We report a rare case of type 1 autoimmune pancreatitis (AIP) forming a polypoid mass at the major duodenal papilla in continuity with a cystic lesion of the pancreatic head, initially misdiagnosed as an intraductal papillary mucinous neoplasm (IPMN). A man in his 70s underwent pancreaticoduodenectomy after imaging revealed a mural nodule within a cystic lesion. Gross examination revealed a papillary polypoid lesion with continuity to a firm nodule in the pancreatic head. Histologically, the lesion exhibited glandular proliferation with pyloric and Brunner's gland-like differentiation in the fibrotic stroma, with dense IgG4-positive plasma cell infiltration and obliterative phlebitis. An incidental 6-mm high-grade pancreatic intraepithelial neoplasia was also identified adjacent to the IgG4-rich fibroinflammatory lesion. The surrounding pancreas showed acinar atrophy, vanishing duct change, and features consistent with resolving inflammation. The postoperative serum IgG4 levels remained elevated. Awareness of this unusual papillary, lumen-extending morphology may prompt consideration of type 1 AIP in the differential diagnosis and guide preoperative evaluation, including serum IgG4 testing and tissue sampling when clinically feasible.

This study aimed to evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in children aged 2 to 13 years with choledocholithiasis, addressing the challenges of using standard adult duodenoscopes in a pediatric population. Materials and Methods: We retrospectively reviewed the medical records of 107 patients who underwent ERCP at a single tertiary ERCP center between 2014 and 2024. Among these, patients with chronic pancreatitis or biliary strictures were excluded, resulting in a final cohort of 70 pediatric patients. A control group of 397 adult patients with similar conditions was analyzed for comparison. Procedural success was defined as successful deep cannulation of the common bile duct and stone extraction. The pediatric group achieved a procedural success rate of 91.4%, compared to 95.2% in adults, with no statistically significant difference (P = .278). Complication rates were low and similar between groups: bleeding occurred in 8.6% of pediatric patients, while pancreatitis was noted in 1.4%. No mortalities were reported in the pediatric cohort. The findings indicate that ERCP can be performed safely and effectively in children using standard adult duodenoscopes by experienced adult gastroenterologists under proper supervision. The procedural success rates and complication rates were comparable to adults, suggesting that ERCP is a viable option for pediatric choledocholithiasis. To optimize outcomes, further multicenter studies and improved pediatric training are recommended.

Background and Purpose: Health literacy among acute pancreatitis patients is understudied due to the lack of specific assessments. This study aimed to develop and validate the Acute Pancreatitis Health Literacy Scale (APHLS). Methods: A two-phase design was used for APHLS development and initial psychometric validation. Item generation was achieved through cognitive interviews and a Delphi survey, ensuring content relevance and expert consensus. Validity was assessed using content, construct, discriminant, and known-group analyses, while reliability was evaluated through Cronbach's alpha, test-retest reliability, and precision measures. Receiver operating characteristic analysis was conducted to determine the optimal cutoff values for the tool. Results: The final 20-item APHLS showed strong content validity, a three-factor structure confirmed by confirmatory factor analysis, good internal consistency (α = .91), and excellent test-retest reliability (intraclass correlation coefficient = .955). Conclusion: The APHLS is reliable, valid, and practical for assessing health literacy in acute pancreatitis patients and supporting educational interventions.

Although the tissue-agnostic FDA approval of pembrolizumab for tumor mutational burden (TMB)-high tumors has provided meaningful clinical benefit to patients, there remains a need to optimize TMB assessment. In this cohort study, we investigated the discordance between whole-exome sequencing (WES) and panel-based methods and evaluated their relative clinical utility in identifying patients likely to benefit from pembrolizumab. Molecularly-profiled tumors from patients treated with pembrolizumab were analyzed (N = 26,756). TMB was calculated using WES data or panels of genes (324, 523, and 648) from commercially available assays (TMB-High ≥ 10 mutations/Mb). Pembrolizumab-specific overall survival (OS) was calculated from insurance claims data (treatment start to last contact). Targeted gene panels tended to overestimate TMB and demonstrated ~ 10-15% discordance in binary TMB calls from WES, which was most pronounced for the smallest panel. Discordant cases for all three panels clustered near the TMB clinical calling threshold. WES offered improved stratification of patients for pembrolizumab treatment: in a subset of "TMB-reliant" tumor types lacking disease-specific immune checkpoint inhibitor (ICI) indications (n = 3,981), median OS was approximately 5 months longer for cases identified as WES-TMB-High but panel-TMB-Low compared to those identified as WES-TMB-Low but panel-TMB-High (p < 0.05 for 324-gene and 648-gene panels). Approximately, 10-11% of patients were potentially misclassified by panels. These findings emphasize the importance of broader gene representation for accurate TMB determination near the clinical threshold-especially in tumor types lacking disease-specific ICI indications, where tissue-agnostic MSI-High/dMMR or TMB-High labeling represents the principal on-label route to ICI therapy.

This study aimed to identify early predictors of severe acute pancreatitis (SAP). Additionally, we examined whether admission laboratory parameters improve the prognostic performance of established severity scoring systems in patients presenting to the emergency department. A prospective observational cohort study was conducted in the ED of a tertiary care hospital between 15 September 2023 and 15 September 2024. A total of 208 adult patients diagnosed with AP were enrolled. Demographic characteristics, clinical findings, laboratory parameters, imaging results, complications, and outcomes were recorded. Variables associated with SAP were examined using univariate analysis followed by backward stepwise multivariate logistic regression. Predictive accuracy was assessed using receiver operating characteristic (ROC) analysis. Of the 208 patients, 52.4% were female, and the median age was 57 years (IQR: 41-68.8). SAP occurred in 11.1% of cases. In multivariate analysis, both the BISAP score (OR: 4.398; 95% CI: 2.205-8.775; p < 0.001) and admission glucose level (OR: 1.009; 95% CI: 1.003-1.016; p = 0.007) were independent predictors of SAP. A combined model incorporating BISAP and glucose demonstrated very good discriminative performance (AUC: 0.889; 95% CI: 0.850-0.972), with 87% sensitivity and 70.3% specificity. BISAP alone also showed strong predictive ability (AUC: 0.833; 95% CI: 0.727-0.938). A glucose-enhanced BISAP model provides a practical and highly accurate early risk-stratification tool for predicting severe disease among ED patients with AP. Incorporating admission glucose into BISAP may support timelier clinical decision-making and improve early management strategies.

Colchicine (COL) is known to ameliorate severe acute pancreatitis (SAP), yet the precise molecular mechanisms remain elusive. This study integrates bioinformatics with in vivo experimentation to elucidate the mechanism by which COL attenuates SAP. An SAP rat model was established via sodium taurocholate injection. Key therapeutic targets were screened using transcriptomics and network pharmacology. Mechanistic validation utilized AAV-mediated lipocalin-2 (LCN2) overexpression, the ferroptosis inhibitor ferrostatin-1 (Fer-1), and the ERK inhibitor PD98059. COL treatment significantly ameliorated pancreatic pathological injury, inflammatory cell infiltration, and cytokine release. LCN2 was identified as a pivotal target markedly upregulated in SAP but downregulated by COL. Crucially, LCN2 overexpression reversed COL's therapeutic benefits and restored ferroptosis markers (COX2, Fe2+, ROS) while suppressing anti-ferroptotic indices. Notably, this reversal was effectively abrogated by co-treatment with either Fer-1 or PD98059, confirming the involvement of the MAPK/ERK pathway. This study is the first to elucidate that COL inhibits ferroptosis in pancreatic acinar cells by downregulating LCN2 and subsequently suppressing the LCN2/MAPK/ERK signaling axis. These findings provide a novel molecular basis for COL and highlight a potential target for therapeutic intervention in SAP.

Immunoglobulin G4 (IgG4)-related disease is a fibroinflammatory condition characterized by tumefactive lesions, dense lymphoplasmacytic infiltrates rich in IgG4-positive plasma cells. We report the case of a 67-year-old man with a history of transient jaundice and recurrent steatorrhea, initially diagnosed at 62 years. Abdominal magnetic resonance imaging raised suspicion of pancreatic cancer owing to a pancreatic head mass. The patient opted for conservative management, and jaundice resolved spontaneously. Diabetes was diagnosed concurrently. The patient was referred to our department for generalized edema of 3 months' duration and an elevated serum IgG4 level at age 67. Kidney biopsy confirmed IgG4-related kidney disease and diabetic nephropathy. Gastrointestinal endoscopy revealed multiple polyps, with IgG4-positive plasma cell infiltration in gastric and colonic tissues. Follow-up computed tomography excluded pancreatic mass. After excluding systemic lupus erythematosus and plasma cell/lymphocytic proliferative disorders, the patient was treated with glucocorticoids and rituximab. Steatorrhea and edema improved, and serum IgG4 levels decreased. Urinary protein resolved, but hypoalbuminemia persisted. Technetium-99m--labeled human serum albumin scintigraphy indicated intestinal protein loss. This case illustrates a significant treatment response in IgG4-related disease involving the kidney, pancreas, and gastrointestinal tract, complicated by protein-losing enteropathy. Routine IgG4 testing should be considered in patients with unexplained kidney disease or tumefactive lesions.

A 36-year-old postpartum woman with prior intrahepatic cholestasis of pregnancy and gallstone pancreatitis presented with right upper quadrant pain, jaundice, and elevated liver enzymes. Initial workup suggested drug-induced liver injury, but laboratory results worsened after antibiotics were discontinued. Imaging and liver biopsies revealed cholestasis and progressive fibrosis. Endoscopic retrograde cholangiopancreatography finally confirmed primary sclerosing cholangitis, though overlap with pregnancy-related liver conditions delayed diagnosis. This case highlights the diagnostic challenges of postpartum cholestasis and illustrates how primary sclerosing cholangitis may emerge in temporal association with pregnancy despite initially nondiagnostic imaging and histology.

Infantile exocrine pancreatic insufficiency is a rare condition, most often encountered in the context of cystic fibrosis or Shwachman-Diamond syndrome. The SPINK1 gene encodes a trypsin inhibitor protein that prevents the premature activation of digestive enzymes in pancreatic tissue. Heterozygous pathogenic SPINK1 variants are known to predispose individuals to hereditary pancreatitis. We report two cases of severe exocrine pancreatic insufficiency without signs of pancreatitis, caused by the same SPINK1 pathogenic variant in siblings, each presenting with distinct initial clinical manifestations, including one patient with biochemical signs of hepatocellular dysfunction. Patient 1 was enrolled in a rapid whole genome sequencing study, which promptly identified a homozygous loss-of-function variant in SPINK1 (c.27delC). To our knowledge, this specific variant has not been previously reported in association with exocrine pancreatic insufficiency, providing new insights into the disease's pathophysiology. This case also underscores the utility of rapid whole genome sequencing in facilitating timely diagnosis and management.

Pancreatic and biliary tract injuries from blunt abdominal trauma are rare in children. Common bile duct (CBD) strictures secondary to pancreatic trauma are even more uncommon, and management traditionally involves surgery. We report a 9-year-old boy who developed a severe distal intrapancreatic CBD stricture after blunt pancreatic trauma during an all-terrain vehicle (ATV) accident. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a 25 mm stricture in the lower CBD. The stricture resolved after two sessions of ERCP with biliary stenting, avoiding surgery. This case highlights a rare but significant delayed biliary complication of pediatric blunt pancreatic trauma. Early recognition and minimally invasive endoscopic intervention can achieve successful stricture resolution and may prevent the need for surgical repair. This case adds to the scarce literature on pediatric traumatic pancreatitis-associated distal CBD stricture managed successfully with ERCP and stenting.