Pancreatitis autoinmune. Serie de casos y actualización bibliográfica

The concept and diagnostic criteria for autoimmune pancreatitis have evolved since the first case reports published in the 1960s. The advances in knowledge during the past two decades have resulted in the recognition of several pancreatic conditions that show, on histological evaluation, variable combinations of inflammation and fibrosis. In fact, autoimmune pancreatitis comprises two distinct diseases: type 1 and type 2. Type 2 autoimmune pancreatitis is a particular pancreatic disease about which there is limited data; it differs from the ‘classic’ IgG4-related type 1 autoimmune pancreatitis in terms of epidemiology, pathological characteristics and natural evolution. There are patients with complex pancreatic conditions where an autoimmune component and good response to steroids are demonstrated, but they do not meet the suggested criteria for the diagnosis of type 1 or type 2 autoimmune pancreatitis. Although the term steroid-responsive pancreatitis may be interpreted as a synonym to type 1 and 2 autoimmune pancreatitis, these are not the only pancreatic conditions that improve with this type of treatment. Here, we present three clinical cases and a literature review related to the diagnosis and treatment of autoimmune pancreatitis and other less frequent pancreatic disorders that present a good response to steroid therapy.

Pancreatic Disorders in Children with Inflammatory Bowel Disease

Background and Objectives: Inflammatory bowel disease (IBD) is a chronic condition and mainly affects the intestines, however, the involvement of the other organs of the gastrointestinal tract (upper part, pancreas, and liver) have been observed. The coexistence of IBD with pancreatic pathology is rare, however, it has been diagnosed more frequently during recent years in the pediatric population. This article reviews the current literature on the most common pancreatic diseases associated with IBD in the pediatric population and their relationship with IBD activity and treatment. Materials and Methods: We performed a systematic review of data from published studies on pancreatic disorders, also reported as extraintestinal manifestations (EIMs), among children with IBD. We searched PubMed and Web of Science to identify eligible studies published prior to 25 April 2020. Results: Forty-four papers were chosen for analysis after a detailed inspection, which aimed to keep only the research studies (case control studies and cohort studies) or case reports on children and only those which were written in English. The manifestations of IBD-associated pancreatic disorders range from asymptomatic increase in pancreatic enzymes activity to severe disease such as acute pancreatitis. Acute pancreatitis (AP) induced by drugs, mainly thiopurine, seems to be the most- often-reported pancreatic disease associated with IBD in children. AP associated with other than drug etiologies, and chronic pancreatitis (CP), are rarely observed in the course of pediatric IBD. The pancreatic involvement can be strictly related to the activity of IBD and can also precede the diagnosis of IBD in some pediatric patients. The course of AP is mild in most cases and may occasionally lead to the development of CP, mainly in cases with a genetic predisposition. Conclusions: The involvement of the pancreas in the course of IBD may be considered as an EIM or a separate co-morbid disease, but it can also be a side effect of IBD therapy, therefore a differential diagnosis should always be performed. As the number of IBD incidences with concomitant pancreatic diseases is constantly increasing in the pediatric population, it is important to include pancreatic enzymes level measurement in the workup of IBD.

Pancreatic disorders

This chapter covers core curriculum topics relating to pancreatic disorders. This includes the investigation and management of acute pancreatitis incorporating knowledge on aetiology, staging of acute pancreatitis, complications including pseudocyst and walled off necrosis, nutritional support, and role of imaging and endoscopy. The chapter also covers genetic pancreatic disorders, anatomical variants of the pancreas, and describes the different cell types of the pancreas. These is also an emphasis on the aetiology and complications of chronic pancreatitis including pancreatic exocrine insufficiency and chronic pain. Finally the chapter also covers the presentation, diagnosis and management of benign and malignant pancreatic tumours. Additional curriculum material regarding pancreatic disorders will also be covered in the mock examination chapter.

Treatment of oversize and recurrent pancreatic pseudocyst after an episode of acute pancreatitis: a case report and review management

Pancreatic cysts are being diagnosed more frequently because of the increasing usage of multiple noninvasive imaging modalities. Moreover, pancreatic pseudocysts (PPs) present a challenging problem for physicians dealing with pancreatic disorders, especially in cases where their treatment will be required. The diagnosis of a PP needs imaging with ultrasonography, Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). In most cases, pancreatic pseudocysts are asymptomatic and resolve spontaneously. [1-3] Asymptomatic PPs up to 6 cm in diameter can be safely observed and monitored with serial imaging.[1] If they evolve and increase in size, they become symptomatic through compression of the adjacent organs and need interven-tion.[1, 4-6] Their management demands the cooperation of surgeons, radiologists and gastroenterolo-gists. The treatment of PPs has evolved considerably over the past decade, moving from what was once open surgical management to increasingly minimally invasive techniques, both by surgery and by endoscopy. Thus, many studies have reported successful drainage through the use of various techniques.[1, 3, 4] However, the absence of a large number of cases as well as guidelines for dealing with them raise even today dilemmas regarding the treatment of choice. Here we present a case of a large pancreatic pseudocyst and a brief review of the literature.

The Role of Artificial Intelligence in Endoscopic Ultrasound for Pancreatic Disorders

The use of artificial intelligence (AI) in various medical imaging applications has expanded remarkably, and several reports have focused on endoscopic ultrasound (EUS) images of the pancreas. This review briefly summarizes each report in order to help endoscopists better understand and utilize the potential of this rapidly developing AI, after a description of the fundamentals of the AI involved, as is necessary for understanding each study. At first, conventional computer-aided diagnosis (CAD) was used, which extracts and selects features from imaging data using various methods and introduces them into machine learning algorithms as inputs. Deep learning-based CAD utilizing convolutional neural networks has been used; in these approaches, the images themselves are used as inputs, and more information can be analyzed in less time and with higher accuracy. In the field of EUS imaging, although AI is still in its infancy, further research and development of AI applications is expected to contribute to the role of optical biopsy as an alternative to EUS-guided tissue sampling while also improving diagnostic accuracy through double reading with humans and contributing to EUS education.