Preliminary experience with pancreatic sphincterotomy as treatment for intraductal papillary mucinous neoplasm-associated recurrent pancreatitis.

Published on Nov 1, 2017in Endoscopy International Open
· DOI :10.1055/S-0043-119753
Laura Bernardoni10
Estimated H-index: 10
(University of Verona),
Stefano Francesco Crinò14
Estimated H-index: 14
(University of Verona)
+ 5 AuthorsArmando Gabbrielli26
Estimated H-index: 26
(University of Verona)
Background and study aims  Pancreatic intraductal papillary mucinous neoplasms (IPMN) are cystic tumors of the pancreas characterized by a malignant potential. IPMN have been associated with recurrent pancreatitis (RP). Obstruction of the main pancreatic duct by thick mucus has been postulated to be the cause of pancreatitis. In a few isolated reports, pancreatic sphincterotomy (PS) has been reported to reduce the frequency of pancreatitis. The aim of this study was to assess the efficacy of PS in patients with IPMN-associated RP. Patients and methods  We retrospectively identified patients with RP and IPMN who underwent PS from June 2010 to December 2015. Patients were included in two different groups: (a) main duct/mixed type IPMN (MD-IPMN) and (b) branch duct IPMN (BD-IPMN) with or without worrisome features/high risk stigmata. Other causes of RP were excluded. The number of pancreatitis episodes occurring during a comparable time period before and after PS was evaluated. Results  In total, 16 patients were analyzed (seven included in the MD-IPMN group and nine in the BD-IPMN group). The numbers of pancreatitis episodes occurring before and after PS were 3.5 ± 2.32 and 0.56 ± 1.03, respectively ( P  50 %), and no response were obtained in 11 (68.7 %), 3 (18.7 %), and 2 patients (12.5 %), respectively. One (6.25 %) case of mild post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis was observed. No cancer was detected in resected patients. None of the BD-IPMN group patients had or developed worrisome features/high risk stigmata during follow-up. Conclusions  PS seems to be effective in reducing the number of episodes of IPMN-associated pancreatitis and should be considered as a treatment option in selected clinical settings. However, active surveillance should be continued considering the malignant potential of IPMN. Further prospective controlled studies are needed to confirm our results.
📖 Papers frequently viewed together
28 Citations
22 Citations
#1Stefano Francesco Crinò (University of Verona)H-Index: 14
#2Laura Bernardoni (University of Verona)H-Index: 10
Last. Armando Gabbrielli (University of Verona)H-Index: 26
view all 9 authors...
Background & Aims Santorinicele, a rare focal cystic dilation of the distal portion of the dorsal pancreatic duct at the minor papilla, can be a cause of recurrent acute pancreatitis (RAP). Endoscopic minor papilla sphincterotomy (EMPS) has been evaluated as a treatment in case reports but never systematically investigated. Methods We performed a retrospective analysis of the efficacy of EMPS in reducing episodes of pancreatitis. We collected data on 30 patients with santorinicele and RAP who un...
6 CitationsSource
#1Kara L. Raphael (Emory University)H-Index: 2
#2Field F. Willingham (Emory University)H-Index: 23
Hereditary pancreatitis (HP) is a rare cause of acute, recurrent acute, and chronic pancreatitis. It may present similarly to other causes of acute and chronic pancreatitis, and often there has been a protracted evaluation prior to the diagnosis of HP. Since it was first described in 1952, multiple genetic defects that affect the action of digestive enzymes in the pancreas have been implicated. The most common mutations involve the PRSS1, CFTR, SPINK1, and CTRC genes. New mutations in these gene...
32 CitationsSource
#1Vicente Morales-Oyarvide (Harvard University)H-Index: 26
#2Mari Mino-Kenudson (Harvard University)H-Index: 93
Last. Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
view all 7 authors...
Background Acute pancreatitis (AP) is a common presenting symptom of intraductal papillary mucinous neoplasms (IPMN). Our objective was to evaluate the clinical and pathologic features of IPMN that present with AP. We hypothesized that the intestinal epithelial subtype, which produces a highly viscous mucin containing MUC2 glycoprotein, is associated with the development of AP. Methods We performed a case-control study, evaluating 325 patients with IPMN resected at our institution. Clinicopathol...
22 CitationsSource
Cystic neoplasms of the pancreas are found with increasing prevalence, especially in elderly asymptomatic individuals. Although the overall risk of malignancy is very low, the presence of these pancreatic cysts is associated with a large degree of anxiety and further medical investigation due to concerns about malignancy. This review discusses the different cystic neoplasms of the pancreas and reports diagnostic strategies based on clinical features and imaging data. Surgical and nonsurgical man...
79 CitationsSource
#1Alexandra M. Roch (IU: Indiana University)H-Index: 10
#2Janak A. Parikh (IU: Indiana University)H-Index: 3
Last. C. Max Schmidt (IU: Indiana University)H-Index: 38
view all 8 authors...
Introduction Pancreatitis is associated with intraductal papillary mucinous neoplasm (IPMN). This association is in part due to inflammation from pancreatic ductal obstruction. Although the correlation between pancreatitis and the malignant potential of IPMN is unclear, the 2012 International Consensus Guidelines (ICG) consider pancreatitis a “worrisome feature.” We hypothesized that serum pancreatic enzymes, markers of inflammation, are a better predictor of malignancy than pancreatitis in pati...
15 CitationsSource
#1Tine Maria Hansen (AAU: Aalborg University)H-Index: 9
#2Matias Nilsson (AAU: Aalborg University)H-Index: 10
Last. Jens Brøndum FrøkjærH-Index: 32
view all 4 authors...
Morphological and functional evaluation of chronic pancreatitis with magnetic resonance imaging
29 CitationsSource
#1Ji Woong Jang (Eulji University)H-Index: 2
#1Ji Woong Jang (Eulji University)H-Index: 2
Last. Jin Hee Kim (UOU: University of Ulsan)H-Index: 22
view all 9 authors...
Background and Aim Comparatively little is known about acute pancreatitis or acute recurrent pancreatitis (AP/ARP) with intraductal papillary mucinous neoplasm of the pancreas (IPMN) as the causative lesion although there have been many reports about the malignant potential of IPMN as a premalignant lesion. Methods From 2000 to 2008, in a single tertiary referral center, out of 784 patients coded by the International Classification of Disease-10 with IPMN, 489 patients fulfilled our diagnostic c...
25 CitationsSource
#1Masao Tanaka (Kyushu University)H-Index: 105
#2Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
Last. Kenji YamaoH-Index: 63
view all 14 authors...
Abstract The international consensus guidelines for management of intraductal papillary mucinous neoplasm and mucinous cystic neoplasm of the pancreas established in 2006 have increased awareness and improved the management of these entities. During the subsequent 5 years, a considerable amount of information has been added to the literature. Based on a consensus symposium held during the 14th meeting of the International Association of Pancreatology in Fukuoka, Japan, in 2010, the working group...
1,578 CitationsSource
#1Preethi G.K. Venkatesh (Cleveland Clinic)H-Index: 24
#2Udayakumar Navaneethan (Cleveland Clinic)H-Index: 47
Last. Santhi Swaroop VegeH-Index: 50
view all 3 authors...
Intraductal papillary mucinous neoplasms (IPMNs) are cystic pancreatic tumors that arise from the pancreatic ducts and are increasingly reported worldwide. Both benign and malignant tumors of the pancreas are thought to contribute to recurrent pancreatitis possibly by pancreatic duct obstruction, an
30 CitationsSource
#1Tooru Shimosegawa (Tohoku University)H-Index: 95
#2Suresh T. ChariH-Index: 103
Last. Lizhi ZhangH-Index: 54
view all 14 authors...
Objectives:To achieve the goal of developing international consensus diagnostic criteria (ICDC) for autoimmune pancreatitis (AIP).Methods:An international panel of experts met during the 14th Congress of the International Association of Pancreatology held in Fukuoka, Japan, from July 11 through 13,
896 CitationsSource
Cited By6
BACKGROUND Recurrent acute pancreatitis (RAP) may be a presenting feature of and an indication for resection of pancreatic cysts, including intra-ductal papillary mucinous neoplasm (IPMN). Few data are available regarding the prevalence of malignancy and post-operative RAP in this population. AIM To study the role of resection to help prevent RAP and analyze if presentation as RAP would be a predictor for malignancy. METHODS This retrospective study assessed 172 patients who underwent surgical r...
Abstract Background We aimed to assess factors impacting the endoscopic minor papilla sphincterotomy (EMPS) success rate, clinical efficacy, and safety in a large cohort of patients with symptomatic pancreas divisum (PD). Methods Retrospective study including patients with PD referred to the Pancreas Institute of Verona from May 2009 to May 2020 to undergo EMPS. The whole population was analyzed to assess EMPS technical success, defined as the rate of deep cannulation of the dorsal duct. Patient...
Pancreatic cyst diagnosis remains a challenge. The present algorithm was based on recent international guidelines and provides a practical overview of diagnostic sequence. We firstly divided cysts into “incidentally detected” and “symptomatic,” trying to highlight the indications to follow-up, surgery, or EUS.
1 CitationsSource
#1Giovanna Del Vecchio Blanco (University of Rome Tor Vergata)H-Index: 20
#2C. Gesuale (University of Rome Tor Vergata)H-Index: 1
Last. Omero Alessandro Paoluzi (University of Rome Tor Vergata)H-Index: 17
view all 5 authors...
Acute pancreatitis (AP) is a common disease associated with a substantial medical and financial burden, and with an incidence across Europe ranging from 4.6 to 100 per 100,000 population. Although most cases of AP are caused by gallstones or alcohol abuse, several other causes may be responsible for acute inflammation of the pancreatic gland. Correctly diagnosing AP etiology is a crucial step in the diagnostic and therapeutic work-up of patients to prescribe the most appropriate therapy and to p...
4 CitationsSource
L’endoscopie occupe une place essentielle et centrale dans la prise en charge de la pancreatite aigue. Elle intervient a differentes periodes de l’evolution de cette pathologie, dont le pronostic en 2018 reste parfois encore reserve. Elle est utile grâce a l’echoendoscopie dans le diagnostic etiologique afin de determiner l’origine de la pancreatite notamment en cas de bilan initial negatif. Elle est efficace dans le cadre du traitement notamment etiologique de la maladie notamment en cas d’orig...