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Pancreatic Neoplasms: HELP
Articles by Luca Frulloni
Based on 22 articles published since 2010
(Why 22 articles?)
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Between 2010 and 2020, L. Frulloni wrote the following 22 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. 2014

Anonymous4770793 / Anonymous4780793 / Buscarini, Elisabetta / Pezzilli, Raffaele / Cannizzaro, Renato / De Angelis, Claudio / Gion, Massimo / Morana, Giovanni / Zamboni, Giuseppe / Arcidiacono, Paolo / Balzano, Gianpaolo / Barresi, Luca / Basso, Daniela / Bocus, Paolo / Calculli, Lucia / Capurso, Gabriele / Canzonieri, Vincenzo / Casadei, Riccardo / Crippa, Stefano / D'Onofrio, Mirko / Frulloni, Luca / Fusaroli, Pietro / Manfredi, Guido / Pacchioni, Donatella / Pasquali, Claudio / Rocca, Rodolfo / Ventrucci, Maurizio / Venturini, Silvia / Villanacci, Vincenzo / Zerbi, Alessandro / Falconi, Massimo / Anonymous4790793. ·Gastroenterology Unit, Maggiore Hospital, Crema, Italy. Electronic address: ebuscarini@rim.it. · Pancreas Unit, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy. · Gastroenterology Unit, CRO-National Cancer Institute, Aviano, Italy. · Gastroenterology and Hepatology Department, A.O. San Giovanni Battista/Molinette, University of Turin, Turin, Italy. · Department of Clinical Pathology, AULSS 12, Venice, Italy. · Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy. · Department of Pathology, University of Verona, Verona, Italy. · Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute, Italy. · Department of Surgery, San Raffaele Scientific Institute, Milan, Italy. · Gastroenterology and Endoscopy Unit, ISMETT, Palermo, Italy. · Department of Laboratory Medicine, University Hospital, Padua, Italy. · Gastroenterology Unit, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy. · Department of Radiology, S. Orsola-Malpighi Hospital, Bologna, Italy. · Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, Sapienza University of Rome at S. Andrea Hospital, Rome, Italy. · Division of Pathology, CRO-National Cancer Institute, IRCCS, Aviano, Italy. · Department of Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. · Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy. · Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy. · Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy. · Department of Clinical Medicine, University of Bologna, Bologna, Italy. · Gastroenterology Unit, Maggiore Hospital, Crema, Italy. · Pathology Unit, A.O. San Giovanni Battista/Molinette, Turin, Italy. · Surgery Unit IV, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy. · Gastroenterology Unit, Mauriziano Hospital, Turin, Italy. · Department of Internal Medicine and Gastroenterology, Bentivoglio Hospital, Bologna, Italy. · 2nd Pathology Section, Spedali Civili, Brescia, Brescia, Italy. · Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Milan, Italy. ·Dig Liver Dis · Pubmed #24809235.

ABSTRACT: This report contains clinically oriented guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms in patients fit for treatment. The statements were elaborated by working groups of experts by searching and analysing the literature, and then underwent a consensus process using a modified Delphi procedure. The statements report recommendations regarding the most appropriate use and timing of various imaging techniques and of endoscopic ultrasound, the role of circulating and intracystic markers and the pathologic evaluation for the diagnosis and follow-up of cystic pancreatic neoplasms.

2 Review Alcohol-related chronic exocrine pancreatic insufficiency: diagnosis and therapeutic management. A proposal for treatment by the Italian Association for the Study of the Pancreas (AISP) and the Italian Society of Alcohology (SIA). 2019

Pezzilli, Raffaele / Caputo, Fabio / Testino, Gianni / Patussi, Valentino / Greco, Giovanni / Macciò, Livia / Rossin, Maria Raffaella / Mioni, Davide / Balbinot, Patrizia / Gandin, Claudia / Zanesini, Francesca / Frulloni, Luca / Aricò, Sarino / Bottaro, Luigi C / Pellicano, Rinaldo / Scafato, Emanuele / Anonymous3420985. ·Pancreas Unit, Department of Gastroenterology, Polyclinic of Sant'Orsola, Bologna, Italy - raffaele.pezzilli@aosp.bo.it. · Italian Association for the Study of the Pancreas, Rome, Italy - raffaele.pezzilli@aosp.bo.it. · Department of Internal Medicine, SS. Annunziata Hospital, Cento, Ferrara, Italy. · G. Fontana Center for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. · Regional Alcohol Center of Liguria Region, ASL3, San Martino Hospital, Genoa, Italy. · Department of Alcohology, Hospital of Florence, Florence, Italy. · Department of Mental Health and Pathological Dependency, AUSL Romagna, SerT Ravenna, Ravenna, Italy. · Alcohol Unit, ASL2 Savonese, Savona, Italy. · ASST Fatebenefratelli, Sacco Hospital, Milan, Italy. · Casa di Cura Parco dei Tigli, Villa Di Teolo, Padua, Italy. · National Observatory on Alcohol, National Institute of Health, Rome, Italy. · Private Practitioner, Genoa, Italy. · Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy. · Unit of Gastroenterology, Mauriziano Hospital, Turin, Italy. · ASL 3 Genovese, Genoa, Italy. · Unit of Gastroenterology, Molinette Hospital, Turin, Italy. ·Minerva Med · Pubmed #30938130.

ABSTRACT: Current estimates of the prevalence of chronic pancreatitis, one of the most common causes of exocrine pancreatic insufficiency, are in the range of 3-10 per 100,000 people in many parts of the world. Alcohol consumption is a very important risk factor for exocrine pancreatic insufficiency and is involved in nearly half of all cases. The main hypothesis regarding the role of chronic alcohol consumption in pancreatitis is that there must be additional environmental or genetic risk factors involved for ongoing damage to occur. Treatment of patients with alcohol-related exocrine pancreatic insufficiency is complex, as the patient has two concomitant pathologies, alcohol-use disorder (AUD) and exocrine pancreatic insufficiency/chronic pancreatitis. Alcohol abstinence is the starting point for treatment, although even this along with the most advanced therapies allow only a slowdown in progression rather than restoration of function. This position paper of the Italian Association for the Study of the Pancreas and the Italian Society of Alcohology provides an overview of the pathogenesis of alcohol-related pancreatitis and discuss diagnostic issues. Treatment options for both exocrine pancreatic insufficiency/chronic pancreatitis (with a focus on pancreatic enzyme replacement therapy) and AUD (acamprosate, disulfiram, oral naltrexone, long-acting injectable naltrexone, sodium oxybate, nalmefene, baclofen, and psychosocial interventions) are also reviewed.

3 Article Residual pancreatic function after pancreaticoduodenectomy is better preserved with pancreaticojejunostomy than pancreaticogastrostomy: A long-term analysis. 2019

Benini, Luigi / Gabbrielli, Armando / Cristofori, Chiara / Amodio, Antonio / Butturini, Giovanni / Cardobi, Nicolò / Sozzi, Carlo / Frulloni, Luca / Mucelli, Roberto Pozzi / Crinò, Stefano / Bassi, Claudio / Marchegiani, Giovanni / Andrianello, Stefano / Malleo, Giuseppe / Salvia, Roberto. ·Gastroenterology B, Department of Medicine, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Radiology, Department of Diagnosis and of Pathology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. Electronic address: claudio.bassi@univr.it. ·Pancreatology · Pubmed #31005377.

ABSTRACT: BACKGROUND: Pancreatico-enteric anastomosis after pancreaticoduodenectomy can be performed using either a pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG). Differences in surgical outcomes are still a matter of debate, and less is known about long-term functional outcomes. METHODS: Twelve years after the conclusion of a comparative study evaluating the surgical outcomes of PJ and PG (Bassi et al., Ann Surg 2005), available patients underwent morphological and functional pancreatic assessment: pancreatic volume and duct diameter measured by MRI, impaired secretion after secretin, fecal fat, fecal elastase-1 (FE-1), serum vitamin D and endocrine function. Quality of life and symptom scores were evaluated with the EORTC QLQ-C30 questionnaire. RESULTS: Only 34 patients were available for assessment. No differences were found in terms of BMI variation, endocrine function, quality of life or symptoms. Exocrine function was more severely impaired after PG than after PJ (fecal fats 26.6 ± 4.1 vs 18.2 ± 3.6 g/day; FE-1 121.4 ± 6.7 vs 170.2 ± 25.5 μg/g, vitamin D 18.1 ± 1.8 vs. 23.2 ± 3.1 ng/mL). MRI assessment identified a lower pancreatic volume (26 ± 3.1 vs. 36 ± 4.1 cm CONCLUSION: Compared to PJ, PG is associated with a more severely impaired exocrine function long-term, but they result similar endocrine function and quality of life. In patients with a long life expectancy, this should be taken into account.

4 Article Histologic retrieval rate of a newly designed side-bevelled 20G needle for EUS-guided tissue acquisition of solid pancreatic lesions. 2019

Armellini, Elia / Manfrin, Erminia / Trisolini, Elena / Andorno, Silvano / Ballarè, Marco / Bernardoni, Laura / Boldorini, Renzo Luciano / Gabbrielli, Armando / Frulloni, Luca / Larghi, Alberto / Occhipinti, Pietro / Scarpa, Aldo / Crinò, Stefano Francesco. ·Department of Gastroenterology, 'Maggiore della Carità' Hospital, Novara, Italy. · Department of Pathology and Diagnostics, G.B. Rossi University Hospital, Verona, Italy. · Department of Health Sciences, School of Medicine, University of Eastern Piedmont 'Amedeo Avogadro', Novara, Italy. · Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy. · Department of Pathology, 'Maggiore della Carità' Hospital, Novara, Italy. · Digestive Endoscopy Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy. · ARC-Net Research Centre, G.B. Rossi University Hospital, Verona, Italy. ·United European Gastroenterol J · Pubmed #30788121.

ABSTRACT: Background: Innovative approaches to improve diagnostic yield of endoscopic ultrasound-guided tissue acquisition (EUS-TA) have focused on needle design with development of fine-needle biopsy (FNB) needles with microcore-acquisition technology. Recently, a 20-gauge (20G) antegrade-cutting-side-bevelled biopsy needle (ProCore®) was developed for EUS-TA, but data about its diagnostic performance and histological capability are scant. Objectives: We assessed the diagnostic performance and histologic retrieval rate of a new 20G antegrade-cutting-side-bevelled biopsy needle compared with a 22G reverse-side-bevelled needle for EUS sampling of solid pancreatic lesions. Patients and methods: A retrospective analysis of 238 consecutively collected patients who underwent EUS-TA using a 20G or a 22G ProCore® needle, without rapid on-site evaluation (ROSE), was conducted at two centres.Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Histologic tissue retrieval was evaluated applying a scoring system for each case. Results: Sensitivity and specificity were estimated as 98.4-100% in the 20G-, and 94.9-100% in the 22G-needle groups, respectively ( Conclusions: Both side-bevelled FNB needles achieved a high diagnostic sensitivity. The 20G-side-bevelled needle obtained a significantly higher microcore retrieval rate.

5 Article Results of First-Round of Surveillance in Individuals at High-Risk of Pancreatic Cancer from the AISP (Italian Association for the Study of the Pancreas) Registry. 2019

Paiella, Salvatore / Capurso, Gabriele / Cavestro, Giulia Martina / Butturini, Giovanni / Pezzilli, Raffaele / Salvia, Roberto / Signoretti, Marianna / Crippa, Stefano / Carrara, Silvia / Frigerio, Isabella / Bassi, Claudio / Falconi, Massimo / Iannicelli, Elsa / Giardino, Alessandro / Mannucci, Alessandro / Laghi, Andrea / Laghi, Luigi / Frulloni, Luca / Zerbi, Alessandro. ·General and Pancreatic Surgery Department, Pancreas Institute, University of Verona, Verona, Italy. · Digestive and Liver Disease Unit, S. Andrea Hospital, University Sapienza, Rome, Italy. · Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Ospedale San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. · Pancreatic Surgery Unit, Casa di Cura Pederzoli Hospital, Peschiera del Garda, Italy. · Internal Medicine, University of Bologna, Bologna, Italy. · Pancreatic Surgery Unit, IRCCS Ospedale San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milano, Italy. · Gastrointestinal Endoscopy, Istituto Clinico Humanitas, Milano, Italy. · Radiology Unit, S. Andrea Hospital, University Sapienza, Rome, Italy. · Hereditary Cancer Genetics Clinic, Humanitas Clinical and Research Center, Milano, Italy. · Gastroenterology B Unit, Pancreas Institute, University of Verona, Verona, Italy. · Pancreatic Surgery Unit, Humanitas Clinical and Research Center, Milano, Italy. ·Am J Gastroenterol · Pubmed #30538291.

ABSTRACT: INTRODUCTION: Surveillance programs on high-risk individuals (HRIs) can detect pre-malignant lesions or early pancreatic cancer (PC). We report the results of the first screening round of the Italian multicenter program supported by the Italian Association for the study of the Pancreas (AISP). METHODS: The multicenter surveillance program included asymptomatic HRIs with familial (FPC) or genetic frailty (GS: BRCA1/2, p16/CDKN2A, STK11/LKB1or PRSS1, mutated genes) predisposition to PC. The surveillance program included at least an annual magnetic resonance cholangio pancreatography (MRCP). Endoscopic ultrasound (EUS) was proposed to patients who refused or could not be submitted to MRCP. RESULTS: One-hundreds eighty-seven HRIs underwent a first-round screening examination with MRCP (174; 93.1%) or EUS (13; 6.9%) from September 2015 to March 2018.The mean age was 51 years (range 21-80).One-hundreds sixty-five (88.2%) FPC and 22 (11.8%) GF HRIs were included. MRCP detected 28 (14.9%) presumed branch-duct intraductal papillary mucinous neoplasms (IPMN), 1 invasive carcinoma/IPMN and one low-grade mixed-type IPMN, respectively. EUS detected 4 PC (2.1%): 1 was resected, 1 was found locally advanced intraoperatively, and 2 were metastatic. Age > 50 (OR 3.3, 95%CI 1.4-8), smoking habit (OR 2.8, 95%CI 1.1-7.5), and having > 2 relatives with PC (OR 2.7, 95%CI 1.1-6.4) were independently associated with detection of pre-malignant and malignant lesions. The diagnostic yield for MRCP/EUS was 24% for cystic lesions. The overall rate of surgery was 2.6% with nil mortality. DISCUSSION: The rate of malignancies found in this cohort was high (2.6%). According to the International Cancer of the Pancreas Screening Consortium the screening goal achievement was high (1%).

6 Article Touch imprint cytology on endoscopic ultrasound fine-needle biopsy provides comparable sample quality and diagnostic yield to standard endoscopic ultrasound fine-needle aspiration specimens in the evaluation of solid pancreatic lesions. 2019

Crinò, Stefano Francesco / Larghi, Alberto / Bernardoni, Laura / Parisi, Alice / Frulloni, Luca / Gabbrielli, Armando / Parcesepe, Pietro / Scarpa, Aldo / Manfrin, Erminia. ·Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy. · Digestive Endoscopy Unit, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy. · Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy. · ARC-Net Research Centre, G.B. Rossi University Hospital, Verona, Italy. ·Cytopathology · Pubmed #30484917.

ABSTRACT: OBJECTIVES: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the gold standard for the diagnosis of solid pancreatic lesions (SPLs). Cytological samples can also be obtained using touch imprint cytology (TIC) on EUS fine-needle biopsy (FNB) specimens. We aimed to compare sample quality and diagnostic yield of EUS-FNA-standard cytology (EUS-FNA-SC) to that of EUS-FNB-TIC in a series of patients with SPLs. METHODS: Thirty-two consecutive patients referred for EUS-tissue acquisition of SPLs who underwent rapid on-site evaluation of both EUS-FNA-SC and paired EUS-FNB-TIC during the same endoscopic session were retrospectively identified. Sample quality (evaluated in terms of blood contamination, presence of clots, tissue casts, cellularity, and necrosis) and diagnostic yield were compared between the techniques. RESULTS: The mean number of passes to reach diagnosis at rapid on-site evaluation was similar between EUS-FNA-SC and EUS-FNB-TIC (1.09 ± 0.3 vs 1.13 ± 0.34, P = .711). EUS-FNA-SC scores of sample quality were comparable to those of EUS-FNB-TIC (blood contamination, 2.47 ± 1.11 vs 2.25 ± 1.14, P = .109; clots, 1.25 ± 0.76 vs 1.19 ± 0.69, P = .624; tissue casts, 3.56 ± 0.88 vs 3.59 ± 1.09, P = .872; cellularity, 2.84 ± 1.11 vs 3.09 ± 1.09, P = .244; necrosis, 2.25 ± 1.08 vs 2.53 ± 1.02 P = .059; total score, 12.38 ± 2.88 vs 17.66 ± 2.38, P = .536). Adequacy, sensitivity and diagnostic accuracy of the two sampling techniques were equal (93.7%, 90.6% and 90.6%, respectively). CONCLUSIONS: EUS-FNB-TIC provides comparable samples to those of EUS-FNA-SC and combines the benefits of cytology and histology for the evaluation of SPLs by employing a single needle during the same endoscopic procedure.

7 Article The importance of pancreatic inflammation in endosonographic diagnostics of solid pancreatic masses. 2018

Vitali, Francesco / Strobel, Deike / Frulloni, Luca / Heinrich, Marc / Pfeifer, Lukas / Goertz, Ruediger Stephan / Hundorfean, Gheorghe / Wachter, David L / Gruetzmann, Robert / Bernatik, Thomas / Neurath, Markus F / Wildner, Dane. ·Med. Klinik 1 Erlangen University Hospital Erlangen Germany. francesco.vitali@uk-erlangen.de. · Department of Internal Medicine 1, Friedrich-Alexander-University, Erlangen- Nuremberg, Germany. Deike.Strobel@uk-erlangen.de. · Department of Medicine, Pancreas Center, University of Verona, Verona, Italy. Luca.Frulloni@uk-erlangen.de. · Department of Radiology, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany. harmf4@hotmail.com. · Department of Internal Medicine 1, Friedrich-Alexander-University, Erlangen- Nuremberg, Germany. Lukas.Pfeifer@uk-erlangen.de. · Department of Internal Medicine 1, Friedrich-Alexander-University, Erlangen- Nuremberg, Germany. Ruediger.Goertz@uk-erlangen.de. · Department of Internal Medicine 1, Friedrich-Alexander-University, Erlangen- Nuremberg, Germany. ghundorfean@gmail.com. · Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany. David.Wachter@uk-erlangen.de. · Department of General and Abdominal Surgery, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany. Robert.Gruetzmann@uk-erlangen.de. · Department of Internal Medicine, Kreisklinik Ebersberg, Germany. Thomas.Bernatik@klinik-ebe.de. · Department of Internal Medicine 1, Friedrich-Alexander-University, Erlangen- Nuremberg, Germany. markus.neurath@uk-erlangen.de. · Department of Internal Medicine 1, Friedrich-Alexander-University, Erlangen- Nuremberg, Germany. dane.wildner@fau.de. ·Med Ultrason · Pubmed #30534648.

ABSTRACT: AIMS: Endosonography (EUS) is one of the main diagnostic tools for the differential diagnosis of pancreatic masses. The aim of our study was to describe the value of this technique in the work-up of solid pancreatic lesions, considering the influence of the morphological evidence of pancreatic inflammation in the diagnostic process. MATERIAL AND METHODS: Retrospective analysis of prospectively collected data in our tertiary University center. From March 2007 to October 2015, 218 patients underwent EUS for a suspected solid pancreatic neoplasm (based on previous cross-sectional imaging results, idiopatic acute pancreatitis, weight loss, pancreatic hyperenzymemia, painless jaundice or elevated Ca 19-9 values). RESULTS: Malignant lesions were diagnosed in 98 (45%) patients. Sensitivity of EUS for malignancy was 91% and specificity 89.2%. Signs of pancreatic inflammation in the surrounding pancreatic parenchyma around the focal lesion were present in 97 patients (44.4%)(more often in men, smokers and drinkers, and the most common etiology was focal chronic pancreatitis) and in these patients the sensitivity and sensibility dropped to 44% and 87.1%, respectively. In patients without signs of pancreatic inflammation, the pancreatic focal lesions were adenocarcinoma, neuroendocrine tumor, ventral/dorsal split, non-pancreatic pathology, pancreatic lipomatosis and autoimmune pancreatitis. CONCLUSION: Pancreatic inflammation (either focal or involving the whole gland) lowers the diagnostic sensibility of EUS in the work- up of pancreatic masses suspected for cancer, requiring further invasive diagnostic methods. Focal autoimmune pancreatitis and paraduodenal pancreatitis are still confused with pancreatic cancer, even in the absence of pancreatic inflammation.

8 Article EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success. 2018

Crinò, Stefano Francesco / D'Onofrio, Mirko / Bernardoni, Laura / Frulloni, Luca / Iannelli, Michele / Malleo, Giuseppe / Paiella, Salvatore / Larghi, Alberto / Gabbrielli, Armando. ·Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy. stefanocrino@hotmail.com or stefanofrancesco.crino@aovr.veneto.it. · Department of Radiology, G.B. Rossi University Hospital, Verona, Italy. · Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy. · Department of Pancreatic Surgery, The Pancreas Institute, G.B. Rossi University Hospital, Verona,Italy. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. ·J Gastrointestin Liver Dis · Pubmed #29557417.

ABSTRACT: BACKGROUND AND AIMS: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a promising technique for the treatment of pancreatic neoplasm. We evaluated the feasibility, safety, and technical success of pancreatic EUS-RFA performed in a single center. METHODS: 9 consecutive patients (8 with pancreatic adenocarcinoma and 1 with renal cancer metastasis) were referred for EUS-RFA between November 2016 and July 2017. EUS-RFA was performed using 18-gauge internally cooled electrode with a 5 or 10 mm exposed tip. Feasibility, technical success or early and late adverse events were assessed. RESULTS: One patient was excluded because of a large necrotic portion. EUS-RFA was feasible in all the other 8 (100%) cases. An ablated area inside the tumor was achieved in all treated patients. No early or late major adverse event was observed after a mean follow-up of 6 months. Three patients experienced mild post-procedural abdominal pain. CONCLUSIONS: EUS-RFA seems a feasible, safe, and effective procedure for pancreatic neoplasms. Its role in the treatment and management of pancreatic masses must be further investigated.

9 Article Diagnostic yield of EUS-FNA of small (≤15 mm) solid pancreatic lesions using a 25-gauge needle. 2018

Crinò, Stefano Francesco / Conti Bellocchi, Maria Cristina / Bernardoni, Laura / Manfrin, Erminia / Parisi, Alice / Amodio, Antonio / De Pretis, Nicolò / Frulloni, Luca / Gabbrielli, Armando. ·Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy. Electronic address: stefanofrancesco.crino@ospedaleuniverona.it. · Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy. · Department of Pathology, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy. ·Hepatobiliary Pancreat Dis Int · Pubmed #29428108.

ABSTRACT: BACKGROUND: Early detection of small solid pancreatic lesions is increasingly common. To date, few and contradictory data have been published about the relationship between lesion size and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnostic yield. The aim of this study was to assess the relation between the size of solid pancreatic lesions and the diagnostic yield of EUS-FNA using a 25-gauge needle in a center without available rapid on-site evaluation. METHODS: In the retrospective cohort study, we selected patients who underwent EUS-FNA for solid pancreatic lesions with a 25-gauge needle from October 2014 to October 2015. Patients were divided into three groups (≤15 mm, 16-25 mm and >25 mm), and the outcomes were compared. RESULTS: We analyzed 163 patients. Overall adequacy, sensitivity, specificity and accuracy were 85.2%, 81.8%, 93.7%, and 80.4%, respectively. When stratified by size, the sensitivity and accuracy correlated with size (P = 0.016 and P = 0.042, respectively). Multivariate analysis showed that lesion size was the only independent factor (P = 0.019, OR = 4.76) affecting accuracy. The role of size as an independent factor affecting accuracy was confirmed in a separate multivariate analysis, where size was included in the model as a covariate (P = 0.018, OR = 1.08). CONCLUSION: Our study demonstrates that, in the absence of rapid on-site evaluation, mass size affects the accuracy of EUS-FNA of solid pancreatic lesions.

10 Article Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition. 2016

Whitcomb, David C / Frulloni, Luca / Garg, Pramod / Greer, Julia B / Schneider, Alexander / Yadav, Dhiraj / Shimosegawa, Tooru. ·Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Cell Biology and Molecular Physiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: Whitcomb@pitt.edu. · Department of Medicine, Gastroenterology Unit, Pancreas Center, University of Verona, Verona, Italy. · Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. · Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. · Department of Medicine II, University Medical Centre Manheim, University of Heidelberg, Mannheim, Germany. · Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. ·Pancreatology · Pubmed #26924663.

ABSTRACT: BACKGROUND: A definition of chronic pancreatitis (CP) is needed for diagnosis and distinguishing CP from other disorders. Previous definitions focused on morphology. Advances in epidemiology, genetics, molecular biology, modeling and other disciplines provide new insights into pathogenesis of CP, and allow CP to be better defined. METHODS: Expert physician-scientists from the United States, India, Europe and Japan reviewed medical and scientific literature and clinical experiences. Competing views and approaches were debated until a new consensus definition was reached. RESULTS: CP has been defined as 'a continuing inflammatory disease of the pancreas, characterized by irreversible morphological change, and typically causing pain and/or permanent loss of function'. Focusing on abnormal morphology makes early diagnosis challenging and excludes inflammation without fibrosis, atrophy, endocrine and exocrine dysfunction, pain syndromes and metaplasia. A new mechanistic definition is proposed--'Chronic pancreatitis is a pathologic fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental and/or other risk factors who develop persistent pathologic responses to parenchymal injury or stress.' In addition, "Common features of established and advanced CP include pancreatic atrophy, fibrosis, pain syndromes, duct distortion and strictures, calcifications, pancreatic exocrine dysfunction, pancreatic endocrine dysfunction and dysplasia." This definition recognizes the complex nature of CP, separates risk factors from disease activity markers and disease endpoints, and allows for a rational approach to early diagnosis, classification and prognosis. CONCLUSIONS: Initial agreement on a mechanistic definition of CP has been reached. This definition should be debated in rebuttals and endorsements, among experts and pancreatic societies until international consensus is reached.

11 Article Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). 2016

Jais, B / Rebours, V / Malleo, G / Salvia, R / Fontana, M / Maggino, L / Bassi, C / Manfredi, R / Moran, R / Lennon, A M / Zaheer, A / Wolfgang, C / Hruban, R / Marchegiani, G / Fernández Del Castillo, C / Brugge, W / Ha, Y / Kim, M H / Oh, D / Hirai, I / Kimura, W / Jang, J Y / Kim, S W / Jung, W / Kang, H / Song, S Y / Kang, C M / Lee, W J / Crippa, S / Falconi, M / Gomatos, I / Neoptolemos, J / Milanetto, A C / Sperti, C / Ricci, C / Casadei, R / Bissolati, M / Balzano, G / Frigerio, I / Girelli, R / Delhaye, M / Bernier, B / Wang, H / Jang, K T / Song, D H / Huggett, M T / Oppong, K W / Pererva, L / Kopchak, K V / Del Chiaro, M / Segersvard, R / Lee, L S / Conwell, D / Osvaldt, A / Campos, V / Aguero Garcete, G / Napoleon, B / Matsumoto, I / Shinzeki, M / Bolado, F / Fernandez, J M Urman / Keane, M G / Pereira, S P / Acuna, I Araujo / Vaquero, E C / Angiolini, M R / Zerbi, A / Tang, J / Leong, R W / Faccinetto, A / Morana, G / Petrone, M C / Arcidiacono, P G / Moon, J H / Choi, H J / Gill, R S / Pavey, D / Ouaïssi, M / Sastre, B / Spandre, M / De Angelis, C G / Rios-Vives, M A / Concepcion-Martin, M / Ikeura, T / Okazaki, K / Frulloni, L / Messina, O / Lévy, P. ·Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France. · The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy. · Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. · Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. · First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan. · Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. · Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. · Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea. · Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, Ancona-Torrette, Italy. · NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. · Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy. · Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. · Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. · Hepato-Pancreato-Biliary Unit, Pederzoli Hospital, Peschiera del Garda, Italy. · Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. · Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China. · Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. · Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea. · Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK. · National Institute of Surgery and Transplantology named after Shalimov, Kiev, Ukraine. · Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. · Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. · Hôpital Privé Mermoz, Gastroentérologie, Lyon, France. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Gastroenterology Department, Hospital de Navarra, Pamplona, Spain. · Department of Gastroenterology and Hepatology, University College Hospital, London, UK. · Department of Gastroenterology, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain. · Department of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy. · Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia. · Radiological Department, General Hospital Cá Foncello, Treviso, Italy. · Division of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Milan, Italy. · Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea. · Department of Gastroenterology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia. · Department of Digestive Surgery, Timone Hospital, Marseille, France. · Gastrohepatology Department, San Giovanni Battista Molinette Hospital, University of Turin, Turin, Italy. · Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca-IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. · The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan. · Department of Medicine, Pancreas Center, University of Verona, Verona, Italy. ·Gut · Pubmed #26045140.

ABSTRACT: OBJECTIVES: Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN: Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS: 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS: After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN. TRIAL REGISTRATION NUMBER: IRB 00006477.

12 Article Role of Amylase-α2A Autoantibodies in the Diagnosis of Autoimmune Pancreatitis. 2015

Sánchez Castañón, María / Zuliani, Valeria / Amodio, Antonio / Campagnola, Pietro / Granato, Anna / Gabbrielli, Armando / Benini, Luigi / López Hoyos, Marcos / Frulloni, Luca. ·From the *Immunology Service, Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain; and †Department of Medicine, Pancreas Center, University of Verona, Verona, Italy. ·Pancreas · Pubmed #26335011.

ABSTRACT: OBJECTIVES: Several serological markers have been reported in autoimmune pancreatitis (AIP) patients. However, only serum IgG4 (sIgG4) is available in clinical practice for AIP diagnosis. Antiamylase α antibodies (AMY-α Abs) have been proposed to diagnose AIP. This study evaluates the utility of AMY-α Abs and sIgG4 for AIP diagnosis. METHODS: Twenty-five AIP patients, 84 disease control groups (31 chronic pancreatitis, 30 acute pancreatitis, 23 pancreatic adenocarcinoma), and 59 healthy donors were prospectively studied. The AMY-α Abs were determined by homemade enzyme-linked immunosorbent assay and sIgG4 by nephelometry. RESULTS: Increased sIgG4 were detected to be present in 52% of AIP, 5% in control groups, and 0% in healthy donors, and AMY-α Abs, respectively, in 76%, 36%, and 2%. sIgG4 was elevated in 92% of the 13 patients with type 1 AIP, but in none of 3 with type 2 and of 8 with not otherwise specified AIP. The AMY-α Abs were present in 79%, 67%, and 75% of type 1, type 2, and not otherwise specified AIP, respectively. Sensitivity and specificity of AMY-α Abs were 76% and 78%, and of sIgG4 50% and 94%. By combining the 2 serological markers, sensitivity was 41%, and specificity was 99%. CONCLUSIONS: The AMY-α Abs may help to diagnosis of AIP and to differentiate AIP subtypes.

13 Article Cyst fluid biomarkers for intraductal papillary mucinous neoplasms of the pancreas: a critical review from the international expert meeting on pancreatic branch-duct-intraductal papillary mucinous neoplasms. 2015

Maker, Ajay V / Carrara, Silvia / Jamieson, Nigel B / Pelaez-Luna, Mario / Lennon, Anne Marie / Dal Molin, Marco / Scarpa, Aldo / Frulloni, Luca / Brugge, William R. ·Department of Surgery, Division of Surgical Oncology; University of Illinois at Chicago, Chicago, IL. Electronic address: amaker@uic.edu. · Digestive Endoscopy Unit, Istituto Clinico Humanitas, Rozzano, Italy. · Department of Surgery, University of Glasgow, Scotland. · Department of Gastroenterology; Instituto Nacional de Ciencias Medicas y Nutrición - School of Medicine - Universidad Nacional Autonoma de Mexico, Mexico City, Mexico. · Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, MD. · Department of Pathology, Johns Hopkins University, Baltimore, MD. · Department of Pathology and Diagnostics, University of Verona; Verona, Italy. · Department of Medicine, Section of Gastroenterology, University of Verona; Verona, Italy. · Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA. ·J Am Coll Surg · Pubmed #25592469.

ABSTRACT: -- No abstract --

14 Article Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings. 2015

Negrelli, Riccardo / Manfredi, Riccardo / Pedrinolla, Beatrice / Boninsegna, Enrico / Ventriglia, Anna / Mehrabi, Sara / Frulloni, Luca / Pozzi Mucelli, Roberto. ·Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy, ricky.negrelli@gmail.com. ·Eur Radiol · Pubmed #25106489.

ABSTRACT: AIM: To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of focal forms of autoimmune pancreatitis (AIP) to describe ductal involvement at diagnosis. METHODS: MR examinations of 123 patients affected by AIP were analysed. We included 26 patients who satisfied International Consensus Diagnostic Criteria and were suffering from focal AIP. Image analysis included: site of parenchymal enlargement, main pancreatic duct (MPD) diameter, MPD stenosis, stricture length, presence of upstream dilation within the stricture, signal intensity, and pancreatic enhancement. RESULTS: Signal intensity abnormalities were localized in the head in 10/26 (38.5%) and in the body-tail in 16/26 (61.5%) patients. MRCP showed a single MPD stenosis in 12/26 (46.1%) and multiple MPD stenosis in 14/26 (53.8%) patients, without a dilation of the upstream MPD (mean: 3.83 mm). Lesions showed hypointensity on T1-weighted images in all patients, and hyperintensity on T2-weighted images in 22/26 (84.6%) patients. The affected parenchyma was hypovascular during the arterial phase in 25/26 (96.2%) patients with contrast retention. CONCLUSIONS: MR-MRCP are effective techniques for the diagnosis of AIP showing the loss of the physiological lobulation and the typical contrastographic appearance. The presence of multiple, long stenoses without an upstream MPD dilation at MRCP suggests the diagnosis of AIP, and can be useful in differential diagnosis of pancreatic adenocarcinoma. KEY POINTS: • MRI represents the gold standard in the diagnosis of AIP. • MRCP is an increasingly useful technique in the diagnosis of focal AIP. • MRCP could be a problem-solving tool in the differential diagnosis of AIP.

15 Article Frequency and characterization of benign lesions in patients undergoing surgery for the suspicion of solid pancreatic neoplasm. 2014

Vitali, Francesco / Hansen, Torsten / Kiesslich, Ralf / Heinrich, Stefan / Kumar, Anisha / Mildenberger, Peter / Amodio, Antonio / Benini, Luigi / Vantini, Italo / Frulloni, Luca. ·From the *Department of Medicine, Pancreas Center, University of Verona, Verona, Italy; and †Institute of Pathology, ‡Department of Internal Medicine, §Department of Surgery, and ∥Department of Radiology, University of Mainz, Mainz, Germany. ·Pancreas · Pubmed #25058888.

ABSTRACT: OBJECTIVES: A diagnosis of benign lesions (BLs) is reported in 5% to 21% of pancreatoduodenectomies performed for neoplasms; no data for body-tail resections are available. The aims were to investigate the frequency and characterize the BLs mimicking cancer in the head and the body-tail of the pancreas. METHODS: This study is a retrospective review of pancreatic specimenscollected from 2005 to 2011 in the pathology database of Mainz (Germany). Patients with final diagnosis excluding malignancy were analyzed by histology, imaging, and clinical aspects. RESULTS: Among 373 patients, 33 patients (8.8%) were diagnosed with a benign disease: 25 (8.4%) of 298 in the pancreatic head and 8 (10.7%) of 75 in the body-tail resections. Paraduodenal pancreatitis was diagnosed in 13 (3.5%) of 373 patients; autoimmune pancreatitis (AIP), in 11 (2.9%); "ordinary" chronic pancreatitis, in 6 (1.6%); and accessory spleen, in 3 (0.8%). In pancreatic head resections, the most frequent diagnoses were paraduodenal pancreatitis (13/298, 4.4%) and AIP (9/298, 3%), whereas in the body-tail, the most frequent diagnoses were accessory spleen (3/75, 4%), chronic pancreatitis (3/75, 4%), and AIP (2/75, 2.7%). CONCLUSIONS: Benign lesions are observed with the same frequency inspecimens of the head or the body-tail of the pancreas.

16 Article Retrospective comparison between preoperative diagnosis by International Consensus Diagnostic Criteria and histological diagnosis in patients with focal autoimmune pancreatitis who underwent surgery with suspicion of cancer. 2014

Ikeura, Tsukasa / Detlefsen, Sönke / Zamboni, Giuseppe / Manfredi, Riccardo / Negrelli, Riccardo / Amodio, Antonio / Vitali, Francesco / Gabbrielli, Armando / Benini, Luigi / Klöppel, Günter / Okazaki, Kazuichi / Vantini, Italo / Frulloni, Luca. ·From the *The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan; †Department of Pathology, Odense University Hospital, Odense, Denmark; Departments of ‡Pathology, §Radiology, and ∥Medicine, Pancreas Center, University of Verona, Verona, Italy; and ¶Department of Pathology, University of Kiel, Kiel, Germany. ·Pancreas · Pubmed #24681878.

ABSTRACT: OBJECTIVE: The objective of this study was to compare the preoperative diagnosis by International Consensus Diagnostic Criteria (ICDC) with histological diagnosis in patients with focal autoimmune pancreatitis (AIP) who underwent surgery. METHODS: Thirty patients (type 1 AIP in 23 and type 2 AIP in 7) with a diagnosis of AIP based on histology of surgical specimens were classified according to ICDC based on their preoperative data. RESULTS: Pancreatic core biopsies and diagnostic steroid trial were not preoperatively performed in any of the patients. Based on preoperative data, ICDC diagnosed 6 patients (20%) as having type 1 AIP and 24 (80%) as probable AIP. Assuming all patients had responded to a steroid trial preoperatively, ICDC would have diagnosed 8 patients (27%) as having type 1 AIP, 4 (13%) as type 2 AIP, 10 as AIP-not otherwise specified (33%), and 8 (27%) as probable AIP. In the hypothetical situation, 7 of 8 type 1 AIP patients and 3 of 3 type 2 AIP patients would have been classified into the correct subtype of AIP. CONCLUSIONS: A steroid trial enhances the possibility of correctly diagnosing AIP by ICDC despite the lack of histology. However, some patients cannot be diagnosed as having AIP or be classified into the correct subtype without histology.

17 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.

18 Article Long term outcome of acute pancreatitis in Italy: results of a multicentre study. 2013

Castoldi, Laura / De Rai, Paolo / Zerbi, Alessandro / Frulloni, Luca / Uomo, Generoso / Gabbrielli, Armando / Bassi, Claudio / Pezzilli, Raffaele / Anonymous2120763. ·Department of Surgery and Emergency Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: lcastoldi@policlinico.mi.it. ·Dig Liver Dis · Pubmed #23831129.

ABSTRACT: BACKGROUND: In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out. AIM: To report the results of a follow-up on a large series of patients hospitalised for pancreatitis. METHODS: Data of 631 patients admitted to 35 Italian hospitals were retrospectively evaluated 51.7±8.4 months after discharge. RESULTS: The average recovery time after mild or severe pancreatitis was 28.2 and 53.4 days respectively. Fourteen sequelae were not resolved and 9 cases required late surgical intervention. Eighty patients (12.7%) had a second hospital admission. Of the patients with mild biliary pancreatitis, 67.9% underwent a cholecystectomy. The overall incidence of relapse was 12.7%. Mortality was 9.8% and no death was related to pancreatitis. Three patients died from carcinoma of the pancreas. CONCLUSION: Reported recovery time after an attack of pancreatitis was longer than expected in the mild forms. The treatment of sequelae was delayed beyond one year after discharge. The incidence of relapse of biliary pancreatitis in patients not undergoing a cholecystectomy was low, due to endoscopic treatment. Mortality from pancreatic-related causes is low, but there is an association with malignant pancreatic or ampullary tumours not diagnosed during the acute phase of the illness.

19 Article Prevalence and risk factors of extrapancreatic malignancies in a large cohort of patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas. 2013

Larghi, A / Panic, N / Capurso, G / Leoncini, E / Arzani, D / Salvia, R / Del Chiaro, M / Frulloni, L / Arcidiacono, P G / Zerbi, A / Manta, R / Fabbri, C / Ventrucci, M / Tarantino, I / Piciucchi, M / Carnuccio, A / Boggi, U / Costamagna, G / Delle Fave, G / Pezzilli, R / Bassi, C / Bulajic, M / Ricciardi, W / Boccia, S. ·Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy. ·Ann Oncol · Pubmed #23676419.

ABSTRACT: BACKGROUND: The objectives of this study are to estimate prevalence and incidence of extrapancreatic malignancies (EPMs) among intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, and to identify risk factors for their occurrence. PATIENTS AND METHODS: We conducted multicentric cohort study in Italy from January 2010 to January 2011 including 390 IPMN cases. EPMs were grouped as previous, synchronous (both prevalent) and metachronous (incident). We calculated the observed/expected (O/E) ratio of prevalent EPMs, and compared the distribution of demographic, medical history and lifestyle habits. RESULTS: Ninety-seven EPMs were diagnosed in 92 patients (23.6%), among them 78 (80.4%) were previous, 14 (14.4%) were synchronous and 5 (5.2%) were metachronous. O/E ratios for prevalent EPMs were significantly increased for colorectal carcinoma (2.26; CI 95% 1.17-3.96), renal cell carcinoma (6.00; CI 95% 2.74-11.39) and thyroid carcinoma (5.56; CI 95% 1.80-12.96). Increased age, heavy cigarette smoking, alcohol consumption and first-degree family history of gastric cancer are significant risk factors for EPMs, while first-degree family history of colorectal carcinoma was borderline. CONCLUSION: We report an increased prevalence of EPMs in Italian patients with IPMN, especially for colorectal carcinoma, renal cell and thyroid cancers. A systematic surveillance of IPMN cases for such cancer types would be advised.

20 Article Risk factors for intraductal papillary mucinous neoplasm (IPMN) of the pancreas: a multicentre case-control study. 2013

Capurso, Gabriele / Boccia, Stefania / Salvia, Roberto / Del Chiaro, Marco / Frulloni, Luca / Arcidiacono, Paolo Giorgio / Zerbi, Alessandro / Manta, Raffaele / Fabbri, Carlo / Ventrucci, Maurizio / Tarantino, Ilaria / Piciucchi, Matteo / Carnuccio, Antonella / Boggi, Ugo / Leoncini, Emanuele / Costamagna, Guido / Delle Fave, Gianfranco / Pezzilli, Raffaele / Bassi, Claudio / Larghi, Alberto / Anonymous6770751 / Anonymous6780751. ·Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, Sapienza University of Rome at S. Andrea Hospital, Rome, Italy. gabriele.capurso@gmail.com ·Am J Gastroenterol · Pubmed #23458848.

ABSTRACT: OBJECTIVES: To investigate environmental, personal, and hereditary risk factors associated with the occurrence of intraductal papillary mucinous neoplasms of the pancreas (IPMNs). METHODS: Multicentre case-control study. Risk factors were identified from a questionnaire collecting data on family and medical history, and environmental factors. Cases were prevalent IPMNs seen at the participating units within an 18-month timeframe. Matched controls were enrolled alongside patients seen at outpatient clinics. RESULTS: Three-hundred and ninety patients with IPMN and 390 matched controls (166 males, mean age 65 in each group) were enrolled. Of the IPMNs, 310 had branch-duct involvement and 80 main-duct involvement. The only cancer with a 1st degree family history significantly higher in IPMN was pancreatic ductal adenocarcinoma (PDAC) (5.4% vs. 1.5%). Previous history of diabetes (13.6% vs. 7.5%), chronic pancreatitis (CP) (3.1% vs. 0.3%), peptic ulcer (7.2% vs. 4.3%), and insulin use (4.9% vs. 1.1%) were all more frequent with IPMNs. Logistic regression multivariate analysis revealed that history of diabetes (odds ratio (OR): 1.79, confidence interval (CI) 95%: 1.08-2.98), CP (OR: 10.10, CI 95%: 1.30-78.32), and family histories of PDAC (OR: 2.94, CI 95%: 1.17-7.39) were all independent risk factors. However, when analysis was restricted to diabetics who had taken insulin, risk of IPMN became stronger (OR: 6.03, CI 95%: 1.74-20.84). The association with all these risk factors seemed stronger for the subgroup with main duct involvement. CONCLUSIONS: A previous history of diabetes, especially with insulin use, CP, and family history of PDAC are all relevant risk factors for the development of IPMN. These results suggest an overlap between certain risk factors for PDAC and IPMN.

21 Article Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. 2013

Hart, Phil A / Kamisawa, Terumi / Brugge, William R / Chung, Jae Bock / Culver, Emma L / Czakó, László / Frulloni, Luca / Go, Vay Liang W / Gress, Thomas M / Kim, Myung-Hwan / Kawa, Shigeyuki / Lee, Kyu Taek / Lerch, Markus M / Liao, Wei-Chih / Löhr, Matthias / Okazaki, Kazuichi / Ryu, Ji Kon / Schleinitz, Nicolas / Shimizu, Kyoko / Shimosegawa, Tooru / Soetikno, Roy / Webster, George / Yadav, Dhiraj / Zen, Yoh / Chari, Suresh T. ·Division of Gastroenterology and Hepatology, Mayo Clinic, , Rochester, Minnesota, USA. ·Gut · Pubmed #23232048.

ABSTRACT: OBJECTIVE: Autoimmune pancreatitis (AIP) is a treatable form of chronic pancreatitis that has been increasingly recognised over the last decade. We set out to better understand the current burden of AIP at several academic institutions diagnosed using the International Consensus Diagnostic Criteria, and to describe long-term outcomes, including organs involved, treatments, relapse frequency and long-term sequelae. DESIGN: 23 institutions from 10 different countries participated in this multinational analysis. A total of 1064 patients meeting the International Consensus Diagnostic Criteria for type 1 (n=978) or type 2 (n=86) AIP were included. Data regarding treatments, relapses and sequelae were obtained. RESULTS: The majority of patients with type 1 (99%) and type 2 (92%) AIP who were treated with steroids went into clinical remission. Most patients with jaundice required biliary stent placement (71% of type 1 and 77% of type 2 AIP). Relapses were more common in patients with type 1 (31%) versus type 2 AIP (9%, p<0.001), especially those with IgG4-related sclerosing cholangitis (56% vs 26%, p<0.001). Relapses typically occurred in the pancreas or biliary tree. Retreatment with steroids remained effective at inducing remission with or without alternative treatment, such as azathioprine. Pancreatic duct stones and cancer were uncommon sequelae in type 1 AIP and did not occur in type 2 AIP during the study period. CONCLUSIONS: AIP is a global disease which uniformly displays a high response to steroid treatment and tendency to relapse in the pancreas and biliary tree. Potential long-term sequelae include pancreatic duct stones and malignancy, however they were uncommon during the study period and require additional follow-up. Additional studies investigating prevention and treatment of disease relapses are needed.

22 Article Faecal elastase-1 is an independent predictor of survival in advanced pancreatic cancer. 2012

Partelli, Stefano / Frulloni, Luca / Minniti, Consolato / Bassi, Claudio / Barugola, Giuliano / D'Onofrio, Mirko / Crippa, Stefano / Falconi, Massimo. ·Department of Surgery, University of Verona, Policlinico GB Rossi, Verona, Italy. ·Dig Liver Dis · Pubmed #22749648.

ABSTRACT: BACKGROUND: The relationship between prognosis of advanced pancreatic cancer and exocrine secretion impairment is unknown. AIM: To investigate a possible correlation between faecal elastase-1 value and survival in advanced pancreatic cancer. METHODS: 194 patients with advanced pancreatic cancer were prospectively enrolled between 2007 and 2009 and underwent faecal elastase-1 measurement. Exocrine pancreatic secretion was defined as "moderately reduced" (faecal elastase-1: 100-200 μg/g), "severely reduced" (faecal elastase-1<100 and >20 μg/g) and "extremely reduced" (faecal elastase-1≤20 μg/g). RESULTS: Median faecal elastase-1 was 204 μg/g (interquartile range 19; 489). Overall, 48 patients (25%) had an extremely reduced exocrine pancreatic secretion, 28 (14%) a severely reduced exocrine pancreatic secretion and 21 (11%) a moderately reduced exocrine pancreatic secretion. Patients with extremely reduced exocrine pancreatic secretion had higher rates of pancreatic head localizations (P<0.01) and of jaundice (P<0.01). Median overall survival was 10.5 months. Patients with faecal elastase-1≤20 μg/g had a worse prognosis (median survival: 7 versus 11 months, P=0.031). Presence of metastases (Hazard ratio 1.81, P<0.0001), haemoglobin ≤12 g/L (Hazard ratio 2.12, P=0.001), albumin ≤40 g/L (Hazard ratio 1.64, P=0.010) and FE-1≤20 μg/g (Hazard ratio 1.59 P=0.023) resulted as independent predictors of survival in advanced pancreatic cancer patients. CONCLUSIONS: A low value of faecal elastase-1 is strongly correlated with a poor survival in advanced pancreatic cancer.