Differential diagnosis of pancreatic diseases: new approaches in laboratory and radiologic diagnosis

Aim. To assess significance of serum fibronectin (FN) and new approaches of processing computed tomography (CT) results for pancreatic cancer (PC) and chronic pancreatitis (CP) differential diagnosis. Materials and methods. Data of 49 patients with pancreatic lesions who underwent multislice computed tomography (MSCT) with intravenous contrast enhancement and FN evaluation in 2018 were analyzed. There were 29 (59.2%) males and 20 (40.8%) females, mean age 51.9±13.9 (30–82). All patients were divided in 3 groups: 1 — PC (17 patients, 34.6%) — morphologically verified, 2 — chronic pancreatitis with previous pancreonecrosis (CPPN) — 16 patients, 32.7%, 3 — chronic calcifying pancreatitis (CCP) — 16 patients, 32.7%. We calculated median of enhancement gradient between region of interest and intact parenchyma (Мgrad) based on MSCT results. Pearson’s correlation coefficient (rp) was calculated for correlation assessment. Results. We assessed mean Мgrad and mean serum FN rate in all three groups: PC — 28.1±2.6, р=0.0001, CPPN — 14.9±2.4, р=0.07, CCP — 13.3±0.7, р=0.08 for Мgrad, and 239.8±30.1, p=0.8, 243.5±33.8, p=0.7, 227.2±34.3, p=0.8 for serum FN rate, respectively. There was statistically significant strong correlation of Мgrad in patients with PC (rp=0.63, p=0.0001). We revealed cut-off point of Мgrad value for PC that was 20 (p=0.001). There were no statistically significant correlations of serum FN rate in all groups (PC rp=0.04, p=0.8; CPPN rp=0.06, p=0.7; CCP rp=-0.03, p=0.8). Conclusions. Mgrad evaluation based on MSCT is an informative marker for differential diagnosis between PC and chronic pancreatitis, high rates of Мgrad positively correlate with PC existence. There was no correlation between serum FN rate and existence of PC, CPPN or CCP.

SpyGlass DS-guided lithotripsy for pancreatic duct stones in symptomatic treatment-refractory chronic calcifying pancreatitis

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) and/or extracorporeal shock wave lithotripsy are first-line therapies for draining an obstructed pancreatic duct (PD) in painful chronic calcifying pancreatitis (CCP). Pancreaticoscopy has shown promising success rates in small series. Materials and methods This study was a retrospective analysis of a clinical database. Included were all digital single-operator digital video (SOV) pancreaticoscopy-guided interventions (n = 23) on CCP patients (n = 20) between 2015 and 2017. Success and complication rates were collected from the database. Clinical success was determined by assessing pain level score (NRS) and quality of life (QoL) using standardized questionnaires. Results Overall technical success rate (successful SOV-pancreaticoscopy and PD drainage) was 95 %. Adverse events occurred in 7 of 23 procedures (30 %) and included extravasation from the PD (n = 1), self-limiting post-sphincterotomy bleeding (n = 1) and post-ERCP pancreatitis (PEP) (n = 6). At 3- to 6-month follow-up, 95 % of patients reported improvement in symptoms and reduction in intake of analgesics. Mean NRS decreased from 5.4 (±1.6) to 2.8 (± 1.8) (P < 0.01). Clinical success was achieved in 95 % of patients. Conclusions Digital SOV-guided lithotripsy was found to be safe and effective in this highly selected population of CCP patients. PD decompression had a beneficial effect on pain reduction and QoL.

Two SPINK1 Mutations Induce Early-Onset Severe Chronic Pancreatitis

The SPINK1 protein is a potent antiprotease that can inactivate any intrapancreatic trypsin activity that would otherwise induce autodigestion of the pancreas. SPINK1 mutations have been recognized to be associated with chronic pancreatitis in patients without a family history of pancreatitis. We here describe the case of a 24-year-old woman referred to our service for recurrent abdominal pain and search for the cause of chronic calcifying pancreatitis, who was found to carry 2 SPINK1 mutations.