Clinical Pancreatology

Since the book Clinical Pancreatology for Practising Gastroenterologists and Surgeons was first published sixteen years ago, the knowledge and clinical management of pancreatic diseases have developed markedly. Thanks to the development of the translational research and the from bench to bedside concept, much progress from the lab has been applied to clinical practice. In addition, several highly relevant clinical trials published over the last years have resulted in the update and optimisation of clinical guidelines.

A new and validated classification of severity and complications of acute pancreatitis is firmly rooted in clinical practice and has been the basis for the development of minimally invasive approaches to pancreatic necrosis. The etiopathogenic knowledge of chronic pancreatitis and other pancreatopaties, like that associated with diabetes mellitus, has developed significantly. Especially important has been the development of the field of cystic pancreatic tumours, which has been reflected in the publication of several guidelines and consensus reports over the last few years. Most research efforts have focused on pancreatic cancer, which have led and will further lead to a significant increase in the therapeutic armamentarium against this devastating disease. Finally, many newly published studies have changed the concept, causes, clinical relevance, diagnosis and treatment of exocrine pancreatic insufficiency.

This new edition of Clinical Pancreatology for Practising Gastroenterologists and Surgeons has enjoyed the collaboration of the world’s leading experts in each of the areas of clinical pancreatology with the aim of facilitating gastroenterologists, surgeons, oncologists, internists, nutritionists, diabetologists, paediatricians, radiologists, pathologists and other specialists in their decision making when facing patients with pancreatic diseases in their daily clinical practice. All in all, this book supplies an indispensable update of the relevant aspects of clinical pancreatology.

Contributors xxxiii

Foreword xlvi

Preface xlvii

Dedication xlviii

Section I Acute Pancreatitis 1

1 Acute Pancreatitis: An Overview 3
Jodie A. Barkin and Jamie S. Barkin

2 How to Deal with the Etiological Diagnosis of Acute Pancreatitis in Clinical Practice? 17
Soumya Jagannath and Pramod Kumar Garg

3 Definition of Complications and Severity of Acute Pancreatitis for Clinical Practice 25
David X. Jin, Peter A. Banks, and Julia McNabb-Baltar

4 Early Prediction of Severity in Acute Pancreatitis: What can be Done in Clinical Practice? 31
Peter J. Lee and Georgios I. Papachristou

5 Role of CT Scan in Acute Pancreatitis: When is it Indicated and What Information can be Obtained? 40
Elham Afghani, Mahya Faghih, and Vikesh K. Singh

6 Role of MRI in Acute Pancreatitis: When is it Indicated and What Information can be Obtained? 47
Fatih Akisik

7 Treatment of Acute Pancreatitis in The Emergency Room: What Should be Done During the First Hours of Disease? 53
Thiruvengadam Muniraj and Santhi Swaroop Vege

8 Acute Pancreatitis: A Practical Guideline for the Monitoring and Treatment of Systemic Complications 59
Enrique de Madaria and Felix Zubia-Olaskoaga

9 Guidelines for the Treatment of Pain in Acute Pancreatitis 66
László Czakó

10 Nutrition in the Acute Phase of Pancreatitis: Why, When, How and How Long? 72
Angela Pham and Chris E. Forsmark

11 Oral Refeeding in Acute Pancreatitis: When and How Should it be Restarted? 78
José Lariño-Noia and Daniel de la Iglesia-García

12 Pharmacological Therapy for Acute Pancreatitis: Any Light at the End of the Tunnel? 83
Rajarshi Mukherjee, Muhammad Awais, Wenhao Cai, Wei Huang, Peter Szatmary, and Robert Sutton

13 Indication and Optimal Timing of ERCP in Acute Pancreatitis 95
Theodor Voiosu, Ivo Boškoski, and Guido Costamagna

14 How to Deal with Infected Pancreatic Necrosis? 100
J. Enrique Domínguez-Muñoz

15 Minimally Invasive Surgical Necrosectomy in Clinical Practice: Indications, Technical Issues, and Optimal Timing 105
Patricia Sánchez-Velázquez, Fernando Burdío, and Ignasi Poves†

16 Endoscopic Necrosectomy in Clinical Practice: Indications, Technical Issues and Optimal Timing 113
Jodie A. Barkin and Andres Gelrud

17 Management of Acute Pancreatic Pseudocyst: When to Observe, When and How to Drain? 120
Muhammad F. Dawwas and Kofi W. Oppong

18 The Disconnected Main Pancreatic Duct Syndrome: How to Proceed in Clinical Practice? 126
Mario Peláez-Luna, Andrea Soriano-Ríos, and Luis Uscanga-Dominguez

19 Vasculature Complications in Pancreatitis: How to Deal with Them? 132
Daniel G. McCall and Timothy B. Gardner

20 Acute Relapsing Pancreatitis: What can be Done to Prevent Relapses? 141
Jorge D. Machicado and Dhiraj Yadav

21 Diagnosis and Therapeutic Approach to Pancreatic Exocrine Insufficiency after Acute Pancreatitis 151
Hester C. Timmerhuis, Christa J. Sperna Weiland, and Hjalmar C. van Santvoort

22 Asymptomatic Chronic Elevation of Serum Pancreatic Enzymes: How to Deal with It? 158
Giuseppe Vanella, Paolo Giorgio Arcidiacono, and Gabriele Capurso

Section II Chronic Pancreatitis 169

23 Definition and Etiology of Chronic Pancreatitis: What is Relevant for Clinical Practice? 171
David C. Whitcomb

24 Epidemiology of Chronic Pancreatitis: An Infrequent Disease or an Infrequently Diagnosed Disease? 180
Philippe Lévy and Vinciane Rebours

25 Alcoholic Chronic Pancreatitis and the Impact of Alcohol and Smoking Cessation in Chronic Pancreatitis 185
Jeremy S. Wilson, Romano C. Pirola, and Minoti V. Apte

26 What is Relevant on Genetics in Chronic Pancreatitis for Clinical Practice? What Genes and When to Evaluate Them? 193
Jonas Rosendahl

27 Pancreas Divisum and Other Potential Obstructive Causes of Chronic Pancreatitis: When and How to Treat Them? 198
Matthew J. DiMagno and Erik-Jan Wamsteker

28 What to do in Clinical Practice Before Defining a Chronic Pancreatitis as Idiopathic? A Practical Protocol 208
Felix Lämmerhirt, Frank Ulrich Weiss, and Markus M. Lerch

29 Computed Tomography for the Diagnosis, Evaluation of Severity, and Detection of Complications of Chronic Pancreatitis in Clinical Practice 218
Roberto García-Figueiras, Sandra Baleato-González, and Gonzalo Tardáguila de la Fuente

30 Role of MRI and MRCP in the Diagnosis, Evaluation of Severity, and Detection of Complications of Chronic Pancreatitis in Clinical Practice 227
Jordan K. Swensson and Temel Tirkes

31 Role of Endoscopic Ultrasound and Associated Methods (Elastography, Contrast Enhancement) in the Diagnosis, Evaluation of Severity, and Detection of Complications of Chronic Pancreatitis in Clinical Practice 233
Julio Iglesias-Garcia

32 Endoscopic Pancreatic Function Test for the Functional Diagnosis of Chronic Pancreatitis: Indications and Practical Protocol 243
Luis F. Lara and Darwin L. Conwell

33 Role of Pancreatic Function Tests for the Diagnosis of Chronic Pancreatitis: Which Tests and How Should they be Performed in Clinical Practice? 250
J. Enrique Domínguez-Muñoz

34 Follow-up of Patients with Chronic Pancreatitis in Clinical Practice: How and What for? 255
Antonio Mendoza-Ladd, Luis F. Lara, and Darwin L. Conwell

35 Quality of Life in Chronic Pancreatitis 265
Colin D. Johnson

36 Medical Treatment of Pain in Chronic Pancreatitis: Guidelines for Clinical Practice 273
Asbjørn Mohr Drewes, Louise Kuhlman, Trine Andresen, and Søren Schou Olesen

37 Endoscopic Treatment of Pain in Chronic Pancreatitis: Indications, Optimal Timing, and Technical Aspects 283
Pauline M. C. Stassen, Pieter J. F. de Jonge, Jan-Werner Poley, Djuna L. Cahen, and Marco .J. Bruno

38 Diagnosis and Management of Pancreatic Exocrine Insufficiency in Chronic Pancreatitis: A Practical Protocol 292
J. Enrique Domínguez-Muñoz

39 Surgical Treatment of Pain in Chronic Pancreatitis: Indications, Optimal Timing and Technical Approaches 301
Benjamin P.T. Loveday and John A. Windsor

40 Management of Chronic Pancreatic Pseudocyst: When to Observe, When and How to Drain? 314
Shyam Varadarajulu

41 Vascular Complications in Chronic Pancreatitis 322
Anil K. Agarwal, Raja Kalayarasan, and Amit Javed

42 Surgical Therapy of Local Complications of Chronic Pancreatitis: Indications, Technical Approaches, and Optimal Timing 333
Ricardo Arvizu Castillo, Elena Muñoz-Forner, and Luis Sabater

43 Endoscopic Treatment of Complications of Chronic Pancreatitis other than Pseudocyst 342
Jahangeer Basha, Rupjyoti Talukdar, and D. Nageshwar Reddy

Section III Autoimmune Pancreatitis 347

44 Autoimmune Pancreatitis: Definition, Clinical Presentation, and Classification 349
Miroslav Vujasinovic and J. -Matthias Löhr

45 Diagnosis of Autoimmune Pancreatitis: A Protocol for Clinical Practice 356
Nicolò de Pretis, Antonio Amodio, and Luca Frulloni

46 Treatment and Follow-up of Autoimmune Pancreatitis in Clinical Practice 360
Sushil Kumar Garg and Suresh T. Chari

Section IV Cystic Fibrosis (CFTR)-associated Pancreatic Disease 369

47 CFTR-associated Pancreatic Disease: Genotype–Phenotype Correlations and Impact of CFTR-modifying Therapy 371
Aimee Joy Wiseman and Chee Y. Ooi

48 Nutritional Therapy, Pancreatic Exocrine Insufficiency, and Pancreatic Enzyme Replacement Therapy in Cystic Fibrosis: a Protocol for Clinical Practice 379
Jefferson N. Brownell, Laura Padula, Elizabeth Reid, Virginia A. Stallings, and Asim Maqbool

Section V Pancreatic Cancer 389

49 Epidemiological Impact of Pancreatic Cancer 391
Patrick Maisonneuve

50 Molecular and Genetic Basis of Pancreatic Carcinogenesis: Which Concepts are Clinically Relevant? 404
Ihsan Ekin Demir, Carmen Mota Reyes, Elke Demir, and Helmut Friess

51 New-onset Diabetes as a Harbinger of Pancreatic Cancer: is Early Diagnosis Possible? 409
Dana K. Andersen, Suresh T. Chari, Eithne Costello, Tatjana Crnogorac-Jurcevic, Phil A. Hart, Anirban Maitra, and Stephen J. Pandol

52 Pancreatic Cancer Screening: Target Populations, Methods, and Protocols for Clinical Practice 418
Christopher Paiji, Anne Marie Lennon, and Elham Afghani

53 Clinical Usefulness of Biological Markers in Pancreatic Cancer 425
David Anz, Ignazio Piseddu, Marlies Köpke, Ujjwal M. Mahajan, and Julia Mayerle

54 Staging Classification and Stratification of Pancreatic Cancer for Clinical Practice 433
Akhil Chawla and Andrew J. Aguirre

55 Imaging Diagnosis and Staging of Pancreatic Cancer: Which Methods are Essential and What Information Should they Provide? 443
Megan H. Lee and Elliot K. Fishman

56 The Role of Endoscopic Ultrasound and Associated Methods (Elastography, Contrast Enhancement) in the Diagnosis and Assessment of Resectability of Pancreatic Cancer 449
Marc. Giovannini

57 EUS-Guided FNA/FNB for Pancreatic Solid Lesions: When is it Indicated and What is the Optimal Technical Approach? 460
Mihai Rimbaș, Gianenrico Rizzatti, and Alberto Larghi

58 Surgical Treatment of Resectable Pancreatic Cancer: What is the Optimal Strategy? 472
Jan G. D’Haese, Bernhard W. Renz, and Jens Werner

59 Complications After Pancreatic Surgery: How to Deal with Them? 477
Tommaso Giuliani, Giovanni Marchegiani, Giuseppe Malleo, and Claudio Bassi

60 Neoadjuvant Treatment of Pancreatic Cancer: When and How? 488
Marta Sandini, Thilo Hackert, Ulla Klaiber, Markus W. Büchler, and John P. Neoptolemos

61 Adjuvant Therapy in Pancreatic Cancer: Options, Safety, and Outcomes 501
Jean-Luc Van Laethem

62 Management of Pain in Pancreatic Cancer: An Algorithm for Clinical Routine 506
J. Enrique Domínguez-Muñoz

63 EUS-guided Celiac Plexus Neurolysis for Pain in Pancreatic Cancer: When and How? 514
Jonathan M. Wyse and Anand V. Sahai

64 The Role of Endoscopy in the Management of Unresectable Pancreatic Cancer 520
Jaimin P. Amin, Ajaypal Singh, and Irving Waxman

65 Chemotherapy for Nonresectable Pancreatic Cancer 530
Raquel Fuentes, Juan José Serrano, Mercedes Rodríguez, and Alfredo Carrato

66 Diagnosis and Management of Pancreatic Exocrine Insufficiency in Pancreatic Cancer 538
Sarah Powell-Brett and Keith J. Roberts

67 Nutrition and Pancreatic Cancer 548
Mary Phillips and Oonagh Griffin

68 Present and Future of Local Therapies for Unresectable Pancreatic Cancer 555
Sabrina Gloria Giulia Testoni, Gemma Rossi, Livia Archibugi, and Paolo Giorgio Arcidiacono

69 New Pharmacological Approaches for Pancreatic Cancer Therapy: A Light at the End of the Tunnel? 564
Vineet K. Gupta, Sulagna Banerjee, and Ashok K. Saluja

Section VI Cystic Tumors of the Pancreas 573

70 Histological Classification of Pancreatic Cystic Neoplasms 575
Giuseppe Zamboni and Anna Pesci

71 Role of Endoscopic Ultrasound and Endoscopic Ultrasound-associated Techniques in the Diagnosis and Differential Diagnosis of Pancreatic Cystic Tumors 584
María-Victoria Alvarez-Sánchez and Bertrand Napoléon

72 The Role of Multidetector CT, MRI and MRCP in the Diagnosis and Differential Diagnosis of Pancreatic Cystic Neoplasms 593
Megan H. Lee and Elliot K. Fishman

73 Intraductal Papillary Mucinous Neoplasm: When to Observe, When to Operate, and Optimal Surgical Approach 599
Zhi Ven Fong and Carlos Fernandez-del Castillo

74 Cystic Tumors Other than IPMN: When to Observe, When to Operate, and Optimal Surgical Approach 608
John W. Kunstman, and James J. Farrell

75 Pancreatic Cystic Tumors: any Role for Local Therapies? 624
Julio Iglesias-Garcia

Section VII Neuroendocrine and Other Tumors of the Pancreas 631

76 Diagnosis and Treatment of Pancreatic Neuroendocrine Tumors: How to Deal with them in Clinical Practice? 633
Francesca Muffatti, Stefano Partelli, Valentina Andreasi, and Massimo Falconi

77 Other less Frequent Pancreatic Tumors: What Should be Known about Clinical Features, Diagnosis and Treatment? 641
Rossana Percario, Paolo Panaccio, Fabio F. di Mola, Pierluigi Di Sebastiano, and Tommaso Grottola

Section VIII Functional Alterations of the Pancreas in Other Clinical Situations 651

78 Diagnosis and Therapy of Exocrine Pancreatic Insufficiency after Gastric and Pancreatic Surgery 653
Raffaele Pezzilli

79 Pancreatic Exocrine Insufficiency in Type 1 and Type 2 Diabetes Mellitus: Lessons from Pancreatologists to
Diabetologists 662
Philip D. Hardt                                   

80 Diabetes Mellitus Related to Diseases of the Exocrine Pancreas (Pancreatogenic Diabetes): Diagnosis and Treatment 668
David A. Bradley and Phil A. Hart

Index 679

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