Showing papers in "Pancreas in 2013"
Stanford University1, Memorial Sloan Kettering Cancer Center2, University of Kentucky3, Ohio State University4, Harvard University5, University of Wisconsin-Madison6, National Institutes of Health7, Icahn School of Medicine at Mount Sinai8, Vanderbilt University9, University of Pennsylvania10, University of South Florida11
TL;DR: A set of consensus tables intended to complement the North American Neuroendocrine Tumor Society guidelines and serve as a quick, accessible reference for the practicing physician are presented.
Abstract: Neuroendocrine tumors are a heterogeneous group of tumors originating in various anatomic locations. The management of this disease poses a significant challenge because of the heterogeneous clinical presentations and varying degrees of aggressiveness. The recent completion of several phase 3 trials, including those evaluating octreotide, sunitinib, and everolimus, demonstrate that rigorous evaluation of novel agents in this disease is possible and can lead to practice-changing outcomes. Nevertheless, there are many aspects to the treatment of neuroendocrine tumors that remain unclear and controversial. The North American Neuroendocrine Tumor Society published a set of consensus guidelines in 2010, which provided an overview for the treatment of patients with these malignancies. Here, we present a set of consensus tables intended to complement these guidelines and serve as a quick, accessible reference for the practicing physician.
495 citations
TL;DR: Endoscopic ultrasound–guided FNA is an excellent diagnostic tool to detect the correct etiology for solid pancreatic masses and should be strongly considered as the first diagnostic tool for sampling these lesions to optimize patient management.
Abstract: ObjectivesThe objective of this study was to evaluate the accuracy of endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) in diagnosing the correct etiology for a solid pancreatic mass.MethodData extracted from EUS-FNA studies with a criterion standard (either confirmed by surgery or appro
312 citations
TL;DR: Modified FOLFIRINOX has an improved safety profile with maintained efficacy in metastatic PC and has promising activity in nonmetastatic disease.
Abstract: ObjectivesFOLFIRINOX (5-fluorouracil [5-FU], oxaliplatin, and irinotecan) as compared with gemcitabine in pancreatic cancer (PC) has superior activity and increased toxicity. The bolus 5-FU contributes to the toxicity. We hypothesized that the elimination of bolus 5-FU and use of hematopoietic growt
176 citations
TL;DR: The tumorigenic role ofmiR-21 and miR-155 was confirmed, whereas down-regulation of mi R-31, miR -145, andMiR-146a, in dispute with current literature, renders necessary the revision of use of microRNAs as biological markers.
Abstract: ObjectivesInvestigation of expression profile of well-established microRNAs in pancreatic adenocarcinoma, and its correlation with clinicopathological factors.MethodsEighty-eight samples of ductal pancreatic adenocarcinoma and 98 control samples were analyzed by real-time polymerase chain reaction f
159 citations
TL;DR: Endoscopic ultrasonography with or without FNA was superior to CT and MRI in accurately classifying a cyst as neoplastic (P < 0.0001), and the addition of EUS-FNA to abdominal imaging significantly increases overall accuracy for diagnosis of neoplastics pancreatic cysts.
Abstract: ObjectivesTo evaluate the performance characteristics of endoscopic ultrasonography (EUS) compared with computed tomography (CT) and magnetic resonance imaging (MRI) and determine the incremental diagnostic yield and accuracy of EUS with or without fine needle aspiration (FNA) over CT and MRI for pr
145 citations
TL;DR: Whereas the prevalence of DM in pancreatic cancer is very high, DM prevalence in other common cancers is no different from that in noncancer controls and new-onset DM is a phenomenon that is unique to PaC.
Abstract: ObjectivesIn pancreatic cancer (PaC), the prevalence of diabetes mellitus (DM), especially new-onset DM (≤36 months of PaC diagnosis), is high. To determine if this observation is unique to PaC, we compared the prevalence and characteristics of DM in lung, breast, prostate, and colorectal cancers wi
126 citations
TL;DR: The size of mural nodules measured with endoscopic ultrasonography showed high predictive ability, however, about 10% of carcinoma patients did not have nodules, and the handling of the diagnosis in such cases is a problem for the future.
Abstract: ObjectivesThe present study was a retrospective investigation of predictors of malignancy in intraductal papillary mucinous neoplasm (IPMN) of the pancreas.MethodsThe subjects were 310 patients who underwent pancreatic resection at 3 high-volume centers. Preoperative laboratory and imaging findings
117 citations
TL;DR: An unusually productive workshop on the risk factors of chronic pancreatitis and diabetes mellitus on the development of pancreatic ductal adenocarcinoma focused on the mechanisms of CP- and DM-associated factors on PDAC development.
Abstract: A workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Cancer Institute (NCI) on "Pancreatitis-Diabetes-Pancreatic Cancer" focused on the risk factors of chronic pancreatitis (CP) and diabetes mellitus (DM) on the development of pancreatic ductal adenocarcinoma (PDAC) Sessions were held on (a) an overview of the problem of PDAC; (b) CP as a risk factor of PDAC; (c) DM as a risk factor of PDAC; (d) pancreatogenic, or type 3c, DM; (e) genomic associations of CP, DM, and PDAC; (f) surveillance of high-risk populations and early detection of PDAC; and (g) effects of DM treatment on PDAC Recent data and current understandings of the mechanisms of CP- and DM-associated factors on PDAC development were discussed, and a detailed review of the possible risks of DM treatment on the development of PDAC was provided by representatives from academia, industry, and the Food and Drug Administration The current status of possible biomarkers of PDAC and surveillance strategies for high-risk populations were discussed, and the gaps in knowledge and opportunities for further research were elucidated A broad spectrum of expertise of the speakers and the discussants provided an unusually productive workshop, the highlights of which are summarized in the accompanying article
112 citations
TL;DR: Positron emission tomography/CE-CT is useful for the clinical management of pancreatic cancer and significant positive correlations were found between the SUVmax and tumor size/markers, suggesting that SUVmax may be a useful indicator for the treatment response.
Abstract: Objectives: Fluorodeoxyglucose (FDG)-positron emission tomography/contrast-enhanced computed tomography (PET/CE-CT) involving whole-body scanning first by non-CE-CT and FDG-PET followed by CE-CT has been used for detailed examination of pancreatic lesions. We evaluated PET/CE-CT images with regard to differential diagnosis, staging, treatment response, and postoperative recurrence in pancreatic cancer.
Methods: Positron emission tomography/CE-CT was conducted in 108 patients with pancreatic cancer and in 41 patients with other pancreatic tumor diseases.
Results: The maximum standardized uptake value (SUVmax) overlapped in benign and malignant cases, suggesting that differential diagnosis of pancreatic tumors based on the SUVmax is difficult. In the evaluation of staging in 31 resectable pancreatic cancer by PET/CE-CT, the diagnostic accuracy rate was more than 80% for most factors concerning local invasion and 94% for distant metastasis but only 42% for lymph node metastasis. Significant positive correlations were found between the SUVmax and tumor size/markers, suggesting that SUVmax may be a useful indicator for the treatment response. Regarding the diagnosis of the postoperative recurrence, PET/CE-CT correctly detected local recurrence in all the 11 cases of recurrence, whereas abdominal CE-CT detected only 7 of 11 cases, suggesting that PET/CE-CT is superior in this context.
Conclusions: Positron emission tomography/CE-CT is useful for the clinical management of pancreatic cancer.
112 citations
TL;DR: Evidence is provided that oral administration of quercetin was capable of inhibiting growth of orthotopic pancreatic tumors in a nude mouse model, which suggests a possible benefit of quERCetin in patients with pancreatic cancer.
Abstract: Objectives
The flavonoid quercetin holds promise as an anti-tumor agent in several preclinical animal models. However, the efficacy of oral administration of quercetin in a pancreatic cancer mouse model is unknown.
108 citations
TL;DR: This study may help to understand the genetic feature of pancreatic cancer and its survival effect in this population of patients and shows that additional genetic insights would contribute to the improvement of patients’ prognosis.
Abstract: ObjectivesThe objective of this study was to evaluate genetic alterations of K-ras, p53, c-erbB-2, and deleted in pancreatic cancer, locus 4 (DPC4) genes in pancreatic ductal adenocarcinoma and correlate these changes with patients’ overall survival.MethodsBetween April 2004 and December 2008, 272 p
TL;DR: The expression of ABC transporters was significantly deregulated in PDAC tumors when compared to nonmalignant tissues and the observed down-regulation of ABCA1, ABCA7, and ABCG1 suggests a possible role of stem cells in the development and progression of PDAC.
Abstract: Objectives: The aim of this study was to evaluate transcript levels of all 49 human ATP-binding cassette transporters (ABCs) in one of the most drug-resistant cancers, namely, the pancreatic ductal adenocarcinoma (PDAC). Association of ABCs levels with clinical-pathologic characteristics and KRAS mutation status was followed as well. Methods: Tumors and adjacent nonneoplastic tissues were obtained from 32 histologically verified PDAC patients. The transcript profile of ABCs was assessed using quantitative real-time polymerase chain reaction with a relative standard curve. KRAS mutations in exon 2 were assessed by high-resolution melting analysis and sequencing. Results: Most ABCs were deregulated in PDAC and 10 ABCs were associated with clinical-pathologic characteristics. KRAS mutations did not change the global expression profile of ABCs. Conclusions: The expression of ABC transporters was significantly deregulated in PDAC tumors when compared to nonmalignant tissues. The observed up-regulation of ABCB4, ABCB11, ABCC1, ABCC3, ABCC5, ABCC10, and ABCG2 in tumors may contribute to the generally poor treatment response of PDAC. The up-regulation of ABCA1, ABCA7, and ABCG1 implicates a serious impairment of cellular cholesterol homeostasis in PDAC. On the other hand, the observed downregulation of ABCA3, ABCC6, ABCC7, and ABCC8 suggests a possible role of stem cells in the development and progression of PDAC.
TL;DR: Serum OPN and TIMP-1 have use as diagnostic biomarkers in PDAC and a potential benefit of using OPN, TIMP -1, and CA 19-9 in a panel to improve diagnostic accuracy inPDAC is suggested.
Abstract: ObjectivesPancreatic ductal adenocarcinoma (PDAC) has a dismal 5-year survival rate of 5%. There is an urgent need for early detection while the tumors are small and surgically resectable. We assessed serum osteopontin (OPN) and tissue inhibitor of metalloproteinase 1 (TIMP-1) as possible diagnostic
TL;DR: Prognosis of patients with pancreatic cancer presenting with PC remains extremely poor and, given the magnitude of the problem, efforts should be undertaken to develop effective treatments in experimental and clinical studies.
Abstract: ObjectivesPeritoneal carcinomatosis (PC) is an important cause of morbidity and mortality among patients with pancreatic cancer. In an era where therapeutic options for PC of multiple origins are emerging, our aim was to provide population-based data on incidence, treatment, and prognosis of PC of p
TL;DR: The optimal treatment strategy may differ among various subgroups within the BR category, and patients in the R group had significantly better survival than those in the PV(+) group.
Abstract: ObjectivesThe objective of this study was to evaluate the relevance of defining borderline resectable (BR) pancreatic cancer as a distinct entity in the treatment scheme of pancreatic cancer as proposed by the National Comprehensive Cancer Network.MethodsAmong 375 patients with pancreatic cancer, 13
TL;DR: In this article, the authors defined the quality of life (QOL) in patients with chronic pancreatitis (CP) and compared it with known scores for several chronic conditions such as heart, kidney, liver, lung disease, and rheumatoid arthritis.
Abstract: OBJECTIVES The objective of this study was to define the quality of life (QOL) in patients with chronic pancreatitis (CP). METHODS We studied 443 well-phenotyped CP subjects and 611 control subjects prospectively enrolled from 20 US centers between 2000 and 2006 in the North American Pancreatitis Study 2. Responses to the SF-12 questionnaire were used to calculate the mental (MCS) and physical component summary scores (PCS) with norm-based scoring (normal ≥50). Quality of life in CP subjects was compared with control subjects after controlling for demographic factors, drinking history, smoking, and medical conditions. Quality of life in CP was also compared with known scores for several chronic conditions. RESULTS Both PCS (38 [SD, 11.5] vs 52 [SD, 9.4]) and MCS (44 [SD, 11.5] vs 51 [SD, 9.2]) were significantly lower in CP compared with control subjects (P < 0.001). On multivariable analyses, compared with control subjects, a profound decrease in physical QOL (PCS 12.02 points lower) and a clinically significant decrease in mental QOL (MCS 4.24 points lower) was seen due to CP. Quality of life in CP was similar to (heart, kidney, liver, lung disease) or worse than (nonskin cancers, diabetes mellitus, hypertension, rheumatoid arthritis) other chronic conditions. CONCLUSIONS The impact of CP on QOL appears substantial. The QOL in CP subjects appears to be worse or similar to the QOL of many other chronic conditions.
TL;DR: Delayed compared to early TEN is associated with higher mortality, increased frequency of infected necrosis/fluid collections, respiratory failure, and a need for intensive care unit hospitalization.
Abstract: ObjectivesThe exact time of initiation of total enteral nutrition (TEN) in severe acute pancreatitis (SAP) and its influence on the disease outcome are not well known.MethodsAn analysis of 197 cases with predicted SAP allocated to: group A (n = 97), early TEN (started within the first 48 hours after
TL;DR: Evidence is provided indicating that metformin offers a potential novel approach for pancreatic ductal adenocarcinoma prevention and therapy.
Abstract: Objective
Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease, with overall 5-year survival rate of only 3-5%. As the current therapies offer very limited survival benefits, novel therapeutic strategies are urgently required to treat this disease. Here, we determined whether metformin administration inhibits the growth of PANC-1 and MiaPaCa-2 tumor xenografts in vivo.
TL;DR: Concern is raised that AIP is associated with an elevated risk of malignancy and should prompt additional studies, and a comparable percentage of patients with AIP had PanIN.
Abstract: ObjectivesTo estimate the risk of malignancy in autoimmune pancreatitis (AIP)MethodsWe examined resected pancreata to compare the prevalence of pancreatic intraepithelial neoplasia (PanIN) in 28 cases of AIP and 30 cases of chronic pancreatitis not otherwise specified (CP-NOS) We also reviewed a c
TL;DR: In this article, the authors investigated the relationship of M2-polarized TAM infiltration of the RLNs, nodal lymphangiogenesis, and occult nodal involvement in pN0 pancreatic cancer.
Abstract: OBJECTIVE Tumor-associated macrophages (TAMs) are reportedly involved in lymphangiogenesis in primary tumors, playing a crucial role in lymphatic metastasis. Furthermore, nodal lymphangiogenesis precedes and promotes regional lymph node (RLN) metastasis. We investigated the relationship of M2-polarized TAM infiltration of the RLNs, nodal lymphangiogenesis, and occult nodal involvement in pN0 pancreatic cancer. METHODS Hematoxylin-eosin-stained primary tumor and regional LN specimens from 40 patients diagnosed with pN0 pancreatic cancer according to the pathological TNM classification were assessed. To evaluate lymphangiogenesis, lymphatic vessel density was measured by using D2-40 antibody. CD163 and cytokeratin AE1/AE3 antibodies were used to detect M2-polarized TAMs and isolated tumor cells in the RLNs, respectively. RESULTS The nodal lymphatic vessel density had a strong association with the M2-polarized TAM density in the RLNs (P < 0.0001). Most of these TAMs expressed vascular endothelial growth factor C. Furthermore, in the RLNs, the M2-polarized TAM density was significantly associated with the incidence of isolated tumor cells (P = 0.0477). CONCLUSIONS M2-polarized TAM infiltration of RLNs is significantly associated with nodal lymphangiogenesis and occult nodal involvement in pN0 pancreatic cancer. Node-infiltrating M2-polarized TAMs may facilitate nodal lymphangiogenesis via the production of vascular endothelial growth factor C and thus promote RLN metastasis.
TL;DR: In this article, the authors used the US Surveillance, Epidemiology, and End Results registry (SEDR) to assess whether improvements in survival of clinical trials translated to a population-based level.
Abstract: OBJECTIVES Patients with pancreatic adenocarcinoma often present with distant metastatic disease. We aimed to assess whether improvements in survival of clinical trials translated to a population-based level. METHODS The US Surveillance, Epidemiology, and End Results registry was queried. Adult patients with distant metastatic adenocarcinoma of the pancreas were included from 1988 to 2008. Overall survival was analyzed using Kaplan-Meier curves as well as multivariable-adjusted Cox proportional hazards models. RESULTS In total, 32,452 patients were included. Mean age was 67.6 (SD: 11.7) years, and 15,341 (47.3%) were female. Median overall survival was 3 months (95% confidence interval [CI], 3-3 months), which increased from 2 (CI, 2-2) months in 1988 to 3 (CI, 3-4) months in 2008. After adjustment for multiple covariates, the hazard ratio (HR) decreased by 0.977 per year (CI, 0.975-0.980). In multivariable-adjusted survival analyses, tumor location in the pancreatic body/tail (HR, 1.10), male sex (HR, 1.09), increasing age (HR, 1.016), African American ethnicity (HR, 1.16), nonmarried civil status (HR, 1.18), and absence of radiotherapy (HR, 1.41) were associated with worse survival (P < 0.001 for all predictors). CONCLUSIONS The improvement in overall survival over the past 2 decades among patients with metastatic pancreatic adenocarcinoma is modest and disappointing. More effective therapeutic strategies for advanced disease are desperately needed.
TL;DR: Cryoimmunotherapy significantly increased OS in metastatic pancreatic cancer and multiple cryoablations and normal pretreatment immunologic function were associated with better prognosis.
Abstract: ObjectiveThe aim of this study was to retrospectively assess the effect of comprehensive cryosurgery (ablation of intrapancreatic and extrapancreatic tumors) plus immunotherapy in metastatic pancreatic cancer.MethodsWe divided 106 patients (57 men, 49 women; median age, 65 years) into the cryoimmuno
TL;DR: Reduced antioxidant defense system capacity and increased markers of oxidative stress were found in PC and CP.
Abstract: OBJECTIVES Oxidative stress has been implicated in the pathogenesis of chronic pancreatitis (CP) and pancreatic cancer (PC). The study aim was to assess the oxidative stress markers and antioxidant defense system in patients with CP and those with PC. METHODS Activities of superoxide dismutase 1 (SOD1), catalase (CAT), glutathione peroxidase 1 (GPX1), glutathione reductase (GR), arylesterase (PON1-A) and lactonase (PON1-L) activities of paraoxonase 1 (PON1) and concentrations of reduced glutathione, conjugated dienes in low-density lipoprotein (CD/LDL) and oxidized LDL (ox-LDL/LDL) were assessed in 50 PC and 50 CP patients and 50 age and sex-matched controls. RESULTS Comparison of PC and CP groups to controls found the following changes: glutathione peroxidase 1 (GPX1) (-20.2%, -25.5%; P < 0.001), glutathione reductase (GR) (-9.5%, -11.9%; P < 0.05), SOD1 (+22.9%; P < 0.01), CAT (-10.6%; P < 0.05), PON1-A (-34.3%, -16.0%; P < 0.001), PON1-L (-44.2%; -17.0%; P < 0.01), conjugated dienes in LDL (CD/LDL) (+20%, +33.3%; P < 0.05) and ox-LDL/LDL (+42.2%, +14.4%; P < 0.05). The patients with PC had changed activities and levels of SOD1 (+24.2%), CAT (-10.4); P < 0.01), PON1-A (-21.7%), PON1-L (-32.9%), and ox-LDL/LDL (+24.3%); (all P < 0.01) compared with the patients with CP. CONCLUSIONS Reduced antioxidant defense system capacity and increased markers of oxidative stress were found in PC and CP. PON1-L and CAT activities, along with ox-LDL/LDL levels, were the independent factors differentiating the patients with PC from the patients with CP.
TL;DR: An overview of mechanism of thrombosis, its pathophysiology, diagnosis, and management in the setting of acute as well as chronic pancreatitis is offered.
Abstract: Pancreatitis is an inflammatory process with local and systemic manifestations One such local manifestation is thrombosis in splanchnic venous circulation, predominantly of the splenic vein The literature on this important complication is very sparse This review offers an overview of mechanism of thrombosis, its pathophysiology, diagnosis, and management in the setting of acute as well as chronic pancreatitis
TL;DR: Cannabidiol and O-1602 showed anti-inflammatory effects in mice with AP and improved the expression of GPR55 in the pancreatic tissue as well.
Abstract: Objectives: The anti-inflammatory effects of O-1602 and cannabidiol (CBD), the ligands of G protein-coupled receptor 55 (GPR55), on experimental acute pancreatitis (AP) were investigated.
Methods: Acute pancreatitis was induced in C57BL mice by intraperitoneal injection of 50 μg/kg cerulein hourly, with a total of 6 times. Drugs (O-1602, 10 mg/kg, or CBD, 0.5 mg/kg) were given by intraperitoneal injection 2 times at 30 minutes before the first injection and immediately before the fifth cerulein injection. At 3 hours after the last injection, the blood, the lungs, and the pancreas were harvested for the pancreatic enzyme activity, myeloperoxidase activity, and pro-inflammatory cytokines measurement; and the expressions of GPR55 mRNA and protein in the pancreas were detected.
Results: Cannabidiol or O-1602 treatment significantly improved the pathological changes of mice with AP and decreased the enzyme activities, IL-6 and tumor necrosis factor α; levels, and the myeloperoxidase activities in plasma and in the organ tissues. G protein-coupled receptor 55 mRNA and protein expressed in the pancreatic tissue, and the expressions were decreased in the mice with AP, and either CBD or O-1602 attenuated these changes to a certain extent.
Conclusion: Cannabidiol and O-1602 showed anti-inflammatory effects in mice with AP and improved the expression of GPR55 in the pancreatic tissue as well.
TL;DR: Plans for a gas chromatography mass spectroscopy–based plasma 5-HIAA assay for the evaluation of neuroendocrine tumors (NETs) yielded identical clinical correlation with other biomarkers and proportional to urinary 5- HIAA values.
Abstract: Objectives5-Hydroxyindoleacetic acid (5-HIAA) is used for the evaluation of neuroendocrine tumors (NETs) but currently requires a 24-hour urine collection.MethodsWe developed a gas chromatography mass spectroscopy–based plasma 5-HIAA assay. We compared 24-hour urine 5-HIAA values against plasma 5-HI
TL;DR: Endoscopic ultrasound-FNA and EUS-TCB may assist with the cytological diagnosis of pancreatic metastases and may have a major clinical impact.
Abstract: ObjectivesThis study aimed to describe a single-center experience with endoscopic ultrasound (EUS) features as well as the diagnostic role and clinical impact of EUS-guided fine-needle aspiration (EUS-FNA) and Trucut biopsy (EUS-TCB) in patients with pancreatic metastases.MethodsDemographic, clinica
TL;DR: Etanercept added to gemcitabine is safe but did not show significant enhancement of gem citabine in patients with advanced pancreatic cancer.
Abstract: ObjectivesEtanercept blocks tumor necrosis factor α (TNF-α), a proinflammatory cytokine that plays a role in cancer-related cachexia and tumor growth. A phase I/II study was conducted to assess the tolerability and efficacy of gemcitabine and etanercept in advanced pancreatic cancer.MethodsTwenty-fi
TL;DR: The acquisition of autophagy-related proteins is associated with poor clinical outcome in PDAC and the detection and inhibition of autophile offers a potential therapeutic target for PDAC.
Abstract: ObjectivesAutophagy is a critical intracellular pathway for the removal of aggregated proteins and damaged organelles. The aim of this study was to explore the contribution of autophagy-related proteins to clinical outcomes of patients with resected pancreatic ductal adenocarcinoma (PDAC).MethodsThe
TL;DR: Despite improving diagnostics, IAP remains a common clinical problem with a significant mortality and standardization of the clinical management of these patients warrants further investigation.
Abstract: OBJECTIVE The study aimed to better define the epidemiology of idiopathic acute pancreatitis (IAP). METHODS We identified admissions with primary diagnosis of acute pancreatitis (AP) in Nationwide Inpatient Sample between 1998 and 2007. Idiopathic AP was defined as all cases after excluding International Classification of Diseases, Ninth Revision, codes for other causes of AP (including biliary, alcoholic, trauma, iatrogenic, hyperparathyroidism, hyperlipidemia, etc). RESULTS Among the primary admissions for AP, 26.9% had biliary pancreatitis, 25.1% alcoholic, and 36.5% idiopathic. Idiopathic AP had estimated 81,8025 admissions with a mean hospitalization of 5.6 days. Patients with IAP accounted for almost half of the fatalities among the cases of AP (48.2%) and had a higher mortality rate than both patients with biliary pancreatitis and patients with alcoholic pancreatitis (1.9%, 1.5%, and 1.0%, respectively, P < 0.01). Forty-six percent of patients with biliary pancreatitis underwent cholecystectomy during the index hospitalization, compared with 0.42% of patients with IAP. Patients with IAP had a demographic distribution similar to that of patients with biliary AP (female predominant and older), which was distinct from patients with alcoholic pancreatitis (male predominant and younger). There was a gradual but steady decrease in the incidence of IAP, from 41% in 1998 to 30% in 2007. CONCLUSIONS Despite improving diagnostics, IAP remains a common clinical problem with a significant mortality. Standardization of the clinical management of these patients warrants further investigation.