In Reply We thank Mr Liu and Mr Chen and colleagues for their comments regarding our randomized clinical trial evaluating ERCP with minor papillotomy in patients with pancreas divisum and unexplained acute recurrent pancreatitis. Liu asks whether anatomical features of impaired dorsal duct outflow modified the treatment effect. In prespecified subgroup analyses stratified by duct diameter or a santorinicele (Figure 4 of the article), we did not find significant treatment × subgroup interactions for the primary outcome. As stated in the article’s Discussion section, the study was not powered for these subgroups. Notably, the prevalence of a santorinicele was 12% using a mix of standard and secretin-enhanced magnetic resonance cholangiopancreatography prior to randomization, which is consistent with the radiology literature. In small santorinicele cohorts, outcomes of minor papillotomy for acute pancreatitis and divisum suggest persistent acute pancreatitis clinically, biochemically, or both in 20% to 30% of patients. Therefore, even though a dilated duct or santorinicele is suggestive of a stenotic orifice, it is unlikely that they are sufficient to ensure a clinically significant benefit of minor papillotomy.
Science Journals
To the Editor Dr Coté and colleagues reported the Sphincterotomy for Acute Recurrent Pancreatitis (SHARP) trial, a multicenter, double-blind, sham-controlled randomized clinical trial evaluating endoscopic retrograde cholangiopancreatography (ERCP) with minor papillotomy for adults with unexplained acute recurrent pancreatitis and pancreas divisum. Recurrent acute pancreatitis beyond 30 days occurred in 34.7% of participants (26/75) in the ERCP with minor papillotomy group vs 43.8% of participants (32/73) in the sham ERCP group (adjusted hazard ratio, 0.83 [95% CI, 0.49-1.41]), whereas pancreatitis within 30 days occurred in 14.7% vs 8.2%, respectively.
The Centers for Medicare & Medicaid Services (CMS) announced that it will provide access to certain glucagon-like peptide-1 (GLP-1) medications for weight loss for $50 a month through a new pilot program for Medicare beneficiaries.
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.
To the Editor Dr Coté and colleagues conducted a multicenter, sham-controlled, double-blind randomized clinical trial to address a long-standing practice question in patients with unexplained acute recurrent pancreatitis and pancreas divisum. The primary time-to-event outcome (acute pancreatitis >30 days after randomization) was not significantly reduced with the use of ERCP with minor papillotomy (adjusted hazard ratio, 0.83 [95% CI, 0.49-1.41]).
This Viewpoint discusses opportunities for policymakers and practitioners to make progress in the public health challenge of obesity while avoiding unintended consequences.
Damp grey of a new year’s day and I’m conversing with a clown.
Moderate protein restriction was associated with favorable outcomes for patients with chronic kidney disease, according to research published in JAMA Network Open.
C. D. Spivak, M.D., President Colorado Medical Library Association; Editor Medical Libraries, Denver, Colo.
This Special Communication explores the challenges currently facing state investment in primary care and outlines how a common fund could address these challenges and sustain primary care as a public utility and common good.
JAMA Senior Editor Derek C. Angus, MD, MPH, spoke with Gil Rabinovici, MD, a neurologist and director of the University of California San Francisco Alzheimer Disease Research Center, about the latest developments in dementia and Alzheimer disease research.
This JAMA Patient Page describes the causes, risk factors, and methods for evaluating stillbirth before and after it occurs.
This Perspective reviews the US Food and Drug Administration’s achievements toward eliminating unnecessary animal-based testing and outlines more human-relevant changes for the future.
A Black woman of Hispanic ethnicity with a history of hypertension, obesity, and headaches had symmetrically distributed, well-demarcated hyperpigmented lines that had developed during pregnancy and that extended from her buttocks to the lower extremities; physical examination was otherwise unremarkable. What is the diagnosis and what would you do next?
This Medical News article discusses the life and legacy of legendary cardiologist Eugene Braunwald, MD, who died on April 22, 2026.
For frail older patients with non–ST-elevation myocardial infarction (NSTEMI), a conservative treatment strategy may be better than an invasive approach, new research suggests.
In this narrative medicine essay, a palliative care physician composes letters in her head to the mothers of aging veterans and to the physician who may one day care for her son as a way to speak for patients who have no one to speak for them.
In Reply In response to the important clinical considerations regarding alternate cisplatin dosing regimens that Dr Szturz outlines, we acknowledge that concurrent weekly cisplatin is widely practiced in lieu of high-dose cisplatin for toxicity concerns in the setting of definitive (rather than adjuvant) radiation. However, there is currently insufficient evidence to adopt weekly cisplatin as the standard of care in the definitive setting for individuals eligible to receive cisplatin, pending the completion of an ongoing clinical trial comparing high-dose cisplatin with weekly cisplatin at 40 mg/m2 (NRG-HN009; NCT05050162). In the adjuvant setting, there are data to support weekly cisplatin administration. As noted, JCOG1008 found that weekly , 40 mg/m2, was noninferior in overall survival with fewer toxicities compared with cisplatin, 100 mg/m2, administered every 3 weeks with postoperative radiation.
To the Editor A recent Review provided a comprehensive overview of the management of squamous cell carcinoma of the head and neck. From a medical oncologist’s perspective, the role of cisplatin and several important clinical considerations should have been highlighted because cisplatin remains the most important cytotoxic agent in both curative and palliative settings for patients with head and neck cancer.
To the Editor A recent Review provided a valuable synthesis of management strategies for head and neck squamous cell carcinoma. It appropriately discussed use of systemic analgesics and local anesthetic mouthwashes to mitigate weight loss, decrease unplanned interruptions of radiotherapy, and reduce hospitalizations in patients with oral mucositis. However, photobiomodulation therapy, which involves the use of low-intensity laser or light to stimulate tissue repair, reduce inflammation, and alleviate pain, was not mentioned, despite accumulating evidence supporting its benefits for these clinical end points.
This meta-analysis assesses the association of digitalis glycosides treatment with risk of the composite outcome of cardiovascular death or first worsening heart failure events in patients with heart failure with mildly reduced ejection fraction or in those with heart failure with reduced ejection fraction.
In Reply We appreciate the Letters about our recent study. With currently available knowledge, treatment of uncomplicated acute appendicitis is no longer about correct vs incorrect management but rather a comprehensive assessment of 2 different treatment strategies, with implications ranging from patient-reported outcomes to health care cost savings. Similarly, for diagnosis of acute appendicitis—it is no longer yes or no—all outcomes, from treatment success to appendiceal tumor prevalence and resource savings, are closely related to the accurate diagnosis of appendicitis severity. The judicious use of CT advocated by Dr Dai and colleagues is important to limit unnecessary radiation exposure, especially because many patients with suspected acute appendicitis are young adults. However, imaging has been considered mandatory to achieve satisfactory accuracy in assessing appendicitis severity, which is achievable using low-dose CT with a marked radiation dose reduction without compromising diagnostic accuracy, underlining the importance of adapting these low-dose imaging protocols. Dai and colleagues also express concern about the use of broad-spectrum antibiotics. Ertapenem was initially selected to standardize the study group treatments for efficacy because ertapenem effectively covers all pathogens that can cause appendicitis. However, there is current evidence that some patients with uncomplicated acute appendicitis may have resolution of symptoms without antibiotic treatment, and most patients can be safely discharged from the emergency department. Therefore, future studies should examine the optimized nonoperative treatment of uncomplicated acute appendicitis in an outpatient setting.
To the Editor The 10-year follow-up of the APPAC trial provides valuable long-term data supporting antibiotics as a feasible treatment option for uncomplicated acute appendicitis. However, several aspects of the analysis and its interpretation warrant clarification.
To the Editor A recent study of 10-year follow-up results from the Appendicitis Acuta (APPAC) trial reported a 37.8% true appendicitis recurrence rate and a 44.3% cumulative appendectomy rate among patients initially treated with antibiotics for uncomplicated acute appendicitis. While the authors concluded that antibiotics remain a viable treatment option for uncomplicated appendicitis, we wish to highlight several concerns about the generalizability, safety, and practicality of this approach.
This population-based screening study examines early-stage (stage 1 or 2) type 1 diabetes prevalence and disease progression to clinical (stage 3) type 1 diabetes in children.