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Pancreatic Neoplasms: HELP
Articles by Gregory A. Coté
Based on 17 articles published since 2010
(Why 17 articles?)
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Between 2010 and 2020, Greg Cote wrote the following 17 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Editorial The Countdown to a Paradigm Shift in Diagnosing Pancreatic Ductal Adenocarcinoma. 2017

Coté, Gregory A. ·Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. ·Clin Gastroenterol Hepatol · Pubmed #28300695.

ABSTRACT: -- No abstract --

2 Review Endoscopic palliation of pancreatic cancer. 2012

Coté, Gregory A / Sherman, Stuart. ·Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. ·Cancer J · Pubmed #23187846.

ABSTRACT: Endoscopy has an increasingly important role in the palliation of patients with pancreatic ductal adenocarcinoma. Endoscopic biliary drainage is still requested in the majority of patients who present with obstructive jaundice, and the increased use of self-expandable metallic stents has reduced the incidence of premature stent occlusion. First-line use of metallic stents is expected to be utilized more frequently as neoadjuvant protocols are improved. The efficacy of endoscopy for palliating gastroduodenal obstruction has advanced with the development of through-the-scope, self-expandable gastroduodenal stents. There have been advances in pain management, with endoscopic ultrasound-guided celiac plexus neurolysis reducing opiate requirements and pain for patients with unresectable malignancy. Future applications of endoscopy in pancreatic cancer may include fine-needle injection of chemotherapeutic and other agents into the lesion itself. This review will summarize the evidence of endoscopy in the management of patients with pancreatic cancer.

3 Article Plasma microRNAs as biomarkers of pancreatic cancer risk in a prospective cohort study. 2017

Duell, Eric J / Lujan-Barroso, Leila / Sala, Núria / Deitz McElyea, Samantha / Overvad, Kim / Tjonneland, Anne / Olsen, Anja / Weiderpass, Elisabete / Busund, Lill-Tove / Moi, Line / Muller, David / Vineis, Paolo / Aune, Dagfinn / Matullo, Giuseppe / Naccarati, Alessio / Panico, Salvatore / Tagliabue, Giovanna / Tumino, Rosario / Palli, Domenico / Kaaks, Rudolf / Katzke, Verena A / Boeing, Heiner / Bueno-de-Mesquita, H B As / Peeters, Petra H / Trichopoulou, Antonia / Lagiou, Pagona / Kotanidou, Anastasia / Travis, Ruth C / Wareham, Nick / Khaw, Kay-Tee / Ramon Quiros, Jose / Rodríguez-Barranco, Miguel / Dorronsoro, Miren / Chirlaque, María-Dolores / Ardanaz, Eva / Severi, Gianluca / Boutron-Ruault, Marie-Christine / Rebours, Vinciane / Brennan, Paul / Gunter, Marc / Scelo, Ghislaine / Cote, Greg / Sherman, Stuart / Korc, Murray. ·Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain. · Department of Medicine, Indiana University School of Medicine, Indianapolis, IN. · Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus C, Denmark. · Danish Cancer Society Research Center, Copenhagen, Denmark. · Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway. · Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. · Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. · Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland. · Department of Clinical Pathology, University Hospital of North Norway, Tromso, Norway. · Department of Medical Biology, UiT The Arctic University of Norway, Tromso, Norway. · School of Public Health, Epidemiology & Biostatistics, Imperial College London, London, United Kingdom. · Human Genetics Foundation (HuGeF), Turin, Italy. · Department of Medical Sciences, University of Turin, Turin, Italy. · Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy. · Lombardy Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. · Cancer Registry and Histopathology Unit, "Civic - M.P, Arezzo" Hospital, ASP, Ragusa, Italy. · Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy. · Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. · Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany. · Dt. for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. · Dt. of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom. · Dt. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. · Dept of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. · MRC-PHE Centre for Environment and Health, Dept of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom. · Hellenic Health Foundation, Athens, Greece. · WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece. · Department of Epidemiology, Harvard School of Public Health, Boston, MA. · Department of Critical Care Medicine & Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece. · Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. · MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom. · Public Health Directorate, Asturias, Spain. · Andalusian School of Public Health, Research Insititute Biosanitary Granada, University Hospital Granada/University of Granada, Granada. · CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain. · Basque Regional Health Department, San Sebatian, Spain. · Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain. · Navarra Public Health Institute, Pamplona, Spain. · IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. · Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France. · Gustave Roussy, Villejuif, France. · Beaujon Hospital, Pancreatology Unit, Clichy, France. · INSERM, University Paris, France. · International Agency for Research on Cancer (IARC), Lyon, France. · Medical University of South Carolina, Charleston, SC. · Departments of Medicine and Biochemistry & Molecular Biology, Indiana University School of Medicine, Indianapolis, IN. · Pancreatic Cancer Signature Center, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN. ·Int J Cancer · Pubmed #28542740.

ABSTRACT: Noninvasive biomarkers for early pancreatic ductal adenocarcinoma (PDAC) diagnosis and disease risk stratification are greatly needed. We conducted a nested case-control study within the Prospective Investigation into Cancer and Nutrition (EPIC) cohort to evaluate prediagnostic microRNAs (miRs) as biomarkers of subsequent PDAC risk. A panel of eight miRs (miR-10a, -10b, -21-3p, -21-5p, -30c, -106b, -155 and -212) based on previous evidence from our group was evaluated in 225 microscopically confirmed PDAC cases and 225 controls matched on center, sex, fasting status and age/date/time of blood collection. MiR levels in prediagnostic plasma samples were determined by quantitative RT-PCR. Logistic regression was used to model levels and PDAC risk, adjusting for covariates and to estimate area under the receiver operating characteristic curves (AUC). Plasma miR-10b, -21-5p, -30c and -106b levels were significantly higher in cases diagnosed within 2 years of blood collection compared to matched controls (all p-values <0.04). Based on adjusted logistic regression models, levels for six miRs (miR-10a, -10b, -21-5p, -30c, -155 and -212) overall, and for four miRs (-10a, -10b, -21-5p and -30c) at shorter follow-up time between blood collection and diagnosis (≤5 yr, ≤2 yr), were statistically significantly associated with risk. A score based on the panel showed a linear dose-response trend with risk (p-value = 0.0006). For shorter follow-up (≤5 yr), AUC for the score was 0.73, and for individual miRs ranged from 0.73 (miR-212) to 0.79 (miR-21-5p).

4 Article Informative Patterns of Health-Care Utilization Prior to the Diagnosis of Pancreatic Ductal Adenocarcinoma. 2017

Coté, Gregory A / Xu, Huiping / Easler, Jeffery J / Imler, Timothy D / Teal, Evgenia / Sherman, Stuart / Korc, Murray. · ·Am J Epidemiol · Pubmed #28541521.

ABSTRACT: Early-detection tests for pancreatic ductal adenocarcinoma (PDAC) are needed. Since a hypothetical screening test would be applied during antecedent clinical encounters, we sought to define the variability in health-care utilization leading up to PDAC diagnosis. This was a retrospective cohort study that included patients diagnosed with PDAC in the Indianapolis, Indiana, area between 1999 and 2013 with at least 1 health-care encounter during the antecedent 36-month period (n = 1,023). Patients were classified by unique patterns of health-care utilization using a group-based trajectory model. The prevalences of PDAC signals, such as diabetes mellitus (DM) and chronic pancreatitis, were compared. Four distinct trajectories were identified, the most common (42.0%) being having few clinical encounters more than 6 months prior to PDAC diagnosis (late acceleration). In all cases, a minority of persons had DM (30.6%, with 9.5% <1.5 years before PDAC) or any pancreatic disorder (39.9%); these were least common in the late-acceleration group (DM, 14.7%; any pancreatic disorder, 32.1% (P < 0.001)). The most common pattern of antecedent care was having few clinical encounters until shortly before PDAC diagnosis. Since the majority of patients diagnosed with PDAC do not have an antecedent PDAC signal, early-detection strategies limited to these groups may not apply to the majority of cases.

5 Article Cystic pancreatic neuroendocrine tumors: outcomes of preoperative endosonography-guided fine needle aspiration, and recurrence during long-term follow-up. 2015

Ridtitid, Wiriyaporn / Halawi, Houssam / DeWitt, John M / Sherman, Stuart / LeBlanc, Julia / McHenry, Lee / Coté, Gregory A / Al-Haddad, Mohammad A. ·Indiana University School of Medicine, Indianapolis, Indiana, USA. · Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. ·Endoscopy · Pubmed #25763832.

ABSTRACT: BACKGROUND AND STUDY AIMS: The role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis and management of cystic pancreatic neuroendocrine tumors (PNETs) is unclear. We aimed to compare clinical/endosonographic characteristics of cystic with solid PNETs, determine diagnostic accuracy of preoperative EUS-FNA, and evaluate recurrence rates after resection. PATIENTS AND METHODS: All patients with cystic or solid PNET confirmed by EUS-FNA between 2000 and 2014 were identified. A matched case-control study compared 50 consecutive patients with cystic PNETs with 50 consecutive patients with solid PNETs, matched by gender and age at diagnosis of index cystic PNET. We compared clinical/endosonographic characteristics, assessed diagnostic accuracy of preoperative EUS-FNA for identifying malignancy, and analyzed tumor-free survival of patients with cystic and solid PNETs. RESULTS: Cystic PNETs tended to be larger than solid PNETs (mean 26.8 vs. 20.1 mm, P = 0.05), more frequently nonfunctional (96 % vs. 80 %, P = 0.03), and less frequently associated with multiple endocrine neoplasia type 1 (10 % vs. 28 %, P = 0.04). With surgical pathology as reference standard, EUS-FNA accuracies for malignancy of cystic and solid PNETs were 89.3 % and 90 %, respectively; cystic PNETs were less associated with metastatic adenopathy (22 % vs. 42 %, P = 0.03) and liver metastasis (0 % vs. 26 %, P < 0.001). Cystic fluid analysis (n = 13), showed benign cystic PNETs had low carcinoembryonic antigen (CEA), Ki-67 ≤ 2 %, and no loss of heterozygosity. Patients with cystic and solid PNETs had similar recurrence risk up to 5 years after complete resection. CONCLUSIONS: Cystic PNETs have distinct clinical and EUS characteristics, but were associated with less aggressive biological behavior compared with solid PNETs. EUS-FNA is accurate for determining malignant potential on preoperative evaluation. Despite complete resection, recurrence is observed up to 5 years following surgery.

6 Article TCGA data and patient-derived orthotopic xenografts highlight pancreatic cancer-associated angiogenesis. 2015

Gore, Jesse / Craven, Kelly E / Wilson, Julie L / Cote, Gregory A / Cheng, Monica / Nguyen, Hai V / Cramer, Harvey M / Sherman, Stuart / Korc, Murray. ·Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. · The Melvin and Bren Simon Cancer Center, and The Center for Pancreatic Cancer Research, Indianapolis, IN 46202, USA. · Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. · Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA. · Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. ·Oncotarget · Pubmed #25762644.

ABSTRACT: Pancreatic ductal adenocarcinomas (PDACs) overexpress pro-angiogenic factors but are not viewed as vascular. Using data from The Cancer Genome Atlas we demonstrate that a subset of PDACs exhibits a strong pro-angiogenic signature that includes 37 genes, such as HDAC9, that are overexpressed in PDAC arising in KRC mice, which express mutated Kras and lack RB. Moreover, patient-derived orthotopic xenografts can exhibit tumor angiogenesis, whereas conditioned media (CM) from KRC-derived pancreatic cancer cells (PCCs) enhance endothelial cell (EC) growth and migration, and activate canonical TGF-β signaling and STAT3. Inhibition of the type I TGF-β receptor with SB505124 does not alter endothelial activation in vitro, but decreases pro-angiogenic gene expression and suppresses angiogenesis in vivo. Conversely, STAT3 silencing or JAK1-2 inhibition with ruxolitinib blocks CM-enhanced EC proliferation. STAT3 disruption also suppresses endothelial HDAC9 and blocks CM-induced HDAC9 expression, whereas HDAC9 re-expression restores CM-enhanced endothelial proliferation. Moreover, ruxolitinib blocks mitogenic EC/PCC cross-talk, and suppresses endothelial p-STAT3 and HDAC9, and PDAC progression and angiogenesis in vivo, while markedly prolonging survival of KRC mice. Thus, targeting JAK1-2 with ruxolitinib blocks a final pathway that is common to multiple pro-angiogenic factors, suppresses EC-mediated PCC proliferation, and may be useful in PDACs with a strong pro-angiogenic signature.

7 Article A pilot study to develop a diagnostic test for pancreatic ductal adenocarcinoma based on differential expression of select miRNA in plasma and bile. 2014

Cote, Gregory A / Gore, A Jesse / McElyea, Samantha D / Heathers, Laura E / Xu, Huiping / Sherman, Stuart / Korc, Murray. ·Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA. · Department of Medicine, Division of Endocrinology, Biochemistry and Molecular Biology, and the Pancreatic Cancer Signature Center at the IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA. · Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA. ·Am J Gastroenterol · Pubmed #25350767.

ABSTRACT: OBJECTIVES: Accurate peripheral markers for the diagnosis of pancreatic ductal adenocarcinoma (PDAC) are lacking. We measured the differential expression of select microRNAs (miRNAs) in plasma and bile among patients with PDAC, chronic pancreatitis (CP), and controls. METHODS: We identified patients (n=215) with treatment-naive PDAC (n=77), CP with bile/pancreatic duct pathology (n=67), and controls (n=71) who had been prospectively enrolled in a Pancreatobiliary Biorepository at the time of endoscopic retrograde cholangiopancreatography or endoscopic ultrasound. Controls were patients with choledocholithiasis but normal pancreata. The sample was separated into training (n=95) and validation (n=120) cohorts to establish and then test the performance of PDAC Signature Panels in diagnosing PDAC. The training cohort (n=95) included age-matched patients with PDAC, CP, and controls. Panels were derived from the differential expression of 10 candidate miRNAs in plasma or bile. We selected miRNAs having excellent accuracy for inclusion in regression models. RESULTS: Using the training cohort, we confirmed the differential expression of 9/10 miRNAs in plasma (miR-10b, -30c, -106b, -132, -155, -181a, -181b, -196a, and -212) and 7/10 in bile (excluding miR-21, -132, and -181b). Of these, five (miR-10b, -155, -106b, -30c, and -212) had excellent accuracy for distinguishing PDAC. In the training and validation cohorts, the sensitivity/specificity for a PDAC Panel derived from plasma was 95/100% and 100/100%, respectively; in bile, these were 96/100% and 100/100%. CONCLUSIONS: Increased expression of miRNA-10b, -155, and -106b in plasma appears highly accurate in diagnosing PDAC. Additional studies are needed to confirm this Panel and explore its value as a prognostic test.

8 Article Improving the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration using microRNAs. 2014

Sina, Marsela / Coté, Gregory A / Korc, Murray. ·Indiana University School of Medicine, Indianapolis, Indiana and University Hospital Center Mother Theresa, Tirana, Albania. · Indiana University School of Medicine, Indianapolis, Indiana. ·Gastroenterology · Pubmed #25150790.

ABSTRACT: -- No abstract --

9 Article Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. 2014

Bellin, Melena D / Freeman, Martin L / Gelrud, Andres / Slivka, Adam / Clavel, Alfred / Humar, Abhinav / Schwarzenberg, Sarah J / Lowe, Mark E / Rickels, Michael R / Whitcomb, David C / Matthews, Jeffrey B / Anonymous9700785 / Amann, Stephen / Andersen, Dana K / Anderson, Michelle A / Baillie, John / Block, Geoffrey / Brand, Randall / Chari, Suresh / Cook, Marie / Cote, Gregory A / Dunn, Ty / Frulloni, Luca / Greer, Julia B / Hollingsworth, Michael A / Kim, Kyung Mo / Larson, Alexander / Lerch, Markus M / Lin, Tom / Muniraj, Thiruvengadam / Robertson, R Paul / Sclair, Seth / Singh, Shalinender / Stopczynski, Rachelle / Toledo, Frederico G S / Wilcox, Charles Melbern / Windsor, John / Yadav, Dhiraj. ·Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. Electronic address: bell0130@umn.edu. · Department of Medicine, University of Minnesota, Minneapolis, MN, USA. · Department of Medicine, University of Chicago, Chicago, IL, USA. · Department of Medicine, University of Pittsburgh, PA, USA. · Department of Neurology, University of Minnesota, Minneapolis, MN, USA. · Department of Surgery, University of Pittsburgh, PA, USA. · Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. · Department of Pediatrics, University of Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, PA, USA. · Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. · Department of Medicine, University of Pittsburgh, PA, USA. Electronic address: whitcomb@pitt.edu. · Department of Surgery, University of Chicago, Chicago, IL, USA. ·Pancreatology · Pubmed #24555976.

ABSTRACT: DESCRIPTION: Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical procedure used to treat severe complications of chronic pancreatitis or very high risk of pancreatic cancer while reducing the risk of severe diabetes mellitus. However, clear guidance on indications, contraindications, evaluation, timing, and follow-up are lacking. METHODS: A working group reviewed the medical, psychological, and surgical options and supporting literature related to TPIAT for a consensus meeting during PancreasFest. RESULTS: Five major areas requiring clinical evaluation and management were addressed: These included: 1) indications for TPIAT; 2) contraindications for TPIAT; 3) optimal timing of the procedure; 4) need for a multi-disciplinary team and the roles of the members; 5) life-long management issues following TPIAP including diabetes monitoring and nutrition evaluation. CONCLUSIONS: TPIAT is an effective method of managing the disabling complications of chronic pancreatitis and risk of pancreatic cancer in very high risk patients. Careful evaluation and long-term management of candidate patients by qualified multidisciplinary teams is required. Multiple recommendations for further research were also identified.

10 Article Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up. 2014

Ridtitid, Wiriyaporn / Tan, Damien / Schmidt, Suzette E / Fogel, Evan L / McHenry, Lee / Watkins, James L / Lehman, Glen A / Sherman, Stuart / Coté, Gregory A. ·Indiana University School of Medicine, Indianapolis, Indiana, USA; Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. · Indiana University School of Medicine, Indianapolis, Indiana, USA. ·Gastrointest Endosc · Pubmed #24094466.

ABSTRACT: BACKGROUND: Endoscopic papillectomy is increasingly used as an alternative to surgery for ampullary adenomas and other noninvasive ampullary lesions. OBJECTIVE: To measure short-term safety and efficacy of endoscopic papillectomy, define patient and lesion characteristics associated with incomplete endoscopic resection, and measure adenoma recurrence rates during long-term follow-up. DESIGN: Retrospective cohort study. SETTING: Tertiary-care academic medical center. PATIENTS: All patients who underwent endoscopic papillectomy for ampullary lesions between July 1995 and June 2012. INTERVENTION: Endoscopic papillectomy. MAIN OUTCOME MEASUREMENTS: Patient and lesion characteristics associated with incomplete endoscopic resection and ampullary adenoma-free survival analysis. RESULTS: We identified 182 patients who underwent endoscopic papillectomy, 134 (73.6%) having complete resection. Short-term adverse events occurred in 34 (18.7%). Risk factors for incomplete resection were jaundice at presentation (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.07-0.69; P = .009), occult adenocarcinoma (OR 0.06; 95% CI, 0.01-0.36; P = .002), and intraductal involvement (OR 0.29; 95% CI, 0.11-0.75; P = .011). The en bloc resection technique was strongly associated with a higher rate of complete resection (OR 4.05; 95% CI, 1.71-9.59; P = .001). Among patients with ampullary adenoma who had complete resection (n = 107), 16 patients (15%) developed recurrence up to 65 months after resection. LIMITATIONS: Retrospective analysis. CONCLUSION: Jaundice at presentation, occult adenocarcinoma in the resected specimen, and intraductal involvement are associated with a lower rate of complete resection, whereas en bloc papillectomy increases the odds of complete endoscopic resection. Despite complete resection, recurrence was observed up to 5 years after papillectomy, confirming the need for long-term surveillance.

11 Article Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts. 2014

Al-Haddad, Mohammad / DeWitt, John / Sherman, Stuart / Schmidt, C Max / LeBlanc, Julia K / McHenry, Lee / Coté, Gregory / El Chafic, Abdul Hamid / Luz, Leticia / Stuart, Jennifer Schaffter / Johnson, Cynthia S / Klochan, Christen / Imperiale, Thomas F. ·Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA. · Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA. · Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA. ·Gastrointest Endosc · Pubmed #23845445.

ABSTRACT: BACKGROUND: Diagnosis of mucinous pancreatic cysts (MPCs) is challenging due to the poor sensitivity of cytology provided by EUS-guided-FNA (EUS-FNA). OBJECTIVE: To quantify the test characteristics of molecular (DNA) analysis in suspected low-risk MPCs. DESIGN: A prospective cohort study performed in between 2008 and 2011. SETTING: Academic referral center. PATIENTS: Consecutive patients who underwent EUS-FNA of suspected MPCs. INTERVENTION: EUS-FNA and molecular (DNA) analysis of cyst fluid. MAIN OUTCOME MEASUREMENTS: The sensitivity and specificity of molecular analysis in the diagnosis of MPCs using the criterion standard of surgical pathology in resected cysts. RESULTS: Patients with suspected MPCs underwent EUS-FNA and cyst fluid DNA analysis. Surgical resection was performed in 48 patients (17%), confirming a mucinous pathology in 38 (79%). In this group, molecular analysis had a sensitivity of 50% and a specificity of 80% in identifying MPCs (accuracy of 56.3%). The combination of molecular analysis with cyst fluid carcinoembryonic antigen (CEA) and cytology resulted in higher MPC diagnostic performance than either one of its individual components, with a sensitivity, specificity, and accuracy of 73.7%, 70%, and 72.9%, respectively. There was no significant difference in accuracy between molecular analysis and CEA/cytology in this group. LIMITATIONS: Single-center experience. CONCLUSION: Molecular analysis aids in the diagnosis of MPCs when cytology is nondiagnostic or cyst fluid is insufficient for CEA or its level is indeterminate. Our results do not support the routine use of molecular analysis, which should be used selectively after review of imaging findings and cyst fluid studies. Further studies are needed to assess DNA's performance in malignant cysts.

12 Article Use of diffusion-weighted MRI to differentiate chronic pancreatitis from pancreatic cancer. 2013

Sandrasegaran, Kumaresan / Nutakki, Kavitha / Tahir, Bilal / Dhanabal, Aginiprakash / Tann, Mark / Cote, Gregory A. ·1 Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN, 46202. ·AJR Am J Roentgenol · Pubmed #24147470.

ABSTRACT: OBJECTIVE: The purpose of this study was to compare diffusion-weighted MRI (DWI) and conventional (non-DWI) MRI sequences in differentiating mass-forming chronic pancreatitis from pancreatic cancer. MATERIALS AND METHODS: A retrospective cohort study included 36 patients who underwent pancreatic resection for pancreatic cancer (n = 13) and chronic pancreatitis (n = 23) after preoperative MRI with DWI. Two independent reviewers assessed the DW images for signal intensity and apparent diffusion coefficient (ADC) values. Four weeks later, they reviewed the other MR images for size of mass, double-duct sign, pancreatic duct cutoff, and perivascular soft-tissue cuffing. A score for conventional MRI was given with 1 meaning definitely benign and 5 meaning definitely malignant. Univariate and multivariate analyses and receiver operating characteristic (ROC) curve analysis were performed with surgical pathologic examination as the reference standard. RESULTS: The only finding that differentiated the two groups was the presence of a well-defined mass, favoring the diagnosis of cancer (p = 0.02, p < 0.01). There was no significant difference between the two groups in signal intensity on DW images (p = 0.82, p = 0.85) or ADC (p = 0.51, p = 0.76). Double-duct sign, pancreatic duct cutoff, and perivascular soft-tissue cuffing were not useful in differentiating the two groups. The areas under the ROC curve were 0.873 and 0.878 for the conventional MRI scores, compared with 0.602 and 0.552 for ADC measurements (p = 0.02, p = 0.008). CONCLUSION: The addition of DWI to conventional MRI does not facilitate differentiation of pancreatic cancer from chronic pancreatitis.

13 Article Endoscopic ultrasound-guided biopsy of pancreatic metastases: a large single-center experience. 2013

El Hajj, Ihab I / LeBlanc, Julia K / Sherman, Stuart / Al-Haddad, Mohammad A / Cote, Gregory A / McHenry, Lee / DeWitt, John M. ·Division of Gastroenterology and Hepatology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA. ·Pancreas · Pubmed #23146924.

ABSTRACT: OBJECTIVES: This study aimed to describe a single-center experience with endoscopic ultrasound (EUS) features as well as the diagnostic role and clinical impact of EUS-guided fine-needle aspiration (EUS-FNA) and Trucut biopsy (EUS-TCB) in patients with pancreatic metastases. METHODS: Demographic, clinical, EUS, pathological, clinical outcome, and follow-up data of patients who underwent EUS at our institution between October 1998 and March 2010 for a known or suspected pancreatic metastasis were abstracted. RESULTS: Forty-nine patients (23 males; median age, 63 years; range 30-83 years) with 72 pancreatic masses were identified. Primary tumor sites included kidney (21), lung (8), skin (6), colon (4), breast (3), small bowel (2), stomach (2), liver (1), ovary (1), and bladder (1). Of the 72 pancreatic lesions, EUS-FNA of 49 was performed (median, 4.1 passes; range, 2-9 passes) without complications. An EUS-TCB after EUS-FNA was performed in 2 patients and confirmed renal cell carcinoma in one and was nondiagnostic in one. The EUS-FNA provided the first diagnosis of "recurrent malignancy" in all the 44 patients at a median time of 65 months (range, 1-348 months) after diagnosis of the primary tumor. CONCLUSIONS: Endoscopic ultrasound-FNA and EUS-TCB may assist with the cytological diagnosis of pancreatic metastases and may have a major clinical impact.

14 Article Outcomes after preoperative endoscopic ultrasonography and biopsy in patients undergoing distal pancreatectomy. 2011

Beane, Joal D / House, Michael G / Coté, Gregory A / DeWitt, John M / Al-Haddad, Mohammad / LeBlanc, Julia K / McHenry, Lee / Sherman, Stuart / Schmidt, C Max / Zyromski, Nicholas J / Nakeeb, Attila / Pitt, Henry A / Lillemoe, Keith D. ·Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA. ·Surgery · Pubmed #22000199.

ABSTRACT: BACKGROUND: This retrospective cohort study analyzes the potential risks associated with preoperative fine needle aspiration (FNA) biopsy guided by endoscopic ultrasonography (EUS) in patients undergoing distal pancreatectomy. METHODS: Excluding 204 patients with acute or chronic pancreatitis and those with previous pancreatic resections, 230 consecutive patients with primary pancreatic neoplasms underwent elective distal pancreatectomy between 2002 and 2009. The most common indications were adenocarcinoma (28%), intraductal papillary mucinous neoplasm (IPMN; 20%), and endocrine neoplasms (17%). Two-way statistical comparisons were performed between patients who did (EUS(+)) or did not (EUS(-)) undergo preoperative EUS-FNA. RESULTS: Distal pancreatectomy was performed open in 118 patients (56%) and laparoscopically in 102 patients (44%). No differences were observed in age, sex, American Society of Anesthesiologists class, operative time, or blood loss between the EUS(+) (n = 179) and EUS(-) (n = 51) groups. Splenectomy was performed in 162 patients (70%) and was more common in the EUS(+) group. With the exception of adenocarcinoma (n = 57 [32%] EUS(+) vs n = 6 [12%] EUS(-); P < .01), the final pathologic diagnosis did not differ significantly between the EUS groups. Postoperative complications were more common in the EUS(+) patients with cystic neoplasms (43% vs 16% EUS(-); P = .04). EUS-FNA caused pancreatitis in 2 patients preoperatively. No differences in overall or recurrence-free survival were noted between cancer patients in the EUS groups. Patterns of tumor recurrence were not associated with EUS-FNA. CONCLUSION: Preoperative EUS-FNA is not associated with adverse perioperative or long-term outcomes in patients undergoing distal pancreatectomy for solid neoplasms of the pancreas. The potentially detrimental long-term impact of preoperative EUS-FNA in patients with resectable pancreatic adenocarcinoma was not observed, but will require additional study.

15 Article EUS-guided FNA of local recurrence of pancreatic cancer after surgical resection. 2010

DeWitt, John / Sherman, Stuart / Al-Haddad, Mohammad / McHenry, Lee / Cote, Gregory A / Leblanc, Julia K. ·Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA. ·Gastrointest Endosc · Pubmed #20869713.

ABSTRACT: BACKGROUND: EUS-guided FNA (EUS-FNA) is a sensitive test for the preoperative diagnosis of pancreatic cancer. Its use for diagnosing local tumor recurrence after surgical resection has not been described. OBJECTIVE: To determine the sensitivity of EUS-FNA for this indication. DESIGN: Retrospective cohort study. SETTING: Tertiary referral hospital in the United States. PATIENTS: Consecutive patients referred for EUS with clinical and/or radiographic suspicion of pancreatic cancer recurrence. INTERVENTIONS: EUS ± FNA of retroperitoneal mass. MAIN OUTCOME MEASUREMENT: Sensitivity of EUS-FNA. RESULTS: Seventeen patients (9 male, median age 71 years) underwent EUS at a median of 17 months (range 7-46 months) after a classic Whipple procedure (n = 7), pylorus-sparing Whipple procedure (n = 7), or distal pancreatectomy (n = 3) for suspected local recurrence of pancreatic cancer. The primary tumor (median size 2.5 cm, range 1.5-7.9 cm) was located in the head in 14 patients, the body in 1, and the tail in 2. Final surgical margins at any site were positive in only 1 of 17 patients (+ retroperitoneal margin). At the time of suspected recurrence, 4 patients (24%) were asymptomatic. EUS disclosed a mass (median size 21 mm, range 12-30 mm) in 16 of 17 patients (94%). Transgastric EUS-FNA (n = 16, median 4.5 passes, range 2-10) disclosed recurrent malignancy in 13 of 16 (79%), atypical cells in 1 of 16 (7%), and benign cytology in 2 of 16 (14%). Subsequent radiographic evidence of increasing tumor burden was seen in 1 of 2 patients with benign cytology; however, follow-up for the 2 other patients with benign biopsy specimens was not available. Depending on the status of the 2 patients without available follow-up, the sensitivity, specificity, and accuracy of EUS-FNA for the diagnosis of recurrent cancer ranged from 81% to 93%, was 100%, and ranged from 81% to 93%, respectively. LIMITATIONS: Small, single-center retrospective cohort. CONCLUSIONS: EUS-FNA is sensitive for the diagnosis of retroperitoneal recurrence of pancreatic cancer after surgical resection.

16 Article Risk of post-ERCP pancreatitis with placement of self-expandable metallic stents. 2010

Coté, Gregory A / Kumar, Nitin / Ansstas, Michael / Edmundowicz, Steven A / Jonnalagadda, Sreenivasa / Mullady, Daniel K / Azar, Riad R. ·Division of Gastroenterology, Washington University, St Louis School of Medicine, St Louis, Missouri, USA. gcote@iupui.edu ·Gastrointest Endosc · Pubmed #20630513.

ABSTRACT: BACKGROUND: There are conflicting data on the risk of post-ERCP pancreatitis (PEP) related to self-expandable metallic stents (SEMSs). OBJECTIVE: To compare rates of PEP in patients who undergo biliary drainage with SEMSs or polyethylene stents (PSs). DESIGN: Retrospective, cohort study. SETTING: Tertiary-care medical center. PATIENTS: This study involved patients undergoing ERCP for malignant biliary obstruction between January 2005 and October 2008. INTERVENTION: First-time placement of a SEMS or PS for biliary decompression. MAIN OUTCOME MEASUREMENTS: Early post-ERCP complications, particularly PEP. RESULTS: We identified 544 eligible patients, 248 SEMSs (102 covered), and 296 PSs. The etiology of malignant biliary obstruction was similar between groups, with 55% from pancreatic cancer. The frequency of PEP was significantly higher in the SEMS group (7.3%) versus the PS group (1.3%) (OR 5.7 [95% CI, 1.9-17.1]). On univariate analysis, patient age of <40 years, a history of PEP, and at least 1 pancreatic duct injection were also significant predictors of PEP, whereas female sex and having pancreatic cancer were not. When significant variables were added to a multiple-predictor regression model, the odds of PEP from SEMS placement increased to 6.8 (95% CI, 2.2, 21.4). However, the frequency of PEP was similar between covered (6.9%) and uncovered (7.5%) SEMSs (OR 0.9 [CI, 0.3-2.4]). Purported SEMS-specific risk factors, including the use of cSEMSs, overlapping SEMSs, or having a biliary sphincterotomy were not found to be significant contributors to the higher risk. LIMITATIONS: Retrospective design. CONCLUSION: After we controlled for confounding variables, the frequency of PEP was significantly higher with placement of a SEMS compared with a PS. Rates of PEP were comparable with use of covered and uncovered SEMSs.

17 Minor Response to Le Large et al. 2015

Cote, Gregory A / Gore, A Jesse / McElyea, Samantha D / Xu, Huiping / Sherman, Stuart / Korc, Murray. ·Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA. · Departments of Medicine, Division of Endocrinology, and Biochemistry and Molecular Biology, and the Pancreatic Cancer Signature Center at the IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA. · Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA. ·Am J Gastroenterol · Pubmed #25942303.

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