Luo-Wei Wang

A Long-Term Follow-Up Study on Endoscopic Management of Children and Adolescents With Chronic Pancreatitis

OBJECTIVES:Data on therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for chronic pancreatitis (CP) in children and adolescents, especially with long-term follow-up of consequences, are rarely reported. The aim of this study was to determine the long-term follow-up results of therapeutic ERCP for CP in children and adolescents.METHODS:All patients with CP who received therapeutic ERCP at Changhai Hospital from January 1997 to May 2009, with the age at first onset of pain being less than 18.0 years, were included. Attempts were made to contact all adolescents and follow-up data were recorded. Clinical data were assessed before and after every ERCP.RESULTS:Follow-up information was available in 42 (91.3%) of the 46 patients who received therapeutic ERCP. There were 20 boys and 22 girls, with the age at first onset being 11.8±4.5 years. A total of 110 therapeutic ERCP sessions were performed in the 42 patients. The post-ERCP complication rate was 17.3%, including mild and moderate pancreatitis (n=17) and mild cholangitis (n=2). The mean follow-up period of time was 61.4 (range: 24–132) months. Five patients underwent subsequent surgery because of refractory abdominal pain after endotherapy. Of the remaining 37 patients who received therapeutic ERCP alone, abdominal pain improved in 30 (81.1%) patients, and was completely relieved in 24 (64.9%) patients during the period of follow-up.CONCLUSIONS:Therapeutic ERCP may offer long-term improvement in pain in children and adolescents with CP.

Chronic pancreatitis in Chinese children: etiology, clinical presentation and imaging diagnosis.

Background and Aims:  There is a paucity of literature regarding the clinical profile of chronic pancreatitis (CP) in children. The aims of this retrospective study were to determine the etiology and clinical presentation, and to present our experience in diagnosing CP in children in China.

Incidence of Pancreatic Cancer in Chinese Patients with Chronic Pancreatitis

Background and Aim: It is suggested that patients with chronic pancreatitis (CP) have a markedly increased risk of pancreatic cancer compared with the general population. This study was designed to determine the rate of pancreatic cancer in CP patients in China. Methods: This was a semiprospective, single-center study including 420 consecutive CP patients (285 males and 135 females, median age at onset 39.5 years), with the median follow-up time being 102.3 months (range 24–419 months). We calculated the standardized incidence ratio (SIR) based on the pancreatic cancer incidence in the general population of China. Results: Four cases of pancreatic cancer (0.9% of patients) were observed in 3,591 patient-years (expected number of cases 0.15; SIR 27.2, 95% CI 7.4–69.6). Similar results were seen in alcoholics and non-alcoholics, and in smokers and non-smokers. When patients lost to follow-up were considered to be followed up until the end point without having developed pancreatic cancer (4,280 patient-years), SIR was 22.8 (CI 6.2–58.4). Based on the Cox model, with inserting factors being sex, age at the time of CP clinical onset, type of pancreatitis, and presence or absence of diabetes, calcification, alcohol use and smoking status, only age was found to correlate positively with the occurrence of pancreatic cancer (>50 years, hazard ratio, 1.8 ± 0.5; p = 0.044). Conclusion: The risk of pancreatic cancer is markedly increased in CP patients in China compared with the general population, especially in older patients.

Evaluation of endoscopic-ultrasound-guided celiac ganglion irradiation with iodine-125 seeds : a pilot study in a porcine model

BACKGROUND AND STUDY AIMS Implantation of iodine-125 ( (125)I) seeds under the guidance of endoscopic ultrasonography (EUS) has been proved to be a safe alternative treatment option for advanced pancreatic cancer. The main purpose of this study was to evaluate the feasibility and safety of EUS-guided radiation of the celiac ganglia with (125)I seeds in a porcine model. METHODS Twelve domestic pigs were randomly divided into three groups. The pigs in group A had blank seeds implanted, and groups B and C had 0.4 mCi and 0.8 mCi (125)I seeds implanted, respectively. Enhanced CT scan and 3-D vascular remodeling were used to check the location of the seeds. All animals were killed and celiac ganglia were checked at 14 and at 60 days after procedure. Necrosis and apoptosis in celiac ganglia and adjacent vessels and organs were also observed. RESULTS EUS-guided implantations of (125)I seeds in celiac plexus were successful at first procedure in 10 animals. The remaining two animals were implanted successfully the next day. No severe complications occurred in any animal and no damage was found in the surrounding organs. At day 60 after operation, the apoptotic index in the ganglia was 0.53 in the 0.4 mCi group and 0.94 in the 0.8 mCi group. No apoptotic cells were found in the control group implanted with blank seeds. Damage to vessels and surrounding organs by radioactive seeds was observed in only one pig at each time point. CONCLUSION EUS-guided implantation of (125)I seeds beside the celiac ganglia is a safe procedure and can induce apoptosis of local neurons. This new method may lead to an alternative treatment for pain accompanying pancreatic diseases in human.

ERCP practitioners in China: results from national surveys in 2007 and 2013

Background and study aims: The endoscopist performing endoscopic retrograde cholangiopancreatography (ERCP) has an essential role in the development of that procedure. Given that the practice status and training background of Chinese ERCP practitioners (ERCPists) were largely unknown, two surveys were conducted to determine the status and development of this professional group. Methods: National surveys were conducted by the Chinese Society of Digestive Endoscopy in 2007 and 2013. Information regarding numbers, demographic characteristics, practice status, and training background of ERCPists was collected. Results: Total numbers of ERCPists in mainland China increased from 1155 to 3345 (0.88 to 2.47 per million inhabitants) between 2006 and 2012. Regional distribution of ERCPists showed significant imbalance, and the ERCPist – population ratio correlated with gross domestic product per capita (2006, r = 0.871, P  Conclusions: Between 2006 and 2012 in China there has been significant development in ERCP personnel and training. However, the shortage and regional imbalances are still obvious and a higher ERCP volume per endoscopist is needed.

The Epidemiology of Chronic Pancreatitis

Chronic pancreatitis (CP) is a disorder of chronic inflammation characterized by chronic abdominal pain, frequent disease exacerbations, and exocrine and/or endocrine insufficiency. It significantly affects patients’ quality of life and may lead to life-threatening complications including diabetes mellitus and pancreatic cancer. Currently, the epidemiology of CP is not well described. The difficulty in the formal diagnosis and high variability in the severity and evolution of the illness may impact the quality of epidemiological studies. Although there are few large population-based epidemiological studies concerning CP, the available data shows the growing incidence and prevalence of CP in the world. In addition, it varies tremendously in different countries, which may be related with differences in study methodology, diagnostic criteria and techniques, and risk factors.

Comparison between endoscopic sphincterotomy and endoscopic papillary balloon dilation in treatment of extrahepatic bile duct stones

Objective To compare endoscopic sphincterotomy( EST) and endoscopic papillary balloon dilation( EPBD)in treating extrahepatic bile duct stones in terms of similarities and differences. Methods The clinical data of 277 patients with extrahepatic bile duct stones,who were treated from August 2009 to July 2011 in gastroenterology department of Shanghai Changhai Hospital,were retrospectively analyzed,with 168 patients receiving EST and 109 receiving EPBD. The general condition,stone diameter,stone extraction method,operation time,stone-free rate by single procedure,postoperative hospital stay and short-term complications were compared between EST group and EPBD group. Results There were no significant differences in the age,sex ratio,or combination with duodenal diverticulum between the two groups. The mean diameters of the stones were not significantly different between the two groups( [11. 3 ± 6. 2]mm in EST group vs [10. 1 ± 5. 7]mm in EPBD group,P = 0. 105 6). There was no significant difference in the proportions of different stone extraction methods between EST group and EPBD group. The operation time,stone-free rate by single procedure,postoperative hospital stay,and total incidence of short-term complications in EST group were( 21. 2 ±3. 1) min,95. 2%,( 4. 1 ±1. 9) d,and 10. 1%,and those in EPBD group were( 20. 7 ±2. 5) min,94. 5%,( 4. 1 ±2. 0) d,and 12. 8%,respectively; with no significant differences found between the two groups( all P 0. 05). The incidence of hemorrhage in EST group was significantly higher than that in the EPBD group( 3. 6% vs 0%,P 0. 05). The incidence of hyperamylasemia in EPBD group was significantly higher than that in the EST group( 8. 3% vs 2. 4%,P 0. 05).Conclusion EST and EPBD each have their own advantages and disadvantages in the treatment of extrahepatic bile duct stones.Operation mode should be chosen according to the specific condition of patients,but not the size of the stones.