Objective: To analyze the therapeutic effect and safety of pancreatic extracorporeal shock wave lithotripsy(P-ESWL) for patients with chronic pancreatitis complicated by stones of the pancreatic duct and to investigate the influencing factors. Methods: A retrospective analysis was performed on clinical data from 81 patients with chronic pancreatitis complicated by pancreatic duct calculus treated with P-ESWL in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi 'an Jiaotong University from July 2019 to May 2022. There were 55 males(67.9%) and 26 females(32.1%). The age was (47±15)years (range: 17 to 77 years). The maximum diameter(M(IQR)) of the stone was 11.64(7.60) mm, and the CT value of the stone was 869 (571) HU. There were 32 patients (39.5%) with a single pancreatic duct stone and 49 patients(60.5%) with multiple pancreatic duct stones. The effectiveness, remission rate of abdominal pain, and complications of P-ESWL were evaluated. Student's t test, Mann Whitney U test, χ² test, or Fisher's exact test was used to compare the characteristics between the effective and ineffective groups of lithotripsy. The factors influencing the effect of lithotripsy were analyzed by univariate and multivariate logistic regression analysis. Results: Eighty-one patients with chronic pancreatitis were treated with P-ESWL 144 times, with an average of 1.78 (95%CI:1.60 to 1.96) times per person. Among them, 38 patients(46.9%) were treated with endoscopy. There were 64 cases(79.0%) with effective removal of pancreatic duct calculi and 17 cases(21.0%) with ineffective removal. Of the 61 patients with chronic pancreatitis accompanied by abdominal pain, 52 cases(85.2%) had pain relief after lithotripsy. After lithotripsy treatment, 45 patients(55.6%) developed skin ecchymosis, 23 patients(28.4%) had sinus bradycardia, 3 patients(3.7%) had acute pancreatitis, 1 patient(1.2%) had a stone lesion, and 1 patient(1.2%) had a hepatic hematoma. Univariate and multivariate logistic regression analysis showed that the factors affecting the efficacy of lithotripsy included the age of patient(OR=0.92, 95%CI: 0.86 to 0.97), the maximum diameter of the stone(OR=1.12,95%CI:1.02 to 1.24) and the CT value of the stone(OR=1.44, 95%CI: 1.17 to 1.86). Conclusions: P-ESWL is effective in the treatment of patients with chronic pancreatitis complicated by calculi of the main pancreatic duct.Factors affecting the efficacy of lithotripsy include patient's age, maximum stone diameter, and CT value of calculi.
Male ; Female ; Humans ; Retrospective Studies ; Acute Disease ; Treatment Outcome ; Calculi/pathology* ; Lithotripsy ; Pancreatitis, Chronic/pathology* ; Pancreatic Diseases/complications* ; Pancreatic Ducts ; Abdominal Pain/therapy*

BACKGROUND: Cell competition is an important feature in pancreatic cancer (PC) progression, but the underlying mechanism remains elusive. This study aims to explore the role of exosomes derived from normal pancreatic ductal epithelial cells involved in PC progression. METHODS: PC cells and pancreatic stellate cells (PSCs) were treated with exosomes isolated from pancreatic ductal epithelial cells. Cell proliferation was assessed by CCK8 assays. Cell migration and invasion were assessed by Transwell assays. PC and matched adjacent non-tumor tissue specimens were obtained from 46 patients pathologically diagnosed with PC at Peking University First Hospital from 2013 to 2017. Tissue miR-485-3p and p21-activated kinase-1 (PAK1) expression was examined by real-time polymerase chain reaction (RT-PCR), and the relationship of the two was analyzed using Pearman's product-moment correlation. The clinical significance of miR-485-3p was analyzed using the Chi-square test, Wilcoxon rank-sum test, and Fisher exact probability, respectively. The binding of miR-485-3p to PAK1 5'-untranslated region (5'-UTR) was examined by luciferase assay. PC cells were xenografted into nude mice as a PC metastasis model. RESULTS: Exosomes from pancreatic ductal epithelial cells suppressed PC cell migration and invasion as well as the secretion and migration of PSCs. MiR-485-3p was enriched in the exosomes of pancreatic ductal epithelial cells but deficient in those of PC cells and PSCs, in accordance with the lower level in PSCs and PC cells than that in pancreatic ductal cells. And the mature miR-485-3p could be delivered into these cells by the exosomes secreted by normal pancreatic duct cells, to inhibit PC cell migration and invasion. Clinical data analysis showed that miR-485-3p was significantly decreased in PC tissues (P < 0.05) and was negatively associated with lymphovascular invasion (P = 0.044). As a direct target of miR-485-3p, PAK1 was found to exert an inhibitory effect on PC cells, and there was a significantly negative correlation between the expression levels of miR-485-3p and PAK1 (r = -0.6525, P < 0.0001) in PC tissues. Moreover, miR-485-3p could suppress PC metastasis in vivo by targeting p21-activated kinase-1. CONCLUSIONS Exosomal miR-485-3p delivered by normal pancreatic ductal epithelial cells into PC cells inhibits PC metastasis by directly targeting PAK1. The restoration of miR-485-3p by exosomes or some other vehicle might be a novel approach for PC treatment.
Animals ; Mice ; MicroRNAs/metabolism* ; Mice, Nude ; p21-Activated Kinases/metabolism* ; Cell Line, Tumor ; Pancreatic Neoplasms/genetics* ; Epithelial Cells/metabolism* ; Pancreatic Ducts/pathology* ; Cell Proliferation ; Cell Movement ; Gene Expression Regulation, Neoplastic

The pancreatoduodenal groove is a small area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla of Vater, and retroperitoneum converge. Despite great advances in imaging techniques, a definitive preoperative diagnosis is challenging because of the complex anatomy of this area. Therefore, surgical intervention is frequently required because of the inability to completely exclude malignancy. We report 3 cases of patients with different groove pathologies but similar clinical and imaging presentation, and show the essential role of endoscopic ultrasound (EUS) in making a specific preoperative diagnosis, excluding malignancy in the first case, changing diagnosis in the second case, and confirming malignancy in the third case. EUS was a fundamental tool in this cohort of patients, not only because of its ability to provide superior visualization of a difficult anatomical region, but because of the ability to guide precise, real-time procedures, such as fine-needle aspiration.
Ampulla of Vater ; Bile Ducts ; Biopsy, Fine-Needle ; Cohort Studies ; Diagnosis ; Duodenum ; Head ; Humans ; Pancreatic Neoplasms ; Pathologic Processes ; Pathology ; Ultrasonography

Advances in imaging modalities have provided useful information in diagnosing ampullary lesions such as adenoma and adenocarcinoma. Endoscopic retrograde cholangiopancreaticography (ERCP) have a role in the diagnosis of unexposed intra-ampullarylesion. We report an interesting case of adenocarinoma of the ampulla of Vater presenting as idiopathic recurrent pancreatitis. A 56 years old woman was referred due to idiopathic recurrent pancreatitis for 2 years. She presented abdominal pain and upper abdominal tenderness. Magnetic resonance cholangiopancreaticography (MRCP) revealed minimal bile and pancreatic ductal dilatation without obstruction. Subsequent ERCP revealed a small polypoid lesion which was exposed after endoscopic sphincterotomy. Endoscopic biopsy showed papillary adenoma with low grade dysplasia. Additional endoscopic papillectomy was performed. Endoscopic biopsy done 3 months later showed papillary adenoma with high grade dysplasia. Pylorus preserving pancreatoduodenectomy was done and final pathology was well differentiated adenocarcinoma. The patient was recovered well but received adjuvant chemotherapy due to metastatic lymph nodes.
Abdominal Pain ; Adenocarcinoma* ; Adenoma ; Ampulla of Vater ; Bile ; Biopsy ; Chemotherapy, Adjuvant ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Dilatation ; Female ; Humans ; Lymph Nodes ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pancreatitis* ; Pathology ; Pylorus ; Sphincterotomy, Endoscopic

OBJECTIVETo develop and test a scoring system to predict the risks of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy(PD).

METHODSClinic data and postoperative complications of the 445 consecutive patients who underwent a PD procedure between January 2008 and April 2015 in Peking University First Hospital were retrospectively collected and analyzed.The patients were randomly selected to modelling and validation sets at a ratio of 3∶1, respectively.The patient data were subjected to univariate and multivariate analysis in the modelling set of patients.A score predictive of POPF was designed and tested in the validation set.

RESULTSPOPF occurred in 88 of 334 patients(26.4%) in the modelling set.The multivariate analysis showed that body mass index (BMI, P<0.01) and pancreatic duct width(P=0.001) are associated with POPF independently.A risk score to predict POPF was constructed based on these factors and successfully tested.The area under the receiver operating characteristic curve were 0.829(95% CI: 0.777-0.881) on the modelling set and 0.885(95% CI: 0.825-0.945) on the validation set, respectively.

CONCLUSIONSBMI and pancreatic duct width were associated with POPF after PD. The preoperative assessment of a patient's risk for POPF is feasible.The present risk score is a valid tool to predict POPF in patients undergoing PD, to make the selection on anastomosis types, and to take precautions against POPF.

Anastomosis, Surgical ; Body Mass Index ; Humans ; Intestines ; surgery ; Multivariate Analysis ; Pancreas ; pathology ; surgery ; Pancreatic Ducts ; pathology ; Pancreatic Fistula ; pathology ; Pancreaticoduodenectomy ; adverse effects ; Postoperative Complications ; Postoperative Period ; ROC Curve ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the effect of utilizing octreotide during perioperative period on pancreatic fistula after pancreaticoduodenectomy (PD).

METHODSThree hundreds and six patients admitted from January 2010 to October 2014, who prepared to undergo pancreaticoduodenectomy (PD) were randomly divided into octreotide group (147 cases) and control group (159 cases). In octreotide group, octreotide was used in subcutaneous injection instantly after PD, each 8 hours until postoperative 10(th) day, and patients in control group were injected with the same volume of saline. Differences of pancreatic fistula (Grade A, Grade B, Grade C), hospitalization days and treatment cost were compared. χ(2) test, t-test and Fisher exact test were used to analyzed to the data, respectively.

RESULTSNo statistical significance (P>0.05) between two groups in the incidence of pancreatic fistula after PD (Grade A: 8.8% vs. 10.2%, Grade B: 2.7% vs. 4.4%, Grade C: 0.7% vs. 1.3%; χ(2)=0.197, 0.700, 0.288; P=0.657, 0.403, 0.591), the length of hospitalization((12.1±1.2)days vs. (13.0±1.2)days)(t=1.711, P=0.104) and treatment cost (79 700±6 700 vs. 77 600±5 200)(t=1.378, P=0.185). When accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, compared with control group, octreotide group had the lower incidence rate of pancreatic fistula and clinical correlative pancreatic fistula(all P<0.05) after PD.

CONCLUSIONSGenerally, octreotide makes no contribution to reduce the incidence of pancreatic fistula after PD. However, for patients who is accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, octreotide can effectively prevent pancreatic fistula after PD.

Anastomosis, Surgical ; Humans ; Incidence ; Octreotide ; therapeutic use ; Pancreas ; pathology ; Pancreatectomy ; Pancreatic Ducts ; pathology ; Pancreatic Fistula ; drug therapy ; Pancreaticoduodenectomy ; adverse effects ; Perioperative Period ; Prospective Studies

BACKGROUND/AIMS: Diffuse or segmental irregular narrowing of the main pancreatic duct (MPD), as observed by endoscopic retrograde cholangiopancreatography (ERCP), is a characteristic feature of autoimmune pancreatitis (AIP). METHODS: ERCP findings were retrospectively examined in 40 patients with AIP in whom irregular narrowing of the MPD was detected near the orifice. The MPD opening sign was defined as the MPD within 1.5 cm from the orifice being maintained. The distal common bile duct (CBD) sign was defined as the distal CBD within 1.5 cm from the orifice being maintained. Endoscopic findings of a swollen major papilla and histological findings of specimens obtained from the major papilla were examined in 26 and 21 patients, respectively. RESULTS: The MPD opening sign was detected in 26 of the 40 patients (65%). The distal CBD sign was detected in 25 of the 32 patients (78%), which showed stenosis of the lower bile duct. The patients who showed the MPD opening sign frequently showed the distal CBD sign (p=0.018). Lymphoplasmacytic infiltration, but not dense fibrosis, was histologically detected in biopsy specimens obtained from the major papilla. CONCLUSIONS: On ERCP, the MPD and CBD adjacent to the major papilla are frequently maintained in patients with AIP involving the pancreatic head. These signs are useful for diagnosing AIP on ERCP.
Autoimmune Diseases/*diagnosis/pathology ; *Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct/pathology ; Female ; Humans ; Male ; Middle Aged ; Pancreas/pathology ; Pancreatic Ducts/pathology ; Pancreatitis/*diagnosis/pathology ; Retrospective Studies

Accurate and early diagnosis of indeterminate bile duct stricture is difficult. There are numerous cases suggesting similarity between benign tumors and malignancy. Therefore, meticulous evaluation with endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound and computed tomography (CT) is necessary. A 50 year-old male presented with painless jaundice. Abdominal CT scan showed distal biliary stricture without definite pancreatic mass. Repeated brush cytology and endobiliary biopsy during ERCP did not reveal malignancy except for eggs of Clonorchis sinensis. The patient declined surgical resection without definite evidence of malignancy. Abdominal CT scan one month later showed progressive parenchymal atrophy and pancreatic duct dilatation. The patient underwent pylorus preserving pancreatoduodenectomy. Pathology revealed pancreatic adenocarcinoma in the head portion. Since accurate preoperative diagnosis of malignant biliary obstruction can be evasive, patients with biliary stricture should undergo evaluation with high index of suspicion.
Adenocarcinoma ; Atrophy ; Bile Ducts ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchis sinensis* ; Constriction, Pathologic* ; Diagnosis ; Dilatation ; Early Diagnosis ; Eggs ; Head ; Humans ; Jaundice ; Male ; Ovum ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Pathology ; Pylorus ; Tomography, X-Ray Computed ; Ultrasonography

Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) and intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) have striking similarities and are recognized as counterparts. However, simultaneous occurrence of IPMN-B and IPMN-P is extremely rare. A 66 year-old female presented with recurrent epigastric pain and fever. During the past 9 years, she had three clinical episodes related to intrahepatic duct stones and IPMN-P in the pancreas head and was managed by medical treatment. Laboratory test results at admission revealed leukocytosis (12,600/mm3) and elevated CA 19-9 level (1,200 U/mL). Imaging study demonstrated liver abscess in the Couinaud's segment 4, IPMN-B in the left lobe, and IPMN-P in the whole pancreas with suspicious malignant change. Liver abscess was drained preoperatively, followed by left lobectomy with bile duct resection and total pancreatectomy with splenectomy. On histologic examination, non-invasive intraductal papillary mucinous carcinoma arising from various degree of dysplastic mucosa of the liver and pancreas could be observed. However, there was no continuity between the hepatic and pancreatic lesions. This finding in our case supports the theory that double primary lesions are more likely explained by a diffuse IPMN leading to synchronous tumors arising from both biliary and pancreatic ducts rather than by a metastatic process. Herein we present a case of simultaneous IPMN of the bile duct and pancreas which was successfully treated by surgical management.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Adenocarcinoma, Papillary/*diagnosis/pathology/surgery ; Aged ; Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Bile Ducts, Intrahepatic/pathology ; CA-19-9 Antigen/analysis ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Female ; Hepatectomy ; Humans ; Leukocytosis/diagnosis ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreaticobiliary diseases and the characteristics of pancreaticobiliary disorders in children.

METHODRetrospective review was conducted on the data of patients younger than 18 years who underwent ERCP between 2005 and 2012 at West China Hospital. The indications,ERCP findings, ERCP procedures, complications, and clinical outcomes were evaluated.ERCP procedures were performed using standard duodenoscopes under general anaesthesia or sedation, which included all endoscopic treatments, such as endoscopic sphincteropapillotomy, stone extraction, stent treatment and so on.

RESULTOne hundred and two ERCPs were performed on 68 patients, and all the procedures were successfully completed in 100% cases. There were 39 girls (57%), and median age at time of procedure was 14.6 years (range, 5-17 years).General anesthesia and sedation were performed in 81% and 19% of procedures, respectively. The ERCP findings were classified as follows:bile duct stone(s) (n = 37, 54%), pancreatic duct stone(s) (n = 8, 12%), bile duct benign stricture (n = 7, 10%) and other nonmalignant pancreaticobiliary diseases (n = 16, 24%).Four cases (4/102, prevalence 4%) were complicated with post-ERCP pancreatitis.Symptoms such as abdominal pain and jaundice were cured obviously after the procedures of ERCP were performed.

CONCLUSIONThe main characteristics of pancreaticobiliary disorders in children were nonmalignant pancreaticobiliary diseases, such as bile duct stone, pancreatic duct stone, and bile/pancreatic duct benign stricture.When performed by well-trained endoscopists, ERCP is safe and effective in children.

Adolescent ; Biliary Tract Diseases ; diagnostic imaging ; surgery ; Calculi ; diagnosis ; pathology ; surgery ; Child ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; diagnosis ; pathology ; surgery ; Female ; Humans ; Male ; Pancreatic Diseases ; diagnosis ; pathology ; surgery ; Pancreatic Ducts ; diagnostic imaging ; surgery ; Retrospective Studies ; Treatment Outcome