0.004) and a large volume of the pancreatic remnant (greater, or equal to, 34 cm3) increased the subsequent risk of pancreatic fistula (57.1% vs. 20.8%; OR: 6.14, 95% CI: 1.14-39.0; P=0.035). Conclusions Development of pancreatic fistula after distal pancreatectomy remains a challenge. The volume of the remaining pancreas and the technique of closure of the transected pancreas were found to affect this risk, thus allowing future preventive measures to be explored and evaluated in clinical trials. Image: 3D volume rendering image of the pancreas with the remaining pancreas shown in blue., JOP. Journal of the Pancreas, Vol 11, No 5 (2010): September - 423-497

Published
2010
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42. Telemedicine : an important aid to perform high-quality endoscopic retrograde cholangiopancreatography in low-volume centers

Author

Påhlsson, H. I., Groth, Kristina, Permert, J., Swahn, F., Löhr, M., Enochsson, L., Lundell, L., Arnelo, U., Påhlsson, H. I., Groth, Kristina, Permert, J., Swahn, F., Löhr, M., Enochsson, L., Lundell, L., and Arnelo, U.

Abstract

Background and study aims: The aim of this study was to investigate whether telemedicine can help to ensure high-quality endoscopic retrograde cholangiopancreatography (ERCP) in patients living in rural areas. The study was conducted by investigators from two centers: the Karolinska University Hospital, a high-volume center which provided the teleguided support, and the Visby District Hospital, a low-volume center. Patients and methods: From September 2010 to August 2011, 26 ERCP procedures performed at a district hospital were teleguided by an experienced endoscopist at the Karolinska University Hospital. To ensure patient data protection, all communication went through a network (Sjunet) that was separate from the Internet and open only to accredited users. The indications for ERCP were common bile duct stones (n=12), malignant strictures (n=12), and benign biliary strictures (n=2). In 15 cases, this was the patient's first ERCP procedure. Results: The common bile duct was successfully cannulated in all 26 teleguided procedures. The local endoscopist scored the teleguided support as crucial for the successful outcome in 8/26 cases, as an important factor in 8, and as being of less importance in the remaining 10. In the eight cases where the teleguided support was judged to be crucial, six subsequent percutaneous trans-hepatic cholangiography procedures and two repeat ERCPs were avoided. The overall cannulation rate at the district hospital improved from 85% to 99% after teleguided support was introduced. No procedure-related complications occurred. Conclusion: Distant guidance of advanced ERCP procedures in a low-volume center, through teleguided support from a high-volume center, has the potential to improve the quality of care, as reflected in high cannulation rates and the ability to complete the scheduled interventions., QC 20130610

Published
2013
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43. Intramuscular autotransplantation of pancreatic islets in a 7-year-old child : a 2-year follow-up

Author

Rafael, Ehab, Tibell, A., Rydén, M., Lundgren, T., Sävendahl, L., Borgström, B., Arnelo, U., Isaksson, B., Nilsson, Bo, Korsgren, Olle, Permert, Johan, Rafael, Ehab, Tibell, A., Rydén, M., Lundgren, T., Sävendahl, L., Borgström, B., Arnelo, U., Isaksson, B., Nilsson, Bo, Korsgren, Olle, and Permert, Johan

Abstract

A 7-year-old girl with severe hereditary pancreatitis underwent total pancreatectomy. A total of 160,000 islet equivalents (6400 islet/kg) were transplanted to the brachioradialis muscle of the right forearm. Her plasma C-peptide level was undetectable after pancreatectomy but increased to 1.37 ng/mL after 17 days; at this time point, her insulin requirement was 0.75 units of insulin/kg/day. At 5- and 27-months, her hemoglobin A1c (HbA1c) and insulin requirements were 4.5 and 5.3% and 0.3 and 0.18 units/kg/day, respectively. Basal and stimulated C-peptide levels were 0.67 +/- 0.07 and 3.36 +/- 1.37 ng/mL, respectively. Stimulated insulin levels were 30% higher in the islet-bearing arm compared to the contralateral arm after glucagon stimulation. After surgery and islet transplantation, the quality of life improved dramatically and she gained 8 kg of weight. In summary, a normal HbA1c, a low insulin requirement and the absence of recurrent hypoglycemia and the gradient of insulin between the arms indicate that the intramuscularly transplanted islets contribute to a long-term clinically significant metabolic control.

Published
2008
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44. European experts consensus statement on cystic tumours of the pancreas

Author

Del Chiaro, Marco, primary, Verbeke, Caroline, additional, Salvia, Roberto, additional, Klöppel, Gunter, additional, Werner, Jens, additional, McKay, Colin, additional, Friess, Helmut, additional, Manfredi, Riccardo, additional, Van Cutsem, Eric, additional, Löhr, Matthias, additional, Segersvärd, Ralf, additional, Abakken, L, additional, Adham, M, additional, Albin, N, additional, Andren-Sandberg, Å, additional, Arnelo, U, additional, Bruno, M, additional, Cahen, D, additional, Cappelli, C, additional, Costamagna, G, additional, Del Chiaro, M, additional, Delle Fave, G, additional, Esposito, I, additional, Falconi, M, additional, Friess, H, additional, Ghaneh, P, additional, Gladhaug, IP, additional, Haas, S, additional, Hauge, T, additional, Izbicki, JR, additional, Klöppel, G, additional, Lerch, M, additional, Lundell, L, additional, Lüttges, J, additional, Löhr, M, additional, Manfredi, R, additional, Mayerle, J, additional, McKay, C, additional, Oppong, K, additional, Pukitis, A, additional, Rangelova, E, additional, Rosch, T, additional, Salvia, R, additional, Schulick, R, additional, Segersvärd, R, additional, Sufferlein, T, additional, Van Cutsem, E, additional, Van der Merwe, SW, additional, Verbeke, C, additional, Werner, J, additional, and Zamboni, G, additional

Published
2013
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49. Gastrointestinal growth factors and pancreatic islet hormones during postoperative IGF-I supplementation in man

Author

Leinsköld, Ted, Adrian, TE, Arnelo, U, Larsson, J, Permert, J, Leinsköld, Ted, Adrian, TE, Arnelo, U, Larsson, J, and Permert, J

Abstract

Insulin-like growth factor-I (IGF-I) has been demonstrated to exert a nitrogen sparing effect, both experimentally and in patients after abdominal surgery. IGF-I is a major mediator for the anabolic effects of growth hormone (GH). Whether elevated circulating IGF-I levels are the sole mediator of the anabolic effects following GH has not been clarified. IGF-I influences glucose metabolism, both through its own specific receptor and by activating the insulin receptor, and has also been proposed to influence pancreatic islet secretion directly. In the present study, the postoperative effects of IGF-I on plasma levels of other gastrointestinal and pancreatic islet hormones and growth factors were measured in patients after abdominal surgery. Fifteen patients who were candidates for large bowel resection were randomly divided into two groups: IGF-I-treated (n=8) and placebo-treated (n=7). The IGF-I group received daily two s.c. injections of human recombinant IGF-I (80 microg/kg body weight) for five days, beginning on the morning of the first postoperative day. The other group received placebo injections. Fasting plasma levels of gastrointestinal growth factors (epidermal growth factor, transforming growth factor-alpha, IGF-II), gastrointestinal hormones (gastrin, enteroglucagon, peptide YY), and islet hormones (insulin, islet amyloid polypeptide (IAPP) and pancreatic glucagon) were determined by RIA preoperatively and after five days of treatment. No significant effects of IGF-I on other growth factors or gastrointestinal hormones were seen. A marked increase in plasma insulin postoperatively compared with the preoperative levels (42+/-3 vs 61+/-5 pM, P<0.05) was seen in the placebo group, whereas the postoperative levels in the IGF-I-treated patients remained unchanged (44+/-3 vs 45+/-4 pM). A similar pattern was observed for IAPP and cortisol concentrations. No differences in glucagon concentrations were seen. In conclusion, these results suggest that IGF-I does

Published
2000
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