TITLE

Is a 2-week steroid trial after initial negative investigation for malignancy useful in differentiating autoimmune pancreatitis from pancreatic cancer? A prospective outcome study

AUTHOR(S)
Moon, S-H; Kim, M-H; Park, D H; Hwang, C Y; Park, S J; Lee, S S; Seo, D W; Lee, S K
PUB. DATE
December 2008
SOURCE
Gut;Dec2008, Vol. 57 Issue 12, p1704
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Autoimmune pancreatitis (AlP) is a peculiar type of chronic pancreatitis that responds dramatically to steroid therapy. To date, there are no worldwide consensus criteria for AlP. Different criteria with institu- tional preference (HISORt, revised Kim and the revised Japanese criteria) are being used to diagnose AlP, and there is controversy regarding the inclusion of steroid responsiveness in the diagnostic criteria. In contrast to the HISORt and revised Kim criteria, the revised Japanese criteria do not include steroid responsiveness as a diagnostic component. Aims: This study was performed to evaluate whether "a 2-week steroid trial and subsequent assessment of its response" is a useful diagnostic tool for the differentiation of AlP from pancreatic cancer. A further aim was to discover the surgical and clinical outcome for a patient who followed the treatment algorithm based on the steroid responsiveness. Patients and methods: From January 2004 to June 2007, in the setting of clinically suspected AlP, 22 consecutive patients with atypical imaging for AlP, while not meeting the classic imaging criteria for pancreatic cancer, were challenged to undergo 2 weeks of steroid therapy (0.5 mg/kg of oral prednisolone per day). After the 2-week steroid trial, steroid responsiveness was assessed based on a marked improvement of narrowing of the main pancreatic duct and a reduction of the pancreatic mass. The steroid trial was continued in the case of positive steroid responsiveness, whereas surgical exploration was conducted in the case of negative steroid responsiveness. The final diagnosis was made by surgical exploration or long-term clinical and radiological follow-up. Results: All patients )n = 15) who responded to steroids were diagnosed as having AlP, whereas all patients )n = 7) who did not show a response to steroids were confirmed as having pancreatic cancer. Complete resec- tion was possible in all (6/6; 100%), except one individual who refused surgery. Conclusion: In the clinical setting of suspected AlP with the continued need for differentiation from pancreatic cancer due to atypical imaging for AlP, "a 2-week steroid trial and subsequent assessment of its response" may be helpful in confirming the diagnosis of AlP without negative consequences for resectable pancreatic cancer. However, a steroid trial should be performed carefully only by specialists in pancreatology.
ACCESSION #
35718734

 

Related Articles

  • Pancreatic cancer risk in hereditary pancreatitis. Weiss, Frank U. // Frontiers in Physiology;Feb2014, Vol. 4/5, p1 

    Inflammation is part of the body's immune response in order to remove harmful stimuli-like pathogens, irritants or damaged cells-and start the healing process. Recurrent or chronic inflammation on the other side seems a predisposing factor for carcinogenesis and has been found associated with...

  • Covered Stents Used for Late, Postpancreatectomy Hemorrhage in the Common Hepatic Artery.  // American Surgeon;Feb2011, Vol. 77 Issue 2, p236 

    The article describes the clinical case of a 76-year-old male patient who was diagnosed with postpancreatectomy hemorrhage (PPH). The patient was referred for operative treatment of suspected pancreatic head cancer. He underwent residual pancreatectomy and splenectomy for grade C pancreatic...

  • Pancreatoduodenectomy for Ductal Adenocarcinoma in the Very Elderly; Is It Safe and Justified? Khan, Saboor; Sclabas, Guido; Lombardo, Kaye Reid; Sarr, Michael G.; Nagorney, David; Kendrick, Michael L.; Donohue, John H.; Que, Florencia G.; Farnell, Michael B. // Journal of Gastrointestinal Surgery;Nov2010, Vol. 14 Issue 11, p1826 

    Background: The outcomes of complex major surgery in the elderly are being scrutinized because of the demands on surgical services by an aging population and the concern whether such endeavors are justified. Pancreatoduodenectomy (PD) for pancreatic adenocarcinoma presents special challenges...

  • Adenocarcinoma of the Pancreas: Is Surgery Making a Difference? Tyler, Douglas // American Journal of Gastroenterology;Sep2001, Vol. 96 Issue 9, p2532 

    Discusses the effect of surgery on the adenocarcinoma of the pancreas. Mean survival among patients diagnosed with the metastatic disease; Focus of treatment for pancreatic cancers; Common cancers in which surgery has a major impact; Misconception conveyed by articles that pancreatic cancer can...

  • Four Decades Fighting Pancreatic Cancer. WARSHAW, ANDREW L. // American Surgeon;Sep2010, Vol. 76 Issue 9, p921 

    The author offers views on the 40 years of battling against pancreatic cancer. According to the author, the development of facts, mostly the result of new imaging capabilities, that resulted in progressive understanding of pancreatic diseases. At the same time, however, the incidence of ductal...

  • Surgical resectability of pancreatic adenocarcinoma: CTA. Wong, Jimmie C.; Raman, Steven // Abdominal Imaging;Aug2010, Vol. 35 Issue 4, p471 

    Imaging studies play an important role in the diagnosis and management of patients with pancreatic adenocarcinoma. Computed tomography (CT) is the most widely available and best validated modality for imaging these patients. Meticulous technique following a well-designed pancreas protocol is...

  • Hyperamylasemia and pancreatitis following posterior spinal surgery. Kobayashi, Kazuyoshi; Imagama, Shiro; Ito, Zenya; Ando, Kei; Shinjo, Ryuichi; Yagi, Hideki; Hida, Tetsuro; Ito, Kenyu; Ishikawa, Yoshimoto; Ishiguro, Naoki // Journal of Orthopaedic Science;Nov2015, Vol. 20 Issue 6, p967 

    Background: Postoperative pancreatitis has primarily been reported as a complication of abdominal surgery, but there are some case reports of postoperative pancreatitis after spinal surgery. The objective of this study was to investigate a case series of hyperamylasemia and...

  • Adjuvant Chemoradiation for Pancreati Cancer: Few Good Data, Much Debate. Twombly, Renee // JNCI: Journal of the National Cancer Institute;12/3/2008, Vol. 100 Issue 23, p1670 

    The article underscores the use of adjuvant chemoradiation for pancreatic cancer. It mentions that the use of combination therapy for pancreatic cancer patients after surgery is widely taken to be problematic, but it established chemoradiation as standard practice in the United States. Relative...

  • Outcome of pancreatic resection in elderly patients. Sperti, Cosimo; Gruppo, Mario; Beltrame, Valentina; Militello, Carmelo; Berselli, Mattia; Frison, Laura; Morbin, Tiziana; Longo, Cristina; Caruso, Valentina; Pedrazzoli, Sergio // BMC Geriatrics;2009 Supplement 1, Vol. 9, Special section p1 

    Clinical background The increasing aging of the Western population is obviously accomplished by an increasing number of older patients with cancer, including pancreatic cancer. Since surgical resection remains the treatment of choice for pancreatic and periampullary neoplasms, increasing number...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics