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中国神经科学学会第四次会员代表大会暨第七届全国学术会议

作者： John H WINSTON Mohan SHENOY Pankaj Jay PASRICHA Division of Gastroenterology and Hepatology Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexas 77555USA

＜正＞The neurobiological basis of pancreatic hyperalgesia in chronic pancreatitis（CP） is poorly understood and treatment of pain in this condition remains empirical and often ineffective.We have previously developed a rat model of trinitrobenzene sulphonic acid（TNBS）-induced chronic pancreatitis that results in nociceptive sensitization in rats manifested by pancreatic hyperalgesia and referred somatic allodynia.The aim of this study was to investigate the molecular substrate of these changes,specifically focusing on the role of the transient receptor potential vanilloid subfamily 1 （TRPV1）.CP was induced in adult rats by a single intraductal injection of TNBS.Dorsal root ganglion（DRG） neurons innervating the pancreas were identified by DiI or cholera B toxin fluorescence labeling.TRPV1 currents in pancreasspecific DRG neurons were measured using perforated patch-clamp techniques.RT-PCR was used to measure mRNA expression of TRPV1 in pancreas-specific DRG neurons after laser capture microdissection（LCM）.Immunofluorescence and western blot analysis,using TRPV1-specific antibodies,were also performed.Pancreatic hyperalgesia was assessed by observing nocifensive behaviors after electrical stimulation of the pancreas and belly withdrawal responses were also recorded after von Fray Filament testing.Three weeks after injection of TNBS,Capsaicin-induced current density of pancreas specific DRG neurons was increased about four-folds（P ＜ 0.02）,along with an increase in proportion of pancreas -specific DRG neurons that responded to capsaicin（52.9%in controls versus 79.0%in TNBS,P ＜ 0.05）.CP was also associated with a significant enhancement of TRPV1 expression both at the mRNA and protein level,including western blots in whole thoracic DRG and immunoreactivity in pancreas specific sensory neurons.Systemic administration of the TRPV1 antagonist（SB-366791） markedly reduced the pain behavioral response to noxious electrical stimulation of pancreas and von Frey Filament stimulation in rats with CP,but not in control animals.Thus

关键词： chronic pancreatitis transient receptor potential vanilloid subfamily 1 rat

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Pancreatic pseudoaneurysm mimicking pancreatic tumor: A casereport and review of literature

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World Journal of Gastrointestinal Oncology 2023年第11期15卷 2041-2048页

作者： Yuan Yang Xue-Mei Liu Hong-Ping Li Rui Xie Bi-Guang Tuo Hui-Chao Wu Department of Gastroenterology Digestive Disease HospitalAffiliated Hospital of Zunyi Medical UniversityZunyi 563000Guizhou ProvinceChina

BACKGROUND Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis(CP)or necrotizing pancreatitis with an incidence of 4%to 17%,but it is potentially life-threatening.It is well known that most pancreatic pseudoaneurysms are clinically associated with pancreatic pseudocysts and are usually in the peripancreatic body-tail.A minority of intrapancreatic pseudoaneurysms occur in the absence of pseudocyst formation.Noninvasive computed tomography(CT)and magnetic resonance imaging(MRI)are most commonly used examinations for screening pancreatic pseudoaneurysms.Notably,the rare intrapancreatic pseudoaneurysm in the pancreatic head can mimic a hypervascular solid mass and be misdiagnosed as a pancreatic tumor.CASE SUMMARY We report the case of a 67-year-old man who had been admitted to our hospital due to recurrent abdominal pain for 1 mo that was aggravated for 5 d.CT and MRI revealed a mass in the pancreatic head with significant expansion of the main pancreatic duct and mild atrophy of the pancreatic body-tail.He was admitted to the department of hepatobiliary and pancreatic surgery due to the possibility of a pancreatic tumor.The patient was then referred for endoscopic ultrasonography(EUS)with possible EUS-FNA.However,EUS showed a cystic lesion in the pancreatic head with wall thickness and enhancing nodules,which was doubtful because it was inconsistent with the imaging findings.Subsequently,color doppler flow imaging demonstrated turbulent arterial blood flow in the cystic lesion and connection with the surrounding vessel.Therefore,we highly suspected the possibility of CP complicated with intrapancreatic pseudoaneurysm,combined with the patient's long-term drinking history and the sonographic features of CP.Indeed,angiography revealed an oval area of contrast medium extravasation(size:1.0 cm×1.5 cm)at the far-end branch of the superior pancreaticoduodenal artery,and angiographic embolization was given immediately at the same time.CONCLUSION EUS is an important differential diagnostic too

关键词： Pancreatic pseudoaneurysm chronic pancreatitis Pancreaticoduodenal artery Endoscopic ultrasonography Case report

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Post-acute pancreatitis diabetes:A complication waiting for more recognition and understanding

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World Journal of Gastroenterology 2023年第28期29卷 4405-4415页

作者： Diego García-Compeán Alan R Jiménez-Rodríguez Juan M Muñoz-Ayala José A González-González Héctor J Maldonado-Garza Jesús Z Villarreal-Pérez Department of Gastroenterology Autonomous University of Nuevo LeónMonterrey 64700Nuevo LeónMexico Department of Endocrinology Autonomous University of Nuevo LeónMonterrey 64700Nuevo LeónMexico

Post-acute pancreatitis diabetes(PAPD)is the second most common type of diabetes below type 2 diabetes mellitus.Due to the boom in research on this entity carried out during the last decade,its recognition has increased.However,much of the medical community still does not recognize it as a medium and long-term complication of acute pancreatitis(AP).Recent prospective cohort studies show that its incidence is about 23%globally and 34.5%in patients with severe AP.With the overall increase in the incidence of AP this complication will be certainly seen more frequently.Due to its high morbidity,mortality and difficult control,early detection and treatment are essential.However,its risk factors and pathophysiological mechanisms are not clearly defined.Its diagnosis should be made excluding pre-existing diabetes and applying the criteria of the American Diabetes Association after 90 d of resolution of one or more AP episodes.This review will show the evidence published so far on the incidence and prevalence,risk factors,possible pathophysiological mechanisms,clinical outcomes,clinical characteristics and preventive and corrective management of PAPD.Some important gaps needing to be clarified in forthcoming studies will also be discussed.

关键词： Acute pancreatitis Diabetes mellitus chronic pancreatitis Post-pancreatitis diabetes Pancreatogenic diabetes

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External use of mirabilite to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis in children:A multicenter randomized controlled trial

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World Journal of Gastrointestinal Surgery 2023年第4期15卷 712-722页

作者： Jing-Qing Zeng Tian-Ao Zhang Kai-Hua Yang Wen-Yu Wang Jia-Yu Zhang Ya-Bin Hu Jian Xiao Zhi-Jian Gu Biao Gong Zhao-Hui Deng Department of Gastroenterology Shanghai Children’s Medical CenterSchool of MedicineShanghai Jiao Tong UniversityShanghai 200127China Department of Clinical Epidemiology and Biostatistics Shanghai Children’s Medical CenterSchool of MedicineShanghai Jiao Tong UniversityShanghai 200127China Department of Gastroenterology Shanghai Shuguang HospitalShanghai University of Traditional Chinese MedicineShanghai 200021China

BACKGROUND Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography(ERCP).Currently,there is no suitable treatment for post-ERCP pancreatitis(PEP)prophylaxis.Few studies have prospectively evaluated interventions to prevent PEP in children.AIM To assess the efficacy and safety of the external use of mirabilite to prevent PEP in children.METHODS This multicenter,randomized controlled clinical trial enrolled patients with chronic pancreatitis scheduled for ERCP according to eligibility criteria.Patients were randomly divided into the external use of mirabilite group(external use of mirabilite in a bag on the projected abdominal area within 30 min before ERCP)and blank group.The primary outcome was the incidence of PEP.The secondary outcomes included the severity of PEP,abdominal pain scores,levels of serum inflammatory markers[tumor necrosis factor-alpha(TNF-α)and serum interleukin-10(IL-10)],and intestinal barrier function markers[diamine oxidase(DAO),D-lactic acid,and endotoxin].Additionally,the side effects of topical mirabilite were investigated.RESULTSA total of 234 patients were enrolled,including 117 in the external use of mirabilite group and theother 117 in the blank group.The pre-procedure and procedure-related factors were notsignificantly different between the two groups.The incidence of PEP in the external use ofmirabilite group was significantly lower than that in the blank group(7.7%vs 26.5%,P<0.001).The severity of PEP decreased in the mirabilite group(P=0.023).At 24 h after the procedure,thevisual analog scale score in the external use of mirabilite group was lower than that in the blankgroup(P=0.001).Compared with those in the blank group,the TNF-αexpressions weresignificantly lower and the IL-10 expressions were significantly higher at 24 h after the procedurein the external use of mirabilite group(P=0.032 and P=0.011,respectively).There were nosignificant differences in serum DAO,D-lactic acid,and endotoxin levels before and after ERCPbetween the two g

关键词： Children Endoscopic retrograde cholangiopancreatography Mirabilite chronic pancreatitis Post-endoscopic retrograde cholangiopancreatography pancreatitis Randomized controlled trial

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Endoscopic retrograde cholangiopancreatography for diagnosing and treating pediatric biliary and pancreatic diseases

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World Journal of Gastrointestinal Surgery 2023年第10期15卷 2272-2279页

作者： Xiu-Min Qin Fei-Hong Yu Chuan-Kai Lv Zhi-Min Liu Jie Wu Department of Gastroenterology Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China Department of Ultrasound Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China Department of Radiology Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijing 100045China

BACKGROUND This study evaluated the safety and effectiveness of endoscopic retrograde cholangiopancreatography(ERCP)in pediatric patients with biliary and pancreatic diseases.A retrospective analysis was conducted on 57 ERCP procedures performed in 41 children,primarily for treating pancreatic diseases.The overall success rate was 91.2%,with no major complications observed.Post-ERCP pancreatitis(PEP)occurred in 8.8%of cases.Follow-up examinations over one year showed no recurrence of biliary or pancreatic diseases.Notably,endoscopic treatment led to a significant increase in body mass index(BMI).These findings demonstrate the valuable role of ERCP in managing such conditions.AIM To evaluate the safety and efficacy of ERCP for the management of biliary and pancreatic diseases in pediatric patients.METHODS We conducted a retrospective analysis of data from children aged 1-18 years who underwent ERCP for biliary and pancreatic diseases at Beijing Children’s Hospital between January 2021 and December 2022.The collected data included procedure time,endoscopic treatment,success rate,and postoperative complications.RESULTS Forty-one children underwent 57 ERCP procedures,including 14 with biliary duct disease and 27 with pancreatic disease.The mean age of the patients was 7.48±3.48 years.Biliary duct-related treatments were performed 18 times,and pancreatic disease treatments were performed 39 times.ERCP was primarily used to treat pediatric pancreatic diseases[68.4%(39/57)of the procedures].The overall success rate was 91.2%(52/57 patients).PEP was noted in five patients(8.8%,5/57),and no instances of bleeding,perforation,or cholangitis were observed.The patients were followed up for over one year,and no recurrence of biliary or pancreatic diseases was detected.Importantly,BMI significantly increased after endoscopic treatment compared to that before treatment(P=0.001).CONCLUSION The high success rate and lack of major complications support the valuable role of ERCP in the management of pediatric biliary and pancreatic

关键词： Pediatric Endoscopic retrograde cholangiopancreatography Choledocholithiasis chronic pancreatitis Pancreatic ducts Postoperative complications

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Pancreatic exocrine insufficiency guidelines:more questions than answers!

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Hepatobiliary Surgery and Nutrition 2023年第3期12卷 428-430页

作者： Nikhil Bush Vikesh K.Singh Division of Gastroenterology and Hepatology Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA

Pancreatic exocrine insufficiency(PEI)has classically been described as a maldigestive disorder resulting from decreased secretion or altered function of pancreatic digestive enzymes(1).As a result of this maldigestion and ensuing malabsorption,patients can experience symptoms such as steatorrhea and weight loss as well as complications related to the loss of fat-soluble vitamins and micronutrients.PEI has been most extensively studied in cystic fibrosis,but other causes include acute and chronic pancreatitis(CP),pancreatic adenocarcinoma(PDAC),and rarely,congenital syndromes such as Shwachman-Diamond and Johnson-Blizzard(2).

关键词： Pancreatic exocrine insufficiency(EPI) pancreatic enzyme replacement therapy(PERT) fecal elastase-1(FE-1) chronic pancreatitis

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Optimizing management of patients with pancreatic exocrine insufficiency

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Hepatobiliary Surgery and Nutrition 2023年第1期12卷 128-130页

作者： Marianna Arvanitakis Alia Hadefi Michael Fernandez Y.Viesca Department of Gastroenterology HUBErasme University Hospital-UniversitéLibre de BruxellesBrusselsBelgium

Pancreatic exocrine insufficiency(PEI)is related to decreased pancreatic enzyme availability and/or activity(1).Multiples underlying mechanisms can cause PEI,such as loss of functioning parenchyma(chronic pancreatitis,pancreatic resections,pancreatic cancer...),decreased secretion despite intact parenchyma(obstruction of the pancreatic duct,decreased endogenous stimulation,intraduodenal inactivation of pancreatic secretions),and asynchrony(gastric resections,Roux-en-Y gastric by-pass)(1).

关键词： Pancreas chronic pancreatitis steatorrhea maldigestion pancreatic surgery

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Hereditary pancreatitis:An updated review in pediatrics

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World Journal of Clinical Pediatrics 2022年第1期11卷 27-37页

作者： Arvind Vasant Panchoo Grant H VanNess Edgardo Rivera-Rivera Trevor J Laborda Division of Gastroenterology Hepatology and NutritionThe Children’s Hospital of San AntonioSan AntonioTX 78207United States Department of Pediatrics Baylor College of MedicineHoustonTX 77030United States Faculty of Medicine Indiana University School of MedicineIndianapolisIN 46202United States Department of Pediatric Gastroenterology Parkview HealthFort WayneIN 46845United States

Hereditary pancreatitis(HP)has emerged as a significant cause of acute,acute recurrent and chronic pancreatitis in the pediatric population.Given that it presents similarly to other causes of pancreatitis,a positive family history and/or isolation of a gene mutation are vital in its designation.Inheritance patterns remain complex,but mutations involving the PRSS1,SPINK1,CFTR and CTRC genes are commonly implicated.Since being first described in 1952,dozens of genetic alterations that modify the action of pancreatic enzymes have been identified.Among children,these variants have been isolated in more than 50%of patients with chronic pancreatitis.Recent research has noted that such mutations in PRSS1,SPINK1 and CFTR genes are also associated with a faster progression from acute pancreatitis to chronic pancreatitis.Patients with HP are at increased risk of developing diabetes mellitus,exocrine pancreatic insufficiency,and pancreatic adenocarcinoma.Management follows a multi-disciplinary approach with avoidance of triggers,surveillance of associated conditions,treatment of pancreatic insufficiency and use of endoscopic and surgical interventions for complications.With significant sequela,morbidity and a progressive nature,a thorough understanding of the etiology,pathophysiologic mechanisms,diagnostic evaluation,current management strategies and future research considerations for this evolving disease entity in pediatrics is warranted.

关键词： Hereditary pancreatitis Acute pancreatitis Acute recurrent pancreatitis chronic pancreatitis pancreatitis Pediatrics

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Percutaneous transluminal angioplasty balloons for endoscopic ultrasound-guided pancreatic duct interventions

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World Journal of Gastrointestinal Endoscopy 2022年第8期14卷 487-494页

作者： Jad P AbiMansour Barham K Abu Dayyeh Michael J Levy Andrew C Storm John A Martin Bret T Petersen Ryan J Law Mark D Topazian Vinay Chandrasekhara Department of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905United States

BACKGROUND Endoscopic ultrasound(EUS)-guided main pancreatic duct(PD)access may be used when conventional endoscopic retrograde cholangiopancreatography(ERCP)techniques fail.The use of a percutaneous transluminal angioplasty balloon(PTAB),originally developed for vascular interventions,can be used to facilitate transmural(e.g.,transgastric)PD access and to dilate high-grade pancreatic strictures.AIM To describe the technique,efficacy,and safety of PTABs for EUS-guided PD interventions.METHODS Patients who underwent EUS with use of a PTAB from March 2011 to August 2021 were retrospectively identified from a tertiary care medical center supply database.PTABs included 3-4 French angioplasty catheters with 3-4 mm balloons designed to use over a 0.018-inch guidewire.The primary outcome was technical success.Secondary outcomes included incidence of adverse events(AEs)and need for early reintervention.RESULTS A total of 23 patients were identified(48%female,mean age 55.8 years).chronic pancreatitis was the underlying etiology in 13(56.5%)patients,surgically altered anatomy(SAA)with stricture in 7(30.4%),and SAA with post-operative leak in 3(13.0%).Technical success was achieved in 20(87%)cases.Overall AE rate was 26%(n=6).All AEs were mild and included 1 pancreatic duct leak,2 cases of post-procedure pancreatitis,and 3 admissions for post-procedural pain.No patients required early re-intervention.CONCLUSION EUS-guided use of PTABs for PD access and/or stricture management is feasible with an acceptable safety profile and can be considered in patients when conventional ERCP cannulation fails.

关键词： Dilating balloon Pancreatic duct intervention chronic pancreatitis Anastomotic stricture

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Trametinib and dactolisib but not regorafenib exert antiproliferative effects on rat pancreatic stellate cells

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Hepatobiliary & Pancreatic Diseases International 2015年第6期14卷 642-650页

作者： Laura Witteck Robert Jaster Department of Medicine Ⅱ Division of GastroenterologyRostock University Medical Center

BACKGROUND： Modulation of the stroma response is considered a promising approach for the treatment of chronic pancreatitis and pancreatic cancer. The aim of this study was to evaluate the effects of three clinically available small molecule kinase inhibitors, regorafenib, trametinib and dactolisib, on effector functions of activated pancreatic stellate cells （PSCs）, which play a key role in pancreatic fibrosis.

关键词： stellate cell biology pancreatic cancer chronic pancreatitis trametinib dactolisib

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