Introduction

Statins and anti-inflammatory non-steroidal drugs (NSAIDs) like aspirin have already been demonstrated to reduce the risk of developing PDAC. Whether there is a beneficial effect of these drugs in patients with established PDAC is poorly investigated.

Aims & Methods

Our aim is to investigate the association between the use of aspirin, statins, angiotensin-converting-enzyme (ACE) inhibitors and sartans and the clinical outcome in a prospective cohort of PDAC patients.
Single-centre prospective cohort of consecutive PDAC patients, with baseline demographics, exposome and pharmacological data, details on tumour features, treatment (chemotherapy/surgery) and survival recorded. The effect of the investigated drugs on overall survival was investigated by Kaplan-Meier curves and multivariate analysis using a Cox proportional hazards regression model. Tests of statistical significance and confidence intervals were two-sided; a value of p < 0.05 was considered statistically significant.

Results

419 patients with histologically diagnosed PDAC were included, mean age 67, 51.7% male; 50 (11.9%) stage I, 152 (36.2%) stage II, 110 (26.2%) stage III, 107 (25.5%) stage IV; 368 patients (87.8%) underwent chemotherapy as first treatment, of whom 304 (82.6%) polychemotherapy (PAXG, FOLFIRINOX or gemcitabine plus nab-paclitaxel); 129 patients (30.7%) underwent surgical resection, most after chemotherapy. Ninety-four patients (22.4%) aspirin users, 101 (24.1%) statin users, 72 (17.1%) ACE inhibitors users, 91 (21.7%) sartans users. Median estimated OS was 20 months with 228 patients (54.4%) dead at last follow-up. In the whole cohort Kaplan Meier survival analysis showed a longer OS in statin users vs non users (21 vs 18 months). At Cox regression use of statins (HR 0.69; p=0.02 (0.506-0.952 95% CI)), age (HR 1.046 (1.030-1.062 95% CI), p<0.0001) and stage (HR 1.466 (1.280-1.679 95% CI), p<0.0001) had a significant impact on OS. In subgroup analyses of patients with resectable patients (stage I and II) and advanced stages (III and IV) there was no significant effect. All the other investigated drugs were not significantly associated with OS.

Conclusion

The present results suggest that chronic use of statins is significantly associated with increased OS in patients affected by PDAC at Cox proportional hazard regression. Whether this beneficial effect is due to less indolent tumours or better response to treatments require further investigation.

Introduction

Inflammatory Bowel Diseases (IBD) can lead to various complications, with Acute Severe Colitis (ASC) being among the most critical. ASC is a medical and surgical emergency that poses a significant risk to life, necessitating prompt and effective diagnosis and management. The first-line treatment typically involves intravenous corticosteroids. However, some cases are resistant to corticosteroids and require second-line medical therapy or immediate surgical intervention.

Aims & Methods

The objective was to identify factors associated with the failure of first-line medical treatment in patients with ASC. A retrospective descriptive and analytical study was conducted over ten years (January 2014 to March 2024) in the gastroenterology department of Charles Nicolle Hospital. The study included patients with IBD complicated by ASC, defined by the Truelove and Witts criteria and a Lichtiger score greater than 10.Patients with bacterial superinfection were not included.

Results

Forty-five patients over 18 years old were included, with a mean age of 37.87 years (range: 18–74 years). There was a slight female predominance (53%), with a male-to-female ratio of 0.87. In 31% of cases, ASC was the initial presentation of the disease. Endoscopic signs of severity at admission were observed in 49% of patients. All patients received intravenous corticosteroid therapy with hydrocortisone hemisuccinate as the first-line treatment. The response rate to first-line treatment was 64.5%. Second-line medical therapy was administered to 24.4% of patients, consisting of cyclosporine in 11.1% and infliximab in 13.3%. Five patients (11.1%) underwent subtotal colectomy due to corticosteroid failure.
In univariate analysis, factors associated with corticosteroid failure included male gender (p=0.011), absence of extraintestinal manifestations (p=0.017), higher average number of stools on the first day (p=0.013), Lichtiger score >10 on the third (p=0.011) and fifth day (p<0.001), hemoglobin levels >11 g/dL on the first day (p<0.001), >10 g/dL on the third day (p=0.009), >9 g/dL on the seventh day (p=0.013), white blood cell count >10,000/mm³ on the first day (p=0.008), >12,000/mm³ on the third (p=0.001) and seventh day (p=0.004), C-reactive protein (CRP) level >30 mg/L on the seventh day (p=0.005), and persistent endoscopic signs of severity after three to five days of corticosteroid therapy (p=0.001).
Multivariate Analysis showed that only the presence of severe endoscopic signs on follow-up endoscopy after three to five days of corticosteroid therapy was predictive of corticosteroid failure (Odds Ratio = 42.2; p=0.028).

Conclusion

Acute Severe Colitis is a potentially life-threatening complication. The presence of severe endoscopic signs after five days of corticosteroid therapy should prompt the initiation of second-line therapy. Understanding the predictive factors for corticosteroid failure is essential for individualized management to improve both immediate and long-term outcomes.

Disclosure

The authors declare no conflicts of interest.

Introduction

Pancreatobiliary disease during pregnancy, though uncommon, poses significant risks. Gallstone-related disorders affect 3–12% of pregnancies and may progress to life-threatening complications such as cholangitis or biliary pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is a highly effective therapeutic approach; however, concerns about foetal radiation exposure and procedure-related maternal complications limit its broader acceptance. There remains a need for rigorous real-world data on the safety and neonatal outcomes of ERCP during pregnancy.

Aims & Methods

This retrospective observational study aimed to evaluate the safety of ERCP in pregnant patients, focusing on two key outcomes:
(1) Maternal and foetal safety during and after the procedure, and
(2) Effectiveness of radiation-minimisation strategies, including fluoroscopy reduction and abdominal shielding.
We reviewed 25 pregnant patients undergoing ERCP at a tertiary referral centre. Indications included choledocholithiasis (84%), cholangitis (4%), biliary pancreatitis (4%), and stent management (8%). Mean maternal age was 19.2 years; mean gestational age at ERCP was 28.3 weeks. Fluoroscopy usage, post-ERCP complications, Apgar scores, and neonatal follow-up at day 30 were recorded. Fluoroscopy-minimising techniques included suction-verification of bile and stent release without imaging.

Results

No maternal or foetal adverse events occurred peri- or post-procedure. ERCP was performed successfully in all 25 patients, with 23 (92%) undergoing sphincterotomy. Fluoroscopy was utilised in 20 cases (80%), with lead shielding employed in all. In five cases (20%), ERCP was conducted without fluoroscopy by using alternative bile verification techniques. Apgar scores ranged from 7 to 10, and all neonates exhibited normal development at 30-day follow-up.

Conclusion

This study confirms that ERCP can be safely performed during pregnancy when executed by skilled endoscopists adhering to radiation-limiting protocols. Fluoroscopy-free ERCP appears feasible in selected cases, significantly reducing foetal radiation exposure without compromising efficacy. Our findings support ERCP as a viable and safe therapeutic option in pregnant patients with biliary obstruction, providing novel evidence for the growing implementation of protective strategies and alternative imaging techniques in high-risk obstetric settings.

References

• Cappell MS, Friedel D. The role of endoscopy in pregnant and lactating women. Gastrointest Endosc Clin N Am. 2020;30(1):69–95.

• Lee SH, et al. Safety of ERCP during pregnancy: systematic review. World J Gastroenterol. 2009;15(4):357–64.

• Ko CW, et al. Complications of ERCP: a prospective study. Gastrointest Endosc. 2007;66(5):1114–9