To evaluate temporal trends in gender, etiology, severity, outcomes, cost and median length of stay (MLS) in patients with acute pancreatitis (AP) in a third-tier Chinese city.

Patients with AP admitted to a university hospital between January 2013 and December 2021. Relationships between etiology, prevalence of severe acute pancreatitis (SAP) and survey years were investigated by joinpoint regression analysis.

A total of 5459 (male 62.3%) patients with AP were included. Between January 2013 and December 2021, we observed: (a) the prevalence of biliary diseases-related AP was stable, while the prevalence of hypertriglyceridemia (HTG)-associated AP (Ptrend = 0.04) and alcohol-associated AP (Ptrend < 0.0001) both increased; (b) there was an increase in crude prevalence of SAP from 4.97% to 12.2% between 2013 and 2021 (Ptrend < 0.0001); (c) compared to female populations, male gender had a higher prevalence of AP; (d) there was a decrease in MLS from 11 days to 8 days (Ptrend < 0.0001) and in median cost of hospitalization (MCH) for all patients (from 20,166 to 12,845 YUAN) (Ptrend < 0.0001); (e) the overall in-hospital mortality rate was 1.28% (70/5459) for patients with AP. There was no statistically significant in the time trend of mortality during the study period (Ptrend = 0.5873). At multivariate analysis, survey year was associated with prevalence of SAP after adjustment by age and biliary diseases (OR: 1.07; 95% CI: 1.03-1.12). Based on the stratification by severity of disease, the decrease of MLS and MCH was more significant in non-SAP vs. SAP patients.

Over the observational period, the proportion of male patients with AP, prevalence of age-adjusted rate of HTG and alcohol-associated AP and SAP increased, while MLS and MCH for all patients decreased, and the time trend of mortality of AP was stable.

To evaluate the single and combined diagnostic performances of CT and MRI radiomics for diagnosis of acute pancreatitis (AP).

We prospectively enrolled 78 patients (mean age 55.7 ± 17 years, 48.7 % male) diagnosed with AP between 2020 and 2022. Patients underwent contrast-enhanced CT (CECT) within 48-72 h of symptoms and MRI ≤ 24 h after CECT. The entire pancreas was manually segmented tridimensionally by two operators on portal venous phase (PVP) CECT images, T2-weighted imaging (WI) MR sequence and non-enhanced and PVP T1-WI MR sequences. A matched control group (n = 77) with normal pancreas was used. Dataset was randomly split into training and test, and various machine learning algorithms were compared. Receiver operating curve analysis was performed.

The T2WI model exhibited significantly better diagnostic performance than CECT and non-enhanced and venous T1WI, with sensitivity, specificity and AUC of 73.3 % (95 % CI: 71.5-74.7), 80.1 % (78.2-83.2), and 0.834 (0.819-0.844) for T2WI (p = 0.001), 74.4 % (71.5-76.4), 58.7 % (56.3-61.1), and 0.654 (0.630-0.677) for non-enhanced T1WI, 62.1 % (60.1-64.2), 78.7 % (77.1-81), and 0.787 (0.771-0.810) for venous T1WI, and 66.4 % (64.8-50.9), 48.4 % (46-50.9), and 0.610 (0.586-0.626) for CECT, respectively.The combination of T2WI with CECT enhanced diagnostic performance compared to T2WI, achieving sensitivity, specificity and AUC of 81.4 % (80-80.3), 78.1 % (75.9-80.2), and 0.911 (0.902-0.920) (p = 0.001).

The MRI radiomics outperformed the CT radiomics model to detect diagnosis of AP and the combination of MRI with CECT showed better performance than single models. The translation of radiomics into clinical practice may improve detection of AP, particularly MRI radiomics.

The clinical utility of body composition in predicting the severity of acute pancreatitis (AP) remains unclear. We aimed to measure body composition using artificial intelligence (AI) to predict severe AP in hospitalized patients.

We performed a retrospective study of patients hospitalized with AP at three tertiary care centers in 2018. Patients with computer tomography (CT) imaging of the abdomen at admission were included. A fully automated and validated abdominal segmentation algorithm was used for body composition analysis. The primary outcome was severe AP, defined as having persistent single- or multi-organ failure as per the revised Atlanta classification.

352 patients were included. Severe AP occurred in 35 patients (9.9%). In multivariable analysis, adjusting for male sex and first episode of AP, intermuscular adipose tissue (IMAT) was associated with severe AP, OR = 1.06 per 5 cm2, p = 0.0207. Subcutaneous adipose tissue (SAT) area approached significance, OR = 1.05, p = 0.17. Neither visceral adipose tissue (VAT) nor skeletal muscle (SM) was associated with severe AP. In obese patients, a higher SM was associated with severe AP in unadjusted analysis (86.7 vs 75.1 and 70.3 cm2 in moderate and mild, respectively p = 0.009).

In this multi-site retrospective study using AI to measure body composition, we found elevated IMAT to be associated with severe AP. Although SAT was non-significant for severe AP, it approached statistical significance. Neither VAT nor SM were significant. Further research in larger prospective studies may be beneficial.

The endoscopic step-up approach is the mainstay of walled-off necrosis management (WON). However, using metal stents versus plastic stents during WON drainage is debatable, with limited high-quality evidence. Therefore, we aim to investigate the comparative safety and efficacy of metal versus plastic stents for endoscopic ultrasound (EUS) guided WON drainage.

A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), retrieved by systematically searching PubMed, EMBASE, WOS, SCOPUS, and Cochrane through July 2024. Continuous and dichotomous outcome variables were pooled using mean difference (MD) and risk ratio (RR), with confidence interval (CI) using Stata MP v. 17. We assessed heterogeneity using the chi-square test and I2 statistic.

CRD42024573859.

Six RCTs with 352 patients were included. There was no difference between both groups regarding clinical success (RR: 1.04 with 95% CI [0.88-1.23], p = 0.61), WON recurrence (RR: 1.46 with 95% CI [0.59-3.61], p = 0.41), the need of necrosectomy (RR: 0.96 with 95% CI [0.65-1.41], p = 0.84), the total number of necrosectomy sessions (MD: 1.03 with 95% CI [- 0.33, 2.40], p = 0.14), total number of interventions (MD: - 0.09 with 95% CI [- 0.72, 0.54], p = 0.79), mortality (RR: 0.87 with 95% CI [0.32-2.37], p = 0.79), bleeding (RR: 1.35 with 95% CI [0.58-3.12], p = 0.48), and stent migration (RR: 0.69 with 95% CI [0.28-1.71], p = 0.42). However, metal stents significantly decreased the procedure duration (MD: - 11.27 with 95% CI [- 17.69, - 4.86], p < 0.001).

There was no significant difference between metal and plastic stents in efficacy and safety outcomes during WON EUS-guided drainage, except for a shorter procedural duration with metal stents.

Alterations in amine metabolite levels are closely associated with the poor progression of pancreatic disease, including acute pancreatitis (AP) and pancreatic cancer (PC). However, effectively quantifying and visualizing these metabolites through mass spectrometry (MS) has proven to be challenging. Here, we have designed a novel and rapid strategy for analyzing the amine submetabolome within liquid chromatography-mass spectrometry (LC-MS) and air-flow-assisted desorption electrospray ionization mass spectrometry imaging (AFADESI-MSI) platforms by inducing a pair of isotope-labeling-based photochemical derivatization reagents. The simultaneous introduction of a 4-amino-1-methylpyridinium moiety renders a 160- to 1037-fold higher response in MS. Coupled with full MS-ddMS2 and precursor ion scan modes, this labeling strategy allows for straightforward detection of 423 peaks for indazolone derivatives and identification of 82 amine metabolites in biological samples. The semiquantitation of the 82 amines in plasma from AP patients and healthy controls resulted in the discovery of unreported aromatic amines and aminoaldehydes with significant changes in AP and employing ethanolamine for distinguishing the severities of AP in the early stage. In the MSI platform, the photochemical reagent can efficiently derivatize primary amine metabolites avoiding spatial deviation and significantly enhancing imaging sensitivity in rat brain and kidney. Further joint analysis of amine submetabolome in plasma and pancreas from PC patients by use of these two platforms allowed for identifying the significant metabolite, methylamine. These results together enhance the role of amine-driven biomarker discovery in the diagnosis of pancreatic disease and accelerate the application of on-tissue photochemical derivation in MSI.

Acute pancreatitis (AP) represents one of the most common reasons for hospital admission and intensive care treatment in internal medicine. The incidence of AP is increasing, posing significant financial burden on healthcare systems due to the necessity for frequent medical interventions. Severe acute pancreatitis (SAP) is a potentially life-threatening condition with substantial morbidity and mortality. The management of SAP requires prolonged hospitalization and the expertise of a multidisciplinary team, comprising emergency physicians, intensivists, internists, gastroenterologists, visceral surgeons, and experts in nutrition, infectious disease, endoscopy, as well as diagnostic and interventional radiology. Effective management and beneficial patient outcomes depend on continuous interdisciplinary collaboration. This review synthesizes recent evidence guiding the practical management of SAP, with a particular focus on emergency and intensive care settings. Both established as well as new diagnostic and therapeutic paradigms are highlighted, including workup, risk stratification, fluid management, analgesia, nutrition, organ support, imaging modalities and their timing, along with anti-infective strategies. Furthermore, the review explores interventions for local and vascular complications of SAP, with particular attention to the indications, timing and selection between endoscopic (both endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS)), percutaneous and surgical approaches. Similarly, the management of biliary AP due to obstructive gallstones, including the imaging, timing of ERCP and cholecystectomy, are discussed. By integrating new evidence with relevant guidance for everyday clinical practice, this review aims to enhance the interdisciplinary approach essential for improving outcomes in SAP management.

Acute pancreatitis (AP) can result in severe complications, with acute respiratory failure (ARF) being among the most critical. Research on ARF in AP remains limited. This study aims to investigate the occurrence, outcomes, and predictors of ARF in AP patients at Cho Ray Hospital, a tertiary care center in Vietnam.

A prospective cohort study was conducted with 230 AP patients at a national hospital in Ho Chi Minh City, Vietnam. Patients were divided into ARF and non-ARF groups, and clinical characteristics were compared. Key outcomes included invasive mechanical ventilation, in-hospital mortality, and length of hospital stay.

ARF developed in 26.1% of patients, with a mortality rate of 25.0% in the ARF group versus 1.2% in the non-ARF group. Mechanical ventilation was required in 48.3% of ARF patients. Significant predictors of ARF were abnormal body mass index (BMI) (p = 0.021), prolonged systemic inflammatory response syndrome (SIRS) (p < 0.001), modified computed tomography severity index (mCTSI) (p = 0.041), and a high bedside index for severity in acute pancreatitis (BISAP) score (p < 0.001). BISAP scores ≥ 2 had a sensitivity of 90.0%, specificity of 73.5%, and AUC of 0.878 (95% CI 0.829-0.921) for predicting ARF. Predictors of mortality in ARF patients included cardiovascular failure (HR 15.83, p = 0.001), prolonged SIRS (HR 4.76, p = 0.038), and high BISAP scores (HR 3.41, p = 0.015).

ARF significantly worsens outcomes in AP patients. Early identification of key predictors, like abnormal BMI, prolonged SIRS, mCTSI, and BISAP scores, could improve interventions and patient prognosis.

The complexity of severe acute pancreatitis (SAP) and the stress caused by the disease is associated with a high incidence of feeding intolerance. However, the factors influencing feeding incontinence in patients with SAP are diverse.

To systematically analyse relevant studies that investigate the occurrence of feeding intolerance in patients with SAP, identify the relevant factors of feeding intolerance in such patients and provide a reference for nursing staff to develop relevant intervention measures.

This scoping review followed the approach proposed by Arksey and O'Malley. Seven electronic databases were searched from their establishment until August 2023. This included research on the factors influencing feeding intolerance in patients with SAP, determining research questions, completing literature screening and quality evaluation, extracting data and summarizing and analysing the data. The PRISMA extension for scoping reviews (PRISMA-ScR) statement has also been included.

A total of 23 articles were included. The factors influencing feeding intolerance in patients with SAP included the patient's condition, disease, treatment, feeding management and follow-up care.

The factors affecting feeding intolerance in patients with SAP are multifaceted. A personalized nursing care plan should be developed based on relevant risk factors to improve feeding tolerance and comfort in patients with SAP and shorten hospitalization time.

Intensive care nurses should identify the risk factors for feeding intolerance in patients with SAP and implement appropriate interventions. To identify the risk factors, nurses must be updated with courses and training. Moreover, a systematic feeding intolerance prediction program can help intensive care nurses effectively identify the risk factors for feeding.

Pancreatic fluid collections (PFCs), including walled-off necrosis (WON), are significant complications of acute pancreatitis, and their management often involves drainage, although the optimal type of stent for this purpose remains uncertain. This meta-analysis aimed to compare metal versus plastic stents for endoscopic ultrasound (EUS)-guided drainage of PFCs.

We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing metal with plastic stents for drainage of PFCs. The odds ratio (OR) was used for binary outcomes and the mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI).

This study included eight RCTs and over 500 patients. Procedure duration was shorter in the metal stent arm compared with the plastic stent arm (MD - 10.63; 95% CI - 16.12 to - 5.15, p < 0.001). However, there was no statistically significant difference between metal and plastic stents in clinical success (OR 1.10; 95% CI 0.56 to 2.14), technical success (OR 1.53; 95% CI 0.23 to 10.0), overall mortality (OR 0.75; 95% CI 0.34 to 1.67), recurrence (OR 1.76; 95%CI 0.70 to 4.44), total number of interventions (MD 0.06; 95% CI - 0.52 to 0.64), need of necrosectomy (OR 1.27; 95% CI 0.77 to 2.11), length of hospitalization (MD - 0.41; 95% CI - 5.10 to 4.27), exocrine insufficiency (OR 1.37; 95% CI 0.50 to 3.71), endocrine insufficiency (OR 1.11; 95% CI 0.57 to 2.16), and adverse events (OR 0.74; 95% CI 0.39 to 1.41).

Metal stents for EUS-guided drainage of WON are associated with a shorter procedure duration. Besides that, it may not improve other clinically relevant outcomes in comparison with plastic stents.

Gastrointestinal fistula (GIF) is a rare but severe complication in patients with necrotizing pancreatitis (NP), significantly prolonging disease course and increasing morbidity and mortality. Its subtle and nonspecific early symptoms often delay diagnosis and intervention. Despite its clinical significance, the low incidence of GIF in NP has resulted in limited research and a lack of consensus on optimal diagnostic and therapeutic strategies.

This review focuses on the epidemiology, pathophysiology, diagnostic approaches, and therapeutic management of GIF in NP patients. Imaging techniques, such as contrast-enhanced computed tomography and endoscopy, have been integral to early diagnosis. Advances in interventional and surgical techniques provide new avenues for treatment, but variability in clinical practice highlights the need for standardized protocols.

Recent advances in diagnostic imaging have improved the detection of GIF, while innovations in interventional and surgical treatments show promise. Current research is still insufficient and varied. Future research should focus on developing diagnostic methods and treatment measures for such complications. By improving early diagnosis and offering insights into effective management strategies, it is hoped that patient outcomes can be improved.

Acute pancreatitis (AP) is a prevalent gastrointestinal emergency with a wide spectrum of clinical outcomes, varying from mild cases to severe forms. The early identification of high-risk patients is essential for improving prognosis. However, the predictive and prognostic potential of the C-reactive protein to serum calcium ratio (CCR) in AP has not been investigated. This study aims to explore the association between CCR and disease severity in patients with AP.

This retrospective cross-sectional study included 476 AP patients. The CCR was calculated from C-reactive protein and serum calcium levels within the first 24 h of admission. Multivariable logistic regression models were used to evaluate the relationship between CCR and AP severity, with restricted cubic spline analysis and receiver operating characteristic (ROC) analysis to assess dose-response and predictive performance, respectively.

Of the 476 patients, 176 (37%) had mild acute pancreatitis (MAP) and 300 (63%) had moderate to severe AP. The CCR distribution had a median value of 17.5, with an interquartile range (IQR) of 3.0 to 60.2. Each unit increase in CCR was associated with a 7% increase in the risk of developing moderate to severe AP (OR: 1.07; 95% CI: 1.06-1.09). In fully adjusted models, this association remained statistically significant. The area under the curve (AUC) for CCR in predicting moderate to severe AP was 86.9%, with a sensitivity of 73.7% and specificity of 89.2%.

The CCR measured within the first 24 h of admission shows promise as a valuable biomarker for predicting the severity of AP. However, further multicenter prospective cohort studies are needed to confirm its clinical utility and investigate its role in improving treatment strategies and patient management.

Severe Acute Pancreatitis, a serious condition caused by factors such as gallstones and chronic excessive alcohol consumption, with a very high mortality rate. Human pancreatic lipase (hPL) is a key digestive enzyme and abnormal activity levels of this enzyme are important indicators for diagnosing and monitoring pancreatic diseases. A fluorescent probe, LPP, has been developed to monitor the activity of hPL, especially in cases of SAP. The probe is based on cyanine isoindole derivatives, in vitro experiments confirmed the high specificity and sensitivity of the probe, with a detection limit of 0.012 U/mL, reactions completed within 10 min, and effective monitoring of pancreatic lipase activity in various biological samples. The stability and low cytotoxicity of LPP make it suitable for clinical applications, providing new tools and perspectives for the research and treatment of pancreatic diseases and related metabolic abnormalities. In addition, the change in fluorescence lifetime after the reaction of the probe with lipase allows for fluorescence lifetime imaging (FLIM), effectively monitoring the dynamic changes of hPL and enabling early diagnosis and monitoring of pancreatitis. This research not only enhances the understanding of pancreatic lipase activity detection but also has the potential to improve the diagnostics and treatment of pancreatitis.

Acute pancreatitis (AP) is one of the most common gastrointestinal emergencies, often resulting in self-digestion, edema, hemorrhage, and even necrosis of pancreatic tissue. When AP progresses to severe acute pancreatitis (SAP), it often causes multi-organ damage, leading to a high mortality rate. However, the molecular mechanisms underlying SAP-mediated organ damage remain unclear. This study aims to systematically mine SAP data from public databases and combine experimental validation to identify key molecules involved in multi-organ damage caused by SAP. Retrieve transcriptomic data of mice pancreatic tissue for AP, lung and liver tissue for SAP, and corresponding normal tissue from the Gene Expression Omnibus (GEO) database. Conduct gene differential analysis using Limma and DEseq2 methods. Perform enrichment analysis using the clusterProfiler package in R software. Score immune cells and immune status in various organs using single-sample gene set enrichment analysis (ssGSEA). Evaluate mRNA expression levels of core genes using reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Validate serum amylase, TNF-α, IL-1β, and IL-6 levels in peripheral blood using enzyme-linked immunosorbent assay (ELISA), and detect the formation of neutrophil extracellular traps (NETs) in mice pancreatic, liver, and lung tissues using immunofluorescence. Differential analysis reveals that 46 genes exhibit expression dysregulation in mice pancreatic tissue for AP, liver and lung tissue for SAP, as well as peripheral blood in humans. Functional enrichment analysis indicates that these genes are primarily associated with neutrophil-related biological processes. ROC curve analysis indicates that 12 neutrophil-related genes have diagnostic potential for SAP. Immune infiltration analysis reveals high neutrophil infiltration in various organs affected by SAP. Single-cell sequencing analysis shows that these genes are predominantly expressed in neutrophils and macrophages. FPR1, ITGAM, and C5AR1 are identified as key genes involved in the formation of NETs and activation of neutrophils. qPCR and IHC results demonstrate upregulation of FPR1, ITGAM, and C5AR1 expression in pancreatic, liver, and lung tissues of mice with SAP. Immunofluorescence staining shows increased levels of neutrophils and NETs in SAP mice. Inhibition of NETs formation can alleviate the severity of SAP as well as the levels of inflammation in the liver and lung tissues. This study identified key genes involved in the formation of NETs, namely FPR1, ITGAM, and C5AR1, which are upregulated during multi-organ damage in SAP. Inhibition of NETs release effectively reduces the systemic inflammatory response and liver-lung damage in SAP. This research provides new therapeutic targets for the multi-organ damage associated with SAP.

This study aimed to evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS) with pancreatic fluid aspiration for the detection of infected pancreatic necrosis (IPN).

This retrospective observational study included 66 patients with suspected IPN. The participants simultaneously underwent pancreatic fluid aspiration mNGS, and microbial and blood culture. We compared the diagnostic performance of mNGS with that of culture in the detection of pathogens associated with IPN.

Of the 66 patients, 45 (68.2 %) were confirmed to have IPN. Pancreatic fluid aspiration mNGS yielded positive results in 32 of these patients (71.1 %), significantly outperforming microbial culture results (25 patients, 55.6 %; P = 0.039); however, both methods exhibited similar specificity (95.2% vs. 100 %). The results of pancreatic fluid aspiration mNGS and microbial culture matched in 73.3 % (33/45) of patients with IPN. The turnaround time for the mNGS results was significantly shorter than that for the microbial culture method (P < 0.001). In addition, survival analysis demonstrated that a positive mNGS result was not associated with increased mortality (hazard ratio, 0.652; 95 % confidence interval 0.157-2.699, P = 0.555).

Our study highlights the potential of mNGS for diagnosing IPN, with implications for improving patient care by facilitating early and accurate diagnosis, guiding appropriate interventions, and possibly improving patient outcomes.

Effectively managing critically ill septic patients requires careful utilization of imaging techniques. While point-of-care ultrasound (POCUS) is invaluable in the ICU, it faces challenges with conventional transcutaneous ultrasound, especially in obese patients. A 22-year-old obese female presented with abdominal pain and renal dysfunction. Abdominal CT confirmed acute biliary pancreatitis, progressing to respiratory failure. Transesophageal and transgastric ultrasound revealed a pulmonary abscess and peripancreatic collection. Expectant management of the lung abscess and percutaneous drainage of the pancreatic collection led to successful recovery. This case highlights POCUS's pivotal role in timely diagnosis, particularly in severe pancreatitis, showcasing its versatility in critical care.

Walled-off necrosis (WON) is a potentially fatal condition best treated endoscopically with metal or plastic stents. This study compares the clinical outcomes of these stents.

PubMed and Cochrane were searched for trials comparing metal and plastic stents for WON. Primary outcomes were clinical and technical success.

Seven studies with 230 metal stent patients and 226 plastic stent patients were included. Metal stents showed significantly shorter procedure times (SMD -0.80, 95% CI: -1.25 to -0.34), better 4-week clinical success (OR 1.94, 95% CI: 1.00 to 3.77), and higher procedure costs (SMD 1.38, 95% CI: 0.56 to 2.20). No significant differences were observed in hospital stay (SMD -0.05, 95% CI: -0.35 to 0.25), technical success (OR 1.45, 95% CI: 0.22 to 9.43), clinical success (OR 1.13, 95% CI: 0.54 to 2.39), interventions (SMD -0.02, 95% CI: -0.34 to 0.29), need for necrosectomy (RR 1.10, 95% CI: 0.59 to 2.04), necrosectomy sessions (SMD 0.35, 95% CI: -0.42 to 1.11), need for percutaneous drainage (RR 0.82, 95% CI: 0.36 to 1.85), stent migration (RR 0.88, 95% CI: 0.29 to 2.66), bleeding (RR 0.97, 95% CI: 0.53 to 1.75), WON recurrence (RR 1.66, 95% CI: 0.70 to 3.92), treatment failure (death) (RR 0.75, 95% CI: 0.37 to 1.53), disconnected pancreatic duct (RR 0.93, 95% CI: 0.79 to 1.11), and total cost (SMD -0.02, 95% CI: -0.29 to 0.26).

Metal stents offer shorter procedure time and better 4-week clinical success, although at a higher cost, with most clinical outcomes showing no significant differences between stent types.

Given the previously reported harmful effects of abdominal fat burden on kidney function, we aim to investigate the relationship between major adverse kidney events within 30 days (MAKE30) and abdominal obesity in acute necrotizing pancreatitis (ANP) patients and explore the underlying risk factors.

A retrospective cohort study of all patients admitted within 72 h after the first episode of ANP to a tertiary center between June 2015 and June 2019 was conducted. Automatic image analysis software was used to calculate the area of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) and skeletal muscle from computed tomography scans at the umbilical level. The potential risk factors of MAKE30 were analyzed by logistic regression.

A total of 208 eligible ANP patients were enrolled, with an incidence of 23% for MAKE30. VAT area was more closely associated with the development of MAKE30, with an area under the ROC curve of 0.69 (cutoff value 200 cm2, 63.8% sensitivity and 66.7% specificity). Multivariate logistic regression analysis demonstrated that VAT area [OR 1.01 (1.01-1.02); p < 0.001] was an independent risk factor in predicting MAKE30. Patients with a VAT area > 200 cm2 had more requirements of renal replacement therapy (32% vs. 12%, P < 0.001), and a significantly higher incidence of other poor clinical outcomes (all p < 0.05).

Early assessment of the VAT area may help identify ANP patients at high risk of MAKE30, suggesting that it could be a potential indicator for adverse kidney events.

Few published studies exist that compare the outcomes of different endoscopic necrosectomy methods for necrotizing pancreatitis (NP). We compared the safety and efficacy of percutaneous versus transmural endoscopic necrosectomy for NP patients.

In this retrospective cohort study, we analyzed adult NP patients who underwent either percutaneous endoscopic necrosectomy (PEN) or endoscopic transmural necrosectomy (ETN), and compared safety and efficacy between the two groups. Propensity score-matched analysis and multivariable logistic regression analysis were conducted.

A total of 280 patients were enrolled, among which 142 underwent PEN and 138 underwent ETN. There were differences in baseline characteristics between the two groups, including body mass index, C-reactive protein, systemic inflammatory response syndrome score. The incidences of sepsis, respiratory failure, and intensive care unit stay were higher among patients who underwent PEN than those who underwent ETN (all P < 0.01). Ninety-one pairs were matched with comparable baseline characteristics and severity. The incidence of postoperative complications, open surgery, clinical success, radiological success, collection recurrence, and reintervention were not significantly different between the ETN group and PEN group (all P > 0.05). Multivariate analysis also showed that the approaches (PEN vs ETN) was not associated with postoperative complications or mortality.

In real world setting, sicker patients tend to be more effectively managed through PEN compared to ETN. PEN demonstrates comparable efficacy and safety to ETN in the treatment of NP patients.

This study aims to analyzing scientific publications related to necrotizing pancreatitis and its mortality, identifying key areas and trends, and determining the leading research institutions, authors, countries, and journals actively working in this field.

The Web of Science and Scopus databases were searched for articles on NP published between January 1, 2013, and April 22, 2024. Articles published before 2013, conference abstracts, and case reports were excluded. The articles were assessed based on various metrics, including the number of citations, publication dates, countries of origin, institutions, journals, and authors.

A total of 929 articles were identified, of which 251 were deemed suitable for analysis after duplicates were removed. China contributed the most articles, followed by the United States and India. The most frequent publications appeared in specialized journals such as "Pancreatology" and "Journal of Gastrointestinal Surgery." The primary research institutions were universities and medical centers. The highest-impact articles focused on minimally invasive treatment methods for NP. There has been a growing body of research in NP over the past decade, particularly in China and the United States.

Despite advancements in medical science, the mortality rate associated with pancreatic necrosis remains high. This highlights the continued challenge in effectively addressing complications of acute pancreatitis. Researchers worldwide are actively exploring alternative therapeutic approaches to mitigate these complications and improve patient outcomes.

The use of antibiotic therapy in acute pancreatitis remains controversial and is currently recommended only for confirmed infections of peripancreatic necrosis. However, reliable early predictors of septic complications and unfavorable outcomes are substantially lacking.

Patients with acute pancreatitis were retrospectively reviewed and divided into two groups: one with a septic course defined by pathogen detection [GERM(+)] and one without [GERM(-)]. After propensity score matching, both groups were compared regarding clinical outcomes. Early predictors of pathogen detection were evaluated by multivariate analysis.

424 patients with acute pancreatitis were included. After propensity score matching 123 GERM(-) patients were compared to 74 GERM(+) patients. GERM(+) patients demonstrated significantly worse clinical outcomes with higher rate of intensive care treatment (59.5% vs. 35.0%; p = 0.0011) and consecutive longer stay in intensive care unit (11.5 ± 25.2d vs. 3.0 ± 7.9d; p = 0.0007), longer in-hospital stay (26.8 ± 22.0d vs. 14.7 ± 15.0d; p = 0.0003) as well as worse results in the composite outcome length of in-hospital stay > 15d or death (67.6% vs. 31.7%; p < 0.0001). Prescence of ascites and elevated white blood cell count at the onset of acute pancreatitis were identified as significant predictive factors in the early disease associated with invasive infection and pathogen detection. The most frequently detected pathogens were commensals of the gastrointestinal tract, observed in 70.7% of the examined body fluids and 50.7% of the examined blood cultures.

Detection of pathogens is associated with unfavorable clinical outcomes in acute pancreatitis. The presence of ascites and elevated white blood cell count at onset of acute pancreatitis are significant predictive factors indicating the risk of invasive infection with relevant bacterial load. Thus, an aggressive, early anti-infective strategy against pathogens of intestinal origin should be considered in these cases and may improve patient outcomes.

To construct a set of scientific and feasible nursing management protocols for early fluid resuscitation in acute pancreatitis (AP) patients that can be used to guide clinical practice and enhance the treatment efficacy in these patients.

Fluid resuscitation is a key means of early treatment for AP patients and has become a clinical consensus. Nurses are important practitioners of fluid resuscitation, and there is a lack of specific enforceable nursing management programs.

Through literature research, on-site research, semi-structured interviews, and other preliminary preparations of the first draft of the nursing management program for early fluid resuscitation in acute pancreatitis, the Delphi method was used to conduct two rounds of correspondence with medical and nursing experts, and then statistically analyzed.

Fifteen and 14 questionnaires were distributed in two rounds, respectively, and 15 and 14 questionnaires were recovered, respectively. The positive coefficient of experts was 100%, the authority coefficient was 0.970 and 0.975, respectively; the coefficient of variation coefficient was 0.05-0.21 and 0.00-0.20, respectively; the expert coordination coefficients of all levels of indices in this study are 0.166-0.335 and 0.189-0.364, respectively. The P values of the first, second, and third level indices are < 0.05 according to the test of Kendall's harmony coefficient. A total of 5 primary indicators, 11 secondary indicators, and 36 tertiary indicators were used to construct the Nursing Management Program for Early Fluid Resuscitation in Acute Pancreatitis.

The constructed nursing management plan for early fluid resuscitation in acute pancreatitis patients puts forward clear requirements and standards for nursing care in the early stage of AP treatment. This plan is scientific, represent good clinical practice, are feasible for nurses to follow, and construct a standardized protocol for the management of early fluid resuscitation in patients with acute pancreatitis.

This study aims to evaluate the clinical efficacy of pancreatic duct stenting in the treatment of SAP, providing reference for clinical diagnosis and treatment.

A retrospective analysis was conducted on clinical data from patients with SAP admitted to the General Hospital of Ningxia Medical University from June 1, 2019 to December 31, 2022. A total of 51 patients were included (33 males, 18 females). Patients were divided into two groups based on treatment: the control group (n = 28) receiving conventional treatment and the stent group (n = 23) undergoing pancreatic duct stenting in addition to conventional treatment. Data collected and analyzed include demographic information, rates of late local complications, late surgical interventions, new-onset OF, infected pancreatic necrosis and new-onset systemic complications. Specific outcomes measured were incidences of new-onset respiratory, renal and circulatory failure, single and multiple OF, sepsis, ACS, abdominal hypertension, and pancreatogenic encephalopathy, as well as use of ≥ 3 types of antibiotics, time of antibiotic use, time of analgesic administration, oral refeeding, length of hospital stay, ICU care, and length of ICU stay. These indicators were used to assess the therapeutic efficacy of pancreatic duct stenting.

All 23 patients in the stent group successfully underwent stenting. The incidence of new-onset OF and new-onset systemic complications was significantly lower in the stent group compared to the control group (χ2 = 4.96, 6.65, P < 0.05). However, no significant differences were observed between the groups regarding late local complications, infected pancreatic necrosis, and late surgical intervention (χ2 = 0.22, 0.002, 0.024, P > 0.05). Notably, two patients in the control group required additional procedures due to inadequate drainage, with one undergoing endoscopic debridement and the other, laparotomy. Mortality rates were 3 (10.7%) in the control group and 4 (17.4%) in the stent group, with no statistically significant difference (P > 0.05). Furthermore, significant differences were noted in new-onset respiratory failure, single OF, sepsis, abdominal hypertension, time of analgesic administration, oral refeeding, length of enzyme inhibitor use, and hospitalization expenses (χ2 = 3.94, 4.37, 5.79, 4.79; Z = - 2.008, - 4.176, - 4.165, - 2.309; P < 0.05). No significant differences were found in new-onset renal, circulatory, multiple OF, ACS, pancreatogenic encephalopathy, use of ≥ 3 types of antibiotics, time of antibiotic use, length of hospital stay, ICU care, and length of ICU stay (P > 0.05).

Pancreatic duct stenting effectively reduces the incidence of new-onset systemic complications and OF in SAP, preventing further deterioration. Pancreatic duct stenting can alleviate symptoms, shorten oral refeeding, and promote patient recovery.

This study was recorded as a single-center, retrospective case-control study (ChiCTR1900025833).

The trend of muscle wasting in patients with acute severe and moderately severe pancreatitis (AP) remains unclear. This retrospective study aimed to investigate the trend of skeletal muscle area (SMA) changes and its impact on patients with severe and moderately severe AP.

Patients diagnosed with AP who had repeated CT scans after intensive care unit (ICU) admission were included. The patients were categorized into moderately severe AP or severe AP groups. The generalized additive mixed model (GAMM) was used to analyze the SMA trajectories.

A total of 126 patients were included. The patients in the severe AP group had more rapid muscle wasting during the first 3 weeks following ICU admission. The SMA decreased by 1.1 cm2 (95% CI: 1.3 to 0.8) per day in the severe AP group, while the SMA decreased by 0.5 cm2 (95% CI: 0.6 to 0.4) in the moderately severe AP group in the GAMM model. A larger change in the SMA during the first 10 days after admission was significantly associated with prolonged length of hospital stay (LOS) (β = - 0.205, P = 0.036).

Patients with severe AP experienced more muscle wasting during the first 3 weeks after ICU admission. A larger reduction in the SMA was associated with prolonged LOS.

Different patterns of muscle wasting were present during the first 3 weeks after ICU admission in moderately severe and severe AP patients. Accordingly, different nutrition and rehabilitation strategies might be employed depending upon the severity of AP.

Endoscopic ultrasound (EUS)-guided drainage of walled-off necrosis (WON) using either plastic or metal stents is the mainstay of WON management. Our single-center randomized controlled trial aimed to evaluate the efficacy of biflanged metal stents (BFMSs) and plastic stents for WON drainage.

Patients with symptomatic WON amenable to EUS-guided drainage were randomized to receive either BFMSs or plastic stents. The primary outcome was reintervention-free clinical success at 4 weeks. Secondary outcomes were: overall clinical success (complete resolution of symptoms and significant reduction in size of WON [<50% of original size and <5 cm in largest diameter at 4-week follow-up]); number of reinterventions; adverse events (AEs); hospital stay for first admission; and medium-term outcomes at 6 months (recurrence, disconnected pancreatic duct, chronic pancreatitis, and new-onset diabetes mellitus).

92 patients were randomized: 46 in each arm. The reintervention-free clinical success rate was significantly higher in the BFMS group on intention-to-treat analysis (67.4% vs. 43.5%; P = 0.02). Overall clinical success at 1 month was similar in both groups. There were significantly fewer reinterventions (median 0 [IQR 0-1] vs. 1 [0-2]; P = 0.03) and shorter hospital stays in the BFMS group (7.0 [SD 3.4] vs. 9.1 [5.5] days; P = 0.04). There were no differences in procedure-related AEs, mortality, or medium-term outcomes.

BFMSs provide better reintervention-free clinical success at 4 weeks, with shorter hospital stay and without increased risks of AEs, compared with plastic stents for EUS-guided drainage of WON. Medium-term outcomes are however similar for both stent types.

Acute pancreatitis (AP) is a common digestive disorder characterized by high morbidity and mortality. This study aims to uncover differentially expressed long noncoding RNAs (lncRNAs) and mRNAs, as well as related pathways, in the early stage of acute pancreatitis (AP), with a focus on the role of Neat1 in AP and severe acute pancreatitis (SAP).

In this study, we performed high-throughput RNA sequencing on pancreatic tissue samples from three normal mice and three mice with cerulein-induced AP to describe and analyze the expression profiles of long non-coding RNAs (lncRNAs) and mRNAs. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were conducted on the differentially expressed mRNAs to identify enriched pathways and biological processes. An lncRNA-miRNA-mRNA interaction network was constructed to elucidate potential regulatory mechanisms. Furthermore, we utilized Neat1 knockout mice to investigate the role of Neat1 in the pathogenesis of cerulein-AP and L-arginine-severe acute pancreatitis (SAP).

Our results revealed that 261 lncRNAs and 1522 mRNAs were differentially expressed in the cerulein-AP group compared to the control group. GO and KEGG analyses of the differentially expressed mRNAs indicated that the functions of the corresponding genes are enriched in cellular metabolism, intercellular structure, and positive regulation of inflammation, which are closely related to the central events in the pathogenesis of AP. A ceRNA network involving 5 lncRNAs, 226 mRNAs, and 61 miRNAs were constructed. Neat1 was identified to have the potential therapeutic effects in AP. Neat1 knockout in mice inhibited pyroptosis in both the AP/SAP mouse models.

We found that lncRNAs, particularly Neat1, play a significant role in the pathogenesis of AP. This finding may provide new insights into further exploring the pathogenesis of SAP and could lead to the identification of new targets for the treatment of AP and SAP.

Severe acute pancreatitis (SAP) is characterized by acute inflammation of the pancreas. The transcription factor BTB and CNC homology 1 (BACH1) has been implicated in various biological processes, including oxidative stress, apoptosis, and cell cycle regulation. However, its involvement in the pathogenesis of SAP remains relatively understudied. In the present work, our data demonstrated that BACH1 level was significantly increased in SAP patients, cellular, and animal models, while heat shock protein B1 (HSPB1) expression was weakened. Mechanistic assays validated that BACH1 acted as a transcriptional inhibitor of HSPB1. Moreover, HPDE6-C7 cells were stimulated with cerulein (Cer) and LPS to mimic the pathological stages of SAP in vitro. Depletion of BACH1 remarkably improved cell survival and alleviated the oxidative stress, ferroptosis, and inflammatory responses in SAP cell models. However, these changes were dramatically reversed upon co-inhibition of HSPB1. Animal findings confirmed that loss of BACH1 decreased pancreatic injury, inflammatory responses, and ferroptosis, but these effects were weakened by HSPB1 silence. Overall, these findings elucidate that the overexpression of BACH1 favors the ferroptosis and inflammation by transcriptionally inhibiting HSBP1, thereby exacerbating SAP progression.

To explore the incidence, dynamic changes, prognostic factors and prognosis of late-onset vascular complications after discharge in patients with necrotizing pancreatitis (NP), and determine the relationship between the pancreatic necrosis volume (PNV) and late-onset vascular complications.

This was a retrospective cohort study that included NP patients who did not have any vascular complications during index hospitalization. Computed tomography (CT) examinations were performed, and the PNV was calculated based on the picture archiving and communication system. Multivariate logistic regression analysis was employed to determine the potential prognostic factors for late-onset vascular complications after discharge.

A total of 35.6 % (37/104) of the patients had late-onset portal venous system involvement during the one-year follow-up period, including 35 patients with stenosis and 2 patients with occlusion. No venous thrombosis or arterial vascular complications were observed. PNV > 134 cm3 (OR, 7.08, 95 % CI 1.83-27.36; P = 0.005) and pancreatic necrosis involving the body and/or tail of the pancreas (OR, 10.05; 95 % CI, 2.66-38.02; P = 0.001) were prognostic factors for abnormal patency of the portal venous system. The abnormal patency of the portal venous system tended to persist during follow-up, and gastric varices were observed in 32.4 % (12/37) of the patients in the abnormal patency group without any symptoms.

Late-onset vascular complications involving venous stenosis or occlusion were common in NP patients after discharge, approximately one third of whom developed gastric varices. PNV and the location of necrosis were closely associated with the development of these complications.

Acute pancreatitis (AP) is one of the most common diseases of the gastrointestinal tract, which in 20% of cases can turn into a severe form, with mortality reaching up to 30%. One of the cornerstones of AP treatment is early nutritional treatment. Feeding intolerance (FI) occurs in up to 25% of patients with AP and is associated with a more severe disease course and poorer clinical outcome. Feeding intolerance can have a multifaceted clinical presentation. The early identification of FI risk factors and appropriately conducted nutritional treatment are critical to the course of the disease. In this review, we summarize the current knowledge of feeding intolerance in AP, its pathomechanisms and risk factors, and its impact on disease progression. We also present suggestions for the management of feeding intolerance.

Acute pancreatitis (AP) is a common and potentially lethal disease. Approximately 10-20% of the patients progress to necrotizing pancreatitis (NP). The step-up approach is the gold standard approach to managing an infected necrotizing pancreatitis with acceptable morbidity and mortality rates. Video-assisted retroperitoneal debridement (VARD) has been described as a safe and feasible approach with high success rates. Multiple studies in the American, European, and Asian populations evaluating the outcomes of VARD have been published; nevertheless, outcomes in the Latin American population are unknown. This study aims to describe a single-center experience of VARD for necrotizing pancreatitis in Colombia with a long-term follow-up.

A prospective cohort study was conducted between 2016 and 2024. All patients over 18 years old who underwent VARD for necrotizing pancreatitis were included. Demographic, clinical variables, and postoperative outcomes at 30-day follow-up were described.

A total of 12 patients were included. The mean age was 55.9 years old (SD 13.73). The median follow-up was 365 days (P25 60; P75 547). Bile origin was the most frequent cause of pancreatitis in 90.1% of the patients. The mean time between diagnosis and surgical management was 78.5 days (SD 22.93). The mean size of the collection was 10.5 cm (SD 3.51). There was no evidence of intraoperative complications. The mean in-hospital length of stay was 65.18 days (SD 26.46). One patient died in a 30-day follow-up. One patient presented an incisional hernia one year after surgery, and there was no evidence of endocrine insufficiency at the follow-up.

According to our data, the VARD procedure presents similar outcomes to those reported in the literature; a standardized procedure following the STEP-UP procedure minimizes the requirement of postoperative drainages. Long-term follow-up should be performed to rule out pancreatic insufficiency.

The development of acute pancreatitis (AP) is strongly linked to blood clotting and fibrinolysis issues. Modern clinical practices now utilize advanced blood markers like thrombin-antithrombin III complex (TAT), plasmin-α2-plasmin inhibitor complex, thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC) to assess thrombosis risk. Our study used a highly sensitive chemiluminescence technique to measure these markers in AP patients, aiming to determine their early predictive value for AP severity.

There were 173 patients with AP, all of whom developed symptoms within 72 h; 102 individuals had onset symptoms within 48 h. The biomarkers were measured upon admission before determining the severity of AP.

The levels of TAT, plasmin-α2-plasmin inhibitor complex, TM, and t-PAIC were significantly higher in the severe acute pancreatitis (SAP) group compared with the mild acute pancreatitis and moderate severe acute pancreatitis groups. For the patients within 72 h of onset, TAT, TM, and t-PAIC predicted the occurrence of SAP. For the patients within 48 h of onset, TAT and t-PAIC predicted the occurrence of SAP. The area under the curve (AUC) of prediction models is similar to Bedside Index for Severity in Acute Pancreatitis (BISAP) but significantly higher than C-reactive protein (P < 0.05). Notably, t-PAIC had a larger AUC than TAT, BISAP, and C-reactive protein.

In the initial 48 h, plasma TAT and t-PAIC levels may predict the development of SAP. Within 72 h, plasma levels of TAT, TM, and t-PAIC may predict the development of SAP, and the TAT + TM + t-PAIC prediction model achieved a maximum AUC of 0.915, comparable to BISAP.

Disconnected pancreatic duct syndrome (DPDS) is a pathological condition that causes various symptoms due to the continuous secretion of pancreatic enzymes from the pancreas upstream, which has been separated due to disconnection of the pancreatic duct (DPD) for various reasons.Acute necrotizing pancreatitis includes a certain probability of DPDS appearance, which makes it necessary to provide various treatments for DPDS. Furthermore, DPDS can impact long-term results, such as recurrence and impaired pancreatic function. Although the development of various modalities has contributed to diagnosis and treatment, especially less invasive endoscopic therapy, DPDS is often overlooked, and the diagnosis can be delayed due to the lack of consensus on its definition and classification. This review summarizes the current knowledge and challenges of DPDS and discusses the optimal strategy for its diagnosis and treatment, as well as future perspectives.

Given the lack of established definition, diagnosis, and treatment of DPDS, we conducted a thorough review of the existing literature.

It is emphasized that a standardized definition and classification of DPDS is essential for designing and conducting clinical studies to address current unmet needs in managing patients with DPDS.

Early recognition of severe acute pancreatitis (AP) is crucial for timely intervention. This study aims to evaluate the prognostic accuracy of the Emergency Room Assessment of AP (ERAP) score and compare it with the Bedside Index for Severity in AP (BISAP) score in predicting severe AP, mortality, and persistent multiple organ failure (MOF) in Vietnamese patients. This prospective cohort study included AP patients admitted to Cho Ray Hospital between August 2021 and May 2022. Patient data, including demographics, clinical presentations, and laboratory results, were collected upon admission. The ERAP and BISAP scores were calculated from these admission data. The prognostic accuracy for severe AP, mortality, and persistent MOF was assessed via the area under the receiver-operating characteristic curve (AUC). Among 167 AP patients (mean age 41.5 ± 12.0 years), hypertriglyceridemia (34.7%) and alcohol (22.2%) were the most prevalent etiologies. Severe AP accounted for 33.5% of the patients. Mortality rates were higher in persistent MOF patients (42.9%) than in persistent single-organ failure patients (3.6%), with a P value <.001. The ERAP score had AUCs for predicting severe AP, mortality, and persistent MOF of 0.899, 0.817, and 0.867, respectively, with an optimal cutoff of ≥2. The ERAP score had a better prognostic value than the BISAP score in predicting severe AP (AUC: 0.899 vs 0.820; P = .0072) and persistent MOF (AUC: 0.867 vs 0.785; P = .0193) but had a similar prognostic value for mortality (AUC: 0.817 vs 0.728; P = .0628). The ERAP score has strong predictive value for severe AP and persistent MOF, surpassing the BISAP score in these categories while maintaining similar accuracy for mortality prediction in the Vietnamese population. The ERAP score can be a valuable tool for the early identification of high-risk AP patients, enabling timely and appropriate clinical interventions.

Acute necrotizing pancreatitis is a severe and life-threatening condition. It poses a considerable challenge for clinicians due to its complex nature and the high risk of complications. Several minimally invasive and open necrosectomy procedures have been developed. Despite advancements in treatment modalities, the optimal timing to perform necrosectomy lacks consensus.

To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United States.

A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions Database. Patients with non-elective admissions for pancreatic necrosis were identified. The participants were divided into two groups based on the necrosectomy timing: The early group received intervention within 48 hours, whereas the delayed group underwent the procedure after 48 hours. The various intervention techniques included endoscopic, percutaneous, or surgical necrosectomy. The major outcomes of interest were 30-day readmission rates, healthcare utilization, and inpatient mortality.

A total of 1309 patients with pancreatic necrosis were included. After propensity score matching, 349 cases treated with early necrosectomy were matched to 375 controls who received delayed intervention. The early cohort had a 30-day readmission rate of 8.6% compared to 4.8% in the delayed cohort (P = 0.040). Early necrosectomy had lower rates of mechanical ventilation (2.9% vs 10.9%, P < 0.001), septic shock (8% vs 19.5%, P < 0.001), and in-hospital mortality (1.1% vs 4.3%, P = 0.01). Patients in the early intervention group incurred lower healthcare costs, with median total charges of $52202 compared to $147418 in the delayed group. Participants in the early cohort also had a relatively shorter median length of stay (6 vs 16 days, P < 0.001). The timing of necrosectomy did not significantly influence the risk of 30-day readmission, with a hazard ratio of 0.56 (95% confidence interval: 0.31-1.02, P = 0.06).

Our findings show that early necrosectomy is associated with better clinical outcomes and lower healthcare costs. Delayed intervention does not significantly alter the risk of 30-day readmission.

The effects of the step-jump approach on the survival and prognosis of infected pancreatic necrosis (IPN) patients have not yet been determined.

Between November 2018 and June 2023, 188 patients were included in this study. There were 144 patients in the step-up group (the SU group) and 44 in the step-jump group (the SJ group). In the SU group, patients successfully treated with percutaneous catheter drainage (PCD) alone were classified into the SU-1 group (n=101), while those requiring additional surgery after PCD were categorized into the SU-2 group (n=43). In the SJ group, patients who underwent minimally invasive necrosectomy (MIN) without PCD were assigned to the SJ-1 group (n=34), whereas those who initially underwent PCD followed by immediate open surgery were placed in the SJ-2 group (n=10). Propensity score matching (PSM) was used to mitigate bias.

After PSM, a total of 34 pairs were successfully matched. A comparison of the SU group with the SJ-1 group (upfront MIN without PCD) revealed similar mortality rates (P=0.239); however, the incidences of multiple drug-resistant organisms (MDROs) (P=0.029) and surgical complications (P<0.001) were significantly lower in the SJ-1 group. After comparing the SU-2 and SJ-2 groups (patients who underwent direct open necrosectomy without MIN after PCD failure), the incidences of surgical complications and MDRO in the SJ-2 group were significantly lower (P<0.05).

Compared with the step-up approach, the step-jump approach is safer and more effective and can significantly reduce the incidence of MDRO and surgical complications.

Acute pancreatitis remains a serious public health problem, and the burden of acute pancreatitis is increasing. With significant morbidity and serious complications, appropriate and effective therapies are critical. Great progress has been made in understanding the pathophysiology of acute pancreatitis over the past two decades. However, specific drugs targeting key molecules and pathways involved in acute pancreatitis still require further study. Natural compounds extracted from plants have a variety of biological activities and can inhibit inflammation and oxidative stress in acute pancreatitis by blocking several signaling pathways, such as the nuclear factor kappa-B and mitogen-activated protein kinase pathways. In this article, we review the therapeutic effects of various types of phytochemicals on acute pancreatitis and discuss the mechanism of action of these natural compounds in acute pancreatitis, aiming to provide clearer insights into the treatment of acute pancreatitis.

Cannabis-induced pancreatitis (CIP) is an emerging clinical entity that presents unique challenges in diagnosis and management. This narrative review explores the current understanding of CIP, synthesizing evidence from epidemiological, pathophysiological, and clinical studies. The rising prevalence of cannabis use worldwide has been paralleled by an increase in reported cases of CIP, particularly among younger populations. Pathophysiological mechanisms involve the interaction of exogenous cannabinoids with pancreatic cannabinoid receptors, potentially disrupting normal pancreatic function and triggering inflammation. Clinical presentation of CIP often mimics other forms of acute pancreatitis (AP), necessitating a high index of suspicion and thorough history-taking for accurate diagnosis. Management strategies align with established protocols for AP, with an emphasis on supportive care and cannabis cessation to prevent recurrence. While short-term outcomes are generally favorable, the risk of progression to chronic pancreatitis in cases of continued cannabis use underscores the importance of long-term follow-up and abstinence counseling. This review also highlights significant knowledge gaps, including the need for standardized diagnostic criteria, a better understanding of dose-response relationships, and potential interactions with other risk factors. Future research directions should focus on elucidating precise pathophysiological mechanisms, developing targeted therapies, and investigating the impact of different cannabis formulations and consumption methods on pancreatic health. As cannabis use continues to increase globally, a comprehensive understanding of its effects on pancreatic function is crucial for improving patient outcomes and informing public health policies.

Acute pancreatitis (AP) is increasing in incidence across the world, and in all age groups. Major changes in management have occurred in the last decade. Avoiding total parenteral nutrition and prophylactic antibiotics, avoiding overly aggressive fluid resuscitation, initiating early feeding, avoiding endoscopic retrograde cholangiopancreatography in the absence of concomitant cholangitis, same-admission cholecystectomy, and minimally invasive approaches to infected necrosis should now be standard of care. Increasing recognition of the risk of recurrence of AP, and progression to chronic pancreatitis, along with the unexpectedly high risk of diabetes and exocrine insufficiency after AP is the subject of large ongoing studies. In this review, we provide an update on important changes in management for this increasingly common disease.

Inflammation-induced dysregulation of the coagulation cascade and vascular stasis in hospitalized patients with acute necrotizing pancreatitis (ANP) serve as a milieu for venous thromboembolism (VTE). Deep vein thrombosis (DVT) and pulmonary embolism (PE) are often underrecognized. We evaluated the incidence and risk factors for VTE in a cohort of patients with ANP.

All adult patients with ANP at our center between 2009 and 2022 were followed for three months after index hospitalization and categorized into cases and controls based on development of VTE. Demographic, clinical, and radiologic characteristics during admission were compared. A multivariable analysis was done to identify independent predictors for VTE. A p value of <0.05 was taken as significant.

Among 643 ANP patients, 512 [males-350, median age-52 years] were eligible for inclusion. VTE developed in 64 (12.5 %) patients - 28 DVT (5 %), 22 PE (4 %) and both in 14 (3 %) after a median 16 days from the diagnosis of ANP. Significant independent predictors for VTE on multivariable analysis were age ≥60 years (OR 1.91; 95 % CI 1.04-3.53), peri-pancreatic extent of necrosis (OR 7.61; 95 % CI 3.94-14.70), infected necrosis (OR 2.26; 95 % CI 1.13-4.50) and total length of stay ≥14 days (OR 4.08; 95 % CI 1.75-9.50).

The overall incidence of VTE in our cohort of patients with ANP was 12.5 %, which was usually diagnosed within one month of hospitalization. High-risk patients can be stratified based on clinical and imaging characteristics and may benefit from intensive DVT screening and prophylaxis during hospitalization and following discharge.