This brand new updated edition of the most comprehensive reference book on pancreatic disease details the very latest knowledge on genetics and molecular biological background in terms of anatomy, physiology, pathology, and pathophysiology for all known disorders. Included for the first time, are two brand new sections on the key areas of Autoimmune Pancreatitis and Benign Cystic Neoplasms. In addition, this edition is filled with over 500 high-quality illustrations, line drawings, and radiographs that provide a step-by-step approach to all endoscopic techniques and surgical procedures. Each of these images can be downloaded via an online image bank for use in scientific presentations.

　Every existing chapter in The Pancreas: An Integrated Textbook of Basic Science, Medicine and Surgery, 3rd Edition has been thoroughly revised and updated to include the many changes in clinical practice since publication of the current edition. The book includes new guidelines for non-surgical and surgical treatment; new molecular biologic pathways to support clinical decision making in targeted treatment of pancreatic cancer; new minimally invasive surgical approaches for pancreatic diseases; and the latest knowledge of neuroendocrine tumors and periampullary tumors.

　　ㆍThe most encyclopedic book on the pancreas—providing outstanding and clear guidance for the practicing clinician
　　ㆍCovers every known pancreatic disorder in detail including its anatomy, physiology, pathology, pathophysiology, diagnosis, and management
　　ㆍCompletely updated with brand new chapters
　　ㆍOver 500 downloadable illustrations
　　ㆍAn editor and author team of high international repute who present global best-practice

　 The Pancreas: An Integrated Textbook of Basic Science, Medicine and Surgery, 3rd Edition is an important book for gastroenterologists and gastrointestinal surgeons worldwide.

Contributors xiii
Preface xxix
Abbreviations xxx
About the Companion Website xlii


Section 1 Anatomy of the Pancreas 1
1 Development of the Pancreas and Related Structures 3
2 Anatomy, Histology, and Fine Structure of the Pancreas 10
3 Congenital and Inherited Anomalies of the Pancreas 24

Section 2 Physiology and Pathophysiology of Pancreatic Functions 41
4 Physiology of Acinar Cell Secretion 43
5 Physiology of Duct Cell Secretion 56
6 Pathophysiology of Experimental Pancreatitis 63
7 Physiology and Pathophysiology of Function of Sphincter of Oddi 75
8 Neurohormonal and Hormonal Control of Pancreatic Secretion 84
9 Regulation of Pancreatic Protein Synthesis and Growth 95
10 Fibrogenesis in the Pancreas: The Role of Stellate Cells 106
11 Fibrogenesis of the Pancreas: The Role of Macrophages 117
12 Insulo–Acinar Relationship 123

Section 3 Acute Pancreatitis 133
13 Epidemiology and Etiology of Alcohol‐Induced Pancreatitis 135
14 Epidemiology and Etiology of Acute Biliary Pancreatitis 146
15 Genetic Factors in Acute Pancreatitis 158
16 The Role of the Intestine and Mesenteric Lymph in the Development of Systemic Inflammation and MODS in Severe Acute Pancreatitis 166
17 The Role of Neurogenic Inflammation in Pancreatitis 173
18 Molecular, Biochemical, and Metabolic Abnormalities in Acute Pancreatitis 178
19 Histopathology of Acute Pancreatitis 193
20 Clinical Classification Systems of Acute Pancreatitis 199
21 Clinical Assessment and Biochemical Markers to Objectify Severity and Prognosis 204
22 Acute Pancreatitis Associated With Congenital Anomalies 213
23 Acute Pancreatitis in Children 219
24 Acute Pancreatitis Associated With Metabolic Disorders, Infectious Diseases, or Drugs 230
25 Radiologic Diagnosis and Staging of Severe Acute Pancreatitis 238
　　― Clinical Course and Medical Treatment of Acute Pancreatitis 251
26 Conservative Therapy of Acute Pancreatitis: Volume Substitution and Enteral and Parenteral Nutrition 251
27 ICU Treatment of Severe Acute Pancreatitis 258
28 Use of Antibiotics in Severe Acute Pancreatitis: Indications and Limitations 265
　　― Interventional and Surgical Management of Acute Pancreatitis 271
29 Indications for Interventional and Surgical Treatment of Necrotizing Pancreatitis 271
30 Management of Infected Pancreatic Necroses: An Endoscopic Approach 277
31 Minimally Invasive Debridement and Lavage of Necrotizing Pancreatitis 283
32 Open Surgical Debridement in Necrotizing Pancreatitis 289
33 Endoscopic Treatment of Biliary Acute Pancreatitis 296
34 Strategies for the Treatment of Pancreatic Pseudocysts and Walled‐Off Necrosis After Acute Pancreatitis: Interventional Endoscopic Approaches 301
35 Strategies for the Treatment of Pancreatic Pseudocysts and Walled‐Off Necrosis After Acute Pancreatitis: Surgical Treatment 305
36 Management of Fluid Collection in Acute Pancreatitis 311
37 Management of Pancreatic Fistula in Acute Pancreatitis 316
　　― Long-Term Outcome After Treatment of Acute Pancreatitis 323
38 Long‐Term Outcome After Acute Pancreatitis 323

Section 4 Chronic Pancreatitis 331
39 Molecular Understanding of Chronic Pancreatitis 333
40 Epidemiology and Pathophysiology of Alcoholic Chronic Pancreatitis 342
41 Pain Mechanisms in Chronic Pancreatitis 349
42 Natural History of Recurrent Acute and Chronic Pancreatitis 355
43 Chronic Pancreatitis with Inflammatory Mass of the Pancreatic Head 365
44 Early Chronic Pancreatitis 371
45 Hereditary Chronic Pancreatitis: Molecular Pattern, Clinical Consequences, and Management Principles 374
46 Epidemiology and Pathophysiology of Tropical Chronic Pancreatitis 384
47 Cystic Fibrosis (CFTR)‐Associated Pancreatic Disease 391
48 Clinical and Laboratory Diagnosis of Chronic Pancreatitis 397
49 Evidence of Contrast‐Enhanced CT and MRI/MRCP 406
50 Chronic Pancreatitis: Risk Factors in Cancer 417
　　― Conservative Treatment of Chronic Pancreatitis 421
51 Pain Management in Chronic Pancreatitis 421
52 Medical Treatment of Chronic Pancreatitis: Pancreatic Digestive Enzymes: Lipases, Proteases 426
53 Nutritional Support of Chronic Pancreatitis 429
54 Medical Therapy for Chronic Pancreatitis: Antioxidants 435
　　― Strategies for Endoscopic and Surgical Treatment of Chronic Pancreatitis 439
55 Evidence of Endoscopic and Interventional Treatment of Chronic Pancreatitis and Pseudocysts 439
56 Indications and Goals of Surgical Treatment 449
57 Pancreatic Duct Drainage Procedure 453
58 Duodenum‐Preserving Pancreatic Head Resection 458
59 Major Pancreatic Resection 467
60 Laparoscopic Surgery 479
　　― Management of Diabetes and Long-Term Outcome of Chronic Pancreatitis 488
61 Chronic Pancreatitis: Long‐Term Outcome After Medical and Surgical Treatment 488
62 Management of Pancreatic Diabetes Secondary to Chronic Pancreatitis 495

Section 5 Autoimmune Pancreatitis 503
63 Epidemiology of Autoimmune Pancreatitis 505
64 Pathogenesis of Autoimmune Pancreatitis 510
65 Histology of Autoimmune Pancreatitis 516
66 Clinical Manifestation of Type 1 Autoimmune Pancreatitis 520
67 Clinical Manifestations of Type 2 Autoimmune Pancreatitis 534
68 Laboratory Diagnosis of Autoimmune Pancreatitis 539
69 What is the Evidence Measuring Immune Markers 544
70 Imaging Diagnosis of Autoimmune Pancreatitis 550
71 Medical Management of Autoimmune Pancreatitis 555
　　― Long-Term Outcome of Management of Autoimmune Pancreatitis 560
72 Long‐Term Outcome After Treatment of Autoimmune Pancreatitis 560

Section 6 Neoplastic Tumors of the Exocrine Tissue: Benign Cystic Neoplasms of the Pancreas 565
73 Epidemiology of Cystic Neoplasms of the Pancreas 567
74 Histologic Classification and Staging of Cystic Neoplasms 573
75 Molecular Mechanisms of Cystic Neoplasia 580
76 Clinical Presentation of Cystic Neoplasms 589
77 Evaluation of Cystic Lesions Using EUS, MRI, and CT 593
78 Cytologic Evaluation of Cystic Neoplasms 603
79 Natural History of Cystic Neoplasms: IPMN, MCN, SCN, and SPN 611
80 Surveillance or Surgical Treatment in Asymptomatic Cystic Neoplasms 618
　　― Local and Standard Surgical Treatment of Cystic Neoplasms 622
81 Duodenum‐Preserving Partial or Total Pancreatic Head Resection 622
82 Pancreatic Middle Segment Resection 627
83 The Indications For and Limitations of Tumor Enucleation 632
84 Standard Surgical Management of IPMN, MCN, SPN, and SCN Lesions: Open Approach 641
85 Surgical Treatment of Cystic Neoplasms: Laparoscopic Approach 649
86 Management of Recurrence of Cystic Neoplasms 655
　　― Long-Term Outcome of Management of Cystic Neoplasms 660
87 Long‐Term Outcome After Observation and Surgical Treatment: What is the Evidence? 660

Section 7 Neoplastic Tumors of Exocrine Tissue: Pancreatic Cancer 665
88 Epidemiology of Pancreatic Cancer 667
89 Smoking, a Risk for Pancreatic Cancer: Experimental and Clinical Data 673
90 Molecular Understanding of Development of Ductal Pancreatic Cancer 679
91 Familial Pancreatic Cancer 688
92 Pathology of Exocrine Pancreatic Tumors 693
93 Pancreatic Cancer: Precancerous Lesions 705
94 Clinical History and Risk Factors of Pancreatic Cancer 717
95 Pancreatic Cancer Within the Uncinate Process: Radiologic and Clinical Characteristics 724
96 The Role of EUS in the Diagnosis and Differential Diagnosis of Neoplastic Lesions 728
97 Radiologic Diagnosis of Pancreatic Cancer: CT, MRI 733
98 Screening of Patients with Hereditary Pancreatic Cancer 745
99 The Role of PET in Diagnosis of Pancreatic Cancer and Cancer Recurrence 755
100 Tumor Markers in Pancreatic Malignancies 762
101 The Role of Laparoscopy and Peritoneal Cytology in the Management of Pancreatic Cancer 766
102 Clinical Assessment and Staging of Advanced Pancreatic Cancer 770
　　― Surgical Treatment of Pancreatic Cancer 776
103 Pancreatic Cancer: Indications for Resection 776
104 Pancreaticoduodenectomy for Pancreatic Cancer, Short‐ and Long‐Term Outcomes After Kausch–Whipple and Pylorus‐Preserving Resection 783
105 Left Pancreatectomy for Body and Tail Cancer 790
106 Total Pancreatectomy: Indications and Limitations 797
107 Laparoscopic and Robotic Resection for Pancreatic Cancer 804
108 Extended Radical Surgery for Pancreatic Cancer 814
109 Palliative Pancreatoduodenectomy: Benefits and Limitations 823
110 Bypass Surgery for Advanced Pancreatic Cancer 828
　　― Nonsurgical Palliation of Pancreatic Cancer 835
111 Endoscopic and Interventional Palliation of Pancreatic Cancer 835
　　― Medical Treatment of Pancreatic Cancer 842
112 Neoadjuvant Treatment of Pancreatic Cancer: Downstaging Results 842
113 Adjuvant Chemotherapy in Pancreatic Cancer 847
114 Immunotherapy for Pancreatic Cancer 856
115 Targeted Therapies for Pancreatic Cancer 865
116 Palliative Chemotherapy for Advanced Pancreatic Cancer: Survival Benefit and Side Effects of Treatment 872
117 Management of Pain in Pancreatic Cancer 879
118 Role of Radio and Proton Beam Therapy for Pancreatic Cancer 886
119 Management of Cancer Recurrence 895
　　― Long-Term Outcome After Treatment of Pancreatic Cancer 906
120 Survival and Late Morbidity After Resection of Pancreatic Cancer 906

Section 8 Neoplastic Tumors of the Endocrine Pancreas: Neuroendocrine Tumors of the Pancreas 919
121 Epidemiology and Classification of Neuroendocrine Tumors of the Pancreas 921
122 Pathology of Neuroendocrine Neoplasms 930
123 Molecular Genetics of Neuroendocrine Tumors 937
124 Clinical Manifestation of Endocrine Tumors of the Pancreas 947
125 Evidence of Hormonal, Laboratory, Biochemical, and Instrumental Diagnostics of Neuroendocrine Tumors of the Pancreas 953
126 Pancreatic Neuroendocrine Tumors in Multiple Neoplasia Syndromes 961
127 Nonfunctioning Pancreatic Neuroendocrine Tumors: Diagnosis and Management Principles 967
128 Medical and Nucleotide Treatment of Neuroendocrine Tumors of the Pancreas 972
129 Interventional Radiology in the Treatment of Pancreatic Neuroendocrine Tumors 979
　　― Surgical Management of Endocrine Tumors of the Pancreas 982
130 Surgical Treatment of Endocrine Tumors: Enucleation 982
131 Local Treatment of Endocrine Tumors: Duodenum‐Preserving Partial or Total Pancreatic Head Resection and Pancreatic Middle‐Segment Resection 989
132 Surgical Treatment of Endocrine Tumors: Major Oncologic Resection 994
133 Management of Insulinoma 1002
134 Evidence of Medical and Surgical Treatment of Gastrinoma 1009
135 Rare Neuroendocrine Tumors of the Pancreas: Management and Evidence of Surgical Treatment 1013
136 Treatment of Neuroendocrine Tumors of the Pancreas and Biliary Tract 1019
　　― Long-Term Outcome After Treatment of Neuroendocrine Tumors of the Pancreas 1029
137 Long‐Term Outcome After Treatment of Endocrine Tumors 1029

Section 9 Periampullary Cancers and Tumors Other Than Pancreatic Cancer 1035
138 Periampullary Cancer: Clinical Presentation and Diagnostic Strategies 1037
139 Histology and Genetics of Cancer of the Papilla, Distal Common Bile Duct, and Duodenum 1047
140 Adenoma and Adenocarcinoma of the Ampulla of Vater: Diagnosis and Management 1058
141 Endoscopic Treatment of Adenomas of the Ampulla of Vater: Techniques, Results, Benefits, and Limitations 1068
142 Surgical Treatment of Adenoma and Cancer of Papilla of Vater 1074
143 Surgical Treatment of Duodenal Cancer 1081
144 Surgical Treatment of Distal Cholangiocarcinoma 1083
145 Adjuvant and Palliative Chemotherapy of Periampullary Cancers 1089
　　― Long-Term Survival After Tumor Resection 1097
146 Long‐Term Survival After Resection of Periampullary Cancer 1097

Section 10 Transplantation of the Pancreas 1107
147 Transplantation of Pancreatic Islets 1109
148 Transplantation of the Pancreas 1121

Index 1129