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Updates on the Treatment of Pancreatic Diseases
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Updates on the Treatment of Pancreatic Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 42364

Special Issue Editor

Prof. Dr. Romain Coriat

E-Mail Website
Guest Editor
1. Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
2. Department of Gastroenterology, Cochin Teaching Hospital, Université de Paris, 75014 Paris, France
Interests: neuroendocrine tumors; endoscopy; pancreatic diseases; gastrointestinal diseases; digestive endoscopy; digestive oncology; motor diseases of the esophagus
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The pancreas is an organ which plays an essential role in converting the food we eat into fuel for the body's cells. The pancreas has exocrine and endocrine functions. Pancreas diseases are frequent, and prognosis is linked to its aetiology—as an example, localised pancreatic adenocarcinoma justified surgery, where intraductal papillary mucinous neoplasm has no wearisome features. Recent updates in diagnosis imaging help to identify pancreas diseases.

In the Special Issue, we stress a focus on updates of pancreatic disease including adenocarcinoma, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, serous cystic neoplasm and pancreatitis. The Special Issue will take into account the clinical, surgical, radiological improvements in pancreatic diseases.

Prof. Dr. Romain Coriat
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreas adenocarcinoma
  • intraductal papillary mucinous neoplasm
  • mucinous cystic neoplasm
  • serous cystic neoplasm
  • pancreatitis

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Published Papers (6 papers)

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Editorial

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2 pages, 178 KiB  
Editorial
Updates on the Treatment of Pancreatic Diseases: Focus on Surgery, Electrochemotherapy and Rituximab
by Romain Coriat and Anna Pellat
J. Clin. Med. 2022, 11(1), 239; https://doi.org/10.3390/jcm11010239 - 3 Jan 2022
Cited by 2 | Viewed by 1510
Abstract
The pancreas plays an important role in the human body with its two main endocrine and exocrine functions [...] Full article
(This article belongs to the Special Issue Updates on the Treatment of Pancreatic Diseases)

Research

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14 pages, 1340 KiB  
Article
A Multicenter Randomized Controlled Prospective Study to Assess Efficacy of Laparoscopic Electrochemotherapy in the Treatment of Locally Advanced Pancreatic Cancer
by Francesco Izzo, Vincenza Granata, Roberta Fusco, Valeria D’Alessio, Antonella Petrillo, Secondo Lastoria, Mauro Piccirillo, Vittorio Albino, Andrea Belli, Guglielmo Nasti, Antonio Avallone, Renato Patrone, Francesca Grassi, Maddalena Leongito and Raffaele Palaia
J. Clin. Med. 2021, 10(17), 4011; https://doi.org/10.3390/jcm10174011 - 5 Sep 2021
Cited by 16 | Viewed by 2985
Abstract
Background: Eighty percent of patients with pancreatic adenocarcinoma present a locally advanced or metastatic disease at diagnosis and are not eligible for surgery if not with palliative intent. In cases of locally advanced disease (LAPC), the combination of chemo and radiotherapy is the [...] Read more.
Background: Eighty percent of patients with pancreatic adenocarcinoma present a locally advanced or metastatic disease at diagnosis and are not eligible for surgery if not with palliative intent. In cases of locally advanced disease (LAPC), the combination of chemo and radiotherapy is the only therapeutic option and correlates with a median survival of 15 months (10 months without treatment), with partial remission of disease in 50% of cases. The feasibility and safety of Electrochemotherapy (ECT) have been demonstrated in the treatment of deep tumors. Aim: The aim of the study is to evaluate the efficacy of electrochemotherapy (ECT) followed by conventional systemic treatment compared to the only conventional systemic treatment in LAPC in terms of objective response and overall survival. Patients and Methods: This study is a phase IIb prospective multicenter randomized controlled trial with two arms. The study will include 90 patients: 45 in the control group and 45 in the experimental group. Patients with LAPC in the control arm will receive conventional chemotherapy (FOLFOXIRI). Patients with LAPC in the experimental arm will be subjected to Electrochemotherapy and subsequently to FOLFOXIRI. The objective response at 30, 90, and 180 days from treatment will be based on the computed tomography (CT), magnetic resonance (MR), and positron emission tomography/CT response (PET/CT). The objective long-term treatment response will be evaluated with the modified response evaluation criteria in solid tumors (m-RECIST) criteria, which will take into account the difference in vascularization, determined by the images obtained by CT and MR of the tumor treated before and after ECT. Conclusions: Not resectable liver metastasis, pancreatic tumors, and locally advanced renal carcinomas can be treated with laparoscopic electrodes. ECT could represent an effective therapeutic option for patients not eligible for surgery susceptible to be managed only with palliative therapies. Full article
(This article belongs to the Special Issue Updates on the Treatment of Pancreatic Diseases)
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16 pages, 877 KiB  
Article
Modified Technique for Wirsung-Pancreatogastric Anastomosis after Pancreatoduodenectomy: A Single Center Experience and Systematic Review of the Literature
by Cinzia Bizzoca, Salvatore Fedele, Anna Stella Lippolis, Fabrizio Aquilino, Marco Castellana, Maria Raffaella Basile, Giuseppe Lucarelli and Leonardo Vincenti
J. Clin. Med. 2021, 10(14), 3064; https://doi.org/10.3390/jcm10143064 - 11 Jul 2021
Cited by 5 | Viewed by 2879
Abstract
Background: The mortality rate following pancreaticoduodenectomy (PD) has been decreasing over the past few years; nonetheless, the morbidity rate remains elevated. The most common complications after PD are post-operative pancreatic fistula (POPF) and delayed gastric emptying (DGE) syndrome. The issue as to which [...] Read more.
Background: The mortality rate following pancreaticoduodenectomy (PD) has been decreasing over the past few years; nonetheless, the morbidity rate remains elevated. The most common complications after PD are post-operative pancreatic fistula (POPF) and delayed gastric emptying (DGE) syndrome. The issue as to which is the best reconstruction method for the treatment of the pancreatic remnant after PD is still a matter of debate. The aim of this study was to retrospectively analyze the morbidity rate in 100 consecutive PD reconstructed with Wirsung-Pancreato-Gastro-Anastomosis (WPGA), performed by a single surgeon applying a personal modification of the pancreatic reconstruction technique. Methods: During an 8-year period (May 2012 to March 2020), 100 consecutive patients underwent PD reconstructed with WPGA. The series included 57 males and 43 females (M/F 1.32), with a mean age of 68 (range 41–86) years. The 90-day morbidity and mortality were retrospectively analyzed. Additionally, a systematic review was conducted, comparing our technique with the existing literature on the topic. Results: We observed eight cases of clinically relevant POPF (8%), three cases of “primary” DGE (3%) and four patients suffering “secondary” DGE. The surgical morbidity and mortality rate were 26% and 6%, respectively. The median hospital stay was 13.6 days. The systematic review of the literature confirmed the originality of our modified technique for Wirsung-Pancreato-Gastro-Anastomosis. Conclusions: Our modified double-layer WPGA is associated with a very low incidence of POPF and DGE. Also, the technique avoids the risk of acute hemorrhage of the pancreatic parenchyma. Full article
(This article belongs to the Special Issue Updates on the Treatment of Pancreatic Diseases)
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13 pages, 1439 KiB  
Article
A Follow-Up Study of a European IgG4-Related Disease Cohort Treated with Rituximab
by Johanna Backhus, Christian Neumann, Lukas Perkhofer, Lucas A Schulte, Benjamin Mayer, Thomas Seufferlein, Martin Müller and Alexander Kleger
J. Clin. Med. 2021, 10(6), 1329; https://doi.org/10.3390/jcm10061329 - 23 Mar 2021
Cited by 26 | Viewed by 6168
Abstract
Objectives: IgG4-related disease (IgG4-RD) is a chronic fibro-inflammatory disorder affecting virtually any organ. Type 1 autoimmune (type 1 AIP) is its pancreatic manifestation. To date, steroids are considered the first-line pancreatitis treatment. The CD20-binding antibody rituximab (RTX) appears a promising steroid-sparing therapy, although [...] Read more.
Objectives: IgG4-related disease (IgG4-RD) is a chronic fibro-inflammatory disorder affecting virtually any organ. Type 1 autoimmune (type 1 AIP) is its pancreatic manifestation. To date, steroids are considered the first-line pancreatitis treatment. The CD20-binding antibody rituximab (RTX) appears a promising steroid-sparing therapy, although long-term data are lacking. We aimed to bridge this gap with a cohort of IgG4-RD patients treated with RTX and to assess the potential value of the Responder Index (RI) as a discriminatory score for disease activity. Methods: We retrospectively evaluated 46 patients from a tertiary referral centre who were diagnosed with IgG4-RD and/or type 1 AIP according to the International Consensus Diagnostic Criteria or Unifying-AIP criteria between June 2006 and August 2019. Results: Patients resembled previous cohorts in terms of characteristics, diagnosis, and therapeutic response. Thirteen of the 46 patients with IgG4-RD/type 1 AIP were treated with RTX pulse therapy due to relapse, adverse reactions to steroids, or high-risk constellations predicting a severe course of disease with multi-organ involvement. Median follow-up after diagnosis was 52 months for all subjects, and 71 months in IgG4-RD patients treated with RTX. While patients in the RTX group showed no significant response to an initial steroid pulse, clinical activity as measured by the RI significantly decreased in the short-term after RTX induction. Within 16 months, 61% of patients relapsed in the RTX group but responded well to re-induction. Clinical and laboratory parameters improved equally in response to RTX. Conclusion: RTX therapy in patients with IgG4-RD is an effective and safe treatment to induce treatment response and possible long-term remission. Repeated RTX administration after 6–9 months may be of value in reducing the risk of relapse. The RI appears to be a reasonable index to assess disease activity and to identify patients with IgG4-related disease who may benefit from B-cell-depleting therapy. Full article
(This article belongs to the Special Issue Updates on the Treatment of Pancreatic Diseases)
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Review

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22 pages, 1858 KiB  
Review
Causes of Exocrine Pancreatic Insufficiency Other Than Chronic Pancreatitis
by Lumír Kunovský, Petr Dítě, Petr Jabandžiev, Michal Eid, Karolina Poredská, Jitka Vaculová, Dana Sochorová, Pavel Janeček, Pavla Tesaříková, Martin Blaho, Jan Trna, Jan Hlavsa and Zdeněk Kala
J. Clin. Med. 2021, 10(24), 5779; https://doi.org/10.3390/jcm10245779 - 10 Dec 2021
Cited by 25 | Viewed by 23647
Abstract
Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and malnutrition, results from primary pancreatic disease or is secondary to impaired exocrine pancreatic function. Although chronic pancreatitis is the most common cause of EPI, several additional causes exist. These include pancreatic tumors, pancreatic [...] Read more.
Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and malnutrition, results from primary pancreatic disease or is secondary to impaired exocrine pancreatic function. Although chronic pancreatitis is the most common cause of EPI, several additional causes exist. These include pancreatic tumors, pancreatic resection procedures, and cystic fibrosis. Other diseases and conditions, such as diabetes mellitus, celiac disease, inflammatory bowel disease, and advanced patient age, have also been shown to be associated with EPI, but the exact etiology of EPI has not been clearly elucidated in these cases. The causes of EPI can be divided into loss of pancreatic parenchyma, inhibition or inactivation of pancreatic secretion, and postcibal pancreatic asynchrony. Pancreatic enzyme replacement therapy (PERT) is indicated for the conditions described above presenting with clinically clear steatorrhea, weight loss, or symptoms related to maldigestion and malabsorption. This review summarizes the current literature concerning those etiologies of EPI less common than chronic pancreatitis, the pathophysiology of the mechanisms of EPI associated with each diagnosis, and treatment recommendations. Full article
(This article belongs to the Special Issue Updates on the Treatment of Pancreatic Diseases)
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12 pages, 5740 KiB  
Review
Parenchymal Sparing Resection: Options in Duodenal and Pancreatic Surgery
by Ugo Marchese, Stylianos Tzedakis, Einas Abou Ali, Olivier Turrini, Jean-Robert Delpero, Romain Coriat and David Fuks
J. Clin. Med. 2021, 10(7), 1479; https://doi.org/10.3390/jcm10071479 - 2 Apr 2021
Cited by 5 | Viewed by 3925
Abstract
Parenchymal sparing duodenal and pancreatic resection are safe procedures in selected patients with the aim to reduce endocrine and exocrine long-term dysfunction. When the tumor is benign or borderline malignant, this appears to be a good option for the surgeon, associated with low [...] Read more.
Parenchymal sparing duodenal and pancreatic resection are safe procedures in selected patients with the aim to reduce endocrine and exocrine long-term dysfunction. When the tumor is benign or borderline malignant, this appears to be a good option for the surgeon, associated with low rates of severe surgery-related early postoperative complications and low in-hospital mortality. This mini review offers comments, tips and tricks, and a review of literature concerning those different options with specific illustrations in order to clarify their indication. Full article
(This article belongs to the Special Issue Updates on the Treatment of Pancreatic Diseases)
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