Reply to Kakutani et al.We have read the letter by Kakutani et al. in the current issue. While we understand and appreciate their ethical concerns sur− rounding our recent publication in Endos− copy attempting to establish an animal model of post−endoscopic retrograde cholangiopancreatography (ERCP) pan− creatitis (PEP) [1], we strongly disagree with their position. In their own words, PEP continues to be "one of the most se− vere complications of interventional en− doscopy," affecting between 1 % and 22 % [2 ± 4] of all patients undergoing ERCP. With the exception of pancreatic stent placement [5,6], all other measures stud− ied for the prevention of this disease have proven to be less effective. The cost, mor− bidity, and mortality associated with PEP is unacceptable, yet the practice of "pilot testing" unproven agents, maneuvers, or devices in humans should stop. As such, we firmly believe that an animal model mimicking PEP would serve as an invalu− able platform for the initial study of phar− maceuticals and devices aimed at its pre− vention, thereby avoiding the wasteful use of resources while studying ineffec− tive measures in humans. We strongly support thoughtful and ethical research in the prevention of PEP, and it is for this reason that our study was designed and carried forward under strict approval from our institution's animal research re− view board ± not for the sole purpose of obtaining "academic kudos." Competing interests: None References1 Buscaglia JM, Simons BW, Prosser BJ et al. Se− verity of post−ERCP pancreatitis directly proportional to the invasiveness of endo− scopic intervention: a pilot study in a ca− nine model. Endoscopy 2008; 40: 506 ± 512 2 Marks JM, Dunkin BJ, Shillingstad BL et al. Pretreatment with allopurinol diminishes pancreatography−induced pancreatitis in a canine model. Gastrointest Endosc 1998; 48: 180 ± 183 3 Freeman ML, Nelson DB, Sherman S et al. Complications of endoscopic biliary sphinc− terotomy. N Engl J Med 1996; 335: 909 ± 918 4 Bilbao MK, Dotter CT, Lee TG et al. Complica− tions of endoscopic retrograde cholangio− pancreatography (ERCP). A study of 10,000 cases. Gastroenterology 1976; 70: 314 ± 320 5 Tarnasky PR, Palesch YY, Cunningham JT et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastro− enterology 1998; 115: 1518 ± 1524 6 Tarnasky PR. Mechanical prevention of post−ERCP pancreatitis by pancreatic stents: results, techniques, and indications. JOP 2003; 4: 58 ± 67
Background and Aims: COVID-19 patients may have asymptomatic hyperlipasemia without abdominal imaging findings or abdominal pain. In addition, primary and secondary pancreatitis have been described in COVID-19 patients. There is limited information on how the groups compare in outcomes. The aim is to compare outcomes among these groups. Methods: This is a retrospective study from 12 hospitals within one healthcare system examining outcomes between hospitalized COVID-19 patients with a lipase <3x upper limit of normal (ULN), asymptomatic hyperlipasemia (>3x ULN), secondary pancreatitis (typical respiratory COVID-19 symptoms and found to have pancreatitis), and primary pancreatitis (presenting with pancreatitis). Results: Of 11,883 patients admitted with COVID-19, 1,560 patients were included: 1,155 COVID-19 patients with a normal serum lipase (control group), 270 with an elevated lipase <3x ULN, 46 patients with asymptomatic hyperlipasemia with a lipase 3xULN, 57 patients with secondary pancreatitis, and 32 patients with primary pancreatitis. On adjusted multivariate analysis, the elevated lipase <3x ULN and asymptomatic hyperlipasemia groups had worse outcomes. The mortality was OR1.6 (95% CI 1.2-2.2) and 1.1 (95% CI 0.5-2.3), respectively. The need for mechanical ventilation was OR 2.8 (95% CI 1.2-2.1) and 2.8 (95% CI 1.5-5.2), respectively. Longer length of stay was OR 1.5 (95%CI 1.1-2.0) and 3.16 (95%CI 1.5-6.5), respectively. Conclusion: COVID-19 patients with an elevated lipase< 3x ULN and asymptomatic hyperlipasemia have generally worse outcomes than those with pancreatitis. This could be attributed to extrapancreatic causes (liver failure, renal failure, enteritis, etc), which may signify a more severe course of clinical disease. Key words: pancreas; SARS-CoV-2; pancreatitis
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.