Introduction

Aims & Methods

The purpose of this study is to evaluate the feasibility of extracting RNA in sufficient quantity and quality to perform genomic analyses from specimens obtained through EUS-fine needle aspiration (EUS-FNA) of PanNENs, comparing three methods of RNA preservation and extraction.

Results

Conclusion

Introduction

Malnutrition is an early yet frequently overlooked dimension of pancreatic cancer, often present at diagnosis due to systemic inflammation, cachexia, or silent pancreatic exocrine insufficiency (PEI). Low body mass index (BMI) and hypoalbuminemia are individually recognized as risk factors for poor outcomes, but their combined evaluation may offer a more robust tool for risk stratification. The Nutritional Risk Index (NRI), which integrates both parameters, is a simple, validated score that remains underused in pancreatic oncology.

Aims & Methods

This study aimed to evaluate whether undernutrition at diagnosis, assessed by BMI, albumin, and NRI, predicts non-resectability and early mortality in patients with pancreatic cancer.
We retrospectively analyzed all pancreatic cancer cases diagnosed at a tertiary center between January 2020 and December 2024. BMI was categorized as <20 vs. ≥20 kg/m². Serum albumin levels were collected, and NRI was calculated using the simplified formula: 1.519 × albumin (g/L), due to unavailable weight loss data. Patients were stratified according to NRI into no risk (≥97.5), moderate risk (83.5–97.4), and severe risk (<83.5). Tumor stage and resectability were assessed through imaging (resectable) or histology (non-resectable). A subgroup analysis was performed on patients with available 3-month survival data. Statistical comparisons used chi-square and non-parametric tests.

Results

Among 293 patients (mean age 64±11 years; 55% male), BMI data were available for 248 cases. Of these, 101 (38.4%) had a BMI <20 kg/m². This group showed lower rates of curative surgery (8.8% vs. 16.9%; p=0.04), more frequent metastatic disease (52.7% vs. 34.2%; p=0.01), and higher rates of hypoalbuminemia (44% vs. 21%; p<0.01).
Serum albumin was available for 289 patients. According to NRI, 39% had severe nutritional risk (NRI <83.5) and 42% had moderate risk. Severe NRI was strongly associated with metastatic disease (61% vs. 28%; p=0.002) and early mortality.
Among 112 patients with 3-month survival data, 83 (74%) had died. Mortality was significantly higher in patients with BMI <20 (82.6% vs. 66.1%; p=0.03) and was even more pronounced in those with NRI <83.5 (87.1% vs. 58.2%; p<0.01).

Conclusion

Undernutrition at diagnosis—whether assessed by BMI, albumin, or NRI—is a strong and early indicator of poor prognosis in pancreatic cancer. The NRI, by combining two simple and routinely available markers, could serve as a practical triage tool to support early nutritional interventions and treatment decisions. Its integration into initial staging workflows may improve outcomes, especially if pancreatic exocrine insufficiency is also considered. Further multivariate analyses are needed to validate NRI as an independent predictor and to facilitate its routine use in multidisciplinary care planning.

Introduction

The consequences of chronic pancreatitis (CP) may not be exclusively limited to the pancreas or restricted to the gastrointestinal tract but could also be systemic. To date, the relationship between chronic pancreatitis and cardiovascular risk factors has not been studied extensively. We conducted a systematic review and meta-analysis to examine if the combination of chronic inflammatory changes may possibly place CP patients at risk for cardiovascular disease.

Aims & Methods

We systematically searched PubMed, Scopus, and Cochrane Register of Controlled Trials for observational studies that compared major cardiovascular outcomes in patients with chronic pancreatitis. The outcomes explored were: (1) acute coronary disease/myocardial infarction; (2) hypertension; (3) hyperlipidemia; and (4) diabetes mellitus. We computed odds ratio (OR) for binary endpoints, with 95% confidence intervals (CI). Heterogeneity was examined I² statistics; p values less than 0.10 and I² > 25% were considered significant for heterogeneity.

Results

Four observational studies comprising a total of 57,721 patients with chronic pancreatitis were included in this meta-analysis. The most consistent finding across studies was a significantly higher risk of diabetes mellitus in patients with chronic pancreatitis compared to a control group without chronic pancreatitis (OR 4.77; 95% CI 1.32–17.28; p=0.017; I²=100%). In contrast, no statistically significant associations were found between chronic pancreatitis and other cardiovascular outcomes, including cerebrovascular disease (OR 1.59; 95% CI 0.98–2.57; p=0.05; I²=99.4%), acute coronary syndrome/myocardial infarction (OR 1.35; 95% CI 1.00–1.82; p=0.049; I²=95.4%), hypertension (OR 0.52; 95% CI 0.30–7.61; p=0.608; I²=99.9%) or hyperlipidemia (OR 2.60; 95% CI 0.36–18.77; p=0.342; I²=100%).

Conclusion

The results of our meta-analysis suggest that chronic pancreatitis is not associated with increased risk of cardiovascular disease despite being associated with a higher risk of diabetes mellitus.

Introduction

Pancreatic fluid collection (PFC) often necessitates drainage or necrosectomy. Recently, minimally invasive endoscopic treatments have emerged as the first-line approach. However, limited data are available on the outcomes of such treatments in elderly patients.

Aims & Methods

This study aimed to evaluate the clinical outcomes of endoscopic treatment for PFC in elderly patients using a large-scale, multicenter cohort from Japan. This retrospective analysis included 349 patients who underwent endoscopic ultrasound-guided pancreatic fluid drainage (EUS-PFD) for PFC. The study cohort, derived from 11 institutions within the WONDERFUL study group between 2010 and 2021, was stratified into an elderly group (n = 54, aged ≥75 years) and a non-elderly group (n = 295). Treatment outcomes were compared between the two groups.

Results

The Charlson Comorbidity Index (CCI) of ≥2 was significantly more prevalent in the elderly group (28.4% vs. 10.1%, p < 0.001). No significant differences were observed between the groups in terms of gender, BMI, etiology of pancreatitis, or indications for treatment. PFC characteristics, including lesion proportion, size, morphology, and the prevalence of walled-off necrosis (WON), were comparable between the groups. However, pre-treatment white blood cell counts were significantly higher in the elderly group (10,250/μL vs. 8,060/μL, p= 0.003), and pre-treatment albumin levels were significantly lower (2.35 g/dL vs. 2.85 g/dL, p < 0.001). Clinical success rates of endoscopic treatment were similar between the elderly and non-elderly groups (82% vs. 87%, p = 0.29), as were rates of endoscopic necrosectomy (24.1% vs. 31.9%, p = 0.54), adverse events (16.7% vs. 17.6%, p = 0.99), surgical conversion (1.9% vs. 7.1%, p = 0.22), PFC recurrence (1.9% vs. 9.4%, p = 0.10), time to clinical success (41 days vs. 46 days, p = 0.49), number of endoscopic treatments (2 vs. 3, p = 0.19), and total treatment duration (86 minutes vs. 114 minutes, p = 0.54). However, the mortality rate was significantly higher in the elderly group (16.7% vs. 5.1%, p = 0.005). Multivariate analysis identified a statistically significant association between CCI ≥2 and mortality (odds ratio [OR]: 5.37, 95% confidence interval [CI]: 1.59–11.4, p = 0.007), while the elderly group showed a trend toward significance (OR: 3.31, 95% CI: 0.93–11.7, p = 0.06).

Conclusion

Elderly patients undergoing endoscopic treatment for PFC exhibited higher comorbidity burdens compared to their younger counterparts, as reflected by higher CCI scores. Despite comparable safety and clinical efficacy outcomes, mortality was significantly higher in the elderly cohort. These findings underscore the importance of comprehensive risk assessment, particularly considering systemic comorbidities, prior to initiating endoscopic treatment for PFC in elderly patients.

Introduction

Biliary stones are a leading cause of acute pancreatitis (AP). Endoscopic Retrograde Cholangiopancreatography (ERCP) is the standard of care when concomitant cholangitis or confirmed choledocholithiasis is present¹. However, spontaneous migration of biliary stones in the latter occurs in approximately 20% of cases², potentially exposing patients to the inherent risks of ERCP without a definitive therapeutic benefit.

Aims & Methods

This study aimed to identify predictors of spontaneous common bile duct stone clearance in patients with acute biliary pancreatitis. We conducted a retrospective cohort study of consecutive patients diagnosed with acute pancreatitis and confirmed choledocholithiasis, who subsequently underwent ERCP. Patients with a prior ERCP or concurrent acute cholangitis were excluded.

Results

Forty-four patients were included, 61.4% female with a mean age of 67±18 years. In 31.8% of cases, no stone was identified at ERCP, suggestive of spontaneous resolution. The median interval from admission to ERCP was 10 days and did not significantly differ between patients with and without stones (p=0.872). Serum levels of total bilirubin (2.5±2.0 vs. 2.3±2.9 mg/dL, p=0.825), AST (160±31 vs. 171±50 U/L, p=0.505), and alkaline phosphatase (267±135 vs. 210±70 U/L, p=0.187) were not significantly different between groups with and without stones at ERCP, respectively. Neither cholecystectomy status (p=0.722), common bile duct dilation on imaging (p=0.955), nor number of stones (p=0.829) correlated with spontaneous clearance. Interestingly, patients without lithiasis at ERCP had significantly smaller common bile duct stones on imaging compared to those with retained stones (5 ± 3 mm vs. 8 ± 5 mm, p=0.025). Stone size was an independent predictor of spontaneous resolution in the multivariate analysis (OR = 1.24; 95% CI: 1.01–1.52; p = 0.036), with a diameter ≥7 mm yielding a sensitivity of 63% and a specificity of 78.6% for predicting the presence of stones at ERCP.

Conclusion

Spontaneous passage of biliary stones is common in the context of acute biliary pancreatitis, particularly when their size is ≤7 mm. These findings support a risk-adapted strategy, in which Endoscopic Ultrasound may be employed to confirm choledocholithiasis immediately prior to ERCP in patients with small biliary stones.

References

1. Manes, G. et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 51, 472–491 (2019).
2. Sperna Weiland, C. J. et al. Suspected common bile duct stones: reduction of unnecessary ERCP by pre-procedural imaging and timing of ERCP. Surg. Endosc. 37, 1194–1202 (2023).

Introduction

We aimed to assess the role of islet autoimmunity and family history of diabetes in the presence of CFRD in children with CF.

Aims & Methods

Data from 78 children were analysed from the CF-related Pancreatic Disorders Registry. Pancreatic islet autoantibodies (AABs) (glutamic acid decarboxylase (GAD), insulin (IAA), islet antigen-2 (IA-2) and zinc transporter 8 (ZnT8) were measured and family history of diabetes was collected in a cross-sectional manner. Family history of T1DM and T2DM was assessed using the criterion by Blackman et al., 2009 and Ferrat et al., 2020. Fischer, Kruskal-Wallis and Mann-Witney U test were used.

Results

Males comprised 55% of the study population, with a median age of 8.7 years (IQR: 5.4–14.0 years). 51 children were on CFTR modulator therapy. Children with CFRD were significantly older with a median age of 15.9 years (IQR: 7.5–18.7) for any AAB-positive CFRD compared to 8.0 years (IQR: 6.2–12.4) for non-CFRD, and 12.1 years (IQR: 9.9–13.5) for AAB-negative CFRD compared to 7.9 years (IQR: 4.0–13.6) for non-CFRD. Any AAB and single AAB positivity was significantly associated with CFRD (Table 1). Only two children reported T1DM in any relative. Family history of diabetes showed no association with CFRD. Any AAB positivity frequency was comparable among children with positive and negative family history (Blackman criteria p=0.136; Ferrat criteria p=0.133).

Conclusion

Islet AAB positivity is associated with CFRD in children with CF. CFRD, regardless of autoantibody status, is more common in older individuals, which aligns with known disease progression in cystic fibrosis. The usefulness of family history of diabetes as a prognostic factor in the development of CFRD is limited.

Introduction

The rs7057398 mutation in the CLDN2-MORC4 locus on the X chromosome has been linked to chronic pancreatitis according to several recent publications and a meta-analysis. However, the mutation itself is located very far from both genes (CLDN2 and MORC4), and according to our current knowledge, the protein products of CLDNS and MORC4 genes are not functionally related to the development of chronic pancreatitis.

Aims & Methods

Our aim was to investigate the frequency of the rs7057398 mutation in Hungarian patients with alcoholic and non-alcoholic pancreatitis and controls. Our study included 139 non-alcoholic (NACP) and 161 alcoholic chronic pancreatitis (ACP) patients and 509 controls recruited by the Hungarian Pancreatic Study Group (HPSG). The rs7057398 mutation (CLDN2 c.-26930T>C) status in DNA samples was examined by conventional PCR amplification and Sanger sequencing.

Results

The “C” allele of the rs7057398 mutation showed significant accumulation in patients with chronic pancreatitis (p<0.0001, OR 1.96, 95% CI 1.6-2.4), especially in the alcoholic group (p<0.0001, OR 2.56, 95% CI 1.98-3.3). When women are grouped separately, it is seen that the significant accumulation of the “C” allele is only significant in alcoholic chronic pancreatitis (p<0.005, OR: 2.5, CI: 1.3-4.8), which is also confirmed by the genotype distribution in the same group containing only women (dominant model: p 0.017, OR 3.55, 95% CI 1.3-10, recessive model: p 0.049, OR 3.01, 95% CI: 1.01-9.01).

Conclusion

The rs7057398 mutation located in the CLDN2-MORC4 locus on the X chromosome predisposes to the development of chronic pancreatitis in the Hungarian population, which association is particularly true in chronic pancreatitis of alcoholic etiology.