-
BMC Gastroenterology Nov 2022Main pancreatic duct (MPD) dilation is a high-risk stigmata/worrisome feature of malignancy in intraductal papillary mucinous neoplasms (IPMNs). The threshold of MPD...
BACKGROUND
Main pancreatic duct (MPD) dilation is a high-risk stigmata/worrisome feature of malignancy in intraductal papillary mucinous neoplasms (IPMNs). The threshold of MPD diameter in predicting malignancy may be related to the lesion location. This study aimed to separately identify the thresholds of MPD for malignancy of IPMNs separately for the head-neck and body-tail.
MATERIALS AND METHODS
A total of 185 patients with pathologically confirmed IPMNs were included. Patient demographic information, clinical data, and pathological features were obtained from the medical records. Those IPMNs with high-grade dysplasia or with associated invasive carcinoma were considered as malignant tumor. Radiological data including lesion location, tumor size, diameter of the MPD, mural nodule, and IPMN types (main duct, MD; branch duct, BD; and mixed type, MT), were collected on computed tomography or magnetic resonance imaging. Serum carbohydrate antigen 19-9 levels, serum carcinoembryonic antigen levels, and the medical history of diabetes mellitus, chronic cholecystitis, and pancreatitis were also collected.
RESULTS
Malignant IPMNs were detected in 31.6% of 117 patients with lesions in the pancreatic head-neck and 20.9% of 67 patients with lesions in the pancreatic body-tail. In MPD-involved IPMNs, malignancy was observed in 54.1% of patients with lesions in the pancreatic head-neck and 30.8% of patients with lesions in the pancreatic body-tail (p < 0.05). The cutoff value of MPD diameter for malignancy was 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail in all type of IPMNs. In MPD-involved IPMNs, the threshold was 8.2 mm for lesion in pancreatic head-neck and 7.7 mm for lesions in the body-tail. Multivariate analysis confirmed that MPD diameter ≥ 6.5 mm (pancreatic head-neck) and MPD diameter ≥ 7.7 mm (pancreatic body-tail) were independent predictors of malignancy (p < 0.05). Similar results were observed in MPD-involved IPMNs using 8.2 mm as a threshold.
CONCLUSION
The thresholds of the dilated MPD may be associated with IPMNs locations. Thresholds of 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail were observed. For MPD-involved IPMNs alone, threshold for lesions in the head-neck was close to that in the body-tail.
Topics: Humans; Carcinoma, Pancreatic Ductal; Pancreatic Ducts; Pancreatic Neoplasms; Head; Tomography, X-Ray Computed
PubMed: 36402960
DOI: 10.1186/s12876-022-02577-3 -
Gastrointestinal Endoscopy Nov 2020
Topics: Drainage; Endosonography; Humans; Pancreatic Ducts
PubMed: 33160488
DOI: 10.1016/j.gie.2020.05.053 -
European Review For Medical and... Jun 2017Intraductal Papillary Mucinous Neoplasms (IPMNs) are the most common cystic tumors of the pancreas and are considered premalignant lesions. IPMNs are characterized by... (Review)
Review
Intraductal Papillary Mucinous Neoplasms (IPMNs) are the most common cystic tumors of the pancreas and are considered premalignant lesions. IPMNs are characterized by the papillary growth of the ductal epithelium with rich mucin production, which is responsible for cystic segmental or diffuse dilatation of the main pancreatic duct (MPD) and/or its branches. According to the different involvement of pancreatic duct system, IPMNs are divided into main duct type (MD-IPMN), branch duct type (BD-IPMN), and mixed type (MT-IPMN). IPMNs may be incidentally discovered in asymptomatic patients, particularly in those with BD-IPMNs, when imaging studies are performed for unrelated indications. The increase in their frequency may reflect the combined effects of new diagnostic techniques, the improvement of radiologic exams and progress in the recognition of the pathology. MD-IPMNs present a higher risk of malignant progression than BD-IPMNs; as a consequence, all the guidelines strictly suggest the need of surgery for MD- and MT- IPMNs with MPD > 10 mm, while the management of BD-IPMNs is still controversial and depends on several cysts and patients features. The choice between non-operative and surgical management depends on the distinction between benign and invasive IPMN forms, assessment of malignancy risk, patient's wellness and its preferences. This manuscript revises the different guidelines for the management of IPMNs that have been published in different world countries: the international (Sendai 2006 and Fukuoka 2012), the 2013 European, the 2014 Italian, and finally the 2015 American guidelines. In summary, this review will integrate the recent insights in the combination of diagnostic techniques, such as Magnetic Resonance Imaging (MRI) and endoscopic ultrasound (EUS), pathology classification, and management of IPMNs.
Topics: Adenocarcinoma, Mucinous; Adenocarcinoma, Papillary; Endosonography; Humans; Magnetic Resonance Imaging; Pancreatic Ducts; Pancreatic Neoplasms; Practice Guidelines as Topic
PubMed: 28682431
DOI: No ID Found -
Toxicologic Pathology Jul 2015This review focuses on the anatomy, histologic preparation, and pathologic evaluation of extraparenchymal bile and pancreatic ducts (BPDs) and their openings at the... (Review)
Review
This review focuses on the anatomy, histologic preparation, and pathologic evaluation of extraparenchymal bile and pancreatic ducts (BPDs) and their openings at the duodenal papillae in the cynomolgus macaque (Macaca fascicularis), the Beagle dog (Canis familiaris), the Wistar Hanover rat (Rattus norvegicus), and the CD1 mouse (Mus musculus). In nonclinical safety assessment, intraparenchymal BPDs (with sections of liver and pancreas, respectively) are evaluated routinely. However, detailed evaluation of the extraparenchymal BPDs or the duodenal papillae is not included. In the context of nonclinical safety assessment studies, this review describes situations in which evaluation of extraparenchymal ductal structures and duodenal papillae may be useful in characterizing test article-related changes; elucidates anatomic similarities between human, macaque, and dog and notable differences in rats and mice; and consolidates the information required for the histopathologic evaluation of these tissues.
Topics: Animals; Bile Ducts; Dogs; Duodenum; Macaca; Mice; Pancreatic Ducts; Pathology; Rats; Toxicity Tests
PubMed: 25633421
DOI: 10.1177/0192623314560612 -
Clinical Gastroenterology and... Jul 2021
Topics: Humans; Pancreatic Ducts; Stents
PubMed: 33249024
DOI: 10.1016/j.cgh.2020.08.056 -
Pancreatology : Official Journal of the... Oct 2019Necrotizing pancreatitis may lead to loss of integrity of the pancreatic duct, resulting in leakage of pancreatic fluid. Pancreatic duct disruption or disconnection is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Necrotizing pancreatitis may lead to loss of integrity of the pancreatic duct, resulting in leakage of pancreatic fluid. Pancreatic duct disruption or disconnection is associated with a prolonged disease course and particular complications. Since a standard treatment for this condition is currently lacking, we performed a systematic review of the literature to compare outcomes of various treatment strategies.
METHODS
A systematic review was performed according to the PRISMA guidelines in the PubMed, EMBASE and Cochrane databases. Included were articles considering the treatment of patients with disrupted or disconnected pancreatic duct resulting from acute necrotizing pancreatitis.
RESULTS
Overall, 21 observational cohort studies were included comprising a total of 583 relevant patients. The most frequently used treatment strategies included endoscopic transpapillary drainage, endoscopic transluminal drainage, surgical drainage or resection, or combined procedures. Pooled analysis showed success rates of 81% (95%-CI: 60-92%) for transpapillary and 92% (95%-CI: 77-98%) for transluminal drainage, 80% (95%-CI: 67-89%) for distal pancreatectomy and 84% (95%-CI: 73-91%) for cyst-jejunostomy. Success rates did not differ between surgical procedures (cyst-jejunostomy and distal pancreatectomy (risk ratio = 1.06, p = .26)) but distal pancreatectomy was associated with a higher incidence of endocrine pancreatic insufficiency (risk ratio = 3.06, p = .01). The success rate of conservative treatment is unknown.
DISCUSSION
Different treatment strategies for pancreatic duct disruption and duct disconnection after necrotizing pancreatitis show high success rates but various sources of bias in the available studies are likely. High-quality prospective, studies, including unselected patients, are needed to establish the most effective treatment in specific subgroups of patients, including timing of treatment and long-term follow-up.
Topics: Drainage; Humans; Pancreatic Ducts; Pancreatitis, Acute Necrotizing
PubMed: 31473083
DOI: 10.1016/j.pan.2019.08.006 -
Journal of Vascular and Interventional... Jul 2021To study the safety, efficacy, and long-term outcomes of percutaneous pancreatic duct drainage (PPDD) for treating pancreatic duct (PD) obstruction. (Observational Study)
Observational Study
PURPOSE
To study the safety, efficacy, and long-term outcomes of percutaneous pancreatic duct drainage (PPDD) for treating pancreatic duct (PD) obstruction.
MATERIALS AND METHODS
This prospective observational cohort study included 73 patients with PD obstruction between December 2010 and June 2020. Patients underwent PPDD under ultrasound and fluoroscopy guidance, computed tomography (CT) and fluoroscopy guidance, or CT guidance only. They were categorized into 2 groups: nonmalignant (26 patients with PD obstruction due to acute and chronic pancreatitis or postoperative stricture) and malignant (47 patients with pancreatic head and ampullary tumors).
RESULTS
The overall technical success rate was 98.6% (72/73). No major complications were encountered; however, severe weakness, lack of appetite, and tachycardia were observed in 4.1% (3/73) of patients, managed with intravenous resuscitation. Multivariate analysis demonstrated that diagnosis type (pancreatic head tumor: P = .049; odds ratio = 1.95 [1.11-2.25], and chronic pancreatitis: P = .048; odds ratio = 6.25 [1.74-22.22]) was associated with mortality. The median survival time was 16.3 months. Moreover, 15.1% (11/73) of the patients were alive 4 years after the PPDD procedure, and the mean overall survival time of nonmalignant and malignant patients was 35.1 and 21.4 months, respectively.
CONCLUSIONS
Image-guided PPDD appears to be feasible and safe and provides a valuable therapeutic option for managing patients with PD obstruction.
Topics: Drainage; Humans; Pancreatic Diseases; Pancreatic Ducts; Pancreatitis, Chronic; Prospective Studies; Treatment Outcome
PubMed: 33857612
DOI: 10.1016/j.jvir.2021.04.004 -
PloS One 2022Three-dimensional surgical simulation, already in use for hepatic surgery, can be used in pancreatic surgery. However, some problems still need to be overcome to achieve...
Three-dimensional surgical simulation, already in use for hepatic surgery, can be used in pancreatic surgery. However, some problems still need to be overcome to achieve more precise pancreatic surgical simulation. The present study evaluates the performance of SYNAPSE VINCENT® (version 6.6, Fujifilm Medical Co., Ltd., Tokyo, Japan) in the semiautomated surgical simulation of the pancreatic parenchyma, pancreatic ducts, and peripancreatic vessels using an artificial intelligence (AI) engine designed with deep learning algorithms. One-hundred pancreatic cancer patients and a control group of 100 nonpancreatic cancer patients were enrolled. The evaluation methods for visualizing the extraction were compared using the Dice coefficient (DC). In the pancreatic cancer patients, tumor size, position, and stagewise correlations with the pancreatic parenchymal DC were analyzed. The relationship between the pancreatic duct diameter and the DC, and between the manually and AI-measured diameters of the pancreatic duct were analyzed. In the pancreatic cancer/control groups, the pancreatic parenchymal DC and pancreatic duct extraction were 0.83/0.86 and 0.84/0.77. The DC of the arteries (portal veins/veins) and associated sensitivity and specificity were 0.89/0.88 (0.89/0.88), 0.85/0.83 (0.85/0.82), and 0.82/0.81 (0.84/0.81), respectively. No correlations were observed between pancreatic parenchymal DC and tumor size, position, or stage. No correlation was observed between the pancreatic duct diameter and the DC. A positive correlation (r = 0.61, p<0.001) was observed between the manually and AI-measured diameters of the pancreatic duct. Extraction of the pancreatic parenchyma, pancreatic duct, and surrounding vessels with the SYNAPSE VINCENT® AI engine assumed to be useful as surgical simulation.
Topics: Humans; Deep Learning; Artificial Intelligence; Pancreatic Ducts; Pancreatic Neoplasms; Algorithms
PubMed: 36306322
DOI: 10.1371/journal.pone.0276600 -
Digestive Diseases and Sciences Aug 2023In this commentary, the recent study "Safety and Efficacy of Long-Term Transmural Plastic Stent Placement After Removal of Lumen Apposing Metal Stent In Resolved...
In this commentary, the recent study "Safety and Efficacy of Long-Term Transmural Plastic Stent Placement After Removal of Lumen Apposing Metal Stent In Resolved Pancreatic Fluid Collections With Duct Disconnection at Head/Neck of Pancreas" is addressed. Some background information regarding endoscopic management of walled off necrosis is mentioned, then the study is summarized, followed by a critique about the strengths and limitations of the study. Further areas of research are also mentioned.
Topics: Humans; Drainage; Pancreatic Diseases; Pancreas; Stents; Necrosis; Syndrome; Pancreatic Ducts
PubMed: 37269370
DOI: 10.1007/s10620-023-07974-6 -
Pancreatology : Official Journal of the... 2017Pancreaticobiliary maljunction (PBM) refers to the union of the pancreatic and biliary ducts outside of the duodenal wall. Patients are at increased risk of bile duct... (Observational Study)
Observational Study
BACKGROUND
Pancreaticobiliary maljunction (PBM) refers to the union of the pancreatic and biliary ducts outside of the duodenal wall. Patients are at increased risk of bile duct and gallbladder cancer, likely secondary to pancreatic juice refluxing into the biliary tree, and it is recommended that they undergo biliary diversion.
METHODS
This is a case series of all patients in our institution with PBM and bilioenteric anastomosis who presented with symptomatic pancreatic duct stones in a disconnected bile duct. IRB approval was obtained prior to the initiation of the study.
RESULTS
We describe eight cases of this finding. All patients underwent ERCP, with stones successfully removed from the disconnected bile duct in seven patients and from the pancreatic duct in one patient.
CONCLUSION
This novel finding has not been described in the medical literature, and may become more prevalent as more patients with PBM undergo bilioenteric anastomosis.
Topics: Adolescent; Adult; Aged; Anastomosis, Surgical; Bile Duct Diseases; Bile Ducts, Extrahepatic; Calculi; Child; Cholangiopancreatography, Endoscopic Retrograde; Female; Follow-Up Studies; Hepatic Duct, Common; Humans; Jejunum; Male; Middle Aged; Pancreatic Diseases; Pancreatic Ducts; Postoperative Complications; Retrospective Studies; Young Adult
PubMed: 27889422
DOI: 10.1016/j.pan.2016.11.003