Investigation of the influence of pancreatic surgery on new‐onset and persistent diabetes mellitus

Yamada, Daisaku; Takahashi, Hidenori; Asukai, Kei; Hasegawa, Shinobu; Wada, Hiroshi; Matsuda, Chu; Yasui, Masayoshi; Omori, Takeshi; Miyata, Hiroshi; Sakon, Masato

doi:10.1002/ags3.12435

Cited by 7 publications

(9 citation statements)

References 27 publications

(72 reference statements)

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“…In a previous study, the remnant pancreatic volume was found to be a significant risk factor for DM, but this relationship was stronger in patients who underwent DP, rather than PD. 16 Another study showed that obstructive pancreatitis caused by periampullary PDAC exacerbates glucose intolerance by inhibiting insulin secretion and that treatment of the periampullary tumor by pancreatectomy sometimes permits the recovery of the function of the remnant pancreas by removing the obstruction. 17…”

Section: Discussionmentioning

confidence: 99%

The impact of postoperative exocrine index on non‐alcoholic fatty liver disease following pancreaticoduodenectomy

Tsunematsu

Gocho

Yanagaki

et al. 2022

Annals of Gastroent Surgery

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Background: To study exocrine function of the remnant pancreas after pancreatoduodenectomy (PD), we propose the use of an exocrine index (PEI) that combines the volume of the remnant pancreas and the intraoperative amylase activity of the pancreatic juice. Here, we aimed to determine whether the PEI can predict non-alcoholic fatty liver disease (NAFLD) following PD.Methods: Fifty-seven patients for whom pancreatic juice amylase activity was measured during PD were enrolled. NAFLD was defined as a liver-to-spleen attenuation ratio of <0.9 on plain CT 1 year following surgery. We retrospectively evaluated clinical parameters, including the PEI, to identify predictors of NAFLD.Results: Fifty-four patients (95%) were regularly administered 1200 mg of pancreatic lipase. NAFLD was diagnosed in 13 participants (23%) 1 year following surgery.NAFLD was associated with pancreatic ductal adenocarcinoma (P = .006), soft pancreas (P = .001), small main pancreatic duct (P = 0008), low remnant pancreatic volume (P < .001), low intraoperative amylase activity in the pancreatic juice (P = .001), high pancreatic fibrosis (P = .032), and large body weight loss (P = .015). The PEI was significantly lower in the participants with NAFLD than in those without (P < .001).The participants were then classified into tertiles of PEI: <5 × 10 6 , 5-25 × 10 6 , and >25 × 10 6 . The prevalence of NAFLD in these groups was 53% (10/19), 11% (2/19), and 5% (1/19), respectively. In multivariable analyses, there was a significant association between NAFLD and the PEI (P value for trend = .042). Conclusion:The PEI, calculated using the remnant pancreatic volume and the intraoperative pancreatic juice amylase activity, predicts NAFLD development following PD.

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Section: Discussionmentioning

confidence: 99%

The impact of postoperative exocrine index on non‐alcoholic fatty liver disease following pancreaticoduodenectomy

Tsunematsu

Gocho

Yanagaki

et al. 2022

Annals of Gastroent Surgery

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“…A previous report suggested preoperative 24-hour urinary C-peptide excretion measurement and multiplication of this value by the predicted pancreatic volume as a predictor of postoperative endocrine function [11]. However, 24-hour urine storage is a complicated and burdensome test for patients and is considered less versatile.…”

Section: Discussionmentioning

confidence: 99%

“…As noted above, some studies examining factors contributing to the occurrence of NODM after pancreatectomy have reported contradictory findings [7–9]. However, only a few studies have evaluated the changes in endocrine function, particularly insulin secretion capacity, before and after pancreatectomy [10,11].…”

Section: Introductionmentioning

confidence: 99%

“…As noted above, some studies examining factors contributing to the occurrence of NODM after pancreatectomy have reported contradictory findings [7][8][9]. However, only a few studies have evaluated the changes in endocrine function, particularly insulin secretion capacity, before and after pancreatectomy [10,11]. 5 There are two known types of insulin secretion: basal insulin secretion, which remains constant regardless of food intake, and additional insulin secretion, which is in response to rising blood glucose levels post food intake.…”

Section: Introductionmentioning

confidence: 99%

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Changes in basal insulin secretion capacity after pancreatectomy: a retrospective study

Kihara

Murotani

Yokomizo

2022

Preprint

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This study evaluated the changes in basal insulin secretion capacity (BISC) after pancreatectomy across two surgical procedures. We also investigated the association between decreased BISC and the introduction of postoperative insulin therapy. The data on 110 patients who underwent pancreatectomy during October 2018–February 2022 at our hospital were analyzed retrospectively. We focused on the C-peptide index (CPI) as an index for BISC. A decreased postoperative BISC was defined as a postoperative CPI (post-CPI) <1.0, which was in turn defined as the event occurrence in our study. The receiver operating characteristic curve for the event occurrence was plotted for factors related to preoperative glucose tolerance. Of the preoperative non-diabetic 73 patients, 44 and 29 who underwent pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), respectively, were examined. A post-CPI of <1.0 was observed in 29 patients (39%). Although the proportion of remnant pancreatic volume was significantly smaller in patients with PD than in patients with DP (38% vs. 68%, p <0.0001), no significant difference was observed in the event rates (39% vs. 41%). In patients with PD, preoperative CPI (area under the curve: 0.75) was used for predicting post-CPI <1.0. Multivariate analysis revealed that preoperative CPI <1.65 (odds ratio: 7.69, 95% confidence interval: 1.87?31.5) was an independent predictor of decreased postoperative BISC. However, in patients with DP, no significant predictors were identified. Induction of insulin therapy was significantly lower in preoperative non-diabetic patients (n=73) after undergoing a pancreatectomy (1.4% vs. 37.5%, p<0.0001) than in preoperative medically treated patients (n=16); there was no significant difference in event (post-CPI <1.0) rates (39.7% vs. 56.2%, p=0.23). Although pancreatectomy reduces BISC after surgery, the coexistence of insulin resistance, which is a pathophysiology of type 2 diabetes mellitus, may play a role in whether postoperative glucose tolerance is reduced to the point where insulin therapy is necessary.

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“…Studies have shown that between 10 and 60 percent of cysts, particularly intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN), have significant potential to develop into malignant cancer [ 10 , 11 , 12 , 13 ]. Patients presenting with likely mucinous cysts are candidates for surgical resection, which carries a 2–4% mortality risk, as well as a 21% risk of post-surgical new onset diabetes [ 14 , 15 ]. Disappointingly, surgical interventions are often performed for cysts that are later found to be benign, while patients with non-mucinous cysts could (if accurately classified) be spared costly long-term surveillance [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Translation of a Protease Turnover Assay for Clinical Discrimination of Mucinous Pancreatic Cysts

Suresh

Byers²,

Rajesh³

et al. 2022

Diagnostics

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The classification of pancreatic cyst fluids can provide a basis for the early detection of pancreatic cancer while eliminating unnecessary procedures. A candidate biomarker, gastricsin (pepsin C), was found to be present in potentially malignant mucinous pancreatic cyst fluids. A gastricsin activity assay using a magnetic bead-based platform has been developed using immobilized peptide substrates selective for gastricsin bearing a dimeric rhodamine dye. The unique dye structure allows quantitation of enzyme-cleaved product by both fluorescence and surface enhanced Raman spectroscopy (SERS). The performance of this assay was compared with ELISA assays of pepsinogen C and the standard of care, carcinoembryonic antigen (CEA), in the same clinical sample cohort. A retrospective cohort of mucinous (n = 40) and non-mucinous (n = 29) classes of pancreatic cyst fluid samples were analyzed using the new protease activity assay. For both assay detection modes, successful differentiation of mucinous and non-mucinous cyst fluid was achieved using 1 µL clinical samples. The activity-based assays in combination with CEA exhibit optimal sensitivity and specificity of 87% and 93%, respectively. The use of this gastricsin activity assay requires a minimal volume of clinical specimen, offers a rapid assay time, and shows improvements in the differentiation of mucinous and non-mucinous cysts using an accurate standardized readout of product formation, all without interfering with the clinical standard of care.

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Investigation of the influence of pancreatic surgery on new‐onset and persistent diabetes mellitus

Cited by 7 publications

References 27 publications

The impact of postoperative exocrine index on non‐alcoholic fatty liver disease following pancreaticoduodenectomy

The impact of postoperative exocrine index on non‐alcoholic fatty liver disease following pancreaticoduodenectomy

Changes in basal insulin secretion capacity after pancreatectomy: a retrospective study

Translation of a Protease Turnover Assay for Clinical Discrimination of Mucinous Pancreatic Cysts

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