Objective To investigate effect of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) on visualization improvement of main and branch pancreatic duct and its diagnostic value of grading chronic pancreatitis (CP) .Methods The 3 .0 T magnetic resonance (MR) imaging data of 88 subjects (23 health volunteers and 65 CP patients) were prospectively analyzed .All the subjects received coronal T2-weighted sequences scan ,thick slab 2-dimensional MRCP sequences scan , routine pancreas plain scan and enhanced scan before and after 0 .1 mL/kg secretin intravenous injection . Sixty-five CP patients were grouped according to Cambridge classification and also according to normal and abnormal of duodenal filling (DF) .The images of main pancreatic duct (MPD) ,branch pancreatic duct (BPD) and DF were compared before and after secretin injection .The result was compared with that of endoscopic retrograde cholangio pancreatography (ERCP) which was the gold standard .One-way analysis of variance test was performed for comparison between healthy control group and CP group .Chi-square test was used for comparison between normal DF group and abnormal DF group .The consistence between the diagnostic results of MRCP ,S-MRCP and the results of ERCP were analyzed by Kappa test .Results Compare with MRCP ,after secretin injection the indexes of MPD ,the sensitivity ,specificity ,positive predictive value and negative predictive value of BPD were all improved ,and the rates of misdiagnosis and missed diagnosis all decreased .Using ERCP as gold standard of CP grade diagnosis ,the consistence of S-MRCP in CP grade diagnosis increased more significantly (Kappa=0 .77 ,P=0 .000 1) compared with that of MRCP (Kappa=0 .55 ,P=0 .000 1) .Among 43 normal DF cases ,the number of MPD dilatation , filling defect and branch duct in pancreatic head was 28 ,23 and 30 ,respectively ;among 22 abnormal DF cases which was 20 ,19 and 21 ,respectively ,and the differences were statistically significant (χ2=5 .01 , 3 .91 ,6 .88 and 4 .26 ,all P<0 .05) .Taking 4 min as the cutoff value of peak time ,the sensitivity and specificity of which in CP diagnosis were 86 .0% and 100 .0% , respectively . Conclusion S-MRCP improves the visualization of MPD and BPD ,and also increases the accuracy of CP grade diagnosis .

Objective To investigate the effect of α-tocopherol on fibrosis of chronic pancreatitis (CP) rat and explore its mechanism.MethodsMale Wistar rats were randomly divided into control group,acute necrotizing pancreatitis (ANP) group,α-tocopherol group.CP was induced by dibutyltindich loride ( 8 mg/kg) infusion into the tail vein.Gastric lavage of α-tocopherol (800 mg/kg body weight,daily) was started 24 hours after dibutyhindich loride infusion for 4 weeks.The rats in ANP and control group received 0.6 ml salad oil gastric lavage.The rats were sacrificed 4 weeks later.Pancreatic tissue was harvested for histological examination and collagen staining,and measurement of the levels of hydroxyproline and malondialdehyde (MDA) of the pancreas were performed.The mRNA expression of transforming growth factor (TGF)-β１ was measured by real time PCR.ResultsAfter gastric lavage for 4 weeks,the pancreatic tissue inflammation,fiber deposition and abnormal structure in rats of α-tocopherol group were greatly reduced.The levels of MDA and hydroxyproline in rats of α-tocopherol group were significantly lower than those in ANP group [ (0.40 ±0.20) vs (1.07 ±0.41) nmol/100mg,(402.49 ±27.62) vs (664.92 ±29.04) μg/g,P＜0.05].The expressions of TGF-β1 mRNA in rats of o-tocopherol group were significantly lower than those in ANP group (2.24 ± 0.89 vs 3.35 ± 0.66,P ＜ 0.05 ).Conclusions Tocopherol gamma can improve pancreatic inflammation and fibrosis by reducing the oxidative stress level and down-regulating the expression of TGFβ1mRNA in rats with CP.

Objective to determine the basal levels of several pancreas-related endocrine hormones in patients with chronic pancreatitis.Methods according to inclusion and exclusion criteria,consecutive patients from February 2016 to August 2016 in Department of Gastroenterology,Changhai Hospital,Second Military Medical University and ten healthy control (matched for age and gender) were included.Basal levels of glucagon-like peptide 1,pancreatic polypeptide,Secretin,glucagon,somatostatin between groups of CP vs healthy control,CP with abnormal glycometabolism vs CP with normal glycometabolism and alcoholic CP vs non-alcoholic CP were compared.Results a total of 53 patients with chronic pancreatitis and 8 healthy subjects were included in this study.(1) CP vs healthy controls:the level of secretin in healthy control patients is significant lower than that in CP patients;(2) CP with abnormal glycometabolism vs CP with normal glycometabolism:the level of triglyceride and somatostatin is significant lower than that in CP patients;the prevalence of patients with chronic alcohol consumption and the level of glucagon-like peptide 1 in CP with abnormal glycometabolism is significant higher than that in CP with normal glycometabolism;(3) the prevalence of abnormal glycometabolism in alcoholic CP group is significant higher than that in non-alcoholic CP.The results above are all of statistical significance.Conclusions in addition to dysfunction of islets/3-cells,CP also easily affects the level of other pancreas-related hormones such as secretin,somatostatin and glucagon-like peptide 1.Otherwise,chronic alcohol consumption is also strongly related with abnormal glycometabolism,the mechanism deserves further researches.

Objective To analyze the clinical characteristic of Chinese autoimmune pancreatitis (AIP) patients.Methods All clinical data of 81 patients with a diagnosis of AIP in Shanghai Changhai Hospital from February 2005 to May 2012 were analyzed.Results The sex ratio was 7.1∶1 and the mean age was (57± 12) years old in 81 patients with AIP.Obstructive jaundice was the initial symptom in 51.9％ (42/81) patients.In patient receiving CT,focal and diffuse type accounted for 45 and 35 patients.respectively,and pseudocyst was the main manifestation in 1 patient,biliary tract was involved in 59(72.8％ ) patients,dilatation of main pancreatic duct was observed in 5 ( 11.1％ ) patients.In patients receiving PET-CT,diffuse increased Flourine-18 FDG uptake by the pancreas was found in 11 patients,focal increased uptake in 2patients,and significant extra-pancreatic uptake was found in 5 patients.The positive rate of serum IgG4,CA19-9,ss DNA,anti-nuclear antibody and ds-DNA antibody was 94.6％ (53/81),54.4％ (37/68),14.3％ (4/28),10.7％ (3/28),7.1％ (2/28),respectively.The pathological findings of H-E staining and IgG4 immunohistochemical analysis in 20 patients were consistent with lymphoplasmacytic sclerosing pancreatitis.Conclusions Type 1 AIP is the main subtype of AIP in China.Combining clinical symptoms,extra-pancreatic manifestations,imaging or nuclear medicine findings,serology,cytology or histology can effectively increase the correct diagnosis rate of AIP.

Objective To investigate the long-term effect of endoscopic management of chronic pan-creatitis(CP) prospectively. Methods Based on the M-ANNHEIM diagnostic criteria of CP, the patients with CP were treated with endoscopic procedures, including papillotomy or pancreatic sphincterotomy, calcu-Ins removal, stonosis dilation and stent insertion. Pre-and post-operative incidence of acute pancreatitis (AP), abdominal pain, weight, endocrine and exocrine functions and change of pancreatic duct diameter were analyzed. Results From January 1,2006 to December 31,2007, a total of 107 patients with CP, in-cluding 74 males and 33 females, with a mean age of 41.2 years at admission, were recruited. All patients except 2 lost ones were followed up at a mean duration of 15 months (3-27 months). During the follow-up, 4 patients received surgery. Abdominal pain was completely resolved in 70 patients and partly resolved in 19 patients, with a total remission rate at 88. 1%. Insufficient endocrine funetion presented as diabetes was de-tooted in 10 patients before the treatment and no improvement was observed during the follow-up. Steatorrhea was presented in 10 patients and was resolved in 7 after the treatments. Weight gain at an average of 4 kg was achieved in 56. 4% (57/101) of the patients. No significant change in diameter of pancreatic duct was observed before and after the endoscopic procedure, which was not correlated with patient outcome. Conclusion Endoscopic managements can relieve abdominal pain and increase body weight in patients with CP.

Chronic pancreatitis (CP) during pregnancy is rare but complicated in clinic, and its pathophysiology, clinical manifestations, diagnosis and treatment are special, which may seriously harm the health of mother and fetus if not properly treated. During pregnancy, physiological changes such as insulin resistance, mechanical pressure caused by the enlarged uterus and increased secretion of estrogen and progesterone will affect patients with CP. CP may increase the risk of pregnancy⁃related complications and adverse perinatal outcomes. The management of pregnant patients with CP mainly includes the improvement of lifestyle, symptomatic treatment and obstetric management. This article mainly reviewed the pancreatic physiology, clinical manifestations and management of pregnant patients with CP.

Objective To investigate the changes of indications, degree of difficulty in procedure, complication and its severity in endoscopic retrograde cholangiopancreatography (ERCP) in Changhai hospital from 2001 to 2007. Methods The clinical data, including demographic data, indications, degree of difficulty in procedure, success rate, complication rate and severity of complication, of 2374 patients who underwent ERCP in 2001 and 2007 (966 in 2001 and 1408 in 2007), were retrospectively reviewed. Results Indications of ERCP changed at an interval of 5 years. Operations due to bile duct stone decreased (59.0% vs. 49.3%, P=0.000), while operations due to pancreas disease, especially chronic pancreatitis (6.6% vs. 18.5%, P=0.000) and recurrent pancreatitis (0.2% vs.1.6%, P=0.001), increased. Patients with biliary duct problems after liver transplantation appeared in 2007. The procedures of ERCP performed in 2007 were more difficult (P=0.000), with an increased percentage of Degree 5 procedure (7.3% vs. 33.3%, P=0.000). The number of diagnostic ERCP significantly decreased (Degree 1 + Degree 3, 30.5% +2.8% vs. 5.9% +3.1%, P=0.000). There was no significant difference in the success rate between the two years (P=0.084). The complication rate of ERCP in 2007 was significantly higher than that in 2001 (3.73% vs. 7.88%, P=0.000), but the severity of complication showed no significant difference (P=0.820). Conclusion Cases of diagnostic ERCP decreased in 2007. Indications of ERCP have changed, with a decrease in bile duct diseases and an increase in pancreatic diseases. The procedures are more complicated, but it does not lead to lower success rate. The increase in complication rate is possibly due to increase of therapeutic ERCP.

ObjectiveTo probe the indication,treatment algorithm,anesthesia method,safety and efficacy ofextracorporealshockwavelithotripsy(ESWL)incombinationwithendoscopicretrograde cholangiopancreatography (ERCP) for pancreatic duct stones.MethodsThe patients with chronic pancreatitis and large pancreatic duct stones ( ＞ 5 mm diameter) and receiving ESWL and ERCP between March and July 2011 in Changhai Hospital were prospective studied.The third generation of extracorporeal shockwave lithotripsy was applied in ESWL,and the localization of stone was determined by X-ray.No more than 5000 shocks were given per session,and ESWL was performed continuously till the calculi were fragmented,and then was cleared by ERCP.ResultsA total of 100 patients underwent ESWL during the 5 months,among whom 84 patients received ERCP treatment and 41 cases failed to deep cannulation (41/84,48.8％ ).Multiple stones were seen in 83 patients.Ninety five patients had radio-opaque stones,two patients had radiolucent calculi,while three patients had both radio-opaque and radiolucent stones.Seventy five percent,14％ and 11％ stones were located in pancreatic head,pancreatic head and body,pancreatic body and tail,respectively.A total of 175 ESWL procedures were performed,43 patients needed 2 or more sessions for successful fragmentation.Anesthesia method was mainly intravenous sedation,accounting for 96％ (168/175).ERCP was successful in 96 patients after ESWL,only 4 patients failed after ESWL. Forty one cases which failed ERCP procedures before ESWL underwent ERCP,and 37 patients (90.2％) achieved successful cannulation.Successful fragmentation ratewas 100％.Complete clearance was achieved in 78 patients,and complication rate of post-ERCP pancreatitis,fever was 1.71％ (n =3 ),0.57％ (n =1 ),and the overall complication rate was 2.28％.Conclusions ESWL is an effective,safe and necessary modality for fragmentation of large PD stones in the management of minimal invasive treatment of chronic pancreatitis.

Objective To analyze the clinical features of recurrent acute pancreatitis (RAP).Methods The clinical data of patients diagnosed as RAP were collected in Changhai Hospital, the Second Military Medical University between January 2016 to July 2016, and chronic pancreatitis(CP) patients and RAP patients to matching, as control group.A prospective cohort study about the clinical features of RAP and CP was set.The survival analysis model was established by Kaplan-Meier′s method, to calculate the cumulative rate of RAP which progressed into CP.Results The morbidity of male patients was 69.0% in the RAP group(n=100) and 60% in the CP group(n=100).The average first onset age of RAP and CP was 38 and 21 years old, respectively;and the teenagers accounted for 12% and 38.6%.The incidence of diabetes was 49.5% and 9%;and the incidence of fatty diarrhea was 46.6% and 19% of the two groups.The cumulative incidence of CP was 2% within 1 year, 4.6% in 3 years, and 12.4% in 5 years.Conclusions Men has higher morbidity in both RAP group and CP group.RAP patients′ first onset age was older than that of CP.Teenagers had a low incidence in RAP group.The risk of diabetes and fatty diarrhea was lower in RAP group than CP group.A certain proportion of RAP patients can progress to CP.

Objectives To investigate the value of oral glucose tolerance (OGTT)-insulin/C peptide release test in early diagnosis of chronic pancreatitis (CP)-associated abnormal glucose tolerance.Methods Sixty patients with CP who were admitted to the Department of Gastroenterology,Changhai Hospital from June 2017 to February 2018 were divided into CP with normal glucose tolerance (CP-NGT),CP with impaired glucose tolerance (CP-IGT),CP with newly diagnosed diabetes(CP-new-DM) and CP with the previous history of diabetes (CP-history-DM) according to previous medical records and data from OGTT-insulin/C peptide release test.The characteristics of glucose metabolism,the changes of blood glucose,insulin and C peptide released among the four groups were compared.Results In 43 cases of patients with CP without diabetes,the abnormal glucose metabolism was detected in 6 cases (14.0％) by fasting blood glucose or glycosylated hemoglobin,and in 30 cases (69.8％) by OGTT-insulin/C-peptide release test.The detection rate of abnormal glucose metabolism was increased by 55.8％.In the group of CP-history-DM,the peak secretion of blood glucose,insulin,C peptide was all at 120 min,and the multiplication of increased release of C peptide (peak/baseline) [4.1 (3.4,4.4) vs (6.1 ± 2.2) 、(6.4 ± 2.5)、(6.8 ± 3.8)],the C peptide area under curve (C-PAUC) [(3.6 ± 1.4)]μg · h-1 · L-1 vs 8.6(7.1,9.7),(8.1 ±3.1),(6.9 ±2.7) μg · h-1 L-1] and the homeostasis model of assessment for β cell (HOMA-β) [24.4 (11.4,37.4) vs 52.4 (44.6,92.1),(89.8 ± 57.2),(72.4 ± 57.0)] were all significantly lower,and the difference was statistically significant(all P＜0.05).In the group of CP-new-DM,the peak of blood glucose was at 60 min,while the peak of insulin,C peptide was at 1 20 min,the early insulin secretion index (/ I30/A G30) [2.2 (0.8,4.2)vs (11.4 ± 9.4)] and insulin secretion sensitivity index-2 (ISSI-2) [256.1 (160.1,340.7) vs (548.5 ± 173.2)] in group of CP-new-DM were significantly lower than those in the group of CP-NGT,and the difference was statistically significant (all P ＜0.05).Conclusions The insulin /C peptide secretion was insufficient in the early stage of CP-related diabetes mellitus.Routine OGTT-insulin / C peptide release test for patients with CP can increase the detection rate of abnormal glucose metabolism.