Pancreas
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Islet autotransplantation (IAT) is performed in nondiabetic patients with chronic pancreatitis at the time of total pancreatectomy (TP) to minimize risk of postoperative diabetes. The role of TP-IAT in patients with chronic pancreatitis and C-peptide-positive diabetes is not established. We postulate that IAT can preserve beta cell mass and thereby benefit patients with preexisting diabetes undergoing TP. ⋯ These findings provide proof of concept that significant islet mass can be isolated in patients with chronic pancreatitis and C-peptide-positive diabetes mellitus undergoing TP-IAT. Stimulated C-peptide may be a useful marker of islet mass before transplantation in these patients.
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Randomized Controlled Trial
Early oral refeeding wisdom in patients with mild acute pancreatitis.
To evaluate the safety and efficacy of early oral refeeding (EORF) in patients with mild acute pancreatitis (AP) and to investigate the optimal duration to commence EORF. ⋯ In patients with mild AP, EORF, with the subjective feeling of hunger, is safe, feasible, and reduces LOH.
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Abdominal pain in chronic pancreatitis (CP) may be visceral or nonvisceral in origin. Differential nerve block (DNB) distinguishes visceral from nonvisceral pain. Endoscopic ultrasound and other imaging tests (eg, computed tomography and magnetic resonance cholangiopancreatography) are used to diagnose and stage CP. However, it is not known whether structural changes predict the presence of visceral pain, which may better respond to endoscopic, surgical, or visceral nerve interventions. We investigated the correlation of pancreatic structural abnormalities evident on imaging tests with the presence of visceral pain on DNB. ⋯ The severity of structural changes of CP found on imaging tests does not predict the presence of visceral pain.
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Meta Analysis
Meta-analysis: the placebo rate of abdominal pain remission in clinical trials of chronic pancreatitis.
Treatment of the pain caused by chronic pancreatitis (CP) is not standardized. Knowledge of the response to placebo in this setting may aid the design of future trials. We aimed at investigating the placebo effect on abdominal pain remission rates in patients with CP. ⋯ This meta-analysis identifies for the first time the efficacy of placebo for pain in CP and variables determining it. These data provide a sound basis for designing future placebo-controlled randomized clinical trials for the treatment of pain in CP.