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Asian Journal of Surgery Aug 2022Endoscopic ultrasound-guided drainage (EUSD) and percutaneous drainage (PD) have reportedly been used for postoperative pancreatic fluid collection (PFC). However, there... (Meta-Analysis)
Meta-Analysis Review
Endoscopic ultrasound-guided drainage (EUSD) and percutaneous drainage (PD) have reportedly been used for postoperative pancreatic fluid collection (PFC). However, there is limited evidence regarding safety and efficacy in a comparison of EUSD and PD for postoperative PFC. We conducted a search of the databases PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, to August 2020. Studies comparing EUSD and PD for postoperative PFC were included. The outcomes included technical success, clinical success, adverse events, and recurrence of PFC.We included a total of 6 studies involving 247 patients in the current study. There was no significant difference between EUSD and PD in terms of technical success (odds ratio [OR] = 0.95; 95% confidence interval [CI]: 0.29-3.12; p = 0.94) and clinical success (OR = 1.36; 95% CI: 0.68-2.72; p = 0.39). PFC recurrence and adverse events were similar between the two groups (OR = 1.82; 95% CI: 0.75-4.37; p = 0.18 and OR = 0.78; 95% CI: 0.31-1.92; p = 0.58, respectively).This meta-analysis confirmed that EUSD has comparable safety and efficacy to PD for postoperative PFC. Additional high-quality studies are required in the future.
Topics: Digestive System Surgical Procedures; Drainage; Endosonography; Humans; Pancreatic Diseases; Pancreatic Juice
PubMed: 34642049
DOI: 10.1016/j.asjsur.2021.09.033 -
Magnetic Resonance in Medical Sciences... Jul 2023This study evaluated the dependence of the signal characteristics of time-spatial labeling inversion pulse (time-SLIP) on flow velocity and tag thickness to depict the...
This study evaluated the dependence of the signal characteristics of time-spatial labeling inversion pulse (time-SLIP) on flow velocity and tag thickness to depict the pancreatic juice flow by analyzing signal profile using a tube phantom study. The tag edge property was evaluated by edge rise distance (ERD). For various slow flow velocities and tag thicknesses, the signal profile characteristics were evaluated using two indices: the tag center value (R) reduction rate and the total signal value along the tube (T). ERD, which was about 10% of the tag thickness, was higher for thicker tags, making slow flow detection difficult. T was proportional to the thickness of the tag and was preserved irrespective of the flow velocity. R became lower with higher flow velocity and decreased significantly with thinner tags. These results suggest that the visualization of pancreatic juice flow might improve stability by considering the appropriate tag thickness.
Topics: Spin Labels; Pancreatic Juice; Magnetic Resonance Imaging; Phantoms, Imaging
PubMed: 35354711
DOI: 10.2463/mrms.tn.2022-0018 -
Gastroenterology May 1989We have investigated a negative feedback mechanism in the intestinal phase of pancreatic exocrine secretion in dogs with gastric cannulas and Thomas duodenal cannulas in...
We have investigated a negative feedback mechanism in the intestinal phase of pancreatic exocrine secretion in dogs with gastric cannulas and Thomas duodenal cannulas in whom pancreatic juice was collected by cannulation of the main pancreatic duct. Intraduodenal infusion of oleic acid emulsion in a dose of 18 mmol/h resulted in a significant increase in pancreatic secretion of water, bicarbonate, and protein, which was accompanied by increased plasma concentrations of both secretin and cholecystokinin. Infusion of pancreatic juice or bovine trypsin into the duodenum significantly inhibited the oleic acid-stimulated pancreatic secretion. This inhibition coincided with a significant decrease in plasma secretin level, whereas plasma cholecystokinin concentration was not affected by either pancreatic juice or trypsin. Neither pancreatic secretion nor plasma secretin concentration was affected by intraduodenal administration of NaHCO3 solution. The trypsin-induced suppression of pancreatic secretion was prevented by intravenous administration of secretin in a dose that achieved a plasma secretin level comparable to that during the oleic acid administration. This study indicates that a negative feedback mechanism is operative in the intestinal phase of pancreatic exocrine secretion in dogs, and endogenous secretin plays a significant role in the mechanism.
Topics: Animals; Bicarbonates; Cholecystokinin; Dogs; Feedback; Female; Male; Oleic Acid; Oleic Acids; Pancreas; Pancreatic Juice; Proteins; Secretin; Trypsin
PubMed: 2703117
DOI: 10.1016/s0016-5085(89)80020-4 -
Annals of Surgery Aug 1981The differential diagnosis between chronic pancreatitis and pancreatic cancer can be very difficult. In 60 patients with either of these conditions, who had satisfactory... (Comparative Study)
Comparative Study
The differential diagnosis between chronic pancreatitis and pancreatic cancer can be very difficult. In 60 patients with either of these conditions, who had satisfactory ERCP study, clinical features were correctly matched with the final diagnosis by discriminant analysis in 44 (73%). The sensitivity of ERCP radiographic findings in pancreatic cancer was 80% and sensitivity of cytology was 54%. To see if exocrine function was specific for cancer, fresh pancreatic secretions were aspirated in 27 patients at the time of ERCP. By isoelectric focusing, a pattern of extreme zymogen depletion was observed in chronic alcoholic pancreatitis (Group 1), pancreatic cancer (Group 2), and chronic nonalcoholic pancreatitis (Group 3). The three groups were not distinguishable. By contrast, significant changes in albumin, IgG and IgA concentrations were seen in Group 2. The albumin level was over ten-fold greater than in Groups 1 and 3 (p less than 0.02 and less than 0.05). The IgG was seven-fold and two-fold greater (p less than 0.01 and greater than 0.2) and the IgA was 15-fold and six-fold greater (p less than 0.002 and less than 0.05) than in Groups 1 and 3, respectively. The two groups of pancreatitis had similar concentrations of albumin and IgA. The ratio of albumin to IgG was also different in Group 2 from the other groups, suggesting different mechanisms for the appearance of proteins in pancreatic secretions. Nonzymogen protein levels can distinguish chronic pancreatitis from pancreatic cancer, and further study of them may identify useful tumor-specific markers.
Topics: Albumins; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Diagnosis, Differential; Female; Humans; Immunoglobulin A; Immunoglobulin G; Isoelectric Focusing; Male; Pancreas; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis
PubMed: 7259347
DOI: 10.1097/00000658-198108000-00014 -
Saudi Journal of Gastroenterology :... 2019Pancreatic fluid collections (PFCs) develop as a result of damage to the major or peripheral pancreatic ducts, complication due to acute or chronic pancreatitis, trauma... (Review)
Review
Pancreatic fluid collections (PFCs) develop as a result of damage to the major or peripheral pancreatic ducts, complication due to acute or chronic pancreatitis, trauma or iatrogenic causes. PFCs include pancreatic pseudocysts (PPs) and walled-off necrosis (WON). PFCs usually resolve spontaneously and are asymptomatic, but if they persist, increase in dimension or became symptomatics, therapeutic intervention is required. Available therapeutic interventions include surgical, percutaneous, and endoscopic drainage. The endoscopic approach is nowadays considered the first line-treatment of PFCs due to various advantages when compared with surgical or percutaneous drainage: decreased morbidity, length of hospital stay, and reduced costs. In the last few years, the endoscopic ultrasound (EUS)-guided transmural drainage, initially with plastic stents, gained popularity. More recently, fully covered self-expanding lumen-apposing metal stents (LAMS) have been demonstrated to be both, safe and effective with high clinical and technical success, reducing the risk of perforation, peritoneal leakage, migration and facilitating the drainage of necrotic contents. In the last few years, several studies evaluating the safety and efficacy of LAMS and their differences with plastic stents have been performed, but literature on the removal timing of this device and associated complications is still limited. The aim of this review is to analyze studies reporting information about the retrieval timing of LAMS and the related adverse events.
Topics: Body Fluids; Device Removal; Drainage; Endoscopy; Endosonography; Female; Humans; Male; Metals; Necrosis; Outcome Assessment, Health Care; Pancreatic Juice; Pancreatic Pseudocyst; Pancreatitis; Stents; Treatment Outcome
PubMed: 31823862
DOI: 10.4103/sjg.SJG_166_19 -
Gut Aug 1980Serum and pancreatic juice carcinoembryonic antigen (CEA) concentrations were studied in a group of 144 patients undergoing endoscopic retrograde...
Serum and pancreatic juice carcinoembryonic antigen (CEA) concentrations were studied in a group of 144 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with a variety of benign and malignant pancreatic and biliary diseases. Serum CEA was found to be a poor diagnostic and discriminating marker for pancreatic disorders and was raised in obstructive jaundice from various causes correlating with serum alkaline phosphatase. A pancreatic juice CEA concentration of greater than 106 mcg/l was associated with pancreatic disease but did not distinguish benign from malignant lesions. Criteria derived from pancreatic juice volumes and bicarbonate responses provided additional diagnostic differentiation of normal from pancreatic disease but not cancer from pancreatitis. Pancreatic juice CEA may have a limited application where imaging techniques have failed or are not available and additional study of pancreatic juice biochemistry is required before adequate diagnostic criteria can be established.
Topics: Biliary Tract Diseases; Carcinoembryonic Antigen; Cholangiopancreatography, Endoscopic Retrograde; Humans; Pancreatic Diseases; Pancreatic Juice; Prospective Studies
PubMed: 7429329
DOI: 10.1136/gut.21.8.656 -
International Journal of Surgery... 2012Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and their pathologic implications has experienced tremendous progress during the last few... (Review)
Review
Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and their pathologic implications has experienced tremendous progress during the last few years. This article reviews the current knowledge on this condition and its pathological implications on gallbladder diseases. Many publications with different levels of evidence were found supporting biliary carcinogenesis associated with pancreaticobiliary reflux in normal and abnormal pancreaticobiliary junction. Also, there are many publications supporting the common occurrence of pancreaticobiliary reflux in normal pancreaticobiliary junction, and sphincter of Oddi dysfunction as the most plausible cause of this condition. Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and their clinical significance, the current evidence does not fully support what has been suggested. The reflux of pancreatic enzymes into the bile tract and gallbladder is a fascinating subject of study which is open to active research. The final demonstration of the pathophysiology and consequences of PBR in NPBL and support by evidence level type I would constitute a major breakthrough in the understanding and eventually in the treatment of gallbladder diseases.
Topics: Common Bile Duct; Gallbladder Diseases; Humans; Pancreatic Ducts; Pancreatic Juice; Sphincter of Oddi Dysfunction
PubMed: 22361306
DOI: 10.1016/j.ijsu.2012.02.009 -
Medicine Nov 2017Several risk factors for pancreatic fistula had been widely reported, but there was no research focusing on the exocrine output of remnant gland.During the study period...
Several risk factors for pancreatic fistula had been widely reported, but there was no research focusing on the exocrine output of remnant gland.During the study period of January 2015 to September 2016, 82 patients accepted pancreaticoduodenectomy (PD, end-to-end dunking pancreaticojejunostomy with internal stent tube). All the data were collected, including preoperative medical status, operative course, final pathology, gland texture, pancreatic duct diameter, size of the stent, length of pancreatic juice in the stent tube, width of the pancreatic stump, diameter of the jejunum and the status of postoperative pancreatic fistula (POPF). POPF was defined according to International Study Group of Pancreatic Fistula criteria.The diameter of pancreatic duct in the POPF group was significantly smaller than that in the group without POPF (1.99 vs 2.90 mm, P = .000). The length of pancreatic juice in the stent tube in the POPF group was significantly longer than that in the group without POPF (18.04 vs 6.92 cm, P = .014). There were more pancreatic ductal adenocarcinoma cases and hard glands in the group without POPF. The length of pancreatic juice in the clinically relevant postoperative pancreatic fistula (CR-POPF) group was significantly longer than that in the grade A group (32.4 vs 9.21 cm, P = .000). Multivariate analysis identified gland texture and length of pancreatic juice as independent predictors for pancreatic fistula. Multivariate analysis also identified the length of pancreatic juice as an independent predictor for CR-POPF.The length of pancreatic juice in the stent tube might be a useful predictive factor of POPF after PD, especially for CR-POPF.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Pancreatic Ductal; Female; Humans; Jejunum; Male; Middle Aged; Multivariate Analysis; Pancreas; Pancreas, Exocrine; Pancreatic Fistula; Pancreatic Juice; Pancreatic Neoplasms; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications; Postoperative Period; Retrospective Studies; Risk Factors; Stents; Treatment Outcome; Young Adult
PubMed: 29095290
DOI: 10.1097/MD.0000000000008451 -
British Journal of Cancer Feb 2011The last decade has seen significant progress in understanding the molecular biology of pancreatic adenocarcinoma. There is now an urgent need to translate these...
BACKGROUND
The last decade has seen significant progress in understanding the molecular biology of pancreatic adenocarcinoma. There is now an urgent need to translate these molecular techniques to clinical practice in order to improve diagnosis and prediction of response to treatment. The objectives of this study are to utilise poly(A) RT-PCR to measure expression levels of diagnostic Indicator genes, selected from microarray studies, of RNA from intraoperatively sampled pancreatic ductal juice and to correlate these expression levels with those in matched pancreatic tissue resection samples.
METHODS
Intraoperative sampling of pancreatic juice and collection of matched tissue samples was undertaken in patients undergoing pancreaticoduodenectomy for suspected tumour. RNA was isolated and poly(A) PCR and real-time PCR used to measure expression levels of 30 genes. Spearman's rank correlation test was used to examine the relationship of gene expression between pancreatic juice and tissue.
RESULTS
Of the 30 Indicator genes measured, just one, ANXA1, showed a significant correlation of expression level between pancreatic juice and tissue samples, whereas three genes, IGFBP3 (P0.035), PSCA (P0.001) and SPINK1 (P0.05), showed significantly different expression between cancerous and benign pancreatic tissue samples.
CONCLUSIONS
These results demonstrate that RNA analysis of pancreatic juice is feasible using the poly(A) cDNA technique, that correlation of gene expression exists between pancreatic juice and tissue for very few genes and that gene expression profiling can distinguish between benign and malignant pancreatic tissue. This indicates possible use of the technique for measurement of Indicator genes in pancreatic tissue for diagnosis of pancreatic cancer from very small tissue samples.
Topics: Adenocarcinoma; Gene Expression Profiling; Humans; Microarray Analysis; Pancreatic Juice; Pancreatic Neoplasms; Pancreaticoduodenectomy; Poly A; Reverse Transcriptase Polymerase Chain Reaction
PubMed: 21245863
DOI: 10.1038/sj.bjc.6606047 -
BioMed Research International 2015Pancreatic juice cytology (PJC) is considered optimal for differentially diagnosing pancreatic masses, but the accuracy of PJC ranges from 46.7% to 93.0%. The aim of...
BACKGROUND AND AIM
Pancreatic juice cytology (PJC) is considered optimal for differentially diagnosing pancreatic masses, but the accuracy of PJC ranges from 46.7% to 93.0%. The aim of this study was to evaluate the clinical impact of measuring the KL-6 concentration of pancreatic juice for diagnosing pancreatic masses.
METHODS
PJC and the KL-6 concentration measurements of pancreatic juice were performed for 70 consecutive patients with pancreatic masses (39 malignancies and 31 benign).
RESULTS
The average KL-6 concentration of pancreatic juice was significantly higher for pancreatic ductal adenocarcinomas (PDACs) (167.7 ± 396.1 U/mL) and intraductal papillary mucinous carcinomas (IPMCs) (86.9 ± 21.1 U/mL) than for pancreatic inflammatory lesions (17.5 ± 15.7 U/mL, P = 0.034) and intraductal papillary mucinous neoplasms (14.4 ± 2.0 U/mL, P = 0.026), respectively. When the cut-off level of the KL-6 concentration of pancreatic juice was 16 U/mL, the sensitivity, specificity, and accuracy of the KL-6 concentration of pancreatic juice alone were 79.5%, 64.5%, and 72.9%, respectively. Adding the KL-6 concentration of pancreatic juice to PJC when making a diagnosis caused the values of sensitivity and accuracy of PJC to increase by 15.3% (P = 0.025) and 8.5% (P = 0.048), respectively.
CONCLUSIONS
The KL-6 concentration of pancreatic juice may be as useful as PJC for diagnosing PDACs.
Topics: Aged; Aged, 80 and over; Biomarkers, Tumor; Female; Humans; Male; Middle Aged; Mucin-1; Pancreatic Juice; Pancreatic Neoplasms; Reproducibility of Results; Sensitivity and Specificity
PubMed: 26451373
DOI: 10.1155/2015/528304