Introduction

Acute pancreatitis (AP) is a major cause of digestive-related hospitalizations. Systemic inflammatory response syndrome (SIRS) is present in 20–60% of cases and is associated with severe AP, multiorgan failure (MOF), or in-hospital mortality. This study aims to assess the clinical impact of transient and persistent SIRS on mortality and MOF, compared with the BISAP score.

Aims & Methods

A retrospective study was conducted on a prospective cohort of patients admitted with AP to a tertiary hospital between March 2017 and June 2019. Blood tests were recorded at admission and at 48 hours. Severity was defined using the 2012 Atlanta classification. MOF was defined as dysfunction of two or more organ systems lasting over 48 hours. Transient SIRS was present only at admission, while persistent SIRS lasted >48h. Univariate analysis and ROC curves were conducted using SPSS. Fagan nomograms estimated post-test probabilities of mortality and MOF using pre-test prevalence from the cohort.

Results

A total of 467 patients were included; 84 (18.41%) had SIRS at admission, of whom 32 (37.52%) had persistent SIRS. ROC analysis showed similar AUCs for persistent SIRS and BISAP ≥2, while transient SIRS had poor predictive value. Fagan nomograms showed persistent SIRS had the highest positive and negative likelihood ratios, and greater post-test probability for mortality and MOF, compared to BISAP ≥2 and transient SIRS.

Conclusion

Persistent SIRS was associated with higher risk of mortality and MOF, while transient SIRS had limited prognostic value. Persistent SIRS and BISAP ≥2 had comparable ROC performance, but Fagan nomograms demonstrated the superior clinical predictive utility of persistent SIRS. It showed post-test probabilities up to 40%, compared to 12–13% for BISAP ≥2. These results highlight the importance of monitoring SIRS persistence in AP for better risk stratification and early intervention.

References

1. Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN; American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology. 2018;154(4):1096–1101. doi:10.1053/j.gastro.2018.01.032.
2. Singh VK, Wu BU, Bollen TL, Repas K, Maurer R, Mortele KJ, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol. 2009;7(11):1247–1251. doi:10.1016/j.cgh.2009.08.012.

Introduction

Pancreatic fluid collections (PFCs) are significant local complications that can arise from acute pancreatitis, and its management often involves drainage, although the benefits of metal stents over plastic stents remain uncertain. This meta-analysis compared the efficacy and safety of metal stents versus plastic stents for endoscopic ultrasound (EUS)-guided drainage of PFCs.

Aims & Methods

We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing metal with plastic stents for drainage of PFCs. The odds ratio (OR) was used for binary outcomes and the mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI).

Results

This study included eight RCTs and over 500 patients. Procedure duration was shorter in the metal stent arm compared with the plastic stent arm (MD -10.63; 95%CI -16.12 to -5.15, p<0.001). However, there was no statistically significant difference between metal and plastic stents in clinical success (p=0.78), technical success (p=0.65), overall mortality (p=0.48), recurrence (p=0.23), number of interventions (p=0.85), need of necrosectomy (p=0.35), need of surgery (p=0.35), length of hospitalization (p=0.86), exocrine insufficiency (p=0.54), endocrine insufficiency (p=0.77), and AEs (p=0.36).

Conclusion

Metal stents for EUS-guided drainage of PFCs are associated with a shorter procedure duration. Besides that, it did not improve other clinically relevant outcomes in comparison with plastic stents.

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer that poses significant therapeutic challenges. In this regard, the identification of prognostic biomarkers is crucial to improve the prediction of clinical outcomes and guide therapeutic decisions. Tumour-associated autoantibodies (TAAbs) have been identified as prognostic biomarkers in several types of cancer, as they can be generated before the first clinically detectable signs of disease.

Aims & Methods

The aim of this study was to identify TAAbs that can be used as prognostic biomarkers in PDAC. 80 sera from patients with PDAC, divided into four groups according to disease stage, were included in the study: patients with premalignant lesions (n = 20), patients undergoing curative resection after diagnosis (CR) (n = 20), patients with unresectable advanced locoregional disease (LA) (n = 20) and patients with metastatic disease (MT) (n = 20). Sera from each group were analysed divided into 4 pools of 5 samples each using the HuProt Human Protreome microarray v4.0 (CDI Laboratories, Baltimore, MD). Candidate TAAbs with high specific reactivity in MT and/or LA samples were selected according to the following criteria: z-score ≥ 3 in at least 2/4 pools and fold-change > 1.2. The RNAseq data collected in the Human Protein Atlas were used to determine protein expression levels and prognostic value. The GSE15471, GSE28735 and GSE16515 databases were used to compare expression levels with those of healthy subjects without the disease.

Results

43 TAAbs demonstrated high levels of specific reactivity in samples from MT and/or LA patients. Of these highly recognised proteins, 15 were selected for showing notable levels of expression in tumour tissue from PDAC patients and prognostic capacity in some types of cancer. Of these 15, 2 proteins involved in tumour development were identified. Survival analyses showed that six of the 15 selected proteins were significantly associated with a worse prognosis in PDAC patients (p < 0.05). Finally, in the comparison with control tumour tissue, 5 proteins were identified with significantly higher expression in patients diagnosed with the disease (p < 0.05 in at least 2 of the cohorts used).

Conclusion

15 TAAbs have been identified as promising candidates for prognostic biomarkers in PDAC. Further validation studies are required to confirm their prognostic value and to develop a robust biomarker signature with potential for clinical application and market translation.

Introduction

The aetiology of acute pancreatitis remains elusive in 10-30% of patients after clinical, biological and morphological investigations. Endoscopic ultrasound has shown promise and is particularly effective in exploring the bilio-pancreatic region.

Aims & Methods

The aim of our study was to evaluate the contribution of endoscopic ultrasound to the aetiological diagnosis of unexplained acute pancreatitis.
This is a retrospective descriptive study of 89 patients who underwent endoscopic ultra sound for unexplained acute pancreatitis between January 2010 and January 2025.

Results

The mean age of our patients was 55 +/- 16.3 years, with extremes ranging from 17 to 89 years. The sex ratio (M/F) was 0.81, with a slight female predominance of 55.1%. A history of previous acute pancreatitis was found in 31.9% of cases, and 16.3% of patients had undergone cholecystectomy. The diagnostic yield in our study was 68%. Biliary origin was retained in 40.4% (n=36) of patients, 19 of whom underwent complementary ERCP at the same anaesthetic time. Neoplastic pathology was found in 32.5% of cases (n=30). Chronic pancreatitis was reported in 22.4% of patients (n=20). Two cases of pancreas divisum, one case of sphincter of Oddi dysfunction and one case of choledocele were found. In the remaining 32% of cases, the endoscopic ultrasound was normal and no cause could be found.

Conclusion

Endoscopic ultrasound is currently an indispensable tool in the etiological investigation of unexplained acute pancreatitis. In our study, the diagnostic efficiency was around 68%.

Introduction

Acute pancreatitis (AP) is a common acute inflammatory disease of the abdomen. ATP citrate lyase (ACLY) has been shown to play a critical role in mitigating acute pancreatitis-associated injury. Lentinan, a multifunctional polysaccharide derived from shiitake mushrooms, exhibits biological activities such as anti-inflammatory, antioxidant, and immunomodulatory effects, and is widely used in clinical settings. However, the role of Lentinan in acute pancreatitis remains unclear.

Aims & Methods

This study aimed to investigate the protective effects of Lentinan against acute pancreatitis and whether this protection depends on ATP citrate lyase. Adult healthy male C57BL/6 mice were randomly divided into control group, acute pancreatitis group, and Lentinan + acute pancreatitis group. The cerulein-LPS induced AP model was established by intraperitoneal injection of cerulein solution (100 μg/kg body weight) 10 times at hourly intervals, followed by a single injection of lipopolysaccharide (5 mg/kg) immediately after the last cerulein injection. In the lentinan + acute pancreatitis group, mice were pretreated with intraperitoneal injections of of Lentinan solution (50 mg/kg, 100 mg/kg, or 200 mg/kg) for three consecutive days before AP induction. The severity of pancreatitis was assessed by comparing plasma activities of amylase, lipase, alanine aminotransferase, aspartate aminotransferase, and plasma levels of urea, and creatinine, as well as pancreatic histopathological scores. Systemic inflammatory response was evaluated by measuring plasma IL-1β and TNF-α levels through enzyme-linked immunosorbent assay. Pancreatic infiltration of macrophages and neutrophils was detected by immunofluorescence, and protein levels of ACLY, NLRP3, and IL-1β in pancreatic tissues were measured by Western blot. To further validate the critical role of ACLY, AP was induced in mice with pancreas-specific ACLY knockout, with Lentinan pretreatment.

Results

Lentinan significantly alleviated pancreatic histopathological damage caused by AP, including edema, necrosis, and inflammatory cell infiltration. It also reduced plasma aminotransferase activity, creatinine, and urea levels, but did not significantly decrease plasma amylase or lipase activity. A higher dose of Lentinan (200 mg/kg) was less effective than lower doses in reducing plasma aminotransferase, creatinine, and urea in AP mice, possibly due to greater hepatorenal toxicity. Therefore, a moderate dose of Lentinan (100 mg/kg) provided effective protection against acute pancreatitis and was therefore selected for subsequent experiments. Additionally, Lentinan reduced pancreatic infiltration of macrophages and neutrophils, decreased plasma pro-inflammatory cytokine levels, upregulated pancreatic ACLY protein expression, and downregulated the levels of NLRP3 inflammasome and IL-1β proteins in pancreatic tissues. In mice with pancreas-specific ACLY knockout, both local pancreatic injury and systemic inflammation caused by AP were significantly exacerbated, and the protective effect of Lentinan against acute pancreatitis was diminished.

Conclusion

Lentinan exerts protective effects against acute pancreatitis by improving local and systemic inflammatory responses. The expression of pancreatic ACLY is indispensable for mediating this protective effect, which was partially achieved through the inhibition of the NLRP3 inflammasome pathway. The present study establishes a novel mechanism for this clinically available immunomodulator, which could have potential therapeutic implications in acute pancreatitis.

Introduction

The learning curve for EUS-guided Gastroenterostomy (EUS-GE) has been assessed through retrospective studies involving few elite senior endoscopists (SE), using procedural time as the main surrogate outcome. This study aims to evaluate the training course of junior endoscopists (JE) approaching EUS-GE using the WEST technique, considering both technical efficiency and clinically relevant patient outcomes.

Aims & Methods

From a prospective single-centre registry of EUS-GE (PROTECT, ClinicalTrials.gov NCT04813055) using the Wireless Simplified Technique (WEST), the learning curve of 3 JE, experienced in pancreatobiliary endoscopy (PBE) was analysed to identify inflection points (“knots”), applying adaptive regression and cumulative sum control chart (CUSUM) on several continuous and dichotomous variables. EUS-GE performed by a SE and those on post-surgical anatomy were excluded.

Results

From a prospective database of 165 EUS-GE, 100 were performed by a JE with previous EUS-GE training (JE1) and 26 by two naïve JEs.
In JE1’s curve, neither procedural nor fluoroscopy time showed any improvement while radiation dose (mean Air Kerma: 392 ± 317 Gy) significantly decreased (F-test p=.0005) after 57 (adaptive regression) and 72 interventions (CUSUM), stabilizing thereafter. The need for supervision/backup from a SE showed a significant knot after 32 procedures (p<.0001). Technical success (100%), clinical success (95.0%), adverse events (AEs; 6.0%) and moderate/severe AEs (4.0%) remained constant through the learning curve, clustered according to the aforementioned knots. Conversion from EUS-GE to enteral stenting was rare (7.2%) and non-significantly decreased over time.
Despite requiring significantly higher fluoroscopy time (234 vs. 187 seconds, p=.009) and procedural time (55 vs. 43 minutes, p=.002), naïve endoscopists achieved efficacy and safety outcomes comparable to the remaining cohort.

Conclusion

From the analysis of a prospective learning curve, performing ≈ 30 EUS-GE seems required for independent practice, and ≈ 70 to stabilize the fluoroscopy usage. EUS-GE training of naïve PBE endoscopists in high-volume institutions, using a standardized technique, does not compromise clinical and safety standards.

Introduction

The revised Atlanta Classification delineates the local complications of acute pancreatitis, categorizing them as acute (peri)pancreatic fluid collections (PFCs), acute necrotic collections, pancreatic pseudocysts, and walled-off pancreatic necrosis (WOPN). Various endoscopic interventions are employed for the management of WOPN, notably including direct transluminal endoscopic necrosectomy (DEN) following the placement of an endoscopic ultrasound-guided (EUS) lumen-apposing metal stent (LAMS). This study aims to assess the clinical outcomes and safety profile of DEN in patients diagnosed with pancreatic WOPN.

Aims & Methods

This single-center retrospective analysis encompasses patients with pancreatic WOPN who underwent DEN at Semmelweis University between October 1, 2021, and October 1, 2024. The procedures were performed by three seasoned specialists in EUS and endoscopic retrograde cholangiopancreatography (ERCP). Comprehensive data on patient demographics, procedural specifics, and follow-up outcomes were collected, with adverse events classified according to the AGREE criteria.

Results

We successfully placed LAMS in 31 patients (61% female, mean age 66.3 years, SD 9.4). The primary indications for intervention included the dimensions of WOPN, exacerbation of gastric outlet obstruction, and signs of infection. The mean dimensions of WOPN were recorded as 98 mm in the anteroposterior direction (SD 35.6), 90 mm laterolateral (SD 44), and 88 mm craniocaudal (SD 27.4), with a predominant occurrence in the head of the pancreas (60%). Alcohol consumption emerged as the leading etiological factor for WOPN in 92% of male patients, whereas biliary causes were identified in 67% of female patients.
In total, we conducted 83 DEN procedures across the 31 patients (51 males and 32 females). The average number of DEN sessions was three for both male and female groups (range: 2-6). The technical success rate achieved was 100%, accompanied by a clinical success rate of 97%. One patient succumbed to the condition; however, three of the surviving 30 required intensive care due to multiorgan failure. To enhance the resolution of infection between DEN sessions, we employed 7 Fr/250 cm nasocystic tubes for irrigation of the WOPN with a saline solution in all patients, with no adverse events reported as a result of this intervention.

Conclusion

DEN can be performed safely in experienced medical centers and demonstrates a high success rate in the treatment of infected WOPN, effectively alleviating symptoms and decreasing enzyme levels. The predominant etiology of WOPN formation in male patients is attributed to alcohol consumption, while biliary factors are more prevalent in female patients.