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The Korean Journal of Gastroenterology... May 2022EUS-guided drainage for gallbladder, bile duct, pancreatic duct, and peripancreatic fluid collection has been performed more frequently in the last decade. The... (Review)
Review
EUS-guided drainage for gallbladder, bile duct, pancreatic duct, and peripancreatic fluid collection has been performed more frequently in the last decade. The development of dedicated stents and delivery systems for EUS-guided interventions have improved the efficacy and safety of these procedures. Furthermore, the introduction of lumen-apposing metal stents has reduced the complication significantly of endoscopic transmural drainage of pancreatic collections and gallbladder. Recent studies show that EUS-guided drainage of pancreaticobiliary ducts and peripancreatic fluid collection produces good results and low complication rates. This review describes the current position and role of interventional EUS for pancreatobiliary disease in clinical practice.
Topics: Bile Ducts; Drainage; Endosonography; Gallbladder; Humans; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 35610550
DOI: 10.4166/kjg.2022.064 -
The Turkish Journal of Gastroenterology... Jan 2023
Topics: Humans; Ampulla of Vater; Common Bile Duct Neoplasms
PubMed: 36656081
DOI: 10.5152/tjg.2020.18997 -
Experimental and Clinical... Sep 2021We report a 39-year-old male patient diagnosed with double extrahepatic biliary ducts by magnetic resonance cholangiopancreatography. Respiratory-triggered 3-dimensional...
We report a 39-year-old male patient diagnosed with double extrahepatic biliary ducts by magnetic resonance cholangiopancreatography. Respiratory-triggered 3-dimensional magnetic resonance cholan - giopancreatography was performed during free breathing. Two extrahepatic biliary ducts, an anomalous union of accessory extrahepatic biliary duct with pancreatic duct, and a unique com - munication channel between 2 extrahepatic biliary ducts were determined on maximum intensity projection and 3-dimensional magnetic resonance cholangiopancreatography volume rendering. This case illustrates the utility of 3-dimensional magnetic resonance cholangiopancreatography for diagnosis of pancreatobiliary ductal system developmental anomalies. Also, we reviewed embryology of the hepatobiliary system and the current classifications of the double extrahepatic biliary ducts and have proposed a new variant of existing classifications.
PubMed: 34498550
DOI: 10.6002/ect.2021.0082 -
United European Gastroenterology Journal Nov 2023Chronic Pancreatitis (CP) causes morphological changes in the pancreatic tissue, leading to complications and pain, which may require endoscopic interventions.
BACKGROUND
Chronic Pancreatitis (CP) causes morphological changes in the pancreatic tissue, leading to complications and pain, which may require endoscopic interventions.
OBJECTIVE
Our aim was to determine the frequency of endoscopic procedures (EP) in CP patients and to analyse pain and quality of life (QoL) in these patients after their EP.
METHODS
This study included 1327 CP patients from the Scandinavian Baltic Pancreatic Club (SBPC) database including four countries and eight centres. We analysed patients undergoing EPs and gathered information on the EP, pancreatic function, pain, disease and duration. The EORTC C-30 QoL questionnaire was gathered prospectively and multivariable analysis was conducted on independent parameters between the groups. The reference population had no interventions (n = 870).
RESULTS
260 CP patients (22%) underwent EPs, median one year (range 0-39 years) after CP diagnosis. 68% were males. The median age was 59 (20-90) years. Most common aetiological factors were alcohol in 65% and smoking in 71%. Extracorporeal shock wave lithotripsy (ESWL) was used in 6% of the CP population and in 21% of the EP group. Biliary duct stenting was performed on 37% and pancreatic stenting was performed on 56% of the patients. There was no difference in pain patterns between patients who had pancreatic stenting and the reference population. The EP group had slightly better QoL (p = 0.047), functioning and fewer symptoms than the reference population, in the multivariable analysis there was no interaction effect analysis between the groups. The pancreatic stent group had better QoL and the same amount of pain than the reference group. The patients who needed later surgery (23%) had more pain (p = 0.043) and fatigue (p = 0.021).
CONCLUSIONS
One in five of the CP patients underwent EP. These patients scored higher on QoL responses and had better symptom scores. CP patients who had pancreatic stenting performed had the same pain patterns as the reference population. Randomised prospective trials are needed to determine the effect of endoscopy procedures on CP patients.
Topics: Male; Humans; Middle Aged; Female; Quality of Life; Prospective Studies; Pancreatic Ducts; Pancreatitis, Chronic; Endoscopy; Pain
PubMed: 37812591
DOI: 10.1002/ueg2.12466 -
Cureus Mar 2023Chronic pancreatitis is a slow, irreversible, and progressive inflammatory condition with abdominal pain, loss of parenchyma, fibrosis, and calculus formation. It also... (Review)
Review
Chronic pancreatitis is a slow, irreversible, and progressive inflammatory condition with abdominal pain, loss of parenchyma, fibrosis, and calculus formation. It also causes loss of exocrine and endocrine function. Gallstones and alcohol is the most frequent cause of chronic pancreatitis. It is also caused by other factors, including oxidative stress, fibrosis, and repeated incidence of acute pancreatitis. Chronic pancreatitis is followed by several sequelae, one of them being formation of calculi in the pancreas. The formation of calculi can occur in the main pancreatic duct, branches of the duct, and parenchyma. The cardinal sign of chronic pancreatitis is pain caused by obstruction of pancreatic ducts and its branches leading to ductal hypertension resulting in pain. The main aim of endotherapy includes pancreatic duct decompression. The management options vary based on the type and size of the calculus. The treatment of choice for small-sized pancreatic calculi is endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction. The large-sized calculi need fragmentation before extraction, which is done by extracorporeal shock wave lithotripsy (ESWL). Surgery can be an option for patients having severe pancreatic calculi if endoscopic therapy fails. For diagnostic purposes, imaging plays a very important role. The treatment options remain complex if the radiological and laboratory findings overlap. Due to advancements in diagnostic imaging, treatment options have become precise and helpful. It can significantly lower the quality of life along with immediate and long-term problems that pose a serious risk to life. This review comprises the various management options available for removing calculi following chronic pancreatitis, including surgical, endoscopic, and medical therapy.
PubMed: 37025704
DOI: 10.7759/cureus.35788 -
Der Chirurg; Zeitschrift Fur Alle... Sep 2021Periampullary neoplasms are a heterogeneous group of different tumor entities arising from the periampullary region, of which pancreatic ductal adenocarcinoma (PDAC) is... (Review)
Review
Periampullary neoplasms are a heterogeneous group of different tumor entities arising from the periampullary region, of which pancreatic ductal adenocarcinoma (PDAC) is the most common subgroup with 60-70%. As typical for pancreatic adenocarcinomas, periampullary pancreatic cancer is characterized by an aggressive growth and early systemic progression. Due to the anatomical location in close relationship to the papilla of Vater symptoms occur at an earlier stage of the disease, so that treatment options and prognosis are overall more favorable compared to pancreatic carcinomas at other locations. Nevertheless, the principles of treatment for periampullary pancreatic cancer are not substantially different from the standards for pancreatic cancer at other locations. A potentially curative approach for non-metastatic periampullary pancreatic cancer is a multimodal therapy concept, which includes partial pancreatoduodenectomy as a radical oncological resection in combination with a systemic adjuvant chemotherapy. As a result, long-term survival can be achieved in patients with favorable prognostic factors. In addition, with the continous development of surgery and systemic treatment potentially curative treatment concepts for advanced initially nonresectable tumors were also established, after completion of neoadjuvant treatment. This article presents the current surgical principles of a radical oncological resection for periampullary pancreatic cancer in the context of a multimodal treatment concept with an outlook for future developments of treatment.
Topics: Adenocarcinoma; Ampulla of Vater; Common Bile Duct Neoplasms; Duodenal Neoplasms; Humans; Pancreatic Neoplasms
PubMed: 34259884
DOI: 10.1007/s00104-021-01462-1 -
International Journal of Molecular... Aug 2021The production of pancreatic β cells is the most challenging step for curing diabetes using next-generation treatments. Adult pancreatic endocrine cells are thought to...
The production of pancreatic β cells is the most challenging step for curing diabetes using next-generation treatments. Adult pancreatic endocrine cells are thought to be maintained by the self-duplication of differentiated cells, and pancreatic endocrine neogenesis can only be observed when the tissue is severely damaged. Experimentally, this can be performed using a method named partial duct ligation (PDL). As the success rate of PDL surgery is low because of difficulties in identifying the pancreatic duct, we previously proposed a method for fluorescently labeling the duct in live animals. Using this method, we performed PDL on neurogenin3 (Ngn3)-GFP transgenic mice to determine the origin of endocrine precursor cells and evaluate their potential to differentiate into multiple cell types. Ngn3-activated cells, which were marked with GFP, appeared after PDL operation. Because some GFP-positive cells were aligned proximally to the duct, we hypothesized that Ngn3-positive cells arise from the pancreatic duct. Therefore, we next developed an in vitro pancreatic duct culture system using Ngn3-GFP mice and examined whether Ngn3-positive cells emerge from this duct. We observed GFP expressions in ductal organoid cultures. GFP expressions were correlated with Ngn3 expressions and endocrine cell lineage markers. Interestingly, tuft cell markers were also correlated with GFP expressions. Our results demonstrate that in adult mice, Ngn3-positive endocrine precursor cells arise from the pancreatic ducts both in vivo and in vitro experiments indicating that the pancreatic duct could be a potential donor for therapeutic use.
Topics: Animals; Antigens, Differentiation; Basic Helix-Loop-Helix Transcription Factors; Green Fluorescent Proteins; Insulin-Secreting Cells; Mice; Mice, Transgenic; Nerve Tissue Proteins; Organoids; Pancreatic Ducts; Stem Cells
PubMed: 34445257
DOI: 10.3390/ijms22168548 -
Revista Espanola de Enfermedades... Sep 2023Due to low incidence rate of pancreatic duct stones,Authoritative consensus has not been reached regarding therapeutic choices in clinical practice. This article...
Due to low incidence rate of pancreatic duct stones,Authoritative consensus has not been reached regarding therapeutic choices in clinical practice. This article reports the treatment of a young woman with chronic pancreatitis complicated with refractory multiple pancreatic duct stones, which provides clinical experience for treatment and provides a new way to study the pathogenesis of chronic pancreatitis complicated with pancreatic duct stones.
Topics: Female; Humans; Pancreatic Ducts; Lithotripsy; Pancreatic Diseases; Pancreatitis, Chronic; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 36562526
DOI: 10.17235/reed.2022.9378/2022 -
Frontiers in Immunology 2022Bile duct, pancreatic, and gastric cancers are deadly digestive system tumors with high malignancy and poor patient prognosis. The efficiencies of conventional surgical... (Review)
Review
Bile duct, pancreatic, and gastric cancers are deadly digestive system tumors with high malignancy and poor patient prognosis. The efficiencies of conventional surgical treatment, radiation therapy, and chemotherapy are limited. In contrast, chimeric antigen receptor (CAR) T-cell therapy represents a landmark therapeutic approach to antitumor immunity with great efficacy in treating several hematological malignancies. CAR T-cell therapy involves genetically engineering the expression of specific antibodies based on the patient's T-cell surface and amplifying these antibodies to identify and target tumor-associated antigens. CAR T-cell therapy can effectively inhibit disease progression and improve the survival of patients with bile duct, pancreatic, and gastric cancers. The effectiveness of CAR T cells in tumor therapy can be validated using xenograft models, providing a scientific testing platform. In this study, we have reviewed the progress in CAR T-cell production and its development, focusing on the current status and optimization strategies for engineered CAR T cells in the bile duct, pancreatic, and gastric cancers.
Topics: Humans; Immunotherapy, Adoptive; Stomach Neoplasms; Bile; T-Lymphocytes; Pancreatic Ducts
PubMed: 36341440
DOI: 10.3389/fimmu.2022.1025608 -
Frontiers in Immunology 2023Patients with pancreatic duct adenocarcinoma (PDAC) have varied prognoses that depend on numerous variables. However, additional research is required to uncover the...
BACKGROUND
Patients with pancreatic duct adenocarcinoma (PDAC) have varied prognoses that depend on numerous variables. However, additional research is required to uncover the latent impact of ubiquitination-related genes (URGs) on determining PDAC patients' prognoses.
METHODS
The URGs clusters were discovered via consensus clustering, and the prognostic differentially expressed genes (DEGs) across clusters were utilized to develop a signature using a least absolute shrinkage and selection operator (LASSO) regression analysis of data from TCGA-PAAD. Verification analyses were conducted across TCGA-PAAD, GSE57495 and ICGC-PACA-AU to show the robustness of the signature. RT-qPCR was used to verify the expression of risk genes. Lastly, we formulated a nomogram to improve the clinical efficacy of our predictive tool.
RESULTS
The URGs signature, comprised of three genes, was developed and was shown to be highly correlated with the prognoses of PAAD patients. The nomogram was established by combining the URGs signature with clinicopathological characteristics. We discovered that the URGs signature was remarkably superior than other individual predictors (age, grade, T stage, et al). Also, the immune microenvironment analysis indicated that ESTIMATEscore, ImmuneScores, and StromalScores were elevated in the low-risk group. The immune cells that infiltrated the tissues were different between the two groups, as did the expression of immune-related genes.
CONCLUSION
The URGs signature could act as the biomarker of prognosis and selecting appropriate therapeutic drugs for PDAC patients.
Topics: Humans; Prognosis; Carcinoma, Pancreatic Ductal; Ubiquitination; Pancreatic Neoplasms; Pancreatic Ducts; Tumor Microenvironment
PubMed: 37359528
DOI: 10.3389/fimmu.2023.1171811