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Tsuji Y, Takahashi N, Isoda H, Koizumi K, Koyasu S, Sekimoto M, Imanaka Y, Yazumi S, Asada M, Nishikawa Y, Yamamoto H, Kikuchi O, Yoshida T, Inokuma T, Katsushima S, Esaka N, Okano A, Kawanami C, Kakiuchi N, Shiokawa M, Kodama Y, Moriyama I, Kajitani T, Kinoshita Y, Chiba T. Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis. J Gastroenterol 2017; 52:1130-1139. [PMID: 28374057 DOI: 10.1007/s00535-017-1330-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Perfusion CT can diagnose pancreatic necrosis in early stage of severe acute pancreatitis, accurately. However, no study to date has examined whether early diagnosis of pancreatic necrosis is useful in predicting persistent organ failure (POF). METHODS We performed a multi-center prospective observational cohort study to investigate whether perfusion CT can predict the development of POF in the early stage of AP, based on early diagnosis of the development of pancreatic necrosis (PN). From 2009 to 2012, we examined patients showing potential early signs of severe AP (n = 78) on admission. Diagnoses for the development of PN were made prospectively by on-site physicians on the admission based on perfusion CT (diagnosis 1). Blinded retrospective reviews were performed by radiologists A and B, having 8 and 13 years of experience as radiologists (diagnosis 2 and 3), respectively. Positive diagnosis for the development of PN were assumed equivalent to positive predictions for the development of POF. We then calculated the area under the curve (AUC) of the receiver operating characteristic for POF predictions. RESULTS Fourteen (17.9%) and 23 patients (29.5%) developed PN and POF, respectively. For diagnoses 1, 2, and 3, AUCs for POF predictions were 74, 68, and 73, respectively. CONCLUSIONS Perfusion CT diagnoses pancreatic necrosis and on that basis predicts the development of POF; http://www.umin.ac.jp/ctr/index-j.htm,UMIN000001926 .
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Affiliation(s)
- Yoshihisa Tsuji
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. .,Department of Gastroenterology and Hepatology, The Japan Baptist Hospital, 47 Kitashirakawa Yamanomotocho, Sakyo-ku, Kyoto, 606-8273, Japan. .,Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2121, Japan.
| | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA
| | - Hiroyoshi Isoda
- Department of Radiology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koji Koizumi
- Division of Clinical Radiology Service, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sho Koyasu
- Department of Radiology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Miho Sekimoto
- Department of Healthcare Economics and Quality Management, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shujiro Yazumi
- Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Masanori Asada
- Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Yoshihiro Nishikawa
- Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Hiroshi Yamamoto
- Department of Gastroenterology and Hepatology, 1 Chome-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan
| | - Osamu Kikuchi
- Department of Gastroenterology and Hepatology, 1 Chome-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan
| | - Tsukasa Yoshida
- Department of Gastroenterology and Hepatology, 1 Chome-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan
| | - Tetsuro Inokuma
- Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, 2-2-1 Minatojima-minami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Shinji Katsushima
- Department of Gastroenterology and Hepatology, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Naoki Esaka
- Department of Gastroenterology and Hepatology, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Akihiro Okano
- Department of Gastroenterology and Hepatology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Chiharu Kawanami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Nobuyuki Kakiuchi
- Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Masahiro Shiokawa
- Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Yuzo Kodama
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ichiro Moriyama
- Division of Clinical Study of Oncology, Shimane University School of Medicine, 1060 Nishikawatsucho, Matsue, Shimane, 690-8504, Japan
| | - Takafumi Kajitani
- Department of Radiology, Shimane University School of Medicine, 1060 Nishikawatsucho, Matsue, Shimane, 690-8504, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 1060 Nishikawatsucho, Matsue, Shimane, 690-8504, Japan
| | - Tsutomu Chiba
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Sharma V, Rana SS, Sharma RK, Gupta R, Bhasin DK. Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis. Gastroenterol Rep (Oxf) 2014; 3:144-7. [PMID: 25305375 PMCID: PMC4423459 DOI: 10.1093/gastro/gou067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/28/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Guidelines recommend that contrast-enhanced computed tomography (CT) should be carried out 72 hours after onset of an attack of acute pancreatitis (AP). However, the exact time beyond 72 hours at which CT will produce the best diagnostic yield for local complications, or whether doing a CT early in acute pancreatitis has any adverse effect on the course of disease, is not clear. METHODS The medical records of 214 consecutive patients with AP were analysed retrospectively and these patients were divided into two groups: the early CT group (CT done at 4-5 days after the onset of pain) and the late CT group (CT done in days 6-14 following onset of pain). The two groups were compared for differences in clinical outcomes and prognostic information obtained from CT, such as detection of pancreatic necrosis and local complications, and CT severity index. RESULTS Of 214 patients [143 (66.8%) males; mean age 39.87 ± 13.52 years], 21 patients were excluded as they did not undergo CT or CT was done more than 14 days after onset of an attack of AP. The early CT group included 114 patients, whilst the late CT group had 79. The mean CT severity index was higher in the late CT group (6.65 ± 2.27 vs. 5.52 ± 2.7; P = 0.005). The incidence of persistent organ failure in the early group was no different from that of the late group (38.6% vs. 49.4%; P = 0.143). Local complications were detected more often in the late CT group (84.8% vs. 68.4%; P = 0.011). There was no difference between the two groups in the need for percutaneous drainage, surgery, or mortality (all P > 0.05). CONCLUSIONS Although performing early CT does not adversely affect the outcome in AP, CT carried out more than 5 days after the onset of symptoms may detect more local complications.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ravi K Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rajesh Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Wan MH, Huang W, Latawiec D, Jiang K, Booth DM, Elliott V, Mukherjee R, Xia Q. Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research. HPB (Oxford) 2012; 14:73-81. [PMID: 22221567 PMCID: PMC3277048 DOI: 10.1111/j.1477-2574.2011.00408.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Acute pancreatitis (AP) is a formidable disease, which, in severe forms, causes significant mortality. Biliary AP, or gallstone obstruction-associated AP, accounts for 30-50% of all clinical cases of AP. In biliary AP, pancreatic acinar cell (PAC) death (the initiating event in the disease) is believed to occur as acinar cells make contact with bile salts when bile refluxes into the pancreatic duct. Recent advances have unveiled an important receptor responsible for the major function of bile acids on acinar cells, namely, the cell surface G-protein-coupled bile acid receptor-1 (Gpbar1), located in the apical pole of the PAC. High concentrations of bile acids induce cytosolic Ca(2+) overload and inhibit mitochondrial adenosine triphosphate (ATP) production, resulting in cell injury to both PACs and pancreatic ductal epithelial cells. Various bile salts are employed to induce experimental AP, most commonly sodium taurocholate. Recent characterization of taurolithocholic acid 3-sulphate on PACs has led researchers to focus on this bile salt because of its potency in causing acinar cell injury at relatively low, sub-detergent concentrations, which strongly implicates action via the receptor Gpbar1. Improved surgical techniques have enabled the infusion of bile salts into the pancreatic duct to induce experimental biliary AP in mice, which allows the use of these transgenic animals as powerful tools. This review summarizes recent findings using transgenic mice in experimental biliary AP.
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Affiliation(s)
- Mei H Wan
- Pancreatic Diseases Research Group, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan UniversityChengdu, China
| | - Wei Huang
- Pancreatic Diseases Research Group, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan UniversityChengdu, China,Liverpool National Institute of Health Research (NIHR) Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of LiverpoolLiverpool, UK
| | - Diane Latawiec
- Liverpool National Institute of Health Research (NIHR) Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of LiverpoolLiverpool, UK
| | - Kun Jiang
- Pancreatic Diseases Research Group, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan UniversityChengdu, China
| | - David M Booth
- Liverpool National Institute of Health Research (NIHR) Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of LiverpoolLiverpool, UK
| | - Victoria Elliott
- Liverpool National Institute of Health Research (NIHR) Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of LiverpoolLiverpool, UK
| | - Rajarshi Mukherjee
- Liverpool National Institute of Health Research (NIHR) Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of LiverpoolLiverpool, UK
| | - Qing Xia
- Pancreatic Diseases Research Group, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan UniversityChengdu, China
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