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Consensus on the nomenclature and indications for reoperation for post-operative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) is lacking. This study explores the available literature to classify the different types of reoperations and report outcomes. A systematic literature search was performed, including articles from 2010 to 2024 reporting reoperations for POPF after PD. The primary outcome was 30- or 90-day-mortality. Secondary outcomes included reoperation date, additional relaparotomy, ICU-admission, hospital stay, rate of pancreatic-exocrine-insufficiency, diabetes and long-term survivors. Twenty-five studies were reviewed with 766 patients reoperated for POPF after PD, 283 (37 %) undergoing completion pancreatectomy (CP) and 483 (63 %) pancreas-preserving-procedures (PPPs). Among PPPs, drainage (30 %), wirsungostomy (14 %), pancreatic anastomosis repair (6 %), "sinking" of pancreatic stump (6 %) and re-do pancreatic anastomosis (4 %) were identified. The main indications for reoperation were post-pancreatectomy hemorrhage, necrotizing acute pancreatitis, sepsis and peritonitis. PPPs were preferred with severe hemodynamic instability. Mortality rates after CP and PPPs ranged from 20 to 56 % and 0–67 %, respectively. Early reoperation was associated with reduced ICU-recovery after "sinking" (p = 0.049). Reoperation for POPF after PD is rarely needed. When it is, early timing seems critical for better outcomes, and PPPs seems to be the best bail out option in patients with severe hemodynamic instability. [ABSTRACT FROM AUTHOR]

Background: Open surgical debridement was the main treatment option for infected pancreatic necrosis (IPN). However, it was associated with significant trauma, leading to a higher mortality rate. With the development of minimally invasive surgery, the step-up treatment principle centered around minimally invasive intervention, significantly reducing the incidence of complications and mortality rates among IPN patients. However, few studies have reported the efficacy of laparoscopic retroperitoneal pancreatic necrosectomy (LRPN), a new minimally invasive debridement technique, in IPN patients with duodenal fistula (DF)—a severe complication of IPN. Therefore, we analyzed the effectiveness and safety of LRPN for treating IPN with DF and discussed the impact of DF on patient prognosis. Methods: We retrospectively examined patients diagnosed with IPN between 2018 and 2023. The patients were divided into two groups based on the presence or absence of DF. Clinical characteristics, treatment strategies, clinical outcomes, and follow-up information were analyzed. A 1:1 propensity score-matching (PSM) method was used to assess differences in outcome indicators more accurately. Results: A total of 197 patients were examined. After PSM, no significant differences were observed between the two groups in in-hospital mortality rate, incidence of single organ failure, rate of postoperative severe complications (Clavien–Dindo Classification ≥ 3), and intensive care unit stay (P > 0.05). However, the incidence of multiorgan failure, gastrointestinal bleeding, number of percutaneous catheter drainage (PCD) procedures, surgery cases, hospital stay, and hospitalization costs were higher in the DF group (P < 0.05). Of these patients, 71.6% (n = 141) were treated with PCD + LRPN, with a conversion rate of 6.38% to open surgery. A higher proportion of patients in the non-DF group showed improved clinical outcomes solely with PCD (22.6% vs. 2.4%, P < 0.05), whereas a higher proportion of patients in the DF group underwent PCD + LRPN (88.1% vs. 67.1%, P < 0.05). Both groups showed a significant reduction in the Sequential Organ Failure Assessment score 72 h postoperatively. Conclusions: For patients with IPN and DF, the LRPN-centered step-up strategy was safe and effective. DF prolongs hospital stay and increases hospitalization costs for patients. [ABSTRACT FROM AUTHOR]

Aim: The current study aims to delineate subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), the sacrospinalis muscle, and all abdominal musculature at the L3–L5 vertebral level from non-contrast computed tomography (CT) imagery using deep learning algorithms. Subsequently, radiomic features are collected from these segmented images and subjected to medical interpretation. Materials and methods: This retrospective analysis includes a cohort of 315 patients diagnosed with acute necrotizing pancreatitis (ANP) who had undergone comprehensive whole-abdomen CT scans. The no new net (nnU-Net) architecture was adopted for the imagery segmentation, while Python scripts were employed to derive radiomic features from the segmented non-contrast CT images. In light of the intrinsic medical relevance of specific features, two categories were selected for analysis: first-order statistics and morphological characteristics. A correlation analysis was conducted, and statistically significant features were subjected to medical scrutiny. Results: With respect to VAT, skewness (p = 0.004) and uniformity (p = 0.036) emerged as statistically significant; for SAT, significant features included skewness (p = 0.023), maximum two-dimensional (2D) diameter slice (p = 0.020), and maximum three-dimensional (3D) diameter (p = 0.044); for the abdominal muscles, statistically significant metrics were the interquartile range (IQR; p = 0.023), mean absolute deviation (p = 0.039), robust mean absolute deviation (p = 0.015), elongation (p = 0.025), sphericity (p = 0.010), and surface volume ratio (p = 0.014); and for the sacrospinalis muscle, significant indices comprised the IQR (p = 0.018), mean absolute deviation (p = 0.049), robust mean absolute deviation (p = 0.025), skewness (p = 0.008), maximum 2D diameter slice (p = 0.008), maximum 3D diameter (p = 0.005), sphericity (p = 0.011), and surface volume ratio (p = 0.005). Conclusion: Diminished localized deposition of VAT and SAT, homogeneity in the VAT and SAT density, augmented SAT volume, and a dispersed and heterogeneous distribution of abdominal muscle density are identified as risk factors for infectious pancreatic necrosis (IPN). [ABSTRACT FROM AUTHOR]

The article discusses the causal role of high intrapancreatic fat deposition in pancreatitis, emphasizing the importance of primary prevention strategies to reduce the overall burden of the disease. The PANcreaticDiseasesOriginating from intRa- pancreatic fAt (PANDORA) hypothesis suggests that reducing intrapancreatic fat could decrease the risks of developing acute and chronic pancreatitis. Clinical studies have supported this hypothesis, highlighting the need for interdisciplinary prevention approaches. The study by Yamazaki et al. provides causal evidence confirming the unique role of high intrapancreatic fat in the development of pancreatitis, offering insights for future prevention strategies. [Extracted from the article]

Pancreatic leaks occur when a disruption in the pancreatic ductal system results in the leakage of pancreatic enzymes such as amylase, lipase, and proteases into the abdominal cavity. While often associated with pancreatic surgical procedures, trauma and necrotizing pancreatitis are also common culprits. Cross-sectional imaging, particularly computed tomography, plays a crucial role in assessing postoperative conditions and identifying both early and late complications, including pancreatic leaks. The presence of fluid accumulation or hemorrhage near an anastomotic site strongly indicates a pancreatic fistula, particularly if the fluid is connected to the pancreatic duct or anastomotic suture line. Pancreatic fistulas are a type of pancreatic leak that carries a high morbidity rate. Early diagnosis and assessment of pancreatic leaks require vigilance and an understanding of its imaging hallmarks to facilitate prompt treatment and improve patient outcomes. Radiologists must maintain vigilance and understand the imaging patterns of pancreatic leaks to enhance diagnostic accuracy. Ongoing improvements in surgical techniques and diagnostic approaches are promising for minimizing the prevalence and adverse effects of pancreatic fistulas. In this pictorial review, our aim is to facilitate for radiologists the comprehension of pancreatic leaks and their essential imaging patterns. [ABSTRACT FROM AUTHOR]

Background. Acute pancreatitis is an inflammatory disease of the exocrine part of the pancreas, accompanied by various complications and further development of necrosis of the gland and parapancreatic tissue with possible secondary infection. The study of experimental models shows that the acinar cells surrounding the islets of Langerhans remain relatively intact, indicating that endogenous insulin is a protective factor for the pancreatic parenchyma. The purpose of the study was to determine the dependence of endogenous insulin levels on the extent of pancreatic parenchymal damage. Materials and methods. Prospective analysis of endogenous insulin levels in 51 patients with acute pancreatitis. Results. Comparison of the mean values of endogenous insulin revealed that in patients with necrotizing pancreatitis, the median value was statistically significantly lower than in patients without pancreatic necrosis (p < 0.001). Moreover, in pancreatic necrosis, the determined level of endogenous insulin did not exceed 9 mcIU/ml and in 7 (13.7 %) patients, insulin was below the reference values. ROC analysis showed that low endogenous insulin is a risk factor for pancreatic necrosis. The threshold value of endogenous insulin, at which pancreatic necrosis was most often diagnosed, was determined, cut-off value of 5.3 mcIU/ml, AUC of 0.96 (95% CI 0.92–1.00) (sensitivity 91.89 % (95% CI 78.09–98.3 %), specificity 71.43 % (95% CI 41.9–91.61 %), PPV 89.47 % (95% CI 78.69–95.14 %), NPV 76.92 % (95% CI 51.74–91.2 %)). Conclusions. There was a statistically significant difference between the mean insulin values depending on the volume and location of pancreatic parenchymal damage (p < 0.001). In patients without pancreatic necrosis, endogenous insulin was statistically significantly higher than in those with pancreatic necrosis (p < 0.001). Binomial logistic regression analysis showed that the development of pancreatic necrosis in patients with acute pancreatitis significantly depended on the values of endogenous insulin at hospitalization. The level of endogenous insulin may be an additional indicator of the acute pancreatitis severity and the formation of necrotic changes in the pancreatic tissue, which will allow for correct initiation of treatment. [ABSTRACT FROM AUTHOR]

Intramural gastric pseudocysts are extremely rare and are often associated with pancreatitis and pancreatic pseudocysts; they can lead to complex clinical presentations requiring careful diagnosis and management. We present a case of a 57-year-old man with a history of pancreatitis and pancreatic pseudocysts who was diagnosed with intramural gastric pseudocysts. The patient was diagnosed with multiple gastric intramural pseudocysts at different locations during separate admissions and imaging studies. This indicates a recurrence of gastric intramural pseudocysts. In these cases, studies rarely discuss recurrence and its underlying causes. This highlights a significant gap in the existing literature.To provide a broader understanding, we reviewed the literature by searching major databases (PubMed, Scopus, and Web of Science) and then extracted and analyzed data from 18 articles, reaching 24 similar cases. Of the 25 patients studied (including our case), 92% were male and 8% were female. Cases had a mean age of 47.68 ± 14.82 years. Additionally, 84% of the patients had a history of alcohol consumption, and 88% had a positive history of pancreatitis. Common symptoms were abdominal pain (especially in the epigastric region), vomiting, nausea, and weight loss. In conclusion, results showed that intramural gastric pseudocysts generally occur in middle-aged men with a history of chronic or heavy alcohol consumption and pancreatitis.

Abstract Introduction Acute pancreatitis (AP) is a common and potentially lethal disease. Approximately 10–20% of the patients progress to necrotizing pancreatitis (NP). The step-up approach is the gold standard approach to managing an infected necrotizing pancreatitis with acceptable morbidity and mortality rates. Video-assisted retroperitoneal debridement (VARD) has been described as a safe and feasible approach with high success rates. Multiple studies in the American, European, and Asian populations evaluating the outcomes of VARD have been published; nevertheless, outcomes in the Latin American population are unknown. This study aims to describe a single-center experience of VARD for necrotizing pancreatitis in Colombia with a long-term follow-up. Methods A prospective cohort study was conducted between 2016 and 2024. All patients over 18 years old who underwent VARD for necrotizing pancreatitis were included. Demographic, clinical variables, and postoperative outcomes at 30-day follow-up were described. Results A total of 12 patients were included. The mean age was 55.9 years old (SD 13.73). The median follow-up was 365 days (P25 60; P75 547). Bile origin was the most frequent cause of pancreatitis in 90.1% of the patients. The mean time between diagnosis and surgical management was 78.5 days (SD 22.93). The mean size of the collection was 10.5 cm (SD 3.51). There was no evidence of intraoperative complications. The mean in-hospital length of stay was 65.18 days (SD 26.46). One patient died in a 30-day follow-up. One patient presented an incisional hernia one year after surgery, and there was no evidence of endocrine insufficiency at the follow-up. Conclusion According to our data, the VARD procedure presents similar outcomes to those reported in the literature; a standardized procedure following the STEP-UP procedure minimizes the requirement of postoperative drainages. Long-term follow-up should be performed to rule out pancreatic insufficiency.

Background: The acute and chronic pancreatitis (CP) can lead to severe complications like walled-off necrosis, large symptomatic pseudocyst or multiorgan failure. The treatment of these complications is multivariate and can differ from conservative, symptomatic treatment or minimal-invasive, endoscopic transgastral stenting to transgastral necrosectomy. Objectives: This study aims to analyse the clinical course for patients that develop local complications of severe pancreatitis. Design: This is a retrospective observational single-centre study on 46 patients with severe pancreatitis. Methods: In this retrospective single-centre study, 46 out of 474 inpatients from January 2014 to December 2020, who were treated because of an acute or CP, developed acute pancreatitis complications and could be included. We analysed and compared the clinical course of different treatments (lumen apposing metal stents, transgastral double pigtail stent, endoscopic retrograde cholangiopancreatography, operation, conservative treatment) and different complications (walled-off necrosis (WON), pancreatic pseudocyst (PPC)). Results: Forty-six patients developed an acute complication due to severe pancreatitis. Twenty-seven patients developed a WON, while 19 patients suffered from PPC. 48% of the whole cohort had an alcoholic aetiology of pancreatitis. 78% were treated with antibiotics, 48% suffered from infected pancreatitis and 22% needed intensive care treatment. WON patients more often had a longer hospitalization of more than 21 days. PPC patients were correlated with an alcoholic aetiology, whereas WON patients were inversely correlated with an alcoholic aetiology. Increased lactate dehydrogenase, lipase, and C-reactive protein levels as well as leucocyte count could be associated with a higher probability to exhibit a WON instead of another local complication. The mortality rate was low with 7% in our study. Conclusion: WON and PPC differ in certain patients and laboratory characteristics such as aetiology, elevated laboratory values, antibiotic treatment or the duration of hospitalization. Invasive treatment is not required in all severe pancreatitis cases. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Infected pancreatic necrosis (IPN) is a major determinant of mortality in acute pancreatitis (AP). Non‐invasive diagnosis of IPN could guide the intervention in AP. We aimed to investigate the role of non‐invasive methods like diffusion weighted magnetic resonance imaging (DW‐MRI) and clinico‐laboratory parameters as predictors of IPN.Prospective evaluation for predictors of IPN by diffusion restriction (DR) on DW‐MRI and clinico‐laboratory parameters was performed.Out of 39 patients included, 31 were analysed after exclusion. Twenty‐six (83.8%) patients had moderately severe AP, and the rest had severe disease. They were categorized into Group A: patients with documented infection after intervention (n = 17) and Group B: successfully managed without intervention or negative culture after intervention (n = 14). On univariate analysis, Group A had significantly more incidence of fever (P = 0.020), persistent unwellness (P = 0.003), elevated neutrophil count (P = 0.007), lymphocyte count (P = 0.007), neutrophil lymphocyte ratio (NLR) (P = 0.028), DR on DW‐MRI (P = 0.001) and low apparent diffusion coefficient (ADC) (P = 0.086). Multivariate analysis revealed DR on DW‐MRI (P = 0.004) and NLR (P = 0.035) as significant predictors of IPN, among other factors. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DW‐MRI were 94.1%, 78.6%, 91.66%, and 84.21%, respectively. The area under curve of NLR on the ROC plot was 0.85 and the best cutoff was >3.5, with sensitivity, specificity, PPV, and NPV of 70.6%, 78.6%, 80%, and 68.7% respectively.DW‐MRI and NLR are promising non‐invasive tools for accurate prediction of IPN and hence can guide the need for intervention in acute pancreatitis. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive surgical necrosectomy plays an important role in the management of infected pancreatic necrosis, with a goal of removing debris and debriding necrotic tissue. Pulse lavage is designed to simultaneously hydrostatically debride and remove the infected necrotic tissue with suction. It is also able to remove significant amounts of debris without traumatic manipulation of the necrotic tissue which may be adherent to surrounding tissue and can result in injury. Methods and results: The surgical technique of utilising a waterjet pulse lavage device during the minimally invasive necrosectomy is detailed. Sixteen patients being managed via a step-up approach underwent endoscopic necrosectomy via a radiologically placed drain tract. All sixteen patients were successfully managed endoscopically without conversion to open necrosectomy, and survived their admission. There were no complications associated with the use of the waterjet pulse lavage. Conclusion: Waterjet pulse lavage is a useful adjunct in minimally invasive necrosectomy, which reduces the length of the necrosectomy procedure, and facilitates removal of necrotic tissue while minimising the risk of traumatising healthy tissue. [ABSTRACT FROM AUTHOR]

The article discusses various studies presented at the British Journal of Surgery, covering topics such as the role of Physician Associates in the NHS, weight regain post-Roux En-Y Gastric Bypass, and long-term quality of life outcomes following surgical management of Complete Intrathoracic Stomach. Other studies explore benign biliary surgery, pancreatic cancer-associated fibroblasts, and the impact of bariatric surgery on obesity indices and reproductive hormones. The article also addresses the management of leaks post-bariatric surgery, outcomes of routine jejunostomy feeding following oesophagectomy, and the use of patient-derived organoids in predicting treatment response in gastric cancer. Additionally, the study on socioeconomic health inequality in oesophago-gastric cancer is presented. The article concludes with findings on the effectiveness of CA19-9 in predicting resectability and survival in pancreatic cancer patients with jaundice, the impact of disposable materials waste in surgical theatres, and the safety and effectiveness of hot and smouldering cholecystectomies in managing acute cholecystitis. [Extracted from the article]

Pharmacological agents regarding the most optimal treatments of acute pancreatitis remain. One‐carbon metabolism nutrients as therapeutic agents in many diseases might be involved in acute pancreatitis. The roles are acquired exploration in acute pancreatitis. We utilized Mendelian randomization to assess the causal impact of folate, homocysteine, and vitamin B12 (VB12) on acute pancreatitis. Wild‐type and corresponding genetically modified mouse models were used to verify the genetic correlating findings. A negative association between genetically predicted serum VB12 levels and risks of acute pancreatitis was identified in human population. The transcobalamin receptor (TCblR)/CD320 gene ablation that decreased cellular VB12 uptake and ATP production in pancreatic tissues promoted necrosis, resulting in much severe pathological changes of induced acute pancreatitis in mice. VB12 pretreatment and posttreatment dramatically increased ATP levels in pancreatic tissues and reduced the necrosis, then the elevated levels of amylase in serum, the levels of CK‐19, the activity of trypsin, and T lymphocyte infiltration in pancreatic tissues, prevented the pancreatic gross loss and ameliorated histopathological changes of mouse pancreases with induced acute pancreatitis. The results reveal that VB12 is potential as a therapeutic agent to inhibit tissue injuries and adaptive inflammatory responses in the pancreas in patients with acute pancreatitis. [ABSTRACT FROM AUTHOR]

Objective: Unknown etiology Background: Chylous ascites is defined as the development of lipid-rich ascitic fluid in the peritoneal cavity. The formation of chylous ascites revolves around non-portal-based and portal-based etiologies, and the diagnosis is made via paracentesis revealing an elevated triglyceride level and milky-white appearance. Chylous ascites is often reported as a postoperative complication in surgical procedures, but it has also been documented in cases of cirrhosis, malignancy, and tuberculosis. However, chylous ascites is rarely seen in chronic pancreatitis and noncirrhotic portal hypertension. This report presents the case of a 65-year-old man with a history of necrotizing pancreatitis and portal hypertension amidst an incidental finding of chylous ascites upon elective umbilical hernia repair. Case Report: We present the case of a patient with chylous ascites discovered during hernia repair. A 65-year-old man with no alcohol or tobacco use and a history of recurrent episodes of acute necrotizing pancreatitis was admitted for umbilical hernia repair. However, upon entering the abdominal cavity, an enlarging mass of ascitic fluid was encountered and tracked into the hernia sac. The fluid was drained via paracentesis and cytology revealed chylous ascites. The patient was discharged in stable condition and was advised to consume a high-protein, lowfat diet. Postoperative computed topography (CT) demonstrated an unchanged necrotic mass in the head of the pancreas. Conclusions: This report demonstrates that when dealing with unexpected findings, it is important to consider the existence of multiple pathologies as the driving cause. We describe a complex cause of chylous ascites, along with a review of the literature on the relationship between chylous ascites and chronic pancreatitis. [ABSTRACT FROM AUTHOR]

Introduction: Acute pancreatitis (AP) is a common and potentially lethal disease. Approximately 10–20% of the patients progress to necrotizing pancreatitis (NP). The step-up approach is the gold standard approach to managing an infected necrotizing pancreatitis with acceptable morbidity and mortality rates. Video-assisted retroperitoneal debridement (VARD) has been described as a safe and feasible approach with high success rates. Multiple studies in the American, European, and Asian populations evaluating the outcomes of VARD have been published; nevertheless, outcomes in the Latin American population are unknown. This study aims to describe a single-center experience of VARD for necrotizing pancreatitis in Colombia with a long-term follow-up. Methods: A prospective cohort study was conducted between 2016 and 2024. All patients over 18 years old who underwent VARD for necrotizing pancreatitis were included. Demographic, clinical variables, and postoperative outcomes at 30-day follow-up were described. Results: A total of 12 patients were included. The mean age was 55.9 years old (SD 13.73). The median follow-up was 365 days (P25 60; P75 547). Bile origin was the most frequent cause of pancreatitis in 90.1% of the patients. The mean time between diagnosis and surgical management was 78.5 days (SD 22.93). The mean size of the collection was 10.5 cm (SD 3.51). There was no evidence of intraoperative complications. The mean in-hospital length of stay was 65.18 days (SD 26.46). One patient died in a 30-day follow-up. One patient presented an incisional hernia one year after surgery, and there was no evidence of endocrine insufficiency at the follow-up. Conclusion: According to our data, the VARD procedure presents similar outcomes to those reported in the literature; a standardized procedure following the STEP-UP procedure minimizes the requirement of postoperative drainages. Long-term follow-up should be performed to rule out pancreatic insufficiency. [ABSTRACT FROM AUTHOR]

Severe acute pancreatitis (SAP) is an inflammatory disease with varying severity, ranging from mild local inflammation to severe systemic disease, with a high incidence rate and mortality. Current drug treatments are not ideal. Therefore, safer and more effective therapeutic drugs are urgently needed. 7α,14β-dihydroxy-ent-kaur-17-dimethylamino-3,15-dione DGA, a diterpenoid compound derivatized from glaucocalyxin A, exhibits anti-inflammatory activity. In this study, we demonstrated the therapeutic potential of DGA against SAP and elucidated the underlying mechanisms. Treatment with DGA markedly (1) inhibited death of RAW264.7 and J774a.1 cells induced by Nigericin and lipopolysaccharide, (2) alleviated edema, acinar cell vacuolation, necrosis, and inflammatory cell infiltration of pancreatic tissue in mice, and (3) inhibited the activity of serum lipase and the secretion of inflammatory factor IL-1β. DGA significantly reduced the protein expression of IL-1β and NLRP3 and inhibited the phosphorylation of NF-κB. However, DGA exhibited no inhibitory effect on the expression of caspase-1, gasdermin D (GSDMD), NF-κB, TNF-α, or apoptosis-associated speck-like protein (ASC) and on the cleavage of caspase-1 or GSDMD. Molecular docking simulation confirmed that DGA can bind to TLR4 and IL-1 receptor. In conclusion, DGA may effectively alleviate the symptoms of SAP in mice and macrophages by inhibiting the binding of TLR4 and IL-1 receptor to their ligands; therefore, DGA is a promising drug candidate for the treatment of patients with SAP. [ABSTRACT FROM AUTHOR]

Background and Objectives: Acute pancreatitis, characterized by pancreatic inflammation, poses significant morbidity and mortality worldwide, with varied etiologies including gallstones, alcohol, and certain medications. Necrotizing pancreatitis represents a severe form of parenchymal damage with considerable impact on patient quality of life. Early identification of necrotizing pancreatitis is crucial for timely intervention and improved outcomes. The aim of this study was to investigate the usability of CONUT and PNI scores as prognostic indicators. Materials and Methods: We conducted a retrospective observational study involving patients presenting to the emergency department with acute pancreatitis between January 2020 and October 2023. The Controlling Nutritional Status (CONUT) score and Prognostic Nutrition Index (PNI) were calculated from serum biomarkers to assess nutritional status. Patients were categorized into necrotizing and nonnecrotizing pancreatitis groups, and the utility of CONUT and PNI scores in predicting necrotizing pancreatitis was evaluated. Results: A total of 339 patients were included, with 8.26% diagnosed with necrotizing pancreatitis. CONUT and PNI scores significantly differed between necrotizing and nonnecrotizing groups, with higher CONUT scores and lower PNI scores observed in the necrotizing group. Receiver operating characteristic (ROC) curve analysis revealed significant predictive value of CONUT and PNI scores for necrotizing pancreatitis, with cutoff values of >5 and ≤34, respectively. Conclusions: CONUT and PNI scores demonstrate promise in predicting necrotizing pancreatitis in patients admitted to the emergency department with acute pancreatitis. Additionally, these scores may serve as prognostic indicators for mortality in acute pancreatitis patients. Early identification using CONUT and PNI scores could facilitate timely intervention, potentially reducing mortality and morbidity in this patient population. [ABSTRACT FROM AUTHOR]

Background and Aim: We aimed to evaluate comparative outcomes of aggressive versus non‐aggressive intravenous fluid (IVF) therapy in patients with acute pancreatitis. Methods: A systematic search of electronic data sources and bibliographic reference lists were conducted. All randomized controlled trials (RCTs) reporting outcomes of aggressive versus non‐aggressive IVF therapy in acute pancreatitis were included and their risk of bias were assessed. Effect sizes were determined for overall mortality, systemic inflammatory response syndrome (SIRS), sepsis, respiratory failure, pancreatic necrosis, severe pancreatitis, clinical improvement, AKI, and length of stay using random‐effects modeling. Trial sequential analysis was conducted to determine risk of types 1 or 2 errors. Results: We included 10 RCTs reporting 993 patients with acute pancreatitis who received aggressive (n = 475) or non‐aggressive (n = 518) IVF therapy. Aggressive IVF therapy was associated with significantly higher rate of sepsis (OR: 2.68, P = 0.0005) and longer length of stay (MD: 0.94, P < 0.00001) compared with the non‐aggressive approach. There was no statistically significant difference in mortality (RD: 0.02, P = 0.31), SIRS (OR: 0.93, P = 0.89), respiratory failure (OR: 2.81, P = 0.07), pancreatic necrosis (OR: 1.98, P = 0.06), severe pancreatitis (OR: 1.31, P = 0.38), clinical improvement (OR: 1.12, P = 0.83) or AKI (OR: 1.06, P = 0.91) between the two groups. Sub‐group analysis demonstrated higher morbidity and mortality associated with the aggressive approach in more severe disease. Trial sequential analysis detected risk of type 2 error. Conclusions: Aggressive IVF therapy may be associated with higher morbidity in patients with acute pancreatitis compared with the non‐aggressive approach, particularly in patients with more severe disease. It may also prolong length of hospital stay. The available evidence is subject to type 2 error indicating the need for adequately powered RCTs. [ABSTRACT FROM AUTHOR]

Introduction: Acute pancreatitis is the commonest cause of acute abdomen requiring surgical intervention. However, this clinical condition is sometimes managed conservatively till interval Appedicectomy is performed. Aims: to assess the laboratory parameters namely Serum albumin, Serum triglyceride, INR, Serum Electrolytes and CRP and correlate the severity index of acute pancreatitis i.e Balthazar index with above Laboratory parameters. Materials and method: The present study was a Prospective Study. This study was conducted from Complete Enumeration technique during this 6-month period at TMC and DR. BRAM Teaching hospital with diagnosis of acute pancreatitis. Result: Among the male participants, a substantial majority (88 Patients) fell within the reference range for INR (0.9 to 1.1). A smaller portion (12 Patients) had INR values exceeding the upper limit (>1.1). This distribution underscores the predominance of participants with INR values within the normal range among males in the study. Serum Sodium Levels: The majority of male participants (65 individuals) had serum sodium levels within the recommended range (135-145 meq/l). A significant proportion (29 patients) had hypernatremia (>145 meq/l), indicating high serum salt levels. A smaller proportion (6 patients) had hyponatremia (135 meq/l), which means their serum sodium levels were lower than usual. Conclusion: CT severity index is good, to describe clinical profile and outcome of patient with acute pancreatits and correlation with severity index. It detects pancreatic necrosis and depict local complications and grading of severity. Mortele index is better than Balthazar index. Revised Atlanta classification is better and more accurate in comparison to Mortele index and Balthazar index for assasing the outcome, i.e. mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background Encapsulated pancreatic fluid collection (PFC) is a requisite for endoscopic drainage procedures. The 4-week threshold for defining walled-off necrosis does not capture the dynamic process of encapsulation. We aim to investigate the changes in the wall characteristics of PFC in acute necrotizing pancreatitis (ANP) by comparing baseline contrast-enhanced computed tomography (CECT) with follow-up CT scans. Methods This retrospective study comprised consecutive patients with ANP who underwent a baseline CECT within first 2 weeks and follow-up CECT in the third to fifth weeks of illness. Presence, extent, and encapsulation thickness (defined as enhancing wall around the collection) on baseline CECT were compared with follow-up CT (done in the third–fifth weeks of illness). Results Thirty patients (19 males and 11 females; mean age 41.5 ± 13.5 years) were included in the study. The mean time to first CECT was 10 ± 3.6 days. There were 58 collections. The most common site was the lesser sac (n = 29), followed by the left pararenal space (n = 15). At baseline CT, 52 (89.7%) collections had varying degree of encapsulation (15.3%, complete encapsulation). Complete encapsulation was seen in 52 and 82.6% collections in third and fourth week, respectively. All collections in fifth week and beyond were encapsulated. The wall was thicker on follow-up CECT scans (p < 0.01). The mean wall thickness was not significantly associated with the degree of encapsulation (p = 0.417). There was no significant association between the site and degree of encapsulation (p = 0.546). Conclusion Encapsulation is dynamic and collections may get "walled off" before 4 weeks. Walled-off collections should be defined based on imaging rather than a fixed 4-week revised Atlanta classification threshold. [ABSTRACT FROM AUTHOR]

Pancreatic or peri pancreatic collections are the most frequent complication of acute pancreatitis. To make the difference between acute edematous and necrotic pancreatitis is crucial to choose the optimal therapeutic approach. Since the Atlanta classification, the different types of collections are well defined. During the first 4 weeks after acute pancreatitis onset, the pancreatic fluid collections (no clear wall, frequently related to an acute edematous pancreatitis with a spontaneously good evolution in most cases) and acute necrotic collections (with a variable solid component and frequently related to an acute necrotic pancreatitis) have been described. After 4 weeks, pancreatic pseudocysts (well-defined liquid collection with no solid component) and Walled-Off Necrosis (or WON, a capsulated collection with solid component) can be found. In 50% of cases, pancreatic collections (pseudocyst or WON) spontaneously disappear, without the need for drainage. Morphological follow-up is therefore recommended. Only symptomatic collections presenting with compression of a neighboring organ (stomach, duodenum, biliary tract), or infection of necrosis need drainage. Endoscopic route should be preferred if they are accessible. The modalities of drainage are based on a minimally invasive approach (called "step-up") as follows: cystostomy under endoscopic ultrasound guidance by metal (lumen-apposing metal stents) or plastic stents (double pigtail design), combined with endoscopic necrosectomy if necessary. Radiological and/or surgical drainage are sometimes necessary, particularly for collections not accessible by endoscopy (parieto-colic gutter, pelvis). [ABSTRACT FROM AUTHOR]

Purpose: In patients with acute necrotizing pancreatitis (ANP), the site, size, and the number of acute necrotic collections (ANC) may determine the outcome of patients. The current study aimed to correlate the nature of ANC with the adverse outcomes in ANP patients. Methods: This was a single-center, prospective study (August 2019-August 2022) recruiting patients with ANP, correlating the site, size, and number of ANC with the length of hospital stay, intensive care unit (ICU) stays, development of organ failure and infection, need for intervention, and mortality. Results: A total of 114 patients (mean age: 37.3 ± 13.4 years, 85.1% males) with ANP were included in the study. The number and maximum diameter of collections significantly correlated with the length of the hospital and ICU stay and the need for intervention. Taking a cut-off size of 8 cm, the sensitivity and specificity for predicting the need for intervention were 82.7% and 74.2%, respectively. ANCs located in the perinephric, paracolic, subhepatic, and epigastric regions had a significant correlation with two or more adverse outcomes. Additional points were added to the modified CT severity index (mCTSI) based on the present study's findings. The new score had significantly higher AUROC than mCTSI for predicting infection, need for intervention, ICU stay > 1 week, and mortality. Conclusion: The site, size, and number of EPNs have a significant correlation with adverse clinical outcomes in patients with ANP. The inclusion of these parameters, along with present scoring systems, will help further improve the prognostication of patients. [ABSTRACT FROM AUTHOR]

Introduction: Disconnected pancreatic duct syndrome (DPDS) is a pathological condition that causes various symptoms due to the continuous secretion of pancreatic enzymes from the pancreas upstream, which has been separated due to disconnection of the pancreatic duct (DPD) for various reasons. Acute necrotizing pancreatitis includes a certain probability of DPDS appearance, which makes it necessary to provide various treatments for DPDS. Furthermore, DPDS can impact long-term results, such as recurrence and impaired pancreatic function. Although the development of various modalities has contributed to diagnosis and treatment, especially less invasive endoscopic therapy, DPDS is often overlooked, and the diagnosis can be delayed due to the lack of consensus on its definition and classification. This review summarizes the current knowledge and challenges of DPDS and discusses the optimal strategy for its diagnosis and treatment, as well as future perspectives. Areas covered: Given the lack of established definition, diagnosis, and treatment of DPDS, we conducted a thorough review of the existing literature. Expert opinion: It is emphasized that a standardized definition and classification of DPDS is essential for designing and conducting clinical studies to address current unmet needs in managing patients with DPDS. [ABSTRACT FROM AUTHOR]

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Introduction: Acute necrotizing pancreatitis (ANP) is the acute inflammation of pancreatic parenchyma, most commonly due to alcohol abuse or cholelithiasis. The treatment can be either conservative or invasive, including a variety of techniques; however, it has not yet been established if the intervention should be early or if it should be delayed. The aim of this review is to investigate the optimal time for intervention in ANP. Methods: A literature search was conducted in PubMed and Scopus from inception until September 2024 for studies reporting the comparison between early and late intervention. Results: Early intervention, within 4 weeks of symptom onset, often involves drainage via percutaneous, endoscopic, or combined methods. Delayed intervention occurs after 4 weeks of symptom onset. This can be conducted either surgically or via minimally invasive means. The results of this review reveal that the time of intervention for ANP plays an important role in the prognosis and the course of the disease. In particular, early intervention is associated with higher mortality, which is also the primary clinical outcome. Delayed intervention is also superior regarding secondary clinical outcomes, specifically the complications associated with the intervention. Thus, it is accompanied by fewer episodes of new-onset organ failure, bleeding, gastrointestinal fistula, pancreatic fistula, wound infection, endocrine pancreatic insufficiency, and other complications. Finally, delayed intervention results in shorter stays, both in hospitals and the ICU. Conclusions: Delayed intervention is clearly more effective than early intervention and should be preferred. However, early intervention appears to be both safe and effective, and it is feasible. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Trial registration The appropriate holistic management is mandatory for successful endoscopic ultrasound (EUS)‐guided treatment of pancreatic fluid collections (PFCs). However, comorbidity status has not been fully examined in relation to clinical outcomes of this treatment.Using a multi‐institutional cohort of 406 patients receiving EUS‐guided treatment of PFCs in 2010–2020, we examined the associations of Charlson Comorbidity Index (CCI) with in‐hospital mortality and other clinical outcomes. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. The findings were validated using a Japanese nationwide inpatient database including 4053 patients treated at 486 hospitals in 2010–2020.In the clinical multi‐institutional cohort, CCI was positively associated with the risk of in‐hospital mortality (Ptrend < 0.001). Compared to patients with CCI = 0, patients with CCI of 1–2, 3–5, and ≥6 had adjusted odds ratios (95% confidence intervals) of 0.76 (0.22–2.54), 5.39 (1.74–16.7), and 8.77 (2.36–32.6), respectively. In the nationwide validation cohort, a similar positive association was observed; the corresponding odds ratios (95% confidence interval) were 1.21 (0.90–1.64), 1.52 (0.92–2.49), and 4.84 (2.63–8.88), respectively (Ptrend < 0.001). The association of higher CCI with longer length of stay was observed in the nationwide cohort (Ptrend < 0.001), but not in the clinical cohort (Ptrend = 0.18). CCI was not associated with the risk of procedure‐related adverse events.Higher levels of CCI were associated with a higher risk of in‐hospital mortality among patients receiving EUS‐guided treatment of PFCs, suggesting the potential of CCI in stratifying the periprocedural mortality risk.The research based on the clinical data from the WONDERFULcohort was registered with UMIN‐CTR (registration number UMIN000044130). [ABSTRACT FROM AUTHOR]

Highlights: What are the main findings? CP and ARP are common in paediatric populations with varied aetiologies. ERCP is more commonly used compared to EUS in paediatrics and is limited to specialist centres. What is the implication of the main finding? ERCP and EUS are safe and efficacious, with minimal complications in the management of CP and ARP in a paediatric cohort. Indications for both diagnostic and therapeutic EUS are increasing. ERCP and EUS offer a more 'patient-friendly', minimally invasive approach to CP and ARP. Objectives: To evaluate the role of ERCP (endoscopic retrograde cholangio-pancreatography) and EUS (endoscopic ultrasound) and to describe the efficacy and safety of these procedures in a paediatric cohort with chronic pancreatitis (CP) and acute recurrent pancreatitis (ARP). Methods: All patients (<18 years) undergoing an ERCP or EUS for ARP and CP between January 2008 and December 2022 were included. Data collection included indications for the procedure, technical success, adverse events and outcome data. Results: A total of 222 ERCPs were performed in 98 patients with CP and ARP (60% female, median age 10 years). The commonest indications were a main pancreatic duct stricture (PD) with or without a stone within the main PD. Successful cannulation was achieved in 98% of cases. Improved stricture resolution was demonstrated in 63% of patients. The overall adverse event rate for ERCP was low (n = 8/222, 3.6%). An improvement in abdominal pain was demonstrated in (75/98) 76% of patients. Their Body Mass Index also significantly improved post ERCP (15.5 ± 1.41 vs. 12.9 ± 1.16 kg/m2, p = 0.001). A total of 54 EUS procedures were undertaken in 48 individuals. Moreover, 35 individuals underwent a therapeutic EUS procedure, for which the commonest indication was the drainage of a pancreatic fluid collection. The overall complication rate was low (n = 2.4%) in all EUS cases. Conclusions: ERCP and EUS can be safely and effectively used in a paediatric population with indications analogous to an adult cohort. [ABSTRACT FROM AUTHOR]

Background: Ingestion of corrosive substances represents a frequent and consequential medical scenario, significantly impacting both vital and functional prognoses through the emergence of acute complications or stenosis, which pose considerable therapeutic challenges. Currently, endoscopy remains the cornerstone modality for diagnostic assessment and management. Nevertheless, recent research highlights computed tomography (CT) as a promising alternative, avoiding the risks associated with endoscopy and reducing the unnecessary surgical interventions based on its findings. Methods: Our retrospective study, spanning three years, encompassed 28 patients who had ingested corrosive substances. Among them, 24 underwent both CT scanning and endoscopic evaluation using CT and endoscopic scores. Results: Employing Standardized CT scoring criteria alongside the Zargar's endoscopic classification, our findings revealed significant concordance between the two modalities, particularly in discerning trans-parietal necrosis within the esophagus and stomach. Notably, radiographic evidence of digestive tract injury was found to be predictive of complications in over 80% of cases, demonstrating high sensitivity and negative predictive value. Furthermore, CT scores indicating moderate to severe injury were significantly associated with stenosis, with slightly inferior performance compared to endoscopy. Of particular note, a CT score indicative of severe injury was found to be a good predictor of mortality, further underscoring the prognostic value of CT in these cases. Conclusion: While the utility of CT in this context is undeniable, its integration with endoscopic findings remains imperative. We advocate for a systematic approach incorporating CT scanning, with further prospective research warranted to explore the feasibility of CT as a standalone diagnostic tool, as suggested by some scholars. [ABSTRACT FROM AUTHOR]

Background/Aims: Coaxial placement of double pigtail plastic stents (DPPS) through lumen-apposing metal stents (LAMSs) is commonly performed to reduce the risk of LAMS obstruction, bleeding, and stent migration when used for the drainage of pancreatic fluid collections (PFCs). A systematic review and meta-analysis were performed to compare the outcomes of LAMS alone and LAMS with coaxial DPPS placement in the management of PFCs. Methods: A systematic review was conducted to identify studies comparing LAMS and LAMS/DPPS for PFC drainage. Primary outcomes included the rate of clinical success, overall adverse events (AEs), bleeding, infection, occlusion, and stent migration. The pooled effect size was summarized using a random-effects model and compared between LAMS and LAMS/DPPS by calculating odds ratios (ORs). Results: Nine studies involving 709 patients were identified (338 on LAMS and 371 on LAMS/DPPS). LAMS/DPPS was associated with a reduced risk of stent obstruction (OR, 0.59; p=0.004) and infection (OR, 0.55; p=0.001). No significant differences were observed in clinical success (OR, 0.96; p=0.440), overall AEs (OR, 0.57; p=0.060), bleeding (OR, 0.61; p=0.120), or stent migration (OR, 1.03; p=0.480). Conclusions: Coaxial DPPS for LAMS drainage of PFCs is associated with a reduced risk of stent occlusion and infection; however, no difference was observed in the overall AE rates or bleeding. [ABSTRACT FROM AUTHOR]

Background/Aims: Metabolic syndrome is common in patients with acute pancreatitis and its components have been reported to be associated with infectious complications. In this post hoc analysis, we aimed to evaluate whether metabolic abnormalities impact the effect of immune-enhancing thymosin alpha-1 (Tα1) therapy in acute necrotizing pancreatitis (ANP) patients. Methods: All data were obtained from the database for a multicenter randomized clinical trial that evaluated the efficacy of Tα1 in ANP patients. Patients who discontinued the Tα1 treatment prematurely were excluded. The primary outcome was 90-day infected pancreatic necrosis (IPN) after randomization. Three post hoc subgroups were defined based on the presence of hyperglycemia, hypertriglyceridemia, or both at the time of randomization. In each subgroup, the correlation between Tα1 and 90-day IPN was assessed using the Cox proportional-hazards regression model. Multivariable propensity-score methods were used to control potential bias. Results: Overall, 502 participants were included in this post hoc analysis (248 received Tα1 treatment and 254 received matching placebo treatment). Among them, 271 (54.0%) had hyperglycemia, 371 (73.9%) had hypertriglyceridemia and 229 (45.6%) had both. Tα1 therapy was associated with reduced incidence of IPN among patients with hyperglycemia (18.8% vs 29.7%: hazard ratio, 0.80; 95% confidence interval, 0.37 to 0.97; p=0.03), but not in the other subgroups. Additional multivariate regression models using three propensity-score methods yielded similar results. Conclusions: Among ANP patients with hyperglycemia, immune-enhancing Tα1 treatment was associated with a reduced risk of IPN (ClinicalTrials.gov, Registry number: NCT02473406) [ABSTRACT FROM AUTHOR]

Background/Aims: Necrotizing pancreatitis (NP) presents a more severe clinical trajectory and increased mortality compared to edematous pancreatitis. Prompt identification of NP is vital for patient prognosis. A risk prediction model for NP among Chinese patients has been developed and validated to aid in early detection. Methods: A retrospective analysis was performed on 218 patients with acute pancreatitis (AP) to examine the association of various clinical variables with NP. The least absolute shrinkage and selection operator (LASSO) regression was utilized to refine variables and select predictors. Subsequently, a multivariate logistic regression was employed to construct a predictive nomogram. The model's accuracy was validated using bootstrap resampling (n=500) and its calibration assessed via a calibration curve. The model's clinical utility was evaluated through decision curve analysis. Results: Of the 28 potential predictors analyzed in 218 AP patients, the incidence of NP was 25.2%. LASSO regression identified 14 variables, with procalcitonin, triglyceride, white blood cell count at 48 hours post-admission, calcium at 48 hours post-admission, and hematocrit at 48 hours post-admission emerging as independent risk factors for NP. The resulting nomogram accurately predicted NP risk with an area under the curve of 0.822, sensitivity of 82.8%, and specificity of 76.4%. The bootstrap-validated area under the curve remained at 0.822 (95% confidence interval, 0.737 to 0.892). This model exhibited excellent calibration and demonstrated greater predictive efficacy and clinical utility for NP than APACHE II, Ranson, and BISAP. Conclusions: We have developed a prediction nomogram of NP that is of great value in guiding clinical decision [ABSTRACT FROM AUTHOR]

The document is a part of the Journal of the American College of Clinical Pharmacy and focuses on a case series about pancreatitis. It provides learning objectives for evaluating and treating acute and chronic pancreatitis, including diagnostic workup, management strategies, and risk factors. The text emphasizes the importance of hydration, pain relief, and early nutrition in treating acute pancreatitis, as well as the significance of alcohol cessation in managing chronic pancreatitis. The document also includes self-assessment questions related to the case studies presented. [Extracted from the article]

The document is a recorded webcast on vaping, featuring Chasity M. Shelton, Christopher M. Jones, and Brittany Florczykowski as presenters. It covers topics such as electronic nicotine delivery systems, regulations, and treatment plans for e-cigarette, or vaping, product use-associated lung injury. The target audience is pharmacotherapy specialists and clinical pharmacists managing patients with pulmonary and gastrointestinal diseases. The document also includes self-assessment questions for continuing education credits. [Extracted from the article]

Inflammation-induced dysregulation of the coagulation cascade and vascular stasis in hospitalized patients with acute necrotizing pancreatitis (ANP) serve as a milieu for venous thromboembolism (VTE). Deep vein thrombosis (DVT) and pulmonary embolism (PE) are often underrecognized. We evaluated the incidence and risk factors for VTE in a cohort of patients with ANP. All adult patients with ANP at our center between 2009 and 2022 were followed for three months after index hospitalization and categorized into cases and controls based on development of VTE. Demographic, clinical, and radiologic characteristics during admission were compared. A multivariable analysis was done to identify independent predictors for VTE. A p value of <0.05 was taken as significant. Among 643 ANP patients, 512 [males-350, median age-52 years] were eligible for inclusion. VTE developed in 64 (12.5 %) patients – 28 DVT (5 %), 22 PE (4 %) and both in 14 (3 %) after a median 16 days from the diagnosis of ANP. Significant independent predictors for VTE on multivariable analysis were age ≥60 years (OR 1.91; 95 % CI 1.04–3.53), peri-pancreatic extent of necrosis (OR 7.61; 95 % CI 3.94–14.70), infected necrosis (OR 2.26; 95 % CI 1.13–4.50) and total length of stay ≥14 days (OR 4.08; 95 % CI 1.75–9.50). The overall incidence of VTE in our cohort of patients with ANP was 12.5 %, which was usually diagnosed within one month of hospitalization. High-risk patients can be stratified based on clinical and imaging characteristics and may benefit from intensive DVT screening and prophylaxis during hospitalization and following discharge. [ABSTRACT FROM AUTHOR]

BackgroundThis study aims to analyzing scientific publications related to necrotizing pancreatitis and its mortality, identifying key areas and trends, and determining the leading research institutions, authors, countries, and journals actively working in this field.MethodsThe Web of Science and Scopus databases were searched for articles on NP published between January 1, 2013, and April 22, 2024. Articles published before 2013, conference abstracts, and case reports were excluded. The articles were assessed based on various metrics, including the number of citations, publication dates, countries of origin, institutions, journals, and authors.ResultsA total of 929 articles were identified, of which 251 were deemed suitable for analysis after duplicates were removed. China contributed the most articles, followed by the United States and India. The most frequent publications appeared in specialized journals such as “Pancreatology” and “Journal of Gastrointestinal Surgery.” The primary research institutions were universities and medical centers. The highest-impact articles focused on minimally invasive treatment methods for NP. There has been a growing body of research in NP over the past decade, particularly in China and the United States.ConclusionDespite advancements in medical science, the mortality rate associated with pancreatic necrosis remains high. This highlights the continued challenge in effectively addressing complications of acute pancreatitis. Researchers worldwide are actively exploring alternative therapeutic approaches to mitigate these complications and improve patient outcomes.

We present a case of prophylactic endovascular embolization in a 51-year-old man with necrotizing pancreatitis (NP) before undergoing endoscopic necrosectomy (EN). Contrast-enhanced CT imaging revealed the presence of a walled-off necrosis (WON) surrounding the pancreas, with the splenic artery coursing through the cavity. The splenic artery was embolized using n-butyl-2-cyanoacrylate (NBCA) and coils to mitigate the risk of massive bleeding in EN. A newly developed polytetrafluoroethylene (PTFE)-coated microcatheter was used to inject NBCA, enabling embolization of a long segment of the splenic artery without adhering to the vessel wall. Coils were placed distal and proximal to the embolized segment to optimize control. Over 5 sessions of EN, no massive bleeding was encountered. This report demonstrates the benefits of utilizing PTFE-coated microcatheters for enhanced safety and maneuverability during embolization with NBCA. Furthermore, it highlights the importance of prophylactic embolization during EN for managing NP.

The incidence of acute pancreatitis (AP), a condition characterized by inflammation in the pancreas, has been increasing globally and is associated with several complications. This review elaborated on the etiology, clinical presentation, severity assessment, and treatment modalities of AP, mainly in the critical care setting. Patients with severe AP, as indicated by organ failure (>48 hours from onset), warrant treatment in the intensive care unit setting. The most common etiologies, biliary disease and alcohol consumption, and the advanced diagnostic tools used for the identification of the cause are highlighted. Different severity assessment tools are utilized for grading the severity of the disease, predicting patient outcomes, determining the associated risk, and guiding treatment decisions. The treatment interventions comprise various approaches, such as anti-infective therapy enteral nutrition, analgesics for pain, or minimally invasive surgical procedures, thereby demonstrating an evolving landscape of AP management. Furthermore, various complications such as necrosis, organ failure, and hemorrhage, necessitate disease monitoring and differential diagnosis and are crucial for optimal management of patients. Novel treatment modalities and advancements in multidisciplinary care emphasize the potential for reducing the burden of AP in critical care settings.

Objective(s): Acute pancreatitis (AP) is an abrupt inflammatory condition characterized by a storm of inflammatory cytokines leading to high morbidity and mortality. The current study aimed to examine the efficacy of Ginkgo biloba extract EGb 761 (GBE) in the treatment of L-arginine-induced AP and its associated lung injury. Materials and Methods: Forty rats were randomly assigned into four groups. The normal group received only saline intraperitoneally while the other groups received two intraperitoneal L-arginine injections (250 mg/100 g b.wt) separated by a 1-hour interval to provoke AP. GBE (200 and 400 mg/kg/day, PO) was administered for 2 weeks post-induction of pancreatitis. Sera and pancreatic tissues were isolated. Results: The outcome of the present study revealed that GBE ameliorated the elevated levels of serum amylase, lipase, and pancreatic inflammatory mediators viz., tumor necrosis factor-alpha (TNF-α), mitogen-activated protein kinase P38 (MAPK-P38), c-Jun N-terminal kinase 1 (JNK1), and nuclear factor-kappa B (NF-κB). Moreover, GBE restored the pancreatic gene expression of Toll-like receptor 4 (TLR4) and prostatic acid phosphatase-2 (PAP-2). Pancreatic and lung histopathological examinations confirmed the aforementioned parameters. Conclusion: GBE interfered with the mechanistic pathway of L-arginine-induced acute pancreatic and its associated lung injury. Due to its anti-inflammatory properties, GBE can be used as a novel therapeutic candidate for the treatment of AP through down-regulating TLR-4/MAPK-p38/JNK and MAPK-p38/NF-κB signaling cascades. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the application of choledochoscopy combined with double-cannula lavage in the treatment of acute pancreatitis (AP) with encapsulated necrosis and analyzed related inflammatory indexes. Methods: Thirty patients with AP with encapsulated necrosis were enrolled and treated with choledochoscopy and double-cannula lavage. Serum white blood cell (WBC), procalcitonin (PCT), C-reactive protein (CRP), interleukin 6 (IL-6), IL-8, tumor necrosis factor alpha (TNF-α), and related inflammatory indexes were detected before and after surgery. Results: All of the participants who underwent the surgery recovered well and were discharged without serious complications; no deaths occurred. The serum WBC, PCT, and CRP of patients after surgery decreased compared with before the procedure, and the differences in WBC and CRP were statistically significant (P < 0.05); the difference in PCT was not statistically significant (P > 0.05). Postoperatively, IL-6, IL-8, and TNF-α levels were higher than before surgery, and the differences were statistically significant (P < 0.05). Conclusion: The surgical method presented herein effectively controlled and alleviated the infection of patients; it also did not increase the risk of infection and can thus be considered a safe and effective surgical method. [ABSTRACT FROM AUTHOR]

Pancreatic neuroendocrine tumors (PNET) represent less than 3% of all primary pancreatic tumors. With the advent of advanced imaging techniques (computed tomography/magnetic resonance imaging/endoscopic ultrasonography), the proportion of incidentally detected small PNET (less than 2 cm) has increased. As surgery in small and/or nonfunctional PNET carries significant morbidity and mortality and is considered as overtreatment, newer methods, viz., EUS-guided radiofrequency ablation and ethanol/ethanol-lipoidal ablation, have been reported with variable success. We reviewed the current literature regarding EUS-guided ablative therapy (EUSGAT) for PNETs. We performed a systematic review, regarding the indications, efficacy, complications, mortality, and morbidity of EUSGAT in management of PNET. Seven prospective studies including 95 PNET patients were identified after systematic search. There were no randomized controlled trials. Among 95 patients, 81% (n = 77) had nonfunctional tumors and 19% (n = 18) had functional tumors. Indication for selecting EUSGAT over surgery was poor functional status of patients. The overall effectiveness of EUSGAT was 90.5% (54–98%) without differences between functional vs. nonfunctional PNETs (p = 0.3). Major complication in the form of pancreatitis was observed in 10.5% (n = 10) patients, and there was no mortality. EUSGAT has acceptable effectiveness rate only for small PNETs. However, associated complication rate is also a cause for concern. As per current evidence, we can only suggest that EUS-guided strategy should be used as experimental therapy in clinical study settings only after discussing goals of treatment and potential complications. [ABSTRACT FROM AUTHOR]

Background: There are no guidelines in the literature for the use of a computed tomography (CT) protocol in the initial phase of acute pancreatitis (AP). Purpose: To evaluate the contribution of single portal venous phase CT compared to triple-phase CT protocol, performed in the initial phase of AP for severity assessment. Material and Methods: In this retrospective study, a total of 175 patients with acute pancreatitis who underwent initial triple-phase CT protocol (non-contrast, arterial phase, and portal venous phase) between D3 and D7 after the onset of symptoms were included. Analysis of AP severity and complications was independently assessed by two readers using three validated CT severity scores (CTSI, mCTSI, EPIC). All scores were applied to the triple-phase CT protocol and compared to the single portal venous phase. Inter-observer analyses were also performed. Results: No significant difference whatever the severity score was observed after analysis of the single portal venous phase compared with the triple-phase CT protocol (interstitial edematous pancreatitis: CTSI: 2 vs. 2, mCTSI: 2 vs. 2, EPIC: 1 vs. 1; necrotizing pancreatitis: CTSI: 6 vs. 6, mCTSI: 8 vs. 8, EPIC: 5 vs. 5). Inter-observer agreement was excellent (ICC = 0.96–0.99), whatever the severity score. Conclusion: A triple-phase CT protocol performed at the initial phase of AP was no better than a single portal venous for assessing the severity of complications and could lead to a 63% reduction in irradiation. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a common acute clinical condition requiring emergency care. The aetiological factors are varied and may include biliary stones, alcoholism, trauma, drugs, and metabolic and idiopathic causes. Most patients have acute oedematous pancreatitis with interstitial inflammation and favourable clinical outcome. Acute pancreatitis includes a wide spectrum of diseases, from mild self-limiting symptoms to a fulminant process with multiple organ failure and high mortality. MATERIALS AND METHODS-Hospital Based Cross-sectional Study conducted in Assam medical college for one year.A detailed history and clinical examination followed by radiological investigations specially Ultrasound whole abdomen was done for all the patients. Follow up of the patients was done. Results:. Test of proportion showed that proportion of patients with alcohol (58.82%) was significantly higher than the patients with stone (35.29%) . In our study, operative intervention was performed in 21cases, out of which 11 underwent simple cholecystectomy, 10 underwent cystogastrostomy and 8 had percutaneous drainage.CONCLUSION-In our study we have found that Alcohol use was the most common cause of acute pancreatitis, followed by Biliary stones in our study. Overall mortality was 4.7%, mostly due to various complications.The majority of the cases were managed conservatively. 6.47% of cases underwent cholecystectomy and in 5.88% of cases, drainage with pigtail for pseudocyst was done. Open cystogastrostomy was done in 5.88% of cases. [ABSTRACT FROM AUTHOR]

Severe acute pancreatitis is a potentially life-threatening condition that can cause multi-organ failure. Early initiation of supportive treatment and determination of severity are crucial for identifying patients at risk of organ failure and providing them with timely critical care support. The management of acute pancreatitis involves fluid resuscitation, pain relief, and early nutrition. The preferred strategy for managing necrotizing pancreatitis is the step-up approach, with endoscopic drainage preferred over surgical intervention. Reliable risk scores for predicting severity in acute pancreatitis are still uncertain, and there is a need for ongoing efforts to identify specific treatments for the disease. [Extracted from the article]

Acute pancreatitis (AP) is a potentially fatal condition with no targeted treatment options. Although inhibiting xanthine oxidase (XO) in the treatment of AP has been studied in several experimental models and clinical trials, whether XO is a target of AP and what its the main mechanism of action is remains unclear. Here, we aimed to re-evaluate whether XO is a target aggravating AP other than merely generating reactive oxygen species that trigger AP. We first revealed that XO expression and enzyme activity were significantly elevated in the serum and pancreas of necrotizing AP models. We also found that allopurinol and febuxostat, as purine-like and non-purine XO inhibitors, respectively, exhibited protective effects against pancreatic acinar cell death in vitro and pancreatic damage in vivo at different doses and treatment time points. Moreover, we observed that conditional Xdh overexpression aggravated pancreatic necrosis and severity. Further mechanism analysis showed that XO inhibition restored the hypoxia-inducible factor 1-alpha (HIF-1 α)-regulated lactate dehydrogenase A (LDHA) and NOD-like receptor family pyrin domain containing 3 (NLRP3) signaling pathways and reduced the enrichment of 13C 6 -glucose to 13C 3 -lactate. Lastly, we observed that clinical circulatory XO activity was significantly elevated in severe cases and correlated with C-reactive protein levels, while pancreatic XO and urate were also increased in severe AP patients. These results together indicated that proper inhibition of XO might be a promising therapeutic strategy for alleviating pancreatic necrosis and preventing progression of severe AP by downregulating HIF-1 α -mediated LDHA and NLRP3 signaling pathways. XO was enormously increased in necrotic murine models and severe patients of acute pancreatitis, pharmacological and genetic intervention of XO significantly affected disease severity via HIF-1 α -regulated LDHA and NLRP3 pathway. [Display omitted] [ABSTRACT FROM AUTHOR]

This study aimed to assess the significance of serum albumin levels within 24 h of patient admission in correlation with the incidence of outcomes and mortality in patients diagnosed with acute pancreatitis. A retrospective study was conducted over a 5-year period, from January 2018 to December 2023, at the Mohammed VI University Hospital in Oujda, Morocco. The study included 371 patients diagnosed with acute pancreatitis. Hypoalbuminemia (≤ 30 g/L) was observed in 124 patients (33.4% of cases), and these patients had a higher mean age compared to those with normal albumin levels (P = 0.003). Hypoalbuminemia was significantly associated with persistent Systemic Inflammatory Response Syndrome (SIRS) (70.8% vs. 29.2%, P = 0.000), a higher BISAP score (66.7% vs. 33.3%, P = 0.000), and a higher CTSI score (51.7% vs. 48.3%, P = 0.000). Hypoalbuminemia was also associated with the presence of pleural effusion (P = 0.000). The mortality in the sample was 4.6%, and it was significantly associated with hypoalbuminemia (76.5%, P = 0.000). In conclusion, serum albumin levels within 24 h of patient admission appear to be a significant prognostic biomarker in acute pancreatitis, particularly in anticipating persistent organ failure and mortality. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the efficacy of admission contrast-enhanced CT scans in formulating strategies for performing early laparoscopic cholecystectomy in cases of acute gallstone pancreatitis. Methods: Patients diagnosed with acute gallstone pancreatitis underwent a CT scan upon admission (after at least 24 h from symptom onset) to confirm diagnosis and assess peripancreatic fluid, collections, gallstones, and common bile duct stones. Patients with mild acute gallstone pancreatitis, following the Atlanta classification and Baltazar score A or B, were identified as candidates for early cholecystectomy (within 72 h of admission). Results: Within the analyzed period, 272 patients were diagnosed with mild acute gallstone pancreatitis according to the Atlanta Guidelines. A total of 33 patients (12.1%) were excluded: 17 (6.25%) due to SIRS, 10 (3.6%) due to local complications identified in CT (Balthazar D/E), and 6 (2.2%) due to severe comorbidities. Enhanced CT scans accurately detected gallstones, common bile duct stones, pancreatic enlargement, inflammation, pancreatic collections, and peripancreatic fluid. Among the cohort, 239 patients were selected for early laparoscopic cholecystectomy. Routine intraoperative cholangiogram was conducted in all cases, and where choledocholithiasis was present, successful treatment occurred through common bile duct exploration. Only one case required conversion from laparoscopic to open surgery. There were no observed severe complications or mortality. Conclusion: Admission CT scans are instrumental in identifying clinically stable patients with local tomographic complications that contraindicate early surgery. Patients meeting the criteria for mild acute gallstone pancreatitis, as per Atlanta guidelines, without SIRS or local complications (Baltazar D/E), can safely undergo early cholecystectomy within the initial 72 h of admission. [ABSTRACT FROM AUTHOR]