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Open questions in medical and endoscopic treatment of acute pancreatitis

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Open questions in medical and endoscopic treatment of acute pancreatitis

Paolo Giorgio Arcidiacono 1, Enrique de-Madaria 2

1 Ospedale San Raffaele, Milan, Italy

2 Hospital General Universitario de Alicante - Gastroenterology, Hospital General Universitario de Ali, Alicante, Spain

Event

UEG Week Vienna 2024

Topics

Endoscopy Gut Microbiota Hepatobiliary Pancreas

Session

Acute pancreatitis: Still devastating outcomes

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Breaking news in pancreatic care: The latest guidelines you can’t miss!

Charlotte Leseman 1

1 Amsterdam UMC, Amsterdam, Netherlands

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Pancreas Standards & Guidelines

Session

From guidelines to clinical practice: Pancreatic lesions, PCN and acute pancreatitis

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Endoscopic ultrasound in BD-IPMN: Cytology, histology, endo-microscopy or molecular biology?

Kasper Overbeek 1

1 Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Histopathology Pancreas

Session

Cystic pancreatic lesions

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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LONG TERM OUTCOMES OF A EUROPEAN COHORT OF AUTOIMMUNE PANCREATITIS PATIENTS

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Introduction

Type 1 autoimmune pancreatitis (AIP) represents the most common manifestation of IgG4-related disease. Type 1 AIP responds well to glucocorticoids, but relapses are common requiring multiple treatment courses and ultimately leading to end-organ damage and treatment-related morbidity. To date, scant reports exist on the long-term outcomes of these patients. Moreover, the role of maintenance treatment in preventing disease relapse is still debated.

Aims & Methods

We aimed to evaluate the long-term outcomes of a large European cohort of patients with type 1 AIP and to assess the role of maintenance treatment in preventing disease relapse. Patients with type 1 AIP fulfilling ICDC criteria were included in this multicentric retrospective study within the PrescrAIP framework involving 40 European university Hospital. Relapses were defined as new onset of either AIP related symptoms or radiological abnormalities after a successful induction of remission. Patients without either complete or partial remission were excluded. The primary endpoint was time to relapse. Predictors of relapse were identified by multivariable logistic regression. A bootstrapping technique was performed to internally validate the model. Regression coefficients from the multivariable model were employed to develop a score for computing the risk of relapse for each patient. Patients were divided into four categories according to the score, from the lowest to highest risk of relapse.

Results

477 patients were included in this analysis (325 male, 68%). Mean age at baseline was 59 (IQR 40-68). 60% of the patients presented with jaundice while 7% of the patient with acute pancreatitis. Other organs involvement was present in 238 patients (48%), being biliary involvement the most frequent one (40%). At baseline, diabetes mellitus and pancreatic exocrine insufficiency were present in 30% and 27% of patients, respectively. After a mean follow up of 32 months (IQR 13-68), 150 (31%) AIP relapses occurred. After accounting for confounders, biliary tree involvement (OR 1.62 95%CI 1.1-2.2), acute pancreatitis at baseline (OR 2.1 95%CI 1.1-4.2), narrowing of the main pancreatic duct (OR 1.6, 95%CI 1.1-2.1) were independently associated with relapse, while AIP presenting as a focal mass resulted in a protective factor (OR 0.65 95%CI 0.46-0.92). Increased serum IgG4 level (OR 1.2 95%CI 0.9-1.7) pointed to higher relapse rate without reaching statistical significance. Notably, any maintenance treatment reduced the relapse rate after correcting for the above-mentioned risk factors (OR 0.51, 95%CI 0.37-0.72). There was no difference in term of relapse free survival between maintenance treatment with any anti-rheumatic drugs (azathioprine, methotrexate, mycophenolate) and low-dose GCs. Maintenance treatment reduced relapse rate only in patients with higher relapse risk. At the longest follow up, DM and PEI were recorded in 33% and 29% of the patients, respectively. Only one pancreatic cancer was detected.

Conclusion

Several disease features increase the risk of relapse in type 1 AIP. Any of the maintenance treatment reduce relapse rate in type 1 AIP. Patients showing multiple risk factors for relapse benefit the most from maintenance treatment. The development of a score predicting disease relapse enhances a personalized approach toward AIP treatment. In European AIP patients the development of pancreatic cancer during follow up appears rare.

LONG TERM OUTCOMES OF A EUROPEAN COHORT OF AUTOIMMUNE PANCREATITIS PATIENTS

Marco Lanzillotta 1, Kasper Overbeek 2, Jakob Lykke Poulsen 3, Peter Macinga 4, Olof Vinge Holmquist 5, Matthias Löhr 6, Jonas Rosendahl 7

1 San Raffaele Hospital: IRCCS Ospedale San Raffaele, Milan, Italy

2 Erasmus MC University Medical Center, Rotterdam, Rotterdam, Netherlands

3 Aalborg, Aalborg, Denmark

4 Institute For Clinical And Experimental Medicine, Prague, Czechia

5 4Department of Digestive Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, Trondheim, Norway

6 Karolinska Institutet, Stockholm, Sweden

7 University Clinic Halle (Saale) - Department of Internal Medicine I, University Clinic Halle (Saale), Halle (Saale), Germany

Event

UEG Week Vienna 2024

Topics

Gut Microbiota IBD Pancreas

Submission format

Abstract

Session

What's new in acute pancreatitis

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Presentation

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Hospitals in crisis

Marcel Levi 1

1 Dutch Research Council, Den Haag, Netherlands

Event

UEG Week Copenhagen 2023

Session

Opening Plenary

Published

2023

UEG Presentation

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MOLECULAR LANDSCAPES OF GASTRIC DYSPLASIA AND CANCER

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Introduction

Gastric dysplasia is a pre-malignant lesion that can progress to gastric cancer (GC), however the factors that influence its progression is still poorly understood. Here, we aim to identify molecular factors that promote the development of GC from gastric dysplasia.

Aims & Methods

We performed whole exome sequencing on 110 gastric dysplasia or GC samples from 82 patients, with an average exome coverage of 154X including the germline normal comparison. The samples were obtained from 2017 to 2019 and included (a) dysplastic samples from 34 patients without GC (b) GC samples from 20 patients without dysplasia (c) concurrent dysplasia and GC samples from 28 patients.

Results

Classification based on TCGA GC subtypes showed CIN (chromosomal unstable) GC to be more prevalent in GC without concurrent dysplasia (60% vs 21.4%; Fisher test p-value 0.030) whereas MSI (microsatellite unstable) GC tend to be concurrent with dysplasia (21.4% vs 5.0%; Fisher test p-value 0.21), suggesting acquisition of copy number alterations to be associated with rapid progression into GC. Consistent with this hypothesis, we also identified a significant increase in copy number alterations in GC samples compared to dysplasia (Wilcoxon test; p=5.1x10^-3), while somatic mutation rate was more modestly increased (Wilcoxon test; p=0.12). CIN samples were enriched with GC samples, TP53 mutations, 17q12 (ERBB2) amplification and 9p21 (CDKN2A) deletion whereas non-CIN samples showed high APC mutations, 5q23 (APC) deletion and is associated with gastric dysplasia.

Conclusion

The molecular data presented in this study is the most comprehensive to date for gastric dysplasia and early GC. Our results suggest copy number alterations may be the key driver of GC progression in dysplastic samples and molecular profiling may be used to identify patients at higher risk of developing GC.

MOLECULAR LANDSCAPES OF GASTRIC DYSPLASIA AND CANCER

Mi Jin Oh 1, Kie Kyon Huang 2, Roxanne Hui Heng Chong 3, Jimmy Bok Yan So 3, Feng Zhu 3, Patrick Tan 2, Khay Guan Yeoh 3, Hyunsoo Chung 4

1 Seoul National University College of Medicine, Seoul, Korea, Republic of

2 Duke‐NUS Medical School, Singapore, Singapore

3 National University of Singapore, Singapore, Singapore

4 Seoul National University College of Medicine, Seoul, Korea, Republic of|||National University of Singapore, Singapore, Singapore|||Seoul National University College of Medicine, Seoul, Korea, Republic of