Introduction

Chronic pancreatitis represents a risk for pancreatic cancer with an estimated effect of 16 in the first 2 years, 7.9 in the first 5 years and over 3 in 9 years. The sensitivity of endoscopic ultrasound fine needle aspiration (EUS-FNA) in diagnosing pancreatic malignancy in cases with and without chronic pancreatitis drops from 91.5% to 65.3%. Although contrast-enhanced fine needle aspiration (CH-EUS-FNA) was not statistically superior to standard EUS-FNA in diagnosing solid pancreatic lesions, some emphasis was placed on the usefulness of CH-EUS-FNA in cases of pancreatic masses on chronic pancreatitis.

Aims & Methods

Aim. To assess and compare the diagnostic rate of CH-EUS tissue acquisition (CH-EUS-TA) compared to standard EUS-TA in cases of solid pancreatic masses with features of chronic pancreatitis.

Material and methods. This is a retrospective unicenter study from 2020 to 2022 that included solid pancreatic masses (solid component > 80%) that required EUS-guided sampling and features of chronic pancreatitis that needed EUS tissue acquisition. We excluded patients with previous surgery or chemotherapy for pancreatic diseases, contraindications for tissue sampling or without 1-year follow-up in negative cases. We divided patients in two groups: group 1 with CH-EUS-FNA and group 2 with standard FNA, both using 22G needles. The final diagnosis was based on FNA or surgery results or on 1-year follow-up.

Results

There were 13 patients included in group 1 and 27 patients included in group 2. The sensitivity for malignancy was 85% in group 1 and 80% in group 2. No difference was proved regarding size or mass location, percentage of definitive chronic pancreatitis between groups. The most common lesion location was the head of the pancreas (60%), while the mean mass size was 2,4 cm. Less than 50% of patients (42%) were classified as “Definitive Chronic Pancreatitis” according to Rosemont Criteria. Regarding the severity of disease according to Cambridge Severity Score, the largest group (45% of patients) was the “Cambridge 3” group. 45% of the patients required main bile duct stenting for main bile duct stenosis. A small percent of patients (15%) showed signs of portal hypertension. In group 1, the hypo-enhancement was observed in 38.4% of patients.

Conclusion

In this retrospective series, the CH-EUS-FNA proved to perform similarly with EUS-FNA when chronic pancreatitis features were noticed. Further studies using EUS fine needle biopsy (EUS-FNB) contrast guided procedures are needed in this category of patients.

References

1. Kirkegard J et al. Chronic Pancreatitis and Pancreatic Cancer Risk: A Systematic Review and Meta-analysis. Am J Gastroenterol 2017
2. Abdallah MA, et al. Endoscopic Ultrasound Guided Fine-Needle Aspiration for Solid Lesions in Chronic Pancreatitis: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2022

Disclosure

The authors have no conflicts of interest to declare.

Introduction

The threat of acute hepatitis A (AHA) to public health may be underestimated. We aimed to determine the frequency, clinical characteristics and outcomes of patients with AHA, and to compare them to those with acute hepatitis B (AHB).

Aims & Methods

This was a retrospective study of all patients diagnosed with AHA or AHB at a tertiary referral center between January 2013 and June 2024. Demographics, clinical presentation, laboratory findings, and outcomes were determined. AHA was defined by the presence of immunoglobulin M (IgM) antibodies to hepatitis A virus. AHB was defined by the presence of IgM antibodies to hepatitis B core antigen and positive hepatitis B surface antigen. Severe hepatitis was defined by serum bilirubin > 10 mg/dl, INR ≥ 1.5, serum creatinine > 2 mg/dl, and/or hepatic encephalopathy. Fulminant hepatitis (FH) was defined by the presence of hepatic encephalopathy.

Results

Over a period of 11 years, 398 patients were diagnosed with acute hepatitis, 367 (92%) with AHA and 31 (8%) with AHB. 336 patients (84.5%) were older than 18 years of age. Compared to patients with AHB, those with AHA were younger, were more likely to be females but were less likely to have an underlying immunocompromising illness (Table 1). There was no difference in the frequency of severe hepatitis, hospitalization rate, FH, and in hospital mortality between the two groups (Table 1). There were 115 patients (31%) with severe AHA, 89% of whom were older than 18 years of age. There was no difference in the mean age (33 ± 14 vs 31 ± 14 years, p=0.32), gender (37% vs 46% females, p=0.16), history of underlying liver disease (2.6% vs 0%, p=0.07) or having an underlying immunocompromising illness (4.2% vs 6.1%, p=0.47), between patients with severe AHA and patients with non-severe AHA. Furthermore, compared to patients with non-severe AHA, patients with severe AHA were more likely to require hospitalization (70% vs 43%, p=<0.001), ICU admission (8.7% vs 0.6%, p=<0.001), and to die during the index of hospitalization (4.3% vs 0%, p=0.01). Among patients with AHA who had a serum bilirubin > 10 mg/dl, INR ≥ 1.5, and/or serum creatinine > 2 mg/dl, 7% developed fulminant hepatitis while only 1% of patients with non-severe AHA developed fulminant hepatitis, p=0.003.

Table 1. Comparison of demographics, clinical characteristics, and outcomes between patients with acute hepatitis A (AHA) and patients with acute hepatitis B (AHB)

Conclusion

AHA is far more common than AHB, but is associated with similar rates of hospitalization, severe hepatitis, and fulminant hepatitis. The high frequency of AHA among adults in low-income countries calls for renewed attention to prevention and vaccination to reduce the burden of this often-overlooked disease. Furthermore, further research may be needed to develop pharmacological treatment for patients with severe AHA and those with fulminant hepatitis, in view of unavailability of liver transplantation in most developing countries.