scholarly journals Pancreatic Fibrosis and Chronic Pancreatitis: Mini-Review of Non-Histologic Diagnosis for Clinical Applications

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 87 ◽  
Author(s):  
Chung-Tsui Huang ◽  
Cheng-Kuan Lin ◽  
Tzong-Hsi Lee ◽  
Yao-Jen Liang
Keyword(s):  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Acoustic Radiation ◽  
Clinical Applications ◽  
Acoustic Radiation Force Impulse ◽  
Pancreatic Fibrosis ◽  
Pancreatic Tumors ◽  
Clinical Scenario ◽  
Histologic Diagnosis ◽  
Selection Of

Pancreatic fibrosis is the dominant reversible pathological change and diagnostic factor in early chronic pancreatitis, defined by a mechanistic approach proposed in 2016. Main guidelines for chronic pancreatitis were published by the American Pancreas Association in 2014, the Japanese Society of Gastroenterology in 2015, and United European Gastroenterology in 2017. All three sets of guidelines mentioned that the staging of chronic pancreatitis is important but challenging. There are various image modalities for the non-histologic diagnosis of pancreatic fibrosis: (1) shear wave elastography, such as an acoustic radiation force impulse with a cut-off value of 1.4 m/s; (2) strain elastography using grades of strain; (3) endoscopic ultrasonography using the Rosemont criteria or endoscopic ultrasound criteria for early chronic pancreatitis proposed by the Japan Pancreas Society; (4) computed tomography using the Hounsfield scale or number of micro-calcifications; and (5) magnetic resonance imaging using the apparent diffusion coefficient and the T1w flash and T2w HASTE sequences. The clinical applications are to (1) evaluate pancreatic tumors and inflammatory disease; (2) monitor dyspepsia with early chronic pancreatitis; (3) monitor individuals with a high risk of pancreatic cancer; (4) analyze a fatty pancreas with fibrosis; (5) predict a fistula after pancreatic surgery; and (6) predict outcomes for chronic pancreatitis or pancreatic cancer. The selection of tools will be dependent on the clinical scenario. Conclusion: There are various modalities for the non-histologic diagnosis of pancreatic fibrosis. The selection of the optimal device will be dependent on the clinical scenario.

scholarly journals Comparison of Duodenal Mucosal Chromogranin-A Expression in Non-Alcoholic Fatty Pancreas Dyspeptic Patients with and without Endosonography-Diagnosed Early Chronic Pancreatitis: A Case Series Study

2019 ◽  
Vol 13 (1) ◽  
pp. 102-112 ◽  
Author(s):  
Chung-Tsui Huang ◽  
Yao-Jen Liang
Keyword(s):  
Chronic Pancreatitis ◽  
Chromogranin A ◽  
Acoustic Radiation ◽  
Case Series ◽  
Acoustic Radiation Force Impulse ◽  
Pancreatic Fibrosis ◽  
Exocrine Function ◽  
Abdominal Sonography ◽  
Case Series Study ◽  
Fatty Pancreas

Nonalcoholic fatty pancreas (NAFP) is hypothetically related to progressive fibro-inflammation of the pancreas whose exocrine function is controlled by enteroendocrine cells (EEC). There is little evidence of pancreatic fibrosis in fatty pancreas and of whether there are quantitative differences for EEC. This study aimed to prove the coexistence of NAFP and pancreatic fibrosis or early chronic pancreatitis (ECP) using acoustic radiation force impulse (ARFI) and endosonography. Besides, the expression of duodenal mucosal chromogranin-A, a surrogate for EEC, was analyzed. Dyspeptic patients were surveyed at the digestive clinic and received abdominal sonography, endosonography, and serology tests. Cases with organic causes of dyspepsia were excluded. Pancreatic fibrosis was defined as an ARFI value ≥1.3 m/s. ECP was defined by at least 2 scores of the Japan Pancreas Society endosonographic criteria. During endosonography, 4 biopsy samples of mucosa in the duodenal first part were obtained for analysis of chromogranin-A expression by Western blot. Mucosal biopsy was also performed at the gastric antrum for surveillance of Helicobacter pylori. Between January and June 2018, a total of 24 patients with NAFP were enrolled among 48 candidates and divided into 2 groups based on whether they had pancreatic fibrosis or not. In the pancreatic fibrosis group (n = 11, pancreatic ARFI: 1.76 ± 0.34 m/s), there was a higher endosonographic criteria score (2.45 vs. 1.61, p = 0.002), increased expression of chromogranin-A (p = 0.001), and more severe fatty pancreas that was defined by pancreatic duct blurring on abdominal sonography (91 vs. 46%, p = 0.062) as compared to the non-pancreatic fibrosis group (n = 13, pancreatic ARFI: 1.11 ± 0.09 m/s). A total of 54 endosonographic abnormalities of ECP was present in these 24 patients in the head (52%), body (31%), and tail (17%), an anatomic pattern similar to pancreatic adenocarcinoma. In conclusion, among dyspeptic patients with NAFP, the duodenal mucosa chromogranin-A showed increased expression in those with pancreatic fibrosis and endosonography-diagnosed ECP.

Acoustic radiation force impulse elastography for noninvasive assessment of chronic pancreatitis

2011 ◽  
Vol 47 (4) ◽  
pp. 427-432 ◽  
Author(s):  
Yoko Yashima ◽  
Naoki Sasahira ◽  
Hiroyuki Isayama ◽  
Hirofumi Kogure ◽  
Hitoshi Ikeda ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Acoustic Radiation ◽  
Radiation Force ◽  
Acoustic Radiation Force ◽  
Acoustic Radiation Force Impulse ◽  
Noninvasive Assessment

scholarly journals CT- and MRI-Based Assessment of Body Composition and Pancreatic Fibrosis Reveals High Incidence of Clinically Significant Metabolic Changes That Affect the Quality of Life and Treatment Outcomes of Patients with Chronic Pancreatitis and Pancreatic Cancer

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 649 ◽  
Author(s):  
Edita Bieliuniene ◽  
Jens Brøndum Frøkjær ◽  
Alius Pockevicius ◽  
Jurate Kemesiene ◽  
Saulius Lukosevičius ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Body Composition ◽  
Chronic Pancreatitis ◽  
Treatment Outcomes ◽  
Metabolic Changes ◽  
Pancreatic Fibrosis ◽  
Fecal Elastase ◽  
Ct And Mri

Background and Objectives: Both chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC) may lead to cachexia, sarcopenia, and osteoporosis due to different mechanisms. Neither patient gender, age, nor body weight are good predictors of these metabolic changes having a significant negative impact on the quality of life (QOL) and treatment outcomes. The aim of this study was to evaluate radiological changes in body composition and to compare them with manifestations of exocrine and endocrine pancreatic insufficiency, body mass, and QOL among patients with CP and PDAC. Materials and Methods: Prospectively collected data of 100 patients with diagnosed CP or PDAC were used for analysis. All patients underwent dual-energy X-ray absorptiometry (DXA), computed tomography (CT), and magnetic resonance imaging (MRI). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) was used to assess QOL. Diabetes and changes in fecal elastase-1 were also assessed. Results: There was no significant difference in skeletal muscle mass (SMM) among patients with CP and PDAC (p = 0.85). Significantly more underweight patients had low SMM (p = 0.002). Patients with CP had more pronounced pancreatic fibrosis (PF) (p < 0.001). Data showed a significant relationship between a high degree of PF and occurrence of diabetes (p = 0.006) and low fecal elastase-1 levels (p = 0.013). A statistically significant lower QOL was determined in patients with PF ≥ 50% and in the CP group. Conclusions: Sarcopenia and osteoporosis/osteopenia are highly prevalent among patients with chronic pancreatitis and pancreatic cancer, and CT- and MRI-based assessment of body composition and pancreatic fibrosis could be a potentially useful tool for routine detection of these significant metabolic changes.

Mixed photon and neutron radiotherapy given concurrently with chemotherapy in unresectable pancreatic cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 328-328
Author(s):  
M. E. Christensen ◽  
P. Paximadis ◽  
A. F. Shields ◽  
P. A. Philip ◽  
D. W. Weaver ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Median Survival ◽  
Local Control ◽  
Neutron Radiation ◽  
Pancreatic Tumors ◽  
Tumor Control ◽  
Unresectable Pancreatic Cancer ◽  
Survival Times ◽  
Histologic Diagnosis

328 Background: Unresectable tumors of the pancreas remain difficult to treat despite the advent of targeted radiotherapy and modern chemotherapy. Randomized trials exploring the efficacy of chemotherapy and radiation have demonstrated median survival of 9 to 11 months. These survival times have not improved appreciably in the modern era. The purpose of this study was to retrospectively review our institutional experience with unresectable pancreatic cancer treated with mixed photon-neutron radiotherapy given concurrently with chemotherapy. Methods: Thirteen patients with unresectable tumors of the pancreas were treated between 1993 and 2001. All patients were treated with mixed photon-neutron radiotherapy given concurrently with chemotherapy. Median photon dose was 39.6 Gy (30.6-45Gy) and median neutron dose was 8 nGy (7-9 nGy). 12 of 13 patients were treated with neoadjuvant chemotherapy, followed by 5-FU given concurrently with radiotherapy. Median survival, overall survival, and local control were calculated for all patients. Results: The median age of all patients was 65 years (46-75 years). Twelve patients had histologic diagnosis of adenocarcinoma, with the other having an islet cell carcinoma. All patients are now deceased. Median survival for all patients was 11.5 months (3.0-25.6 months). The 1 and 2- year overall survival was 46.2% and 7.7%, respectively. Local control of the primary tumor was excellent at 92.3%. The rate of distant metastasis was 76.9%. One patient experienced decline without documented recurrence. No grade ≥3 acute toxicities were reported. However, there were 2 grade 5 late toxicities, both caused by gastrointestinal bleeding. Conclusions: Our experience demonstrates that treatment of unresectable pancreatic tumors with mixed photon-neutron radiotherapy given concurrently with chemotherapy results in excellent local control, with survival time equivalent to or exceeding that demonstrated in previous series. With the added capability of intensity modulated neutron radiation therapy (IMNRT), the incidence of treatment-related morbidity may be improved while taking advantage of the superior tumor control that high-LET radiation may impart. No significant financial relationships to disclose.

Acoustic Radiation Force Impulse Elastography (ARFI) Assessment of Chronic Pancreatitis

2013 ◽  
Vol 39 (5) ◽  
pp. S62
Author(s):  
T.N. Oliveira ◽  
L. Barreto ◽  
M.J. D'Avila ◽  
R. França ◽  
I. Clausius ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Acoustic Radiation ◽  
Radiation Force ◽  
Acoustic Radiation Force ◽  
Acoustic Radiation Force Impulse

scholarly journals News of European pancreatology (by materials of the 51st Meeting of the European Pancreatic Club)

2019 ◽  
Vol 45 (4) ◽  
pp. 6-16
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevich ◽  
A. Ye. Klochkov ◽  
P. G. Fomenko ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Bacterial Overgrowth ◽  
Basic Research ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Tumors ◽  
Modern Theory ◽  
Genetic Characteristics ◽  
Randomized Controlled Studies

This article presents an overview of the results of practical and basic research in the field of pancreatology, which were presented during the 51st Meeting of the European Pancreatic Club (2019). Achievements of leading European pancreatologists in the study of the etiology, pathogenesis, diagnosis, treatment of pancreatitis, pancreatic tumors are briefly described. The article presents clinical features of acute and chronic pancreatitis, depending on the variety of concomitant pathology, genetic characteristics, bad habits, drugs taken. New opportunities for the differential diagnosis of chronic pancreatitis and pancreatic cancer using miRNA are considered, as well as the feasibility of determining the soluble urokinase-type plasminogen activator receptor (suPAR) in order to differentiate benign and malignant pancreatic tumors. Approaches to the diagnosis of abdominal pain, use of computed tomography for the diagnosis of sarcopenia are described. Results of basic research analyzing the mechanisms of pancreatic cancer development are presented. Modern theory on the role of microbiota and syndrome of bacterial overgrowth in the pancreatic oncogenesis processes is revealed. Pathogenetic features of the formation of exocrine pancreatic insufficiency and effectiveness of its correction via enzyme replacement therapy with the use of modern drugs are emphasized. Results of randomized controlled studies that proved effectiveness and safety of microtablet preparation in correction of exocrine pancreatic insufficiency in patients undergoing pancreatoduodenectomy are presented.  

Sign in / Sign up

Export Citation Format

Share Document