June 2024
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2 Reads
Endoscopy
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June 2024
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2 Reads
Endoscopy
June 2024
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10 Reads
Digestive Endoscopy
Walled‐off necrosis (WON) develops as local complications after acute necrotizing pancreatitis. Although less invasive interventions such as endoscopic ultrasonography (EUS)‐guided drainage and endoscopic necrosectomy are selected over surgical interventions, delayed and step‐up interventions are still preferred to avoid procedure‐related adverse events. However, there is a controversy about the appropriate timing of drainage and subsequent necrosectomy. The advent of large‐caliber lumen‐apposing metal stents has also brought about potential advantages of proactive interventions, which still needs investigation in future trials. When step‐up interventions of necrosectomy and additional drainage are necessary, a structured or protocoled approach for WON has been reported to improve safety and effectiveness of endoscopic and/or percutaneous treatment, but has not been standardized yet. Finally, long‐term outcomes such as recurrence of WON, pancreatic endocrine, and exocrine function are increasingly investigated in association with disconnected pancreatic duct syndrome. In this review we discuss current evidence and controversy on EUS‐guided management of WON.
June 2024
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19 Reads
Journal of Gastroenterology
Excess body weight may modulate the progression of various cancer types. The prognostic relevance of body mass index (BMI) has not been fully examined in patients with biliary tract cancer. Using a single-institutional cohort of 360 patients receiving gemcitabine-based chemotherapy for advanced biliary tract cancer, we examined the association of BMI with overall survival (OS). Using the Cox regression model with adjustment for potential confounders, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for OS according to BMI. The findings were validated using a Japanese nationwide inpatient database including 8324 patients treated at 201 hospitals. In the clinical cohort, BMI was not associated with OS (Ptrend = 0.34). Compared to patients with BMI = 18.5–24.9 kg/m2, patients with BMI < 18.5 kg/m2 and ≥ 25.0 kg/m2 had adjusted HRs for OS of 1.06 (95% CI, 0.78–1.45) and 1.01 (95% CI, 0.74–1.39), respectively. There was no evidence on a non-linear relationship between BMI and OS (Pnonlinearity = 0.63). In the nationwide cohort, the null findings were validated (Ptrend = 0.18) with adjusted HRs of 1.07 (95% CI, 0.98–1.18) for BMI < 18.5 kg/m2 and 1.05 (95% CI, 0.96–1.14) for BMI ≥ 25.0 kg/m2 (vs. BMI = 18.5–24.9 kg/m2). In the clinical cohort, BMI was not associated with progression-free survival (Ptrend = 0.81). BMI was not associated with survival outcomes of patients with advanced biliary tract cancer. Further research is warranted incorporating more detailed body composition metrics to explore the prognostic role of adiposity in biliary tract cancer.
June 2024
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23 Reads
Background and study aims Pancreatitis is a potentially lethal adverse event of endoscopic transpapillary placement of a self-expandable metal stent (SEMS) for malignant biliary obstruction (MBO). Deep learning-based image recognition has not been investigated in predicting pancreatitis in this setting. Patients and methods We included 70 patients who underwent endoscopic placement of a SEMS for nonresectable distal MBO. We constructed a convolutional neural network (CNN) model for pancreatitis prediction using a series of pre-procedure computed tomography images covering the whole pancreas (≥ 120,960 augmented images in total). We examined the additional effects of the CNN-based probabilities on the following machine learning models based on clinical parameters: logistic regression, support vector machine with a linear or RBF kernel, random forest classifier, and gradient boosting classifier. Model performance was assessed based on the area under the curve (AUC) in the receiver operating characteristic analysis, positive predictive value (PPV), accuracy, and specificity. Results The CNN model was associated with moderate levels of performance metrics: AUC, 0.67; PPV, 0.45; accuracy, 0.66; and specificity, 0.63. When added to the machine learning models, the CNN-based probabilities increased the performance metrics. The logistic regression model with the CNN-based probabilities had an AUC of 0.74, PPV of 0.85, accuracy of 0.83, and specificity of 0.96, compared with 0.72, 0.78, 0.77, and 0.96, respectively, without the probabilities. Conclusions The CNN-based model may increase predictability for pancreatitis following endoscopic placement of a biliary SEMS. Our findings support the potential of deep learning technology to improve prognostic models in pancreatobiliary therapeutic endoscopy.
June 2024
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34 Reads
Digestive Endoscopy
June 2024
Endoscopy
June 2024
Gastrointestinal Endoscopy
June 2024
Gastrointestinal Endoscopy
June 2024
Gastrointestinal Endoscopy
June 2024
Clinical Gastroenterology and Hepatology
... Furthermore, necrosectomy is less often required during early EUS-D. In our meta-analysis of 235 cases of POPFCs, 48 there were no significant differences in clinical success and AE between early and delayed EUS-D, although all studies included in the analysis were retrospective. ...
November 2023
Surgical Endoscopy
... Cancer remains a leading cause of death worldwide, posing a significant burden on global health. 1,2 The high incidence of cancer may be caused by several factors, such as genetic mutations, environmental factors, insufficient physical activity, diverse lifestyles, unstable behaviors related to diet, smoking, and alcohol consumption. [3][4][5][6][7] The current treatment methods for different stages of various cancers include chemotherapy, radiation therapy, and surgical procedures for solid tumors, or a combination of the above. ...
Reference:
Drug repurposing for cancer therapy
October 2023
... Severe bleeding associated with lumen-apposing metal stent placement for walled-off necrosis: bloody memory in WONderland Lumen-apposing metal stents (LAMSs) may facilitate endoscopic ultrasound (EUS)-guided treatment of walled-off necrosis (WON) as a transluminal port for necrosectomy [1,2]. However, this modality has a risk of potentially lethal bleeding [3,4]. ...
September 2023
Digestive Endoscopy
... Therefore, the utility of CNN-based stratification of risk of post-ERCP pancreatitis should be investigated in patients receiving ERCP overall. In addition, scoring systems based on different sets of clinical parameters from the current study have been reported for prediction of post-ERCP pancreatitis [34,35]. Therefore, future research is warranted to investigate whether integration of deep learning-based image recognition with these scoring systems improves predictive ability. ...
August 2023
Pancreatology
... Their BART model, utilizing seven robust and relevant variables, yielded AUCs ranging from 0.67 to 0.83 (median: 0.74) through five-fold crossvalidation. The relatively elevated AUC could potentially be attributed to a richer dataset, as their investigation analyzed 75 clinicopathologic, immune, microbial, and genomic factors within 815 stage II-III patients across two comprehensive U.S.-wide prospective cohorts, resulting in the identification of seven consistent survival predictors [21]. Additionally, Gupta et al. pursued a study employing data mining techniques and extant CRC risk prediction models, wherein deep autoencoders achieved exceptional performance outcomes, attaining 95% AUC. ...
June 2023
npj Precision Oncology
... There are no apparent causal factors associated with the oncogenesis and progression of pancreatic cancer; however, the major modifiable risk factors are tobacco smoking, obesity, diabetes mellitus, and alcohol intake [3]. Mutations in tumor protein 53, cyclin-dependent kinase inhibitor 2A, Kirsten rat sarcoma, and small mothers against decapentaplegic homolog 4 (SMAD4) have been recognized as major drivers of pancreatic carcinogenesis [4]. Surgical resection remains the preferred treatment for resectable pancreatic tumors. ...
June 2023
... The WONDER-02 trial has been designed and will be implemented by the WONDERFUL (WON anD pERipancreatic FlUid coLlection) study group in Japan, which consisted of expert endoscopists, gastroenterologists, interventional radiologists, and epidemiologists at high-volume centres in Japan (5,6,8,25,(28)(29)(30). ...
May 2023
Trials
... The optimal timing to perform necrosectomy for patients with pancreatic necrosis is still evolving [30]. According to the 2020 clinical practice update from the American Gastroenterological Association, the optimal timing for pancreatic debridement should be around four weeks [31]. ...
May 2023
Digestive Endoscopy
... Sarcopenia at cancer diagnosis may serve as a surrogate for various cancer-related factors with negative impacts on survival times, including impaired nutritional status, unfavorable metabolic alterations, and sustained systemic inflammation [10]. Further research suggests that clinical outcomes of cancer patients may depend on postdiagnostic alterations in skeletal muscle status due to the invasiveness of surgery [11,12] or the toxicity of chemotherapy [13][14][15]. A better understanding of the pathogenesis of skeletal muscle alterations in the context of postdiagnostic clinical course of cancer patients would help to develop and implement new management strategies of the patients [16]. ...
March 2023
Supportive Care in Cancer
... IPMN is the most common reason for significant MPD dilatation. At the same time, a correlation was noted between the degree of duct dilatation and the likelihood of malignant tumor development [6]. According to Hamada T. et al. [6] among all patients with IPMN, the number of patients with MPD dilatation Giant dilatation of pancreatic duct associated with congenital anomaly | 3 (H and E, × 200). of more than 5 mm is 10%, and 26% of them had malignancy. ...
February 2023
Clinical Gastroenterology and Hepatology