title: Autoimmune pancreatitis associated with pancreatic cyst: how can we manage it?
abstract: BACKGROUND
  Autoimmune pancreatitis (AIP) with cyst formation (ACF) is often refractory to corticosteroid treatment (CST).
  
  
  OBJECTIVE
  To determine the characteristic features for the development of ACF.
  
  
  METHODS
  We studied characteristics in AIP patients (n = 116) whether any factors might be related to ACF. Additionally, an individual database of 24 patients was compiled to investigate factors included CST effectiveness.
  
  
  RESULTS
  The results of univariate analysis for type 1 AIP patients revealed significant association of ACF with the elevation of pancreatic enzymes, peripancreas vascular involvement (PVI) and varix formation at disease onset (P < 0.05), while multivariate analysis revealed only the absence of varix formation (odds ratio = 0.033, P = 0.0015) as a significant independent predictor of the development of ACF. The comparison of the characteristic features in ACF grouped by the diameter of the cysts revealed that only the effectiveness of the CST was significantly recognized in ACF measuring less than 55 mm in diameter than that with patients in the group with smaller cysts (P < 0.05).
  
  
  CONCLUSIONS
  The varix formation is an independent predictor of the development of ACF. A pooled analysis indicated that the disease process might be irreversible in AIP patients with large cystic lesions exceeding 55 mm in diameter and those patients tended to show a refractory course even if CST were conducted.
authors.affiliation: Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 236-0004, Japan. kubotak@yokohama-cu.ac.jp.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fujita
authors.forename: Takamistu
authors.initials: T
authors.lastname: Sato
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sekino
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hosono
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Fujisawa
authors.forename: Koji
authors.initials: K
authors.lastname: Kagawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Matsuhashi
authors.forename: Emiko
authors.initials: E
authors.lastname: Tanida
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications* / Q000628:therapy*; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D004322:Drainage; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000209:etiology* / Q000628:therapy*; D010195:Pancreatitis / Q000150:complications* / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Autoimmune pancreatitis; Pancreatic cyst; Varix