Search Results (810)

Background/Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) in children with acute or chronic pancreatitis, or following pancreatic trauma, is technically demanding and may be associated with an increased risk of complications. Evidence on technical success and complication rates in preadolescent children is limited. This study aimed to evaluate the short- and long-term outcomes of ERCP with pancreatic stenting in children with pancreatic conditions. Methods: In this retrospective single-center cohort study, consecutive patients aged ≤12 years who underwent ERCP with pancreatic stenting for acute or chronic pancreatic diseases or pancreatic trauma were included. Demographic, clinical, and procedural data were collected, and complications and clinical response, were assessed. Results: A total of 20 patients (mean age 7 years, range 2–12; 45% female) underwent 62 ERCP procedures for pancreatic indications. Nine patients (45%) had a known genetic mutation. Post-ERCP pancreatitis occurred in 2 procedures (3.2%), and bleeding in 1 procedure (1.6%). No perforations or procedure-related mortality were observed. Technical success was achieved in 57/62 procedures (91.9%), with associated improvement in symptoms, pain, or inflammatory markers. Conclusion: In this pilot study from Sweden, ERCP with pancreatic stenting appears to be a feasible therapeutic option in pre-teen children with pancreatic diseases, with a good technical success rate and relatively low complication rates. Further studies are warranted to better define long-term outcomes in this population. Full article

Background/Objectives: Acute pancreatitis is increasingly recognized as a risk factor for disturbances in glucose metabolism and the development of diabetes mellitus (DM). However, the long-term endocrine consequences of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remain poorly characterized. This study aimed to evaluate the association between post-ERCP pancreatitis and the risk of new-onset diabetes mellitus (NODM). Methods: This retrospective cohort study included patients who underwent ERCP between 2019 and 2024 at a tertiary referral center. New-onset diabetes mellitus was defined using laboratory data and International Classification of Diseases (ICD) diagnostic codes within one year after ERCP. Multivariable logistic regression adjusting for age, sex, hypertension, and coronary artery disease was performed. Results: A total of 2695 patients were included. Post-ERCP pancreatitis occurred in 165 patients (6.1%). New-onset diabetes developed in 9/165 patients (5.5%) in the PEP group and in 27/2530 patients (1.1%) in the non-PEP group. An increased incidence of new-onset diabetes was observed among patients who developed post-ERCP pancreatitis (crude OR 5.35, 95% CI 2.47–11.57; p < 0.001). In multivariable analysis adjusting for age, sex, hypertension, and coronary artery disease, post-ERCP pancreatitis remained significantly associated with new-onset diabetes in the fully adjusted model (adjusted OR 5.33, 95% CI 2.42–11.77; p < 0.001). The absolute risk increase was 4.39%, corresponding to a number needed to harm of 23. Conclusions: An increased incidence of new-onset diabetes was observed among patients who developed post-ERCP pancreatitis. This association remained significant after adjustment for baseline cardiovascular comorbidities. Although the absolute risk increase was modest, these findings may be clinically relevant. Because this was a retrospective study with a limited number of diabetes cases, the findings should be considered hypothesis-generating and require confirmation in prospective studies. Full article

Background: Aspirin, initially recognized for its anti-inflammatory, antipyretic and analgesic properties, holds a prominent role in the treatment of cardiovascular disease. The utility of aspirin in cancer therapeutics has been explored and stratified into COX-dependent and -independent mechanisms. COX2 gene expression has been demonstrated to be significantly upregulated in colorectal cancer and various other gastrointestinal malignancies including pancreatic, esophageal, and gastric cancer. This study investigates the relationship of aspirin use and outcomes in patients with colorectal cancer. Methods: The Nationwide Inpatient Sample (NIS) database from 2017 to 2022 was analyzed for patients age > 18 who were hospitalized for colorectal cancer and its decompensations using ICD-10 diagnostic codes. These patients were further stratified based on the long-term use of aspirin. The principal outcome of this investigation are the odds of in-hospital mortality, with secondary outcomes including odds of pulmonary embolism, portal vein thrombosis, acute kidney injury, septic shock, requiring an ICU level of care and odds of hepatic, pulmonary, gastrointestinal and peritoneal or retroperitoneal metastatic disease. Multivariate logistic regression accounting for hospital and patient characteristics was implemented for analysis, with the Charlson Comorbidity Index used to adjust for coexisting comorbidity burden; a p-value (p) of <0.05 was considered statistically significant. Results: In our analysis of the NIS, 596,160 patients were identified with colorectal cancer and 11.7% (69,750) of this population were identified with long-term use of aspirin. Aspirin use was identified to have a significantly reduced odds of in-patient mortality (adjusted odds ratio) [aOR] 0.530, p value < 0.001 95% CI (confidence interval): 0.460–0.617. Patients with aspirin use also demonstrated significantly reduced odds of adverse outcomes and gastrointestinal, hepatic, pulmonary and retroperitoneal/peritoneal metastasis; (aOR 0.606, 95% CI: 0.564–0.653, p < 0.001), (aOR 0.628, 95% CI: 0.582–0.678, p < 0.001), (aOR 0.676, 95% CI: 0.605–0.755, p < 0.001) and (aOR 0.751, 95% CI: 0.685–0.825, p < 0.001) respectively. Conclusions: In recent years, there has been an alarming increase in incidence of colorectal cancer, particularly amongst younger individuals with increased associated mortality. This mortality increase, albeit alarming, is a driving force for treatment innovation with continual examination of our repertoire of medications for possible repurposed applications. COX2-mediated signaling serves as a key promotor of tumorigenic molecular signaling that directly contributes to tumor cell proliferation, angiogenesis and metastasis in colorectal cancer. Aspirin use and its inhibitory action on COX2 demonstrated a significantly reduced odds of in-hospital mortality. Aspirin use is also associated with significantly reduced odds of developing metastatic disease to the liver, gastrointestinal system, lungs and peritoneum in patients with colorectal cancer. These findings convey that aspirin use reduces the likelihood of in-hospital mortality, major comorbid conditions and of developing metastatic disease as compared to those who do not use aspirin. Full article

The pancreatic pseudocyst is a collection of pancreatic fluid surrounded by a non-epithelialized wall comprising granulation tissue and fibrosis, occurring in approximately 10% of patients diagnosed with acute pancreatitis and in 20–38% of those with chronic pancreatitis. Most pseudocysts are situated in the pancreatic head and pancreatic body, but about 20% develop in extrapancreatic locations. We present the case of a 46-year-old male patient diagnosed with chronic alcohol pancreatitis with acute exacerbation, who developed a large pancreatic pseudocyst with subcapsular location in the right hepatic lobe; this was successfully treated by laparoscopic surgical drainage, with no postoperative complications and no recurrence of the pseudocyst. The computed tomography scan and postoperative biochemical analysis of the intracystic fluid played a key role in establishing the diagnosis of this rare condition. An intrahepatic pancreatic pseudocyst is a rare location for pancreatic pseudocysts, but one located in the right hepatic lobe is extremely rare. The treatment of intrahepatic pancreatic pseudocysts may be conservative, though endoscopic, percutaneous, or surgical drainage may be necessary. The presence of symptoms, signs of extrinsic compression, or complications require drainage of the pseudocyst. The “take-away” lesson learned from this case: surgical treatment for pancreatic pseudocysts located subcapsularly in the liver may be considered when they are very large, or when minimally invasive treatment has not been effective. Full article

Chronic pancreatitis (CP) is a fibro-inflammatory condition defined by permanent anatomical changes in the pancreas. The causes of CP are described by the TIGAR-O classification system: toxin-related, idiopathic, genetic mutations, autoimmune disorders, episodes of recurrent acute pancreatitis, and obstructions. Pain is multifactorial in nature, and common psychopathological consequences of CP, including depression and anxiety, complicate the clinical picture of chronic pancreatitis. As a result, the quality of life of patients with CP is decreased. This review describes the pathophysiology of pain and its relationship to underlying psychological consequences, with a focus on a long-term, holistic management approach. Strategies that combine physical and psychological management align with SDG 3 (Good Health and Well-being). CP predominantly affects patients from low socioeconomic backgrounds due to disparities in medical care, underscoring the relevance of achieving SDG 10 (Reduced Inequalities). This review emphasizes the importance of targeted research in developing a holistic care model for CP that aligns with the SDGs. Full article

Acute pancreatitis (AP) is a severe inflammatory disorder with limited therapeutic options. Novel bile acids have emerged as potent immunomodulators, but the function of norcholic acid (NorCA) previously remained unknown. In this study, we identified NorCA’s role as a novel immunomodulator that alleviates acute pancreatitis through peroxisome proliferator-activated receptor α (PPARα)-mediated macrophage reprogramming and efferocytosis. Targeted metabolomics was performed on serum from patients with AP and caerulein-induced AP mice. The functional role and mechanism of NorCA were investigated using flow cytometry, immunofluorescence, efferocytosis assays, and network pharmacology, both in vitro and in vivo. Our findings indicate that NorCA levels were significantly elevated in both patients and mice with AP, correlating with disease severity and complications. NorCA treatment markedly reduced serum amylase/lipase and pancreatic histopathological damage in AP mice. Mechanistically, NorCA promoted M1-to-M2 macrophage reprogramming and enhanced efferocytosis of apoptotic cells. These effects were dependent on PPARα activation, as demonstrated by siRNA silencing and pharmacological antagonism. These findings position NorCA as a promising therapeutic candidate and severity-associated metabolite in AP. Full article

Background/Objectives: Acute infected necrotizing pancreatitis remains associated with substantial morbidity and mortality. The step-up approach combines minimal-invasive drainage with endoscopic transgastric or percutaneous necrosectomy and has been shown to improve outcomes compared with open surgery. Laparoscopic-assisted necrosectomy (LAPN) may be performed in cases of infected walled-off necrosis (WON) following percutaneous drainage and is typically carried out using laparoscopic instrumentation. A newly implemented interdisciplinary approach includes sinus tract endoscopy, guided necrosectomy (STEN), which employs flexible endoscopy through a surgically created sinus tract and offers a less invasive and more targeted alternative to LAPN, providing improved visualization of complex necrotic cavities and facilitating repeatable step-up debridement. This study aimed to assess the introduction of STEN compared with LAPN in the management of infected WON within a step-up approach. Methods: A retrospective analysis of patients with infected walled-off necrosis (WON) treated using a step-up approach between 2019 and 2025 was conducted. Patients who underwent CT-guided percutaneous drainage followed by either STEN or LAPN were included. Demographic characteristics and clinical outcomes were collected. The primary endpoint was a composite outcome comprising major complications and 6-month mortality. Secondary outcomes included overall complication rates, need for reinterventions, and length of hospital stay. Results: During the study period, 17 patients were included. All patients were managed using a step-up approach: nine underwent STEN and eight underwent LAPN. In the STEN group, six patients (66.7%) met the primary endpoint, all due to major complications, with no mortality observed. In the LAPN group, the primary endpoint occurred in four patients (50.0%), including one death and three major complications. Conclusions: Our study showed that both STEN and LAPN were effective in treating infected WON within a step-up approach. STEN and LAPN showed comparable outcomes. However, these findings should be interpreted as exploratory and with caution given the retrospective design and the small sample size of this study. Further studies with larger patient cohorts are warranted to confirm these findings and to better define the role of this technique in the management of infected necrotizing pancreatitis. Full article

Objective: Due to the varied clinical manifestations of acute pancreatitis (AP), prompt identification of patients predisposed to extended hospitalization is essential for efficient resource allocation. This study assessed the predictive efficacy of inflammatory and immunonutritional ratios—namely, C-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hemoglobin, albumin, lymphocyte, and platelet score (HALP)—in predicting hospitalizations lasting more than 7 days. Methods: A retrospective cohort analysis was performed on 306 patients treated at a tertiary center from June 2020 to June 2025. We used Mann–Whitney U tests, ROC analysis, and multivariate logistic regression models to evaluate the relationship between admission laboratory-derived ratios and length of stay. Results: In total, 27.5% (n = 84) of the cohort experienced prolonged hospitalization. Individual markers exhibited moderate discrimination; however, procalcitonin and CAR displayed high negative predictive values (>85%), demonstrating clinical utility in excluding prolonged hospital stays. Multivariate analysis revealed advanced age (p < 0.001) and increased CAR (p < 0.001) as the most significant independent predictors. On the other hand, the HALP score was much lower in the group that stayed longer, but it was not an independent predictor in the multivariate model. Conclusions: Older age and a higher CAR are both independent factors that can predict longer hospital stays in AP. The high negative predictive value of CAR is important because it represents a reliable way to exclude prolonged hospitalization. Low CAR levels at admission may help clinicians identify patients eligible for early discharge, thereby optimizing bed management. Full article

The ubiquitously transcribed tetratricopeptide repeat Y-linked gene (UTY/KDM6C), a catalytically impaired histone demethylase encoded on the Y chromosome, has garnered increasing attention for its emerging roles in tumorigenesis and cancer progression. Despite high sequence homology with its X-linked paralog UTX/KDM6A, UTY exhibits markedly reduced or absent H3K27me3 demethylase activity due to critical amino acid substitutions in its Jumonji C domain. Consequently, UTY primarily functions through non-enzymatic mechanisms, acting as a scaffold in chromatin-remodelling complexes like COMPASS and SWI/SNF, or mediating protein–protein interactions that regulate transcriptional programs independent of demethylation. This aligns with epigenetic dysregulation in cancers, where imbalances in repressive H3K27me3 and active H3K4me either drive tumour suppressor silencing or oncogene activation. Unlike frequently mutated UTX in cancers such as breast, renal cell carcinoma, and acute myeloid leukaemia, UTY’s contributions in cancer are less defined, constrained by male-specific expression. Emerging evidence suggests UTY as a context-dependent tumour suppressor in AML and squamous-like pancreatic ductal adenocarcinoma. While direct functional validation remains limited in several cancer types, UTY is increasingly implicated as a potential tumour suppressor in haematological malignancies and prostate cancer. Therapeutically targeting UTY’s scaffold functions shows promise for male-specific cancers and merits future investigation. Full article

Background: Gamma-glutamyl transferase (GGT) has been associated with increased risks of multiple cancers and mortality. Because GGT is also a marker of hepatobiliary injury, metabolic dysfunction, and alcohol exposure, this study evaluated associations between persistently elevated GGT and hepatobiliary and pancreatic outcomes. Materials and Methods: This retrospective cohort study used TriNetX data from the US Collaborative Network to compare adults aged 40 years or older with persistently elevated GGT against those with normal GGT using a 65 U/L threshold on two occasions 6–12 months apart. Outcomes were assessed from 180 to 1095 days after the index event. Following 1:1 propensity score matching, 14,590 patients per cohort were analyzed. Cox proportional hazards analysis estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Elevated GGT was associated with increased hazards of cholangiocarcinoma (HR 3.715, 95% CI 1.899–7.268), hepatocellular carcinoma (HR 2.260, 95% CI 1.677–3.045), acute pancreatitis (HR 3.359, 95% CI 2.284–4.941), chronic pancreatitis (HR 3.086, 95% CI 1.975–4.821), pancreatic cysts (HR 2.160, 95% CI 1.493–3.127), hospitalization (HR 1.363, 95% CI 1.236–1.503), and all-cause mortality (HR 2.250, 95% CI 2.051–2.467). No statistically significant association was observed with pancreatic cancer (HR 1.591, 95% CI 0.766–3.303; log-rank p = 0.209). Mean follow-up after matching was 799.722 ± 391.071 days in the elevated GGT cohort and 844.685 ± 374.676 days in controls. Conclusions: Persistent GGT elevation was associated with hepatobiliary malignancies, pancreatic inflammatory diseases, pancreatic cysts, hospitalization, and all-cause mortality, but not pancreatic cancer. These results suggest that persistent GGT elevation may be a non-specific clinical marker of underlying hepatobiliary and metabolic risk. Full article

Acute pancreatitis is a common inflammatory digestive disease with an unpredictable clinical course, ranging from self-limited forms to severe forms, associated with complications and increased mortality. Early identification of patients at risk of severe disease is particularly important from a surgical perspective, as it has a significant impact on subsequent management. Traditional severity scores, such as APACHE (Acute Physiology And Chronic Health Evaluation) II and BISAP (Bedside Index for Severity in Acute Pancreatitis), remain widely used, but their rigid structure and delayed applicability may limit initial risk assessment. In this review we highlight the evolving role of artificial intelligence in predicting the severity of acute pancreatitis and supporting clinical decision-making, with a focus on surgical management. Recent advances show that data-driven models could improve early risk assessment compared to traditional methods. Although their potential clinical benefits are becoming increasingly clear, real-world implementation remains limited. Initial results are encouraging, but important questions regarding reliability, safety, and integration into clinical practice still need to be addressed. Full article

Background: Acute pancreatitis (AP) is increasingly recognised as a disease with clinically significant long-term consequences. However, the extent to which aetiology influences the spectrum of long-term pancreatic sequelae remains unclear. This systematic review and meta-analysis evaluated long-term complications following a first episode of AP, with a protocol-defined focus on the impact of aetiology. Methods: This review evaluated eligible studies that included adults with a first episode of AP who were followed for chronic pancreatitis (CP), exocrine pancreatic insufficiency (EPI), or new-onset diabetes mellitus (NODM). A comprehensive search of PubMed, Scopus, Web of Science, and CENTRAL was conducted from January 2002 to June 2025. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random-effects meta-analyses were performed to estimate pooled incidence proportions. A prespecified network meta-analysis was not feasible because outcome-specific event counts stratified by aetiology were inconsistently reported. This study satisfied PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251074032). Results: Eight studies met eligibility criteria with extractable data for quantitative synthesis. Five studies (n ≈ 10,780) reported chronic pancreatitis (CP), with a pooled incidence of approximately 7–8% following a first episode of acute pancreatitis (AP) and substantial heterogeneity (I² ≈ 96%). Three studies (n = 796) reported exocrine pancreatic insufficiency (EPI), with a pooled incidence of approximately 23%, although estimates were highly heterogeneous (I² ≈ 98%). Four studies (n = 2706; 415 events) reported new-onset diabetes mellitus (NODM), with a pooled incidence of approximately 20% (I² ≈ 93%). Although aetiology-specific quantitative comparisons were not possible, narrative synthesis consistently demonstrated higher long-term risk following alcohol-associated AP, lower risk after biliary AP, and intermediate but variable outcomes in idiopathic AP. Conclusions: Clinically meaningful long-term pancreatic dysfunction is common after a first episode of acute pancreatitis, particularly new-onset diabetes mellitus. While aetiology-specific risks could not be quantified, consistent patterns suggest that aetiology shapes long-term outcomes. These findings support structured, aetiology-informed follow-up after acute pancreatitis and the need for standardised outcome reporting in future studies. Full article

Somatostatin is a potent endocrine regulator and neurotransmitter, exerting predominantly inhibitory effects in different tissues of the body, via G-protein coupled receptors. Five such specific receptors have been identified, with different effects and tissue distribution. The multifaceted actions and effects of somatostatin make it useful as a potential therapeutical means in various pathologies; however, in clinical practice, somatostatin analogues, namely octreotide, lanreotide and pasireotide, are commonly used instead, due to their increased half-life and increased receptor selectivity, with pasireotide showing a more extensive receptor binding profile and high affinity for somatotastin receptor (SSTR) 5, which may prove effective in cases of resistance to first-generation analogues. Apart from their many uses in neoplastic pathologies, somatostatin analogues represent viable treatment choices in some ocular pathologies, congenital hyperinsulinism, gastrointestinal bleedings and portal hypertension, acute pancreatitis, and dumping syndrome. They have also been used in some cases, with varying degrees of success, in patients with post-surgical gastrointestinal and lymphatic fistulas, refractory chronic diarrhoea and polycystic kidney disease; many applications in paediatric patients have also been documented. The aim of this review is to present the applications of somatostatin and its analogues as alternative or second-line therapies, along with insights into their effectiveness and future potential. Full article

Assessing disease severity and prognosis in canine acute pancreatitis (AP) remains a major clinical challenge. This study evaluated the clinical utility of the Adapted Modified Canine Activity Index (aMCAI), a clinical scoring system refined from the original MCAI. A prospective observational study was conducted on 42 dogs diagnosed with AP, with aMCAI scores assessed on Days 1, 3, and 5. A linear mixed model (LMM) was used to analyze score progression over time and differences between survivors and non-survivors. Receiver operating characteristic (ROC) curves evaluated the prognostic accuracy for 30 day survival. The LMM analysis revealed that non-survivors had significantly higher aMCAI scores than survivors (p = 0.035), and overall scores decreased significantly over time (p < 0.001). ROC analysis showed poor discrimination on Days 1 and 3. However, on Day 5 the aMCAI demonstrated good prognostic performance (AUC = 0.813, p < 0.001). A cutoff value of ≥2.5 on Day 5 yielded 100% sensitivity, a negative likelihood ratio of 0.00 and a 100% negative predictive value, providing clinically relevant prognostic information. These findings suggest that the aMCAI is a practical tool for monitoring disease progression and may support the identification of dogs with a high likelihood of survival. Full article

Chronic kidney disease (CKD) in dogs is associated with increased serum pancreatic lipase activity, complicating the diagnosis of acute pancreatitis (AP). This prospective study evaluated pancreatic lipase activity measured using a quantitative DGGR assay in dogs with CKD while excluding cases with clinical or imaging evidence of AP, and the DGGR results were compared with the qualitative SNAP cPL test. Twenty-five dogs with IRIS stage 1–4 CKD were enrolled. The DGGR results were within the reference range in 52% of dogs and elevated in 48%, whereas the SNAP cPL results were abnormal in 72% of cases. Discordance between tests was common, with several dogs showing abnormal SNAP cPL results despite normal DGGR values, a difference that was statistically significant (p = 0.016). The DGGR results revealed significant differences between normal and abnormal values relative to serum creatinine and blood urea nitrogen concentration, as well as total serum lipase activity, suggesting an influence of impaired renal function on pancreatic lipase. No significant association was observed between CKD stage and either DGGR or SNAP cPL results. These findings indicate that pancreatic lipase activity may be increased in dogs with CKD independently of AP and that SNAP cPL may overestimate pancreatic enzyme elevation in this population. DGGR appears to be more reliable for excluding AP in dogs with CKD, although positive results should be interpreted cautiously in conjunction with clinical and imaging findings. Full article