Endoscopic Management of Early-Stage Chronic Pancreatitis Based on M-ANNHEIM Classification System

He, Yuan-Xiang; Xu, Hongwei; Sun, Xiaotian; Zhou, Ye; Wang, Wei; Lai, Xiaowei; Wang, Xintao; Hu, Liang‐Hao; Sun, Chang; Liao, Zhuan; Li, Zhao‐Shen

doi:10.1097/mpa.0000000000000140

Cited by 23 publications

(13 citation statements)

References 17 publications

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“…CP was diagnosed based on clinical symptoms and imaging morphologic changes13 and M-ANNHEIM classification system was adopted to define the clinical stage of CP37 (Appendix 1). Stage 1a and 1b (CP patients without pancreatic function insufficiency, with recurrent acute pancreatitis [1a] or chronic abdominal pain [1b]) were defined as early CP and the effectiveness of this definition was proved in previous study with long-term follow-up38. Blood samples from 10 patients with early CP and 9 healthy controls with matched ages and sex were collected for miRNA microarrays.…”

Section: Methodsmentioning

confidence: 99%

Novel blood-based microRNA biomarker panel for early diagnosis of chronic pancreatitis

Xin

Gao

Wang

et al. 2017

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Chronic pancreatitis (CP) is an inflammatory disease characterized by progressive fibrosis of pancreas. Early diagnosis will improve the prognosis of patients. This study aimed to obtain serum miRNA biomarkers for early diagnosis of CP. In the current study, we analyzed the differentially expressed miRNAs (DEmiRs) of CP patients from Gene Expression Omnibus (GEO), and the DEmiRs in plasma of early CP patients (n = 10) from clinic by miRNA microarrays. Expression levels of DEmiRs were further tested in clinical samples including early CP patients (n = 20), late CP patients (n = 20) and healthy controls (n = 18). The primary endpoints were area under curve (AUC) and expression levels of DEmiRs. Four DEmiRs (hsa-miR-320a-d) were obtained from GEO CP, meanwhile two (hsa-miR-221 and hsa-miR-130a) were identified as distinct biomarkers of early CP by miRNA microarrays. When applied on clinical serum samples, hsa-miR-320a-d were accurate in predicting late CP, while hsa-miR-221 and hsa-miR-130a were accurate in predicting early CP with AUC of 100.0% and 87.5%. Our study indicates that miRNA expression profile is different in early and late CP. Hsa-miR-221 and hsa-miR-130a are biomarkers of early CP, and the panel of the above 6 serum miRNAs has the potential to be applied clinically for early diagnosis of CP.

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Section: Methodsmentioning

confidence: 99%

Novel blood-based microRNA biomarker panel for early diagnosis of chronic pancreatitis

Xin

Gao

Wang

et al. 2017

Sci Rep

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“…As a tertiary medical center, Changhai Hospital admitted patients with previous pancreas-related surgical, endoscopic, or other invasive procedures from primary medical centers. In our center, minimally invasive interventions were taken as principle methods prior to surgery: extracorporeal shock wave lithotripsy (ESWL)/endoscopic retrograde cholangiopancreatography (ERCP) for stone removal and main pancreatic duct (MPD) drainage, insertion of stents to treat dominant MPD stricture and biliary duct stricture, and endoscopic drainage for uncomplicated pseudocyst with endoscopic reach 28 35 38 39 40 41 42 43 44 45 . For CP patients who did not experience pain, interventions were performed only when CP was complicated by CBD stricture, pancreatic portal hypertension, et al ; DM or steatorrhea was not an indication for invasive treatment of CP 13 .…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Steatorrhea in Chronic Pancreatitis: A Cohort of 2,153 Patients

Pan

et al. 2016

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This study aimed to investigate the occurrence of and determine the risk factors for steatorrhea in chronic pancreatitis (CP). It was based on analysis of both retrospectively and prospectively acquired database for CP patients admitted to our center from January 2000 to December 2013. Demographic data, course of disease, medical history, and follow-up evaluations of patients were documented in detail. Cumulative rate of steatorrhea was calculated by using the Kaplan–Meier method. For risk factor analysis, multivariate analysis by Cox proportional hazards regression model was performed. A total of 2,153 CP patients were included with a mean follow-up duration of 9.3 years. Approximately 14% (291/2,153) of CP patients presented with steatorrhea at diagnosis of CP. Cumulative rates of steatorrhea at 1, 5, 10, and 20 years after diagnosis of CP were 4.27% (95% CI: 3.42%–5.34%), 12.53% (95% CI: 10.74%–14.59%), 20.44% (95% CI: 17.37%–23.98%) and 30.82% (95% CI: 20.20%–45.21%), respectively. Male gender (HR = 1.771, p = 0.004), diabetes (HR = 1.923, p < 0.001), alcohol abuse (HR = 1.503, p = 0.025) and pancreaticoduodenectomy (HR = 2.901, p < 0.001) were independent risk factors for steatorrhea while CP in adolescents (HR = 0.433, p = 0.009) was a protective factor. In conclusion, male gender, adult, diabetes, alcohol abuse and pancreaticoduodenectomy lead to increased risk of steatorrhea in CP patients.

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“…With this stent exchange policy, sepsis of pancreatic origin was reported in 15 (5.2 %) of 288 patients in four series [66, 68 -69, 72] and surgery was required in two patients for pancreatic abscesses; this was reported in the only series in which no additional investigations at regular intervals were performed [72]. On the other hand, in 12 series (521 patients) with stent exchange scheduled at shorter intervals, usually 3 months, septic complications have not been reported [5,14,65,67,70,73,74,88,90,92,97,98].…”

Section: Pancreatic Stenting: Technical Factors and Complicationsmentioning

confidence: 99%

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

et al. 2019

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Main RecommendationsESGE suggests endoscopic therapy and/or extracorporeal shockwave lithotripsy (ESWL) as the first-line therapy for painful uncomplicated chronic pancreatitis (CP) with an obstructed main pancreatic duct (MPD) in the head/body of the pancreas. The clinical response should be evaluated at 6 – 8 weeks; if it appears unsatisfactory, the patient’s case should be discussed again in a multidisciplinary team and surgical options should be considered.Weak recommendation, low quality evidence.ESGE suggests, for the selection of patients for initial or continued endoscopic therapy and/or ESWL, taking into consideration predictive factors associated with a good long-term outcome. These include, at initial work-up, absence of MPD stricture, a short disease duration, non-severe pain, absence or cessation of cigarette smoking and of alcohol intake, and, after initial treatment, complete removal of obstructive pancreatic stones and resolution of pancreatic duct stricture with stenting.Weak recommendation, low quality evidence.ESGE recommends ESWL for the clearance of radiopaque obstructive MPD stones larger than 5 mm located in the head/body of the pancreas and endoscopic retrograde cholangiopancreatography (ERCP) for MPD stones that are radiolucent or smaller than 5 mm. Strong recommendation, moderate quality evidence.ESGE suggests restricting the use of endoscopic therapy after ESWL to patients with no spontaneous clearance of pancreatic stones after adequate fragmentation by ESWL.Weak recommendation, moderate quality evidence.ESGE suggests treating painful dominant MPD strictures with a single 10-Fr plastic stent for one uninterrupted year if symptoms improve after initial successful MPD drainage. The stent should be exchanged if necessary, based on symptoms or signs of stent dysfunction at regular pancreas imaging at least every 6 months. ESGE suggests consideration of surgery or multiple side-by-side plastic stents for symptomatic MPD strictures persisting beyond 1 year after the initial single plastic stenting, following multidisciplinary discussion. Weak recommendation, low quality evidence.ESGE recommends endoscopic drainage over percutaneous or surgical treatment for uncomplicated chronic pancreatitis (CP)-related pseudocysts that are within endoscopic reach.Strong recommendation, moderate quality evidence.ESGE recommends retrieval of transmural plastic stents at least 6 weeks after pancreatic pseudocyst regression if MPD disruption has been excluded, and long-term indwelling of transmural double-pigtail plastic stents in patients with disconnected pancreatic duct syndrome.Strong recommendation, low quality evidence.ESGE suggests the temporary insertion of multiple side-by-side plastic stents or of a fully covered self-expandable metal stent (FCSEMS) for treating CP-related benign biliary strictures.Weak recommendation, moderate quality evidence.ESGE recommends maintaining a registry of patients with biliary stents and recalling them for stent removal or exchange.Strong recommendation, low quality evidence.

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Endoscopic Management of Early-Stage Chronic Pancreatitis Based on M-ANNHEIM Classification System

Abstract: We demonstrated that a sophisticated M-ANNHEIM classification system for CP will improve diagnosis by allowing for more timely intervention. Furthermore, prompt treatment of CP may achieve improved pain relief and patient outcomes.

Cited by 23 publications

References 17 publications

Novel blood-based microRNA biomarker panel for early diagnosis of chronic pancreatitis

Novel blood-based microRNA biomarker panel for early diagnosis of chronic pancreatitis

Risk Factors for Steatorrhea in Chronic Pancreatitis: A Cohort of 2,153 Patients

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018

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