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Pancreatic Neoplasms: HELP
Articles by Felicity T. Enders
Based on 5 articles published since 2010
(Why 5 articles?)
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Between 2010 and 2020, Felicity Enders wrote the following 5 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Clinical Trial Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: an international multicentre study. 2011

Sugumar, Aravind / Levy, Michael J / Kamisawa, Terumi / Webster, G J / Kim, Myung-Hwan / Enders, Felicity / Amin, Zahir / Baron, Todd H / Chapman, Mike H / Church, Nicholas I / Clain, Jonathan E / Egawa, Naoto / Johnson, Gavin J / Okazaki, Kazuichi / Pearson, Randall K / Pereira, Stephen P / Petersen, Bret T / Read, Samantha / Sah, Raghuwansh P / Sandanayake, Neomal S / Takahashi, Naoki / Topazian, Mark D / Uchida, Kazushige / Vege, Santhi Swaroop / Chari, Suresh T. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. ·Gut · Pubmed #21131631.

ABSTRACT: BACKGROUND: Characteristic pancreatic duct changes on endoscopic retrograde pancreatography (ERP) have been described in autoimmune pancreatitis (AIP). The performance characteristics of ERP to diagnose AIP were determined. METHODS: The study was done in two phases. In phase I, 21 physicians from four centres in Asia, Europe and the USA, unaware of the clinical data or diagnoses, reviewed 40 preselected ERPs of patients with AIP (n=20), chronic pancreatitis (n=10) and pancreatic cancer (n=10). Physicians noted the presence or absence of key pancreatographic features and ranked the diagnostic possibilities. For phase II, a teaching module was created based on features found most useful in the diagnosis of AIP by the four best performing physicians in phase I. After a washout period of 3 months, all physicians reviewed the teaching module and reanalysed the same set of ERPs, unaware of their performance in phase I. RESULTS: In phase I the sensitivity, specificity and interobserver agreement of ERP alone to diagnose AIP were 44, 92 and 0.23, respectively. The four key features of AIP identified in phase I were (i) long (>1/3 the length of the pancreatic duct) stricture; (ii) lack of upstream dilatation from the stricture (<5 mm); (iii) multiple strictures; and (iv) side branches arising from a strictured segment. In phase II the sensitivity (71%) of ERP significantly improved (p<0.05) without a significant decline in specificity (83%) (p>0.05); the interobserver agreement was fair (0.40). CONCLUSIONS: The ability to diagnose AIP based on ERP features alone is limited but can be improved with knowledge of some key features.

2 Article Risk of Pancreatic Cancer in Patients With Pancreatic Cysts and Family History of Pancreatic Cancer. 2018

Mukewar, Saurabh S / Sharma, Ayush / Phillip, Nissy / Gupta, Ridhi / Aryal-Khanal, Anupama / de Pretis, Nicolo / Anani, Vincent / Enders, Felicity T / Larson, Joseph J / Takahashi, Naoki / Levy, Michael J / Topazian, Mark / Pearson, Randall K / Vege, Santhi S / Chari, Suresh T. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. · Department of Hematology and Oncology, Stanford University, Palo Alto, California. · Division of Epidemiology, Mayo Clinic, Rochester, Minnesota. · Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. · Department of Radiology, Mayo Clinic, Rochester, Minnesota. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: surest1@gmail.com. ·Clin Gastroenterol Hepatol · Pubmed #29425780.

ABSTRACT: BACKGROUND & AIMS: A diagnosis of pancreatic cancer in a first-degree relative increases an individuals' risk of this cancer. However, it is not clear whether this cancer risk increases in individuals with pancreatic cystic lesions who have a first-degree relative with pancreatic cancer. The Fukuoka criteria are used to estimate risk of pancreatic cancer for patients with pancreatic cystic lesions: individuals with cysts with high risk or worrisome features (Fukuoka positive) have a higher risk of pancreatic cancer than individuals without these features (Fukuoka negative). We aimed to compare the risk of pancreatic cancer and surgery based on presence or absence of pancreatic cystic lesions and a first-degree relative with pancreatic cancer. METHODS: We performed a retrospective study of patients seen at the Mayo Clinic in Rochester, Minnesota, from January 1, 2000, through December 31, 2012. We identified individuals with: pancreatic cystic lesions and first-degree relative with pancreatic cancer (group 1, n = 269), individuals with pancreatic cystic lesions but no first-degree relative with pancreatic cancer (group 2, n = 1195), and individuals without pancreatic cystic lesions but with a first-degree relative with pancreatic cancer (group 3, n = 720). We compared, among groups, as well among patients with cysts classified according to Fukuoka criteria, proportions of individuals who developed pancreatic cancer or underwent pancreatic surgery within a 5-year period. RESULTS: A significantly higher proportion of individuals in group 1 developed pancreatic cancer during the 5-year period than in group 3 (6.64% vs 1.69%; P = .03); there was no significant difference between the percentage of individuals in group 1 vs group 2 who developed pancreatic cancer (6.64% vs 4.05%; P = .41). There was no significant difference in pancreatic cancer development among individuals with Fukuoka-positive cysts with vs without a family history of pancreatic cancer (P = .39). There was no significant difference in the proportion of patients in group 1 vs group 2 who underwent pancreatic surgery for their pancreatic cyst over the 5-year period (14.37% vs 11.80%; P = .59). Among patients with Fukuoka-negative cysts, a significantly higher proportion underwent surgery in group 1 than in group 2 (10.90% vs 5.90%; P = .03). However, among patients with Fukuoka-positive cysts, there was no difference in proportions of patients who underwent surgery between groups 1 and 2 (P = .66). CONCLUSIONS: In a retrospective study of patients with pancreatic cysts and/or cancer, we found that a family history of pancreatic cancer does not affect 5-year risk of pancreatic cancer in patients with pancreatic cystic lesions. Despite this, among patients with Fukuoka-negative cysts, a higher proportion of those with a family history of pancreatic cancer undergo surgery than patients without family history of pancreatic cancer.

3 Article Fukuoka criteria accurately predict risk for adverse outcomes during follow-up of pancreatic cysts presumed to be intraductal papillary mucinous neoplasms. 2017

Mukewar, Saurabh / de Pretis, Nicolo / Aryal-Khanal, Anupama / Ahmed, Nazir / Sah, Raghuwansh / Enders, Felicity / Larson, Joseph J / Levy, Michael J / Takahashi, Naoki / Topazian, Mark / Pearson, Randall / Vege, Santhi S / Chari, Suresh T. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA. · Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. ·Gut · Pubmed #27390303.

ABSTRACT: OBJECTIVE: Fukuoka consensus guidelines classify pancreatic cystic lesions (PCLs) presumed to be intraductal papillary mucinous neoplasms (IPMNs) into Fukuoka positive (FP) (subgroups of high-risk (HR) and worrisome features (WFs)) and Fukuoka negative (FN) (non-HR feature/WF cysts). We retrospectively estimated 5-year risk of pancreatic cancer (PC) in FN, WF and HR cysts of patients with PCL-IPMN. DESIGN: From Mayo Clinic databases, we randomly selected 2000 patients reported to have a PCL; we excluded inflammatory or suspected non-IPMN cysts and those without imaging follow-up. We re-reviewed cross-sectional imaging and abstracted clinical and follow-up data on PCL-IPMNs. The study contained 802 patients with FN cysts and 358 with FP cysts. RESULTS: Patients with PCL-IPMN had median (IQR) follow-up of 4.2 (1.8-7.1) years. Among FN cysts, 5-year PC risk was low (2-3%) regardless of cyst size (p=0.67). After excluding events in the first 6 months, 5-year PC risk remained low (0-2%) regardless of cyst size (p=0.61). Among FP cysts, HR cysts (n=66) had greater 5-year PC risk than WF cysts (n=292) (49.7% vs 4.1%; p<0.001). In HR cysts, 3-year PC risk was greatest for obstructive jaundice versus enhancing solid component or main pancreatic duct >10 mm (79.8% vs 37.3% vs 39.4%, respectively; p=0.01). CONCLUSIONS: Fukuoka guidelines accurately stratify PCL-IPMNs for PC risk, with FN cysts having lowest and HR cysts having greatest risk. After 6-month follow-up, WF and FN cysts had a low 5-year PC risk. Surveillance strategies should be tailored appropriately.

4 Article Pancreatic cyst epithelial denudation: a natural phenomenon in the absence of treatment. 2016

Gómez, Victoria / Majumder, Shounak / Smyrk, Thomas C / Topazian, Mark D / Chari, Suresh T / Gleeson, Ferga C / Harmsen, William S / Enders, Felicity T / Abu Dayyeh, Barham K / Iyer, Prasad G / Pearson, Randall K / Petersen, Bret T / Rajan, Elizabeth / Takahashi, Naoki / Vege, Santhi S / Wang, Kenneth K / Levy, Michael J. ·Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA; Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA. · Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA. · Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA. · Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA. · Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. ·Gastrointest Endosc · Pubmed #27060714.

ABSTRACT: BACKGROUND AND AIMS: The presence and significance of epithelial denudation among treatment-naïve pancreatic cystic lesions (PCLs) remain undetermined. The aims of this study were to determine the prevalence, extent, and predictors of epithelial denudation in treatment-naïve PCLs. METHODS: Single-center retrospective study including patients who underwent EUS preceded by cross-sectional imaging and who subsequently underwent surgical resection of treatment-naïve PCLs. Surgically resected PCLs were reviewed by a pathologist in a fashion that allowed evaluation from evenly distributed regions of the cyst. RESULTS: A total of 140 patients were identified (60% female, mean age 63 years). Eighty-five cysts (60.7%) were classified as intraductal papillary mucinous neoplasms (IPMNs), 33 (23.5%) as main duct IPMNs (m-IPMNs), 11 (7.9%) as serous cystadenomas (SCAs), and 11 (7.9%) were composed of other cyst subtypes. A greater extent of epithelial denudation was seen in mucinous cystic neoplasm (MCN) compared with IPMN and SCA (mean percentage of denuded epithelium 45.1%, 10.8%, and 22.4%, respectively [P < .0001]). An association existed between the extent of denuded epithelium and degree of cyst epithelial dysplasia for IPMN and MCN combined (mean percentage of denuded epithelium for low-, moderate-, and high-grade dysplasia being 23.3%, 4.5%, and 1.2%, respectively; P = .02). PCLs resected from the neck and/or body and/or tail of the pancreas were associated with a greater extent of mean percentage of denuded epithelium than PCLs resected from the head and/or uncinate of the pancreas (23.9% vs 13.4%; P = .035). CONCLUSIONS: The presence and extent of cyst epithelial denudation of treatment-naïve PCLs vary with cyst histology and other factors. The observation of denudation after intracystic ablative therapy may not provide an adequate metric of successful intervention. Further studies are needed to validate these findings.

5 Article The string sign for diagnosis of mucinous pancreatic cysts. 2015

Bick, Benjamin L / Enders, Felicity T / Levy, Michael J / Zhang, Lizhi / Henry, Michael R / Abu Dayyeh, Barham K / Chari, Suresh T / Clain, Jonathan E / Farnell, Michael B / Gleeson, Ferga C / Kendrick, Michael L / Pearson, Randall K / Petersen, Bret T / Rajan, Elizabeth / Vege, Santhi Swaroop / Topazian, Mark. ·Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States. · Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States. · Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, United States. · Department of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota, United States. ·Endoscopy · Pubmed #25730281.

ABSTRACT: BACKGROUND AND STUDY AIMS: Pancreas cyst fluid analysis does not provide optimal discrimination between mucinous and nonmucinous cysts. The aim of this study was to assess the performance characteristics of the "string sign" - a test performed at the time of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), for the diagnosis of mucinous pancreatic cysts (branch duct intraductal papillary mucinous neoplasms [bIPMN] and mucinous cystic neoplasms). PATIENTS AND METHODS: Patients undergoing EUS-FNA of pancreatic cystic lesions at one referral center between 2003 and 2012 were included. The string sign was performed prospectively, and was considered positive if ≥ 1 cm string formed in cyst fluid and lasted for ≥ 1 second. Performance characteristics of the string sign and a sequential cyst fluid test interpretation model were assessed. RESULTS: For 98 histologically proven cases, the sensitivity, specificity, positive predictive value, and negative predictive value of the string sign for diagnosis of mucinous cysts were 58 % (95 % confidence interval [CI] 44 % - 70 %), 95 % (83 % - 99 %), 94 % (81 % - 99 %), and 60 % (46 % - 72 %), respectively. When string sign results and carcinoembryonic antigen (CEA) concentration (≥ 200 ng/mL) were combined, diagnostic accuracy improved from 74 % and 83 %, respectively, to 89 % (P ≤ 0.03). Among bIPMN, a positive string sign was associated with gastric and intestinal epithelial subtypes. The sequential cyst fluid test interpretation model (including cytology, mucin stain, CEA, and string sign) yielded an overall sensitivity for mucinous lesions of 96 %, with a specificity of 90 %. CONCLUSIONS: The string sign is highly specific for diagnosis of mucinous pancreatic cysts, and improves overall diagnostic accuracy of pancreatic cyst fluid analysis. Sequential cyst fluid test interpretation yields high diagnostic sensitivity and specificity for mucinous cysts.