Preliminary Study of Postoperative Steroid in Treatment for Autoimmune Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Wenchuan , JIN Dayong , WANG Dansong ,  LOU Wenhui , QIN Xinyu

Department of General Surgery， Zhongshan Hospital， Fudan University， Shanghai 200032， China;

Corresponding author：

LOU Wenhui, Email: lou.wenhui@zs-hospital.sh.cn

Keywords：

Autoimmune pancreatitis; γ-globulin; Steroid treatment; Operation

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Objective 　To investigate the postoperative biochemical changes and the strategy of steroid treatment for autoimmune pancreatitis （AIP）.
Methods 　Six patients with AIP from January 2007 to October 2011 in this hospital were included in this study. Four patients received pancreaticoduodenectomy or distal pancreatectomy for being preoperatively misdiagnosed as malignant tumors. Two patients avoided the unnecessary resection and received the internal drainage for obstructive jaundice and postoperative steroid medication because of a confirmation of AIP by intraoperative frozen biopsy. All the patients underwent routine examinations， including liver function， CA19-9 level， and imaging data. Measurement of serum IgG or IgG4 was performed for fewer patients after operation.
Results 　CA19-9 levels were normal or slightly elevated in six AIP patients. For five patients with AIP in the head of pancreas， preoperative serum γ-GT levels were elevated. For these patients， whether pancreaticoduodenectomy or the internal drainage were performed， TB/DB levels were transiently elevated on day 1 or 4 after operation but dropped to below preoperative levels
or normal levels on day 7 after operation， and serum γ-GT levels among them presented a downward. Serum γ-globulin levels exhibited a downward trend among four AIP patients after resection， while a upward trend was found in another two AIP patients receiving internal drainage. From the limited data， elevated serum level of IgG in the AIP patients were found. As to IgG4， the only case was tested on month 7 after operation， the serum IgG4 level was elevated. CT showed that the swollen status of pancreas obviously reduced on month 3 after operation as compared with before operation.
Conclusions 　Postoperative steroid therapy of AIP should be based on the serum γ-globulin level and operation method. CT or MRI imaging is used to evaluate the response to steroid treatment for the AIP patients.

Citation： WU Wenchuan,JIN Dayong,WANG Dansong,LOU Wenhui,QIN Xinyu,.. Preliminary Study of Postoperative Steroid in Treatment for Autoimmune Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(2): 130-134. doi: Copy

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13.	Weber SM， Cubukcu-Dimopulo O， Palesty JA， et al. Lymphoplasmacytic sclerosing pancreatitis：inflammatory mimic of pancreatic carcinoma[J]. J Gastrointest Surg， 2003， 7(1)：129-137.
14.	Sah RP， Chari ST. Serologic issues in IgG4-related systemic disease and autoimmune pancreatitis[J]. Curr Opin Rheumatol， 2011， 23(1)：108-113.
15.	Smyk DS， Rigopoulou EI， Koutsoumpas AL， et al. Autoantibodies in autoimmune pancreatitis[J]. Int J Rheumatol， 2012， 2012：940831.
16.	Uchida K， Kusuda T， Koyabu M， et al. Regulatory T cells in type 1 autoimmune pancreatitis[J]. Int J Rheumatol， 2012， 2012：795026.
17.	Okazaki K， Uchida K， Koyabu M， et al. Recent advances in the concept and diagnosis of autoimmune pancreatitis and IgG4-related disease[J]. J Gastroenterol， 2011， 46(3)：277-288.

1. Sah RP， Chari ST. Autoimmune pancreatitis：an update on classification， diagnosis， natural history and management[J]. Curr Gastroenterol Rep， 2012， 14(2)：95-105.
2. Agrawal S， Daruwala C， Khurana J. Distinguishing autoimmune pancreatitis from pancreaticobiliary cancers：current strategy[J]. Ann Surg， 2012， 255(2)：248-258.
3. Learn PA， Grossman EB， Do RK， et al. Pitfalls in avoidingoperation for autoimmune pancreatitis[J]. Surgery， 2011， 150(5)：968-974.
4. Shimosegawa T， Chari ST， Frulloni L， et al. International consensus diagnostic criteria for autoimmune pancreatitis：guidelines of the International Association of Pancreatology[J]. Pancreas， 2011， 40(3)：352-358.
5. Kamisawa T， Okazaki K， Kawa S， et al. Japanese consensus guidelines for management of autoimmune pancreatitis：Ⅲ. Treatment and prognosis of AIP[J]. J Gastroenterol， 2010， 45(5)：471-477.
6. Chari ST. Current concepts in the treatment of autoimmune pancreatitis[J]. JOP， 2007， 8(1)：1-3.
7. Wakabayashi T， Kawaura Y， Satomura Y， et al. Clinical study of chronic pancreatitis with focal irregular narrowing of the main pancreatic duct and mass formation：comparison with chronic pancreatitis showing diffuse irregular narrowing of the main pancreatic duct[J]. Pancreas， 2002， 25(3)：283-289.
8. 楼文晖. 自身免疫性胰腺炎：外科医生的挑战与困惑[J]. 中国实用外科杂志， 2011， 31(9)：791-794.
9. Frulloni L， Cavallini G. Treatment of autoimmune pancreatitis: The search for an optimal management continues[J] . Pancreatology， 2005， 5(2-3)：238-240.
10. Nishimori I， Otsuki M. Autoimmune pancreatitis and IgG4-associated sclerosing cholangitis[J]. Best Pract Res Clin Gastroenterol， 2009， 23(1)：11-23.
11. Ghazale A， Chari ST. Optimising corticosteroid treatment for autoimmune pancreatitis[J]. Gut， 2007， 56(12)：1650-1652.
12. Ito T， Nishimori I， Inoue N， et al. Treatment for autoimmune pancreatitis：consensus on the treatment for patients with autoimmune pancreatitis in Japan[J]. J Gastroenterol， 2007， 42 Suppl 18(Suppl 18)：50-58.
13. Weber SM， Cubukcu-Dimopulo O， Palesty JA， et al. Lymphoplasmacytic sclerosing pancreatitis：inflammatory mimic of pancreatic carcinoma[J]. J Gastrointest Surg， 2003， 7(1)：129-137.
14. Sah RP， Chari ST. Serologic issues in IgG4-related systemic disease and autoimmune pancreatitis[J]. Curr Opin Rheumatol， 2011， 23(1)：108-113.
15. Smyk DS， Rigopoulou EI， Koutsoumpas AL， et al. Autoantibodies in autoimmune pancreatitis[J]. Int J Rheumatol， 2012， 2012：940831.
16. Uchida K， Kusuda T， Koyabu M， et al. Regulatory T cells in type 1 autoimmune pancreatitis[J]. Int J Rheumatol， 2012， 2012：795026.
17. Okazaki K， Uchida K， Koyabu M， et al. Recent advances in the concept and diagnosis of autoimmune pancreatitis and IgG4-related disease[J]. J Gastroenterol， 2011， 46(3)：277-288.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preliminary Study of Postoperative Steroid in Treatment for Autoimmune Pancreatitis

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