Development of a miRNA-based diagnostic assay for pancreatic ductal adenocarcinoma.

Diagnosis of pancreatic cancer remains a clinical challenge. Both chronic pancreatitis and pancreatic cancer may present with similar symptoms and similar imaging features, often leading to incorrect interpretation. Thus, the use of an objective molecular test that can discriminate between chronic pancreatitis and pancreatic cancer will be a valuable asset in obtaining a definitive diagnosis of pancreatic cancer.

Mass spectrometry-based proteomics of endoscopically collected pancreatic fluid in chronic pancreatitis research.

MS-based investigation of pancreatic fluid enables the high-throughput identification of proteins present in the pancreatic secretome. Pancreatic fluid is a complex admixture of digestive, inflammatory, and other proteins secreted by the pancreas into the duodenum, and thus is amenable to MS-based proteomic analysis. Recent advances in endoscopic techniques, in particular the endoscopic pancreatic function test (ePFT), have improved the collection methodology of pancreatic fluid for proteomic analysis.

Proteomic analysis of endoscopically (endoscopic pancreatic function test) collected gastroduodenal fluid using in-gel tryptic digestion followed by LC-MS/MS.

Purpose: Proteomic analysis of gastroduodenal fluid offers an alternative strategy to study diseases, such as peptic ulcer disease and gastric cancer. We use in-gel tryptic digestion followed by LC-MS/MS (GeLC-MS/MS) to profile the proteome of gastroduodenal fluid collected during the endoscopic pancreatic function test (ePFT).

Experimental Design: Gastroduodenal fluid specimens collected during ePFT from six patients with upper abdominal pain were subjected to proteomic analysis.

Acute pancreatitis: imaging utilization practices in an urban teaching hospital--analysis of trends with assessment of independent predictors in correlation with patient outcomes.

Purpose: To evaluate imaging utilization trends in patients with acute pancreatitis (AP) and to assess independent predictors of radiology usage in relation to patient outcomes.

Materials And Methods: Institutional review board approval was obtained for this HIPAA-compliant study; written informed consent was waived. AP-related radiologic studies in 252 patients admitted for AP between June 2005 and December 2007 were collected during and for a 1-year period after hospitalization.

A scoring system to predict readmission of patients with acute pancreatitis to the hospital within thirty days of discharge.

Background & Aims: Reducing rapid readmission of patients after discharge could improve quality of treatment and reduce costs. Little is known about clinical predictors of early readmission for acute pancreatitis (AP). We developed a strategy to identify and stratify patients with AP at risk for readmission within 30 days of discharge.

High prevalence of low-trauma fracture in chronic pancreatitis.

Objectives: Chronic pancreatitis (CP) is associated with risk factors that may negatively impact bone and mineral metabolism. The important clinical end point of osteoporosis is "low-trauma" fracture. The purpose of this study was to examine the prevalence of "low-trauma" fracture in patients with CP, compared with fracture rates in "high-risk" gastrointestinal (GI) illnesses, for which metabolic bone disease screening guidelines are in place.

Optimized sample preparation of endoscopic collected pancreatic fluid for SDS-PAGE analysis.

The standardization of methods for human body fluid protein isolation is a critical initial step for proteomic analyses aimed to discover clinically relevant biomarkers. Several caveats have hindered pancreatic fluid proteomics, including the heterogeneity of samples and protein degradation. We aim to optimize sample handling of pancreatic fluid that has been collected using a safe and effective endoscopic collection method (endoscopic pancreatic function test).

The management of acute and chronic pancreatitis.

Pancreatitis, which is most generally described as any inflammation of the pancreas, is a serious condition that manifests in either acute or chronic forms. Chronic pancreatitis results from irreversible scarring of the pancreas, resulting from prolonged inflammation. Six major etiologies for chronic pancreatitis have been identified: toxic/ metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, and obstruction.

Early readmission in acute pancreatitis: incidence and risk factors.

Objectives: Early unplanned readmission is a potential target for quality improvement and cost reduction. The aims of this study were to (i) determine the frequency of early readmission following hospitalization for acute pancreatitis (AP) and (ii) identify risk factors for early readmission in patients hospitalized for AP.

Methods: A retrospective, observational cohort study was performed including all inpatients with AP at a tertiary-care hospital between June 2005 and December 2007.

Update in acute pancreatitis.

Acute pancreatitis is a common cause for hospitalization that carries a substantial burden of disease in the United States and worldwide. Recent reports have encompassed a wide array of topics including new insights into the acinar cell pH microenvironment, signal pathways for acinar cell fate, and the innate immune response. Clinical researchers have reported new methods to assess disease severity, innovative techniques for management of local complications, the importance of early recognition of pancreatic or extrapancreatic infection, and prevention of disease recurrence.

Early hemoconcentration is associated with pancreatic necrosis only among transferred patients.

Objectives: Studies evaluating hemoconcentration as a marker of necrosis in acute pancreatitis have reached different conclusions. The aim of this study was to determine the impact of transfer status on the accuracy of hemoconcentration for the prediction of pancreatic necrosis.

Methods: We prospectively enrolled 339 patients in an observational cohort study from June 2005 to December 2007.

Identification of pancreas-specific proteins in endoscopically (endoscopic pancreatic function test) collected pancreatic fluid with liquid chromatography--tandem mass spectrometry.

Objectives: We aimed to establish the endoscopic pancreatic function test (ePFT) as a method that can safely obtain pancreatic fluid for mass spectrometric analysis from patients during upper endoscopy and to reproducibly identify pancreas-specific proteins.

Methods: We performed a sodium dodecyl sulfate-polyacrylamide gel electrophoresis and mass spectrometry-based proteomic analysis (in-gel tryptic digestion followed by liquid chromatography-tandem mass spectrometry [GeLC-MS/MS]) on ePFT-collected pancreatic fluid from 3 individuals, without evidence of chronic pancreatitis, who were undergoing an upper endoscopy for dyspepsia and chronic abdominal pain.

Results: Pancreatic fluid was safely collected from all subjects.

Magnetic resonance cholangiopancreatography reports in the evaluation of chronic pancreatitis: a need for quality improvement.

Background: Numerous publications from academic centers suggest that magnetic resonance cholangiopancreatography (MRCP) can diagnose early chronic pancreatitis (CP) and assess pancreatic secretory reserve/function. However, the rigorous composite interpretation methods and quantitative secretory dynamics reported in these studies are not routinely measured in clinical practice. Therefore, the utility of routine MRCP reports in the clinical setting is unknown.

Prospective comparison of radial and linear endoscopic ultrasound for diagnosis of chronic pancreatitis.

Background And Study Aims: Linear endoscopic ultrasonography (EUS) is currently favored by many endosonographers for the evaluation of pancreatic pathology. However, radial EUS was used in early studies validating EUS for chronic pancreatitis. Radial and linear EUS have never been compared for the diagnosis of chronic pancreatitis.

Early hemoconcentration predicts increased mortality only among transferred patients with acute pancreatitis.

Background/aims: The prognostic utility of hemoconcentration in acute pancreatitis (AP) remains controversial.

Methods: We examined the relationship between early hemoconcentration and in-hospital mortality in an observational cohort study. Data was collected from 177 US hospitals from January 2004 to September 2005.

Secretin-enhanced MRCP: proceed with cautious optimism.

Magnetic resonance imaging (MRI) is a safe and universally available test that has much appeal to generalists and subspecialists evaluating patients with pancreatic disease. Testoni et al. report the clinical utility of magnetic resonance pancreaticocholangiography (MRCP) and secretin-enhanced MRCP in the evaluation of patients with asymptomatic abnormalities in pancreatic enzymes.

Disparities in emergency department wait times for acute gastrointestinal illnesses: results from the National Hospital Ambulatory Medical Care Survey, 1997-2006.

Objectives: (i) The aims of this study were to report wait times for visits to US emergency departments (EDs) for acute gastrointestinal illnesses, (ii) to identify whether racial/ethnic disparities exist in wait times, and (iii) to characterize factors associated with delays in physician assessment.

Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1997 to 2006. We studied wait times for acute pancreatitis, appendicitis, cholecystitis, and upper gastrointestinal hemorrhage (UGIH).

Early changes in blood urea nitrogen predict mortality in acute pancreatitis.

Background & Aims: Routine laboratory tests that reflect intravascular volume status can play an important role in the early assessment of acute pancreatitis (AP). The objective of this study was to evaluate accuracy of serial blood urea nitrogen (BUN) versus serial hemoglobin (Hgb) measurement for prediction of in-hospital mortality in AP.

Methods: We performed an observational cohort study on data from 69 US hospitals from January 2003 to December 2006.

A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis.

Objectives: Our aim was to prospectively evaluate the ability of the bedside index for severity in acute pancreatitis (BISAP) score to predict mortality as well as intermediate markers of severity in a tertiary center.

Methods: The BISAP score was evaluated among 397 consecutive cases of acute pancreatitis admitted to our institution between June 2005 and December 2007. BISAP scores were calculated on all cases using data within 24 h of presentation.

Chronic pancreatitis.

Purpose Of Review: As in previous reviews in this journal, this review is focused on the most important new observations in chronic pancreatitis made in the last year.

Recent Findings: Important observations included the search for biomarkers and alternative methods for the detection of early chronic pancreatitis; stellate cell activation and their role in fibrogenesis; the natural history of chronic pancreatitis; reports outlining the complexity in diagnosis of autoimmune pancreatitis; emerging roles of endoscopic ultrasound and magnetic resonance cholangiopancreatography in chronic pancreatitis diagnosis; a better understanding of neurobiology of chronic pancreatitis pain; and the potential role of surgery as first-line therapy in advanced chronic pancreatitis.

Summary: In 2007, major advances were made in our understanding of central processing in chronic pancreatitis pain.

Findings on endoscopic retrograde cholangiopancreatography and pancreatic function test in suspected chronic pancreatitis and negative cross-sectional imaging.

Background & Aims: The diagnosis of chronic pancreatitis (CP) often relies on cross-sectional imaging, which may be insensitive for early disease. The aim of this study was to assess the utility of cholecystokinin pancreatic function test and endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of CP in patients with negative or inconclusive cross-sectional imaging.

Methods: Consecutive patients with suspicion of CP and negative or inconclusive cross-sectional imaging (computerized tomography and magnetic resonance cholangiopancreatography) were evaluated with cholecystokinin-stimulated endoscopic pancreatic function test (ePFT) and ERCP.

Systematic review: pancreatic enzyme treatment of malabsorption associated with chronic pancreatitis.

Background: Pancreatic enzyme supplementation is standard treatment for malabsorption caused by chronic pancreatitis. The FDA recently required all manufacturers to submit New Drug Applications to continue to market these agents because published data demonstrated variation in formulation, bioavailability and shelf-life while providing limited data about efficacy and safety.

Aim: To review systematically the design and results of randomized, parallel-design trials of pancreatic enzyme supplements in chronic pancreatitis patients with steatorrhea.