Pancreatology (PANCREATOLOGY )

Publisher: International Association of Pancreatology; European Pancreatic Club, Elsevier


Pancreatology' is the new official journal of the International Association of Pancreatology (IAP) and the European Pancreatic Club (EPC). Dedicated to the understanding and treatment of pancreatic disease, this multidisciplinary periodical is concerned with the endocrine and exocrine pancreas in health and disease, including endocrine-exocrine interactions. New treatment modalities are presented alongside more basic information relating to the etiology and progression of pancreatic disease and abnormal pancreatic function: Findings from the fields of gastroenterology, oncology, surgery, pharmacology, cell and molecular biology as well as endocrinology, immunology and epidemiology are brought together to present an integral picture. Featuring, among other things, original articles, re-views and case reports, 'Pancreatology' emphasizes not only clinical aspects, but also offers valuable information for the researcher.

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    Pancreatology (Online)
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Publications in this journal

  • [show abstract] [hide abstract]
    ABSTRACT: Objectives To investigate the limited benefit of antibiotics in ameliorating the outcome of acute necrotizing pancreatitis, we analyzed antibiotic therapy in primarily infected necrotizing pancreatitis in mice with respect to the local pancreatic pathology as well as systemic, pancreatitis induced adverse events. Methods Sterile pancreatic necrosis (SN) was induced by retrograde injection of 4% taurocholate in the common bile duct of Balb/c mice. Primarily infected pancreatic necrosis (IN) was induced by co-injecting 108CFU/ml E. coli. 10mg/kg of moxifloxacin was administered prior to pancreatitis induction (AN). After 24 hours, animals were sacrificed to examine serum as well as organs for signs of SIRS. Results Moxifloxacin significantly reduced bacterial count in pancreatic lysates of animals with infected pancreatic necrosis (IN 4.1 107±2.4 107 vs. AN 4.9 104±2.6 104 CFU/g; p<0.001). However, it did not alter pancreatic histology or pulmonary damage (Histology score: IN 23.8±2.7 vs. AN 22.6±1.7). Moxifloxacin reduced systemic immunoactivation (Serum IL-6: IN 330.5±336.6 vs. 38.7±25.5 pg/ml; p<0.001), hypoglycemia (serum glucose: IN 105.8±12.7 vs. AN 155.7±39.5 mg/dl; p<0.001), and serum aspartate aminotransferase (IN 606±89.7 vs. AN 255±52.1; p<0.05). These parameters were significantly increased in animals with necrotizing pancreatitis. Conclusion In the experimental setting, initial antibiotic therapy with moxifloxacin in acute infected necrotizing pancreatitis in mice does not have a beneficial impact on pancreatic pathology or pulmonary damage. However, other systemic complications induced by infected necrosis in acute pancreatitis are reduced by the administration of moxifloxacin.
    Pancreatology 01/2014;
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    ABSTRACT: Background Patients with type 1 autoimmune pancreatitis (AIP) have several immunologic and histologic abnormalities. It is known that depletion of B cells by rituximab is effective for treatment of IgG4-related disease (IgG4-RD) such as type 1 AIP, suggesting that B cells may be a key player in IgG4-RD. However, the role of regulatory B cells (Bregs) in type 1 AIP is unclear, and the objective of this paper is to clarify the role of Bregs in the pathophysiology of type 1 AIP by analyzing circulating Bregs. Method We recruited 21 patients with type 1 AIP as determined by the International Consensus Diagnostic Criteria for AIP (ICDC). No patients received corticosteroid treatments. For comparison, we recruited 14 patients with chronic pancreatitis (CP), 20 patients with pancreatic cancer, and 25 healthy subjects as controls. We analyzed Bregs as CD19+CD24highCD38high and CD19+CD24highCD27+ from peripheral blood by flow cytometry. Results In peripheral blood, CD19+CD24highCD38high Bregs were significantly increased in type 1 AIP patients compared with CP, pancreatic cancer, and healthy controls. Although not significant different, CD19+CD24highCD27+ Bregs of type 1 AIP were decreased compared to those of other groups. IL-10+ B cells were not significantly different from type1 AIP patients and healthy controls. In untreated type 1 AIP patients, the number of CD19+CD24highCD38high Bregs and IgG4 were not correlated. Conclusions Our data suggested that CD19+CD24highCD38high Bregs seemed to increase reactively to suppress the disease activity, and are consistent with the hypothesis that CD19+CD24highCD27+ Bregs might be involved in the development of type 1 AIP, although it still remains unclear whether the decrease of CD19+CD24highCD27+ cells is cause or effect of AIP.
    Pancreatology 01/2014;
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    ABSTRACT: Objectives Adenosquamous carcinoma of the pancreas (ASC) is a rare malignant neoplasm of the pancreas, exhibiting both glandular and squamous differentiation. However, little is known about its imaging features. This study examined the imaging features of pancreatic ASC. Methods We evaluated images of contrast-enhanced computed tomography (CT) and endoscopic ultrasonography (EUS). As controls, solid pancreatic neoplasms matched in a 2:1 ratio to ASC cases for age, sex and tumor location were also evaluated. Results Twenty-three ASC cases were examined, and 46 solid pancreatic neoplasms (43 pancreatic ductal adenocarcinomas, two pancreatic neuroendocrine tumors and one acinar cell carcinoma) were matched as controls. Univariate analysis demonstrated significant differences in the outline and vascularity of tumors on contrast-enhanced CT in the ASC and control groups (P<0.001 and P<0.001, respectively). A smooth outline, cystic changes, and the ring-enhancement pattern on contrast-enhanced CT were seen to have significant predictive powers by stepwise forward logistic regression analysis (P=0.044, P=0.010, and P=0.001, respectively). Of the three, the ring-enhancement pattern was the most useful, and its predictive diagnostic sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of ASC were 65.2%, 89.6%, 75.0% and 84.3%, respectively. Conclusions These results demonstrate that presence of the ring-enhancement pattern on contrast-enhanced CT is the most useful predictive factor for ASC.
    Pancreatology 01/2014;
  • Pancreatology 11/2013;
  • [show abstract] [hide abstract]
    ABSTRACT: Background: Pancreatic ductal adenocarcinoma (PDAC) is characterized by overexpression of Akt signaling pathway, which has been shown to be associated with aggressive behaviour and chemoresistance. Aim: The aim of this study was to evaluate the therapeutic potential of perifosine, as a novel Akt inhibitor, in combination with gemcitabine in PDAC. Materials & methods: In vitro studies were performed in 14 pancreatic-cancer-cells, including seven primary PDAC cultures. Growth inhibitory effects of perifosine and gemcitabine were evaluated in PDAC cells, whereas modulation of Akt and phospho-Akt was investigated by Western-blotting and ELISA. Cell-cycle perturbation, apoptosis-induction and anti-migratory behaviors of perifosine were studied by flow-cytometry, AnnexinV, membrane potential, and migration assay, while pharmacological interaction with gemcitabine was determined with combination index (CI) method. Results: Akt expression was detected by quantitative-RT-PCR in 14 PDAC cells, including 7 primary cell cultures. Perifosine (IC50s, 2-hour-exposure) modulated the expression of Akt, phospho-Akt, mTOR, Bcl-2, Bad and PARP proteins, and synergistically enhanced the antiproliferative activity of gemcitabine, with combination index values of 0.1 (CFPAC-1), 0.45 (PANC-1) and 0.75 (PP109). The drug combination reduced the percentages of cells in G2/M phase (e.g., from 28 to 16% in PANC-1, P<0.05), and significantly increased apoptosis compared to gemcitabine-alone. Moreover, perifosine decreased cell migration, which was additionally reduced by perifosine/gemcitabine combination (e.g., -20% in PP109, after 8hr exposure, P<0.05). Conclusion: These data show the ability of perifosine to specifically target Akt, interfere with cell-proliferation, induce apoptosis, reduce migration and synergistically interact with gemcitabine, supporting further studies on this novel therapeutic approach for treatment of pancreatic cancer.
    Pancreatology 05/2013; 13(3, Suppl.):S17.
  • Pancreatology 03/2013; 13(2):e52-e53.
  • [show abstract] [hide abstract]
    ABSTRACT: With more widespread application of and improved outcomes from pancreatoduodenectomy, late complications of this procedure are appearing more commonly in the clinical setting. Presented here is an unusual case of hemobilia secondary to cavernous portal vein transformation one year following pylorus-sparing pancreatoduodenectomy. Common and unusual causes of gastrointestinal bleeding following pancreatoduodenectomy are discussed.
    Pancreatology 01/2013;
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    ABSTRACT: Background Internal pancreatic fistula (IPF) is a well-recognized complication of pancreatic diseases. Although there have been many reports concerning IPF, the therapy for IPF still remains controversial. We herein report our experiences with endoscopic transpapillary pancreatic stent therapy for IPF and evaluate its validity. Method Six patients with IPF who presented at our department and received endoscopic transpapillary pancreatic stent therapy were investigated, focusing on the clinical and imaging features as well as treatment strategies, the response to therapy and the outcome. Results All patients were complicated with stenosis or obstruction of the main pancreatic duct, and in these cases the pancreatic ductal disruption developed distal to the areas of pancreatic stricture. The sites of pancreatic ductal disruption were the pancreatic body in five patients and the pancreatic tail in one patient. All patients received endoscopic stent placement over the stenosis site of the pancreatic duct. Three patients improved completely and one patient improved temporarily. Finally, three patients underwent surgical treatment for IPF. All patients have maintained a good course without a recurrence of IPF. Conclusion Endoscopic transpapillary pancreatic stent therapy may be an appropriate first-line treatment to be considered before surgical treatment. The point of stenting for IPF is to place a stent over the stenosis site of the pancreatic duct to reduce the pancreatic ductal pressure and the pseudocyst's pressure.
    Pancreatology 01/2013; 13(6):621–624.
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    ABSTRACT: Introduction: Prior studies have evaluated laboratory markers on admission as predictors of necrotiziing pancreatitis (NP). However, they did not account for possibility that some might have NP on admission or those with interstitial pancreatitis (IP) on admission may develop NP later during hospitalization. Aims: To evaluate early predictors of NP in patients who underwent a contrast-enhanced CT (CECT) during first 24 hours and >72 hours after admission. Patients & methods: Adults (>18 years old) presenting with AP to JHH between 2003-2011 were evaluated. Only patients with CECT in first 24 hours and >72 hours after admission included. Transfer patients excluded. Demographic, clinical, and laboratory variables on admission were evaluated. NP was defined by the CECT >72 hours after admission. Organ failure (OF) defined by revised Atlanta classification. Results: There were 1504 patients with AP. 99 (4.38%) met inclusion. 29 (29.3%) developed NP. Of the 70 with IP at admission, none developed NP. There were no statistically significant differences between the NP and IP in age, gender, prior AP admissions, etiology, and comorbidity. HCT>44% was found in 12 (41.4%) NP and 12 (17.1%) IP patients (p=0.01). NP patients had higher rates of SIRS (48.3% vs. 22.9%, p=0.01) and OF (70.6% vs. 12.9%, p=0.002) compared with IP. BISAP scores (greater-than or equal to)3, BUN>25, and symptoms duration prior to admission were not significantly different between two groups. Only OF (OR= 5.36, 95% CI 1.67-17.14) was significant independent predictor of NP on multivariable analysis. Conclusion: OF on day 1 is strong predictor for development of NP in patients with (greater-than or equal to)2 CECTs during hospitalization.
    Pancreatology 01/2013; 13(3):S69.
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    ABSTRACT: Although systemic chemotherapy significantly improves the overall survival of pancreatic cancer patients, the prognosis remains extremely poor. The development of a drug resistance, either de novo or induced resistance, significantly limits the effectiveness of chemotherapy. SLC29A1 gene encodes human equilibrative nucleoside transporter 1 (hENT1) protein that is mediating the transport of nucleotides, both purines and pyrimidines, into the tumor cells. The aim of this mini-review is to summarize the current information concerning the prognostic and predictive role of SLC29A1 transporter (hENT1) expression in pancreatic cancer. Increased expression of SLC29A1 in vitro has been described as a potential critical factor determining the sensitivity of pancreatic cancer cells to gemcitabine and 5-fluorouracil, the principal cytotoxic agents used in the treatment of pancreatic cancer. The reports on the relationship between SLC29A1 expression and prognosis of patients with pancreatic cancer are currently rather conflicting. However, majority of studies on patients with resected pancreatic cancer have suggested that high SLC29A1expression may be predictive of improved survival in patients treated with gemcitabine. SLC29A1 has not been shown to represent a predictive biomarker for patients treated by 5-fluorouracil. In conclusion, potential prognostic and predictive role of SLC29A1 has been demonstrated for selected subset of patients.
    Pancreatology 01/2013; 13(6):558–563.
  • [show abstract] [hide abstract]
    ABSTRACT: Background: Systemic inflammatory response syndrome (SIRS) has been associated with severity in acute pancreatitis. Aim: To evaluate the role of SIRS in diagnosing and predicting the severity of post-ERCP pancreatitis (PEP) Methods: All adult patients (>18 yrs) with an ERCP between 1/1/00 and 12/31/10 from our institution were evaluated (n=4511). Only outpatients who were subsequently admitted after their ERCP and had a CT during hospitalization were included. Patients with acute pancreatitis within 2 months of ERCP were excluded. CT was used to evaluate complications due to pancreatitis and to exclude other complications of ERCP. The diagnosis and severity of PEP was defined by the consensus criteria. The relationship of SIRS, measured over the first 48 hours of admission after ERCP, with the diagnosis and severity of PEP was evaluated using Chisquare testing. Results: 156 patients with suspected PEP were identified of whom 100 met the consensus definition. Among the 156 suspected PEP patients, 28.2% had SIRS at 0-6 hrs., 3.8% at 6-12 hrs.,12.8% at 12-24 hrs., and 23.1% at 24-48 hrs. SIRS at 0-6 hrs. (p=0.23), 6-12 hrs. (p=0.42) and 12-24 hrs. (p=0.14) were not associated with a diagnosis of PEP. However, SIRS at 24- 48 hrs. was significantly associated with diagnosis of PEP (p=0.006) with a sensitivity of 37.5% and specificity of 92.1%. SIRS at 24-48 hrs. also predicts the development of moderate to severe PEP (p<0.0001). Conclusions: 1) SIRS on day 1 is not useful for diagnosing PEP. 2) Patients who do not have SIRS on day 2 are likely to have a benign course. 3) Day 2 SIRS can be used as an endpoint for clinical trials evaluating interventions to reduce the incidence and severity of PEP.
    Pancreatology 01/2013; 13(2):e74.

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