Volume 9 Issue 8, August 2012

Acute pancreatitis is the most common and feared complication following endoscopic retrograde cholangiopancreatography (ERCP). Pharmacological prevention of post-ERCP pancreatitis has been disappointing, especially in high-risk patients. However, a prospective multicentre trial has demonstrated the efficacy of rectal administration of indomethacin for preventing post-ERCP pancreatitis in high-risk cases.

Hepatitis E virus (HEV) infection is the most common cause of hepatitis worldwide. In the developing world, HEV infection is also a common cause of decompensation in patients with chronic liver disease and has a very high mortality. Could the same be true in the UK? A recent paper examines this issue.

Various methods screen for alcohol consumption in patients with alcoholic liver disease. However, each test has its own limitations. The feasibility of the methanol test for identifying recent alcohol consumption in liver transplant candidates has been investigated. New studies are required to optimize the best strategy in these patients.

Survival in patients with advanced pancreatic cancer is particularly poor, and improvements in diagnosis and treatment are urgently needed. Identification of new biomarkers and targets in pancreatic cancer could enable prediction of treatment response. In this Review, Costello and colleagues describe predictive pancreatic cancer biomarkers as well as novel treatment approaches and future treatment targets.

Familial pancreatic cancer (FPC) is a rare, hereditary tumour syndrome. High morbidity and mortality is associated with development of pancreatic cancer in these high-risk individuals and, as outlined in this Review, screening of FPC families seems appropriate. Here, Bartsch and colleagues describe the current knowledge of FPC, including phenotype, underlying genetic causes and clinical management (including genetic counselling and screening).

Abundant fibrotic stroma is a typical feature of pancreatic ductal adenocarcinoma (PDAC) in humans. It is becoming clear that this stromal tissue is not just a bystander in PDAC, but has a crucial role in tumorigenesis, angiogenesis and resistance to therapy. Targeting the stroma for diagnostic and therapeutic purposes opens a new avenue of research in the management of PDAC.

Pancreatic surgery is challenging for both surgeon and patient. With the advent of minimally invasive surgical techniques, patient morbidity could be reduced. In this article, Josh Winer and colleagues review the techniques and outcomes of robotic-assisted pancreatic resections, focusing on robotic-assisted pancreaticoduodenectomy, robotic-assisted distal pancreatectomy and robotic-assisted central pancreatectomy.

Pancreatic cancer is a highly lethal malignancy that presents multiple technical challenges for genomic studies. Next-generation sequencing and its applications have proven successful in other tumour types, and could be useful for studying pancreatic cancer. This Review outlines pancreatic cancer genomics to date, the genomic discovery applications enabled by next-generation sequencing technology and analysis, and a synthesis of the two areas that might be suggestive of a path forward.

Pancreatic cancer is one of the leading causes of cancer-related deaths worldwide. There has been a great deal of work to improve the care of patients with pancreatic cancer, as the treatment options currently available are quite limited. The five Review articles in this Focus Issue cover hot topics in the field: new biomarkers and targets, diagnostic and therapeutic implications of the role of stroma, current knowledge of familial pancreatic cancer, robotic pancreatic surgery and the potential of next-generation sequencing.