BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of a...BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of approximately 85%.AIM To identify EUS features that differentiate PDAC from other lesions such as neuroendocrine tumors(NETs)and helping in the differential diagnosis,by analyzing a large sample of solid pancreatic lesions.METHODS This observational,retrospective,multicenter study analyzed the endosonographic characteristics of 761 patients with a radiological diagnosis of solid pancreatic lesion,who underwent pancreatic EUS for typing and staging with needle biopsies between 2015 and 2023.General patient characteristics(age and sex)and solid lesion features were collected and described,such lesion size(Bmode),vessel involvement(compression or invasion),ductal dilation,lymphadenopathy,echogenicity,echopattern,margin regularity,multifocality,internal vascularization and elastography.Subsequently,a predictive analysis was performed through univariate and multivariate logistic regression to identify predictive features for PDAC or NET diagnoses.RESULTS Our study enrolled 761 patients,predominantly male with a mean age of 68.6.PDACs were generally larger(mean 33 mm×27 mm),often had irregular margins,and displayed significant upstream ductal dilation.Hypoechogenicity was common across malignant lesions.In contrast,NETs were smaller(mean 20 mm×17 mm)and typically had regular margins with multiple lesions.Vascular involvement,although predominant in PDAC,is a common feature of all malignant neoplasms.Multifocality,however,although a rare finding,is more typical of NETs and metastases,and practically absent in the remaining lesions.Predictive analyses showed that ductal dilation and irregular margins were the most significant predictors for PDAC[odds ratio(OR)=5.75 and 3.83],with hypoechogenicity,heterogeneous echopattern and lymphadenopathies also highly significant(OR=3.51,2.56 and 1.99).These features were inversely associated with NETs,with regular margins and absence of ductal involvement or lymphadenopathies(OR=0.24,0.86 and 0.45 respectively),as already shown by the descriptive analysis.Finally,age,despite achieving statistical significance,lacks clinical value given an OR trending towards 1.CONCLUSION This study provides a comprehensive overview of EUS features for solid pancreatic lesions,identifying distinct features like upstream ductal dilation and irregular margins for PDAC vs regular margins for NETs as strong diagnostic predictors.These findings enhance the understanding of pancreatic pathologies,offering valuable insights for improved differential diagnosis and clinical management,especially in complex cases.Further prospective studies could build on these results.展开更多
BACKGROUND Pancreatic surgery has markedly evolved during the past several years with the development of minimally invasive techniques such as laparoscopy.pancreaticojejunostomy(PJ),also known as pancreatoenterostomy,...BACKGROUND Pancreatic surgery has markedly evolved during the past several years with the development of minimally invasive techniques such as laparoscopy.pancreaticojejunostomy(PJ),also known as pancreatoenterostomy,is a critical step in surgical reconstruction after pancreatic resection.However,the laparoscopic performance of PJ presents additional technical challenges,especially in achieving a secure anastomosis while preserving the integrity of pancreatic tissue.AIM To evaluate the effectiveness and safety of binding and interlocking PJ(BIPJ)as a novel technique in laparoscopic pancreatic surgery.METHODS Data of patients who underwent laparoscopic pancreatic surgery from 2018 to 2023 were obtained from the hepatobiliary and pancreatic surgery database of the Second Affiliated Hospital of Zhejiang University School of Medicine and retrospectively analyzed.According to the different PJ methods used during surgery,the patients were divided into two groups:The BIPJ group and the ductto-mucosa PJ(DMPJ)group.RESULTS BIPJ was performed in 33 patients,and DMPJ was performed in 34 patients.The operative time was significantly shorter in the BIPJ group(median,340 minutes;interquartile range,310-350)than in the DMPJ group(median,388 minutes;interquartile range,341-464)(P=0.004).No significant differences were found between the DMPJ and BIPJ groups in terms of the rates of pancreatic fistula,intra-abdominal hemorrhage,intra-abdominal abscess,postoperative biliary fistula,reoperation,or postoperative hospital stay.CONCLUSION The suitability of laparoscopic PJ for all pancreatic textures,ability to perform full laparoscopy,shorter operation time,and comparable safety with traditional PJ make BIPJ a promising option for both surgeons and patients.展开更多
High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatograph...High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.展开更多
A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incisio...A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).展开更多
Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological me...Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological mechanisms underlying IPFD remain unclear,with several potential contributing factors,including oxida-tive stress,alterations in the gut microbiota,and hormonal imbalances.IPFD was found to be highly correlated with the occurrence and prognosis of exocrine pan-creatic diseases.Although imaging techniques remain the primary diagnostic approach for IPFD,an expanding array of biomarkers and clinical scoring systems have been identified for screening purposes.Currently,effective treatments for IPFD are not available;however,existing medications,such as glucagon-like peptide-1 receptor agonists,and new therapeutic approaches explored in animal models have shown considerable potential for managing this disease.This paper reviews the pathogenesis of IPFD,its association with exocrine pancreatic disea-ses,and recent advancements in its diagnosis and treatment,emphasizing the significant clinical relevance of IPFD.展开更多
Irreversible electroporation is a promising non-thermal ablation method that has been shown to increase overall survival in locally advanced pancreatic cancer in some studies.However,higher quality studies with proper...Irreversible electroporation is a promising non-thermal ablation method that has been shown to increase overall survival in locally advanced pancreatic cancer in some studies.However,higher quality studies with proper controls and randomization are required to establish its superiority when added with neoadjuvant chemotherapy over the current management of choice,which is chemotherapy alone.Further studies are required before establishment of any survival benefit in metastatic pancreatic carcinoma,and such evidence is lacking at present.展开更多
BACKGROUND The treatment strategy for pancreatic pseudocysts(PPC)is comprehensive and warrants multidisciplinary participation.However,at present,the treatment concepts for PPC are inconsistent.Moreover,the timing of ...BACKGROUND The treatment strategy for pancreatic pseudocysts(PPC)is comprehensive and warrants multidisciplinary participation.However,at present,the treatment concepts for PPC are inconsistent.Moreover,the timing of interventional therapy is unclear,and complication management is insufficient.Therefore,the deve-lopment of a multidisciplinary expert consensus on PPC is warranted.At present,endoscopic treatment is recommended for managing PPC in American Society for Gastrointestinal Endoscopy guideline and Chinese Consensus guidelines.CASE SUMMARY In this study,we present a rare case of PPC identified by endoscopy and imaging examination,and successfully managed by endoscopic and percutaneous dra-inage.In detail,an obese patient with a history of recurrent pancreatitis presents an irregular,elliptical cystic low-density shadow in the pancreatic region.En-doscopic ultrasound combined with double knife incision technique was used to endoscopic drainage,resulting in a favorable prognosis.CONCLUSION Ultrasound-guided endoscopic drainage for the management of PPC may provide additional insights to current clinical guidelines.展开更多
BACKGROUND As a heterogeneous group of lesions,pancreatic cystic lesions(PCLs)vary enormously in malignant potential,mandating different treatment strategies.Despite significant advances in diagnostic imaging and labo...BACKGROUND As a heterogeneous group of lesions,pancreatic cystic lesions(PCLs)vary enormously in malignant potential,mandating different treatment strategies.Despite significant advances in diagnostic imaging and laboratory tests,the accurate diagnosis of PCLs remains challenging,leading to overtreatment or delayed/missed surgical timing in patients with PCLs.CASE SUMMARY We present a case of a 64-year-old female patient in whom an asymptomatic,incidental cystic mass was found in the pancreatic tail on a routine abdominal ultrasound.After a comprehensive work-up with laboratory examinations,contrast-enhanced computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreatography,a pancreatic pseudocyst was suspected.Subsequent endoscopic ultrasound with fine-needle aspiration and needle-based confocal laser endomicroscopy supported a benign diagnosis.Follow-up computed tomography and magnetic resonance imaging examinations five months later showed significant cyst shrinkage without any abnormalities.However,three years after being lost to follow-up,the patient was readmitted and diagnosed with pancreatic adenocarcinoma with multiple metastases,suggesting that the initial lesion was a mucinous cystic neoplasm misdiagnosed as a pan-creatic pseudocyst.CONCLUSION Comprehensive integration of all available information(e.g.,cyst features,abnormal imaging findings,cyst biochemistry,clinical history,and patient demographics)rather than over-reliance on imaging or endoscopic findings is pivotal to diagnosing PCLs,and patients with concerning features should undergo strict surveillance.展开更多
Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these p...Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these patients.Of late,various recurrence patterns have been observed;the most common of them being distant metastasis followed by the pancreatic bed and lymph node recurrence.Recurrence in the remnant pancreas is on the rise due to improved survival in patients who previously underwent surgery for pancreatic cancer.Total remnant pancreatectomy is an appealing option in resectable remnant pancreatic carcinoma without distant metastasis.It is an entity showing an increasing incidence and demanding further in-depth studies to elucidate the exact pathological mechanism and to establish appropriate management protocols.展开更多
BACKGROUND Pancreatic fluid leakage is a rare complication of pancreatic cancer and often requires drainage when conservative therapy fails.Endoscopic,percutaneous,and surgical drainage are options.Minimally invasive ...BACKGROUND Pancreatic fluid leakage is a rare complication of pancreatic cancer and often requires drainage when conservative therapy fails.Endoscopic,percutaneous,and surgical drainage are options.Minimally invasive endoscopic procedures are generally considered the first-line treatment,with either a transpapillary approach or an endoscopic ultrasound-guided transmural approach selected depending on the case.Various dilators are used to dilate tracts to the leakage site.However,reports of dilation through a rigid trans-tumoral tract using a drill dilator remain extremely rare.CASE SUMMARY A 74-year-old woman with pancreatic body and tail cancer developed fever and left-sided chest pain after multiple courses of chemotherapy.Computed tomography revealed fluid accumulation around the pancreatic tail and spleen along with a left pleural effusion.The effusion was diagnosed as reactive secondary to pancreatic fluid leakage.Endoscopic retrograde cholangiopancreatography identified irregular stenosis of the main pancreatic duct in the pancreatic body.Distal to the stenosis,the main ductal structure was nearly obliterated by the tumor.The contrast medium had leaked into the pancreatic fluid leakage area through several fine,disrupted ductal structures.The guidewire was successfully advanced through an extremely fine tract that was not the main contrast-filling route.Standard dilators failed to expand the rigid trans-tumoral tract.A second endoscopic retrograde cholangiopancreatography using a drill dilator successfully expanded the trans-tumoral tract,enabling endoscopic nasopancreatic drainage tube placement.Subsequently,the pancreatic fluid leakage and pleural effusion resolved.CONCLUSION Even in rigid trans-tumoral tracts,the use of a drill dilator can facilitate successful tract expansion,enabling effective drainage.展开更多
Since its inception,localized pancreatic cancer has been identified as a systemic illness.Hence,to increase its survival rates,surgical resection followed by ad-juvant chemotherapy is used as a treatment option.A sign...Since its inception,localized pancreatic cancer has been identified as a systemic illness.Hence,to increase its survival rates,surgical resection followed by ad-juvant chemotherapy is used as a treatment option.A significant barrier,though,is the high morbidity and drawn-out recovery after extensive surgical resection,which may postpone or prohibit the prompt administration of adjuvant therapy.Thereby,acknowledging the efficacy of neoadjuvant therapy in various digestive tract malignancies like rectal,gastric,and oesophagal cancers in en-hancing long-term survival and the likelihood of successful resection,researchers have turned their attention to exploring its potential benefits in the context of both resectable and borderline resectable pancreatic cancer(RPC).According to recent data,neoadjuvant chemoradiation has major advantages for both resectable and borderline RPC.These advantages include increased surgical resection rates,longer survival times,decreased recurrence rates,and better overall disease control with a manageable toxicity profile.Despite its benefits,research is still being done to determine the best way to sequence and combine chemotherapy and radiation.Furthermore,studies have demonstrated the potential for cus-tomized therapy regimens based on the patient’s general health status and the tumor’s biological behavior to maximize the neoadjuvant approach.As progress continues,neoadjuvant chemoradiation is set to become a key component of treatment for both resectable and borderline RPC,providing a more efficient way to manage this deadly condition.While further development is required to fully grasp its potential in enhancing long-term patient outcomes,evidence supports its increasing usage in clinical practice.展开更多
BACKGROUND Postoperative pancreatic fistula(POPF)is the most frequent cause of morbimortality after pancreaticoduodenectomy,but the best technique to use to prevent its development is unclear.The choice of drainage me...BACKGROUND Postoperative pancreatic fistula(POPF)is the most frequent cause of morbimortality after pancreaticoduodenectomy,but the best technique to use to prevent its development is unclear.The choice of drainage method external duct stent(EDS),internal duct stent(IDS),or non-ductal stent(NDS)is also controversial.AIM To compare the three groups(EDS,IDS and NDS),analyzing the patient characteristics,perioperative examinations and survival.METHODS Patients who underwent pancreaticoduodenectomy and pancreaticojejunostomy between 2012 and 2020,were divided into the EDS,IDS and NDS groups.RESULTS Of the 244 patients included,129 were in the EDS group,71 in the IDS group,and 44 in the NDS group.Except for preoperative pancreatitis in the NDS patients,comorbidities were similar among the groups.Patients in the NDS group had a high caliber of the Wirsung duct and frequently presented with a hard pancreas(P<0.001).A lower rate of grade C POPF was observed in the EDS(1.6%)compared to the NDS(9.1%)and IDS group(14.1%)(P=0.009).The groups showed similar findings for delayed gastric emptying,postoperative hemorrhage,reoperation,and 5-year survivals.Ninety-day mortality rate was significantly higher in the IDS group(5.6%)compared to the EDS(1.6%)and NDS(4.5%)groups(P=0.046).Multivariate analysis showed that the use of EDS was a protective factor for grade B/C POPF(P=0.034),and 90-day mortality(P=0.018).Additionally,a Wirsung duct diameter<3 mm was the only risk factor for grade B/C POPF(P=0.001),and 90-day mortality(P=0.031).CONCLUSION The use of the EDS was a protective factor for grade B/C POPF and 90-day mortality,and the Wirsung duct<3 mm was a risk factor for grade B/C POPF and 90-day mortality.展开更多
BACKGROUND Middle pancreatectomy(MP)is a surgical procedure that removes non-invasive lesions in the pancreatic neck and body,allowing for the preservation of pan-creatic function.However,MP is associated with a highe...BACKGROUND Middle pancreatectomy(MP)is a surgical procedure that removes non-invasive lesions in the pancreatic neck and body,allowing for the preservation of pan-creatic function.However,MP is associated with a higher risk of postoperative complications,and there’s no clear consensus on which anastomotic method is preferable.In recent years,our team has developed a new method called inter-locking main pancreatic duct-jejunal(IMPD-J)internal bridge drainage to MP.AIM To compare perioperative and postoperative outcomes in patients who underwent IMPD-J bridge drainage and those underwent traditional duct-to-mucosa pancreatojejunostomy.METHODS Patients who underwent MP in our hospital between October 1,2011 and July 31,2023 were enrolled in this study.Patients were divided into two groups based on their pancreatojejunostomy technique:IMPD-J bridge drainage group and duct-to-mucosa pancreatojejunostomy group.Demographic data(age,gender,body mass index,hypertension,diabetes,etc.)and perioperative indicators[operation time,intraoperative bleeding,clinically relevant postoperative pancreatic fistula(CR-POPF),delayed gastric emptying,etc.]were recorded and analyzed statist-ically.RESULTS A total of 53 patients were enrolled in this study,including 23 in the IMPD-J Bridge Drainage group and 30 in the traditional duct-to-mucosa pancreatojejun-ostomy group.There were no significant differences in demographic or preope-rative characteristics between the groups.Compared to traditional duct-to-mucosa pancreaticojejunostomy,IMPD-J bridge drainage had a significant shorter operation time(4.3±1.3 hours vs 5.8±1.8 hours,P=0.002),nasogastric tube retention days(5.3±1.7 days vs 6.5±2.0 days,P=0.031),lower incidence of delayed gastric emptying(8.7%vs 36.7%,P=0.019),and lower incidence of CR-POPF(39.1%vs 70.0%,P=0.025).Multivariate logistic regression analysis showed that pancreaticojejunostomy type(odds ratio=4.219,95%confidence interval=1.238-14.379,P=0.021)and plasma prealbumin(odds ratio=1.132,95%confidence interval=1.001-1.281,P=0.049)were independent risk factor for CR-POPF.In IMPD-J bridge drainage group,only one patient experienced recurrent pancreatitis due to the large diameter of the silicone tube and had it removed six months after surgery.CONCLUSION Compared to traditional duct-to-mucosa pancreatojejunostomy,IMPD-J bridge drainage has the advantages of simplicity and fewer perioperative complications,with favorable long-term outcomes.展开更多
Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into...Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon enti-ty,revealing striking geographical variations and questioning current treatment paradigms.This editorial commentary analyzes the study's key findings,inclu-ding the predominance of solid pseudopapillary neoplasms and their younger age of onset,which contrast sharply with Western data.It explores the implications for clinical practice and research,emphasizing the need for population-specific approaches to diagnosis and treatment.The revealed limited institutional expe-rience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases,suggesting benefits of centralizing healthcare services.Furthermore,the commentary advocates for international collaborative studies to elucidate the genetic,environmental,and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations.It also outlines future directions,calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes.Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.展开更多
This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a...This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.展开更多
BACKGROUND Pancreatic fibrosis,which decreases risk of postoperative pancreatic fistula(POPF),can be estimated using extracellular volume fraction(ECVf).AIM To investigate the correlation between ECVf and pancreatic h...BACKGROUND Pancreatic fibrosis,which decreases risk of postoperative pancreatic fistula(POPF),can be estimated using extracellular volume fraction(ECVf).AIM To investigate the correlation between ECVf and pancreatic histology,as well as the usefulness of ECVf in predicting POPF.METHODS In 71 patients who underwent pancreatic resection,we caluculated pancreatic ECVf by comparing absolute enhancements of the pancreas and aorta between pre-contrast and equilibrium phases.Areas of fibrosis,fat,acini,and islets were calculated based on resection specimens.RESULTS ECVf correlated with fibrosis(r=0.724;P<0.001)and negatively correlated with acini(r=-0.510;P<0.001).Among 48 patients who underwent pancreatoduoden ectomy,21 developed POPF.Main pancreatic duct diameter≤2 mm and ECVf<36%were selected as risk factors by multivariate analysis[respective odds ratios(OR)and P values,4.26 and P=0.048;OR=11.07 and P=0.036].Using these factors as a risk score(0-2 points),POPF occurred in 0%,50%,and 70%of patients with 0,1,and 2 points,respectively.CONCLUSION ECVf is useful in predicting acinar loss and pancreatic fibrosis,and ECVf<36%may be a risk factor for POPF.展开更多
Acute pancreatitis(AP)remains a clinical challenge due to its heterogeneous presentation and potential for rapid progression to severe disease.In their editorial,Wang et al highlight phospholipase D2(PLD2)as a novel c...Acute pancreatitis(AP)remains a clinical challenge due to its heterogeneous presentation and potential for rapid progression to severe disease.In their editorial,Wang et al highlight phospholipase D2(PLD2)as a novel candidate biomarker,proposing its involvement in key inflammatory pathways and its inverse correlation with disease severity.While this represents a promising improvement in precision diagnostics,significant gaps remain that require further investigation.Specifically,the functional role of PLD2 in the molecular cascade of AP is not yet fully understood.Questions still remain,such as:Is the observed downregulation of PLD2 a causal factor or an epiphenomenon?Does PLD2 modulation offer a tangible therapeutic benefit beyond a mere correlation?These questions highlight the necessity of mechanistic in vivo studies to validate the role and therapeutic potential of PLD2.Furthermore,interindividual variability in inflammatory responses raises concerns regarding PLD2’s predictive consistency across genetically diverse populations.The temporal dynamics of PLD2 expression in AP also remain unclear;establishing whether its variations precede clinical deterioration is essential for its use in early risk stratification,integrating multiomics research(proteomics,metabolomics,transcriptomics,and lipidomics),which can clarify the biological interactions and regulatory pathways of PLD2 under complex mechanisms.Likewise,well-designed,multicenter,prospective studies will be essential in determining its true clinical value.The research by Wang et al initiates an intriguing direction in the quest for AP biomarkers,but further research is required before PLD2 can be established as a clinically applicable tool.Additional efforts are required to close this gap and define whether its role transcends a mere association in order for it to become a therapeutic target.展开更多
Pancreatic cancer is still one of the neoplasms with the worst prognosis.Late presentation at an unresectable or metastatic stage precluding surgery,aggressive biology,and resistance to antiblastic drugs make this dis...Pancreatic cancer is still one of the neoplasms with the worst prognosis.Late presentation at an unresectable or metastatic stage precluding surgery,aggressive biology,and resistance to antiblastic drugs make this disease a formidable foe.The authors,following the path already traced by the previous review,investigate and summarize the breakthroughs of recent years concerning this lethal disease.Areas of progress include improving prevention and early detection strategies,refining molecular understanding of pancreatic cancer,identifying more effective systemic therapies,and improving quality of life and surgical outcomes.No less important is the technological aspect that looks primarily at artificial intelligence.展开更多
Copyright 2025,Hepatobiliary&Pancreatic Diseases International.All rights reserved.www.hbpdint.com,Aims and Scope Hepatobiliary&Pancreatic Diseases International publishes peerreviewed original papers,reviews(...Copyright 2025,Hepatobiliary&Pancreatic Diseases International.All rights reserved.www.hbpdint.com,Aims and Scope Hepatobiliary&Pancreatic Diseases International publishes peerreviewed original papers,reviews(meta-analysis,systematic review)and editorials concerned with clinical practice and research in the fields of hepatobiliary and pancreatic diseases.Papers cover the medical,surgical,radiological,pathological,biochemical,physiological and histological aspects of the subject areas under the headings Liver,Biliary,Pancreas,Transplantation,Research,Editorials,Review Articles,New Techniques,Clinical Images,Viewpoints and Letters to the Editor.展开更多
Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct.Its relevance has grown in recent years with the introduction of novel technologies,allowing for both...Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct.Its relevance has grown in recent years with the introduction of novel technologies,allowing for both diagnosis and treatment within a single procedure.In therapeutic applications,it facilitates interventions such as stone fragmentation,stone retrieval,and tumor-related obstruction management.In diagnostic applications,it improves the accuracy of biopsies for suspicious lesions,particularly in cases of cystic neoplasms,indeterminate strictures,and pancreatic fistula assessments.The most common complications include postprocedural pancreatitis and self-limited abdominal pain,with their incidence mitigated by prophylactic anti-inflammatory drugs and pancreatic stent placement.Despite being limited by the need for specialized equipment and trained personnel,technological advancements may position pancreatoscopy as a first-line tool in modern clinical practice.展开更多
基金Supported by the Italian Ministry of Health-Current research IRCCS(Funds Dedicated to the Research of the Gastroenterology and Digestive Endoscopy Unit,Fondazione IRCCS Ca’Granda,Ospedale Maggiore Policlinico,Milano).
文摘BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of approximately 85%.AIM To identify EUS features that differentiate PDAC from other lesions such as neuroendocrine tumors(NETs)and helping in the differential diagnosis,by analyzing a large sample of solid pancreatic lesions.METHODS This observational,retrospective,multicenter study analyzed the endosonographic characteristics of 761 patients with a radiological diagnosis of solid pancreatic lesion,who underwent pancreatic EUS for typing and staging with needle biopsies between 2015 and 2023.General patient characteristics(age and sex)and solid lesion features were collected and described,such lesion size(Bmode),vessel involvement(compression or invasion),ductal dilation,lymphadenopathy,echogenicity,echopattern,margin regularity,multifocality,internal vascularization and elastography.Subsequently,a predictive analysis was performed through univariate and multivariate logistic regression to identify predictive features for PDAC or NET diagnoses.RESULTS Our study enrolled 761 patients,predominantly male with a mean age of 68.6.PDACs were generally larger(mean 33 mm×27 mm),often had irregular margins,and displayed significant upstream ductal dilation.Hypoechogenicity was common across malignant lesions.In contrast,NETs were smaller(mean 20 mm×17 mm)and typically had regular margins with multiple lesions.Vascular involvement,although predominant in PDAC,is a common feature of all malignant neoplasms.Multifocality,however,although a rare finding,is more typical of NETs and metastases,and practically absent in the remaining lesions.Predictive analyses showed that ductal dilation and irregular margins were the most significant predictors for PDAC[odds ratio(OR)=5.75 and 3.83],with hypoechogenicity,heterogeneous echopattern and lymphadenopathies also highly significant(OR=3.51,2.56 and 1.99).These features were inversely associated with NETs,with regular margins and absence of ductal involvement or lymphadenopathies(OR=0.24,0.86 and 0.45 respectively),as already shown by the descriptive analysis.Finally,age,despite achieving statistical significance,lacks clinical value given an OR trending towards 1.CONCLUSION This study provides a comprehensive overview of EUS features for solid pancreatic lesions,identifying distinct features like upstream ductal dilation and irregular margins for PDAC vs regular margins for NETs as strong diagnostic predictors.These findings enhance the understanding of pancreatic pathologies,offering valuable insights for improved differential diagnosis and clinical management,especially in complex cases.Further prospective studies could build on these results.
基金Supported by National Natural Science Foundation of China,No.82272634 and No.62233016.
文摘BACKGROUND Pancreatic surgery has markedly evolved during the past several years with the development of minimally invasive techniques such as laparoscopy.pancreaticojejunostomy(PJ),also known as pancreatoenterostomy,is a critical step in surgical reconstruction after pancreatic resection.However,the laparoscopic performance of PJ presents additional technical challenges,especially in achieving a secure anastomosis while preserving the integrity of pancreatic tissue.AIM To evaluate the effectiveness and safety of binding and interlocking PJ(BIPJ)as a novel technique in laparoscopic pancreatic surgery.METHODS Data of patients who underwent laparoscopic pancreatic surgery from 2018 to 2023 were obtained from the hepatobiliary and pancreatic surgery database of the Second Affiliated Hospital of Zhejiang University School of Medicine and retrospectively analyzed.According to the different PJ methods used during surgery,the patients were divided into two groups:The BIPJ group and the ductto-mucosa PJ(DMPJ)group.RESULTS BIPJ was performed in 33 patients,and DMPJ was performed in 34 patients.The operative time was significantly shorter in the BIPJ group(median,340 minutes;interquartile range,310-350)than in the DMPJ group(median,388 minutes;interquartile range,341-464)(P=0.004).No significant differences were found between the DMPJ and BIPJ groups in terms of the rates of pancreatic fistula,intra-abdominal hemorrhage,intra-abdominal abscess,postoperative biliary fistula,reoperation,or postoperative hospital stay.CONCLUSION The suitability of laparoscopic PJ for all pancreatic textures,ability to perform full laparoscopy,shorter operation time,and comparable safety with traditional PJ make BIPJ a promising option for both surgeons and patients.
文摘High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.
基金supported by grants from the National Natu-ral Science Foundation of China(81302161 and 82003103)the Science and Technology Department of Sichuan Province(2021YFS0375 and 2020YJ0450).
文摘A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).
基金Supported by National Natural Science Foundation of China,No.82170651and the Research Support Fund of Hubei Microcirculation Society,No.HBWXH2024(1)-1.
文摘Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological mechanisms underlying IPFD remain unclear,with several potential contributing factors,including oxida-tive stress,alterations in the gut microbiota,and hormonal imbalances.IPFD was found to be highly correlated with the occurrence and prognosis of exocrine pan-creatic diseases.Although imaging techniques remain the primary diagnostic approach for IPFD,an expanding array of biomarkers and clinical scoring systems have been identified for screening purposes.Currently,effective treatments for IPFD are not available;however,existing medications,such as glucagon-like peptide-1 receptor agonists,and new therapeutic approaches explored in animal models have shown considerable potential for managing this disease.This paper reviews the pathogenesis of IPFD,its association with exocrine pancreatic disea-ses,and recent advancements in its diagnosis and treatment,emphasizing the significant clinical relevance of IPFD.
基金Supported by Department of Biotechnology,Government of India,No.RLS/BT/Re-entry/05/2012.
文摘Irreversible electroporation is a promising non-thermal ablation method that has been shown to increase overall survival in locally advanced pancreatic cancer in some studies.However,higher quality studies with proper controls and randomization are required to establish its superiority when added with neoadjuvant chemotherapy over the current management of choice,which is chemotherapy alone.Further studies are required before establishment of any survival benefit in metastatic pancreatic carcinoma,and such evidence is lacking at present.
基金Supported by Research Project of the Chinese Digestive Early Cancer Physicians’Joint Growth Program,No.GTCZ-2021-AH-34-0012.
文摘BACKGROUND The treatment strategy for pancreatic pseudocysts(PPC)is comprehensive and warrants multidisciplinary participation.However,at present,the treatment concepts for PPC are inconsistent.Moreover,the timing of interventional therapy is unclear,and complication management is insufficient.Therefore,the deve-lopment of a multidisciplinary expert consensus on PPC is warranted.At present,endoscopic treatment is recommended for managing PPC in American Society for Gastrointestinal Endoscopy guideline and Chinese Consensus guidelines.CASE SUMMARY In this study,we present a rare case of PPC identified by endoscopy and imaging examination,and successfully managed by endoscopic and percutaneous dra-inage.In detail,an obese patient with a history of recurrent pancreatitis presents an irregular,elliptical cystic low-density shadow in the pancreatic region.En-doscopic ultrasound combined with double knife incision technique was used to endoscopic drainage,resulting in a favorable prognosis.CONCLUSION Ultrasound-guided endoscopic drainage for the management of PPC may provide additional insights to current clinical guidelines.
基金Supported by the National Key Research and Development Program of China,‘Clinical Performance Verification of Radial Ultrasound Endoscope’,No.2017YFC0109804the National High Level Hospital Clinical Research Funding,No.2022-PUMCH-A-076.
文摘BACKGROUND As a heterogeneous group of lesions,pancreatic cystic lesions(PCLs)vary enormously in malignant potential,mandating different treatment strategies.Despite significant advances in diagnostic imaging and laboratory tests,the accurate diagnosis of PCLs remains challenging,leading to overtreatment or delayed/missed surgical timing in patients with PCLs.CASE SUMMARY We present a case of a 64-year-old female patient in whom an asymptomatic,incidental cystic mass was found in the pancreatic tail on a routine abdominal ultrasound.After a comprehensive work-up with laboratory examinations,contrast-enhanced computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreatography,a pancreatic pseudocyst was suspected.Subsequent endoscopic ultrasound with fine-needle aspiration and needle-based confocal laser endomicroscopy supported a benign diagnosis.Follow-up computed tomography and magnetic resonance imaging examinations five months later showed significant cyst shrinkage without any abnormalities.However,three years after being lost to follow-up,the patient was readmitted and diagnosed with pancreatic adenocarcinoma with multiple metastases,suggesting that the initial lesion was a mucinous cystic neoplasm misdiagnosed as a pan-creatic pseudocyst.CONCLUSION Comprehensive integration of all available information(e.g.,cyst features,abnormal imaging findings,cyst biochemistry,clinical history,and patient demographics)rather than over-reliance on imaging or endoscopic findings is pivotal to diagnosing PCLs,and patients with concerning features should undergo strict surveillance.
文摘Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these patients.Of late,various recurrence patterns have been observed;the most common of them being distant metastasis followed by the pancreatic bed and lymph node recurrence.Recurrence in the remnant pancreas is on the rise due to improved survival in patients who previously underwent surgery for pancreatic cancer.Total remnant pancreatectomy is an appealing option in resectable remnant pancreatic carcinoma without distant metastasis.It is an entity showing an increasing incidence and demanding further in-depth studies to elucidate the exact pathological mechanism and to establish appropriate management protocols.
文摘BACKGROUND Pancreatic fluid leakage is a rare complication of pancreatic cancer and often requires drainage when conservative therapy fails.Endoscopic,percutaneous,and surgical drainage are options.Minimally invasive endoscopic procedures are generally considered the first-line treatment,with either a transpapillary approach or an endoscopic ultrasound-guided transmural approach selected depending on the case.Various dilators are used to dilate tracts to the leakage site.However,reports of dilation through a rigid trans-tumoral tract using a drill dilator remain extremely rare.CASE SUMMARY A 74-year-old woman with pancreatic body and tail cancer developed fever and left-sided chest pain after multiple courses of chemotherapy.Computed tomography revealed fluid accumulation around the pancreatic tail and spleen along with a left pleural effusion.The effusion was diagnosed as reactive secondary to pancreatic fluid leakage.Endoscopic retrograde cholangiopancreatography identified irregular stenosis of the main pancreatic duct in the pancreatic body.Distal to the stenosis,the main ductal structure was nearly obliterated by the tumor.The contrast medium had leaked into the pancreatic fluid leakage area through several fine,disrupted ductal structures.The guidewire was successfully advanced through an extremely fine tract that was not the main contrast-filling route.Standard dilators failed to expand the rigid trans-tumoral tract.A second endoscopic retrograde cholangiopancreatography using a drill dilator successfully expanded the trans-tumoral tract,enabling endoscopic nasopancreatic drainage tube placement.Subsequently,the pancreatic fluid leakage and pleural effusion resolved.CONCLUSION Even in rigid trans-tumoral tracts,the use of a drill dilator can facilitate successful tract expansion,enabling effective drainage.
文摘Since its inception,localized pancreatic cancer has been identified as a systemic illness.Hence,to increase its survival rates,surgical resection followed by ad-juvant chemotherapy is used as a treatment option.A significant barrier,though,is the high morbidity and drawn-out recovery after extensive surgical resection,which may postpone or prohibit the prompt administration of adjuvant therapy.Thereby,acknowledging the efficacy of neoadjuvant therapy in various digestive tract malignancies like rectal,gastric,and oesophagal cancers in en-hancing long-term survival and the likelihood of successful resection,researchers have turned their attention to exploring its potential benefits in the context of both resectable and borderline resectable pancreatic cancer(RPC).According to recent data,neoadjuvant chemoradiation has major advantages for both resectable and borderline RPC.These advantages include increased surgical resection rates,longer survival times,decreased recurrence rates,and better overall disease control with a manageable toxicity profile.Despite its benefits,research is still being done to determine the best way to sequence and combine chemotherapy and radiation.Furthermore,studies have demonstrated the potential for cus-tomized therapy regimens based on the patient’s general health status and the tumor’s biological behavior to maximize the neoadjuvant approach.As progress continues,neoadjuvant chemoradiation is set to become a key component of treatment for both resectable and borderline RPC,providing a more efficient way to manage this deadly condition.While further development is required to fully grasp its potential in enhancing long-term patient outcomes,evidence supports its increasing usage in clinical practice.
文摘BACKGROUND Postoperative pancreatic fistula(POPF)is the most frequent cause of morbimortality after pancreaticoduodenectomy,but the best technique to use to prevent its development is unclear.The choice of drainage method external duct stent(EDS),internal duct stent(IDS),or non-ductal stent(NDS)is also controversial.AIM To compare the three groups(EDS,IDS and NDS),analyzing the patient characteristics,perioperative examinations and survival.METHODS Patients who underwent pancreaticoduodenectomy and pancreaticojejunostomy between 2012 and 2020,were divided into the EDS,IDS and NDS groups.RESULTS Of the 244 patients included,129 were in the EDS group,71 in the IDS group,and 44 in the NDS group.Except for preoperative pancreatitis in the NDS patients,comorbidities were similar among the groups.Patients in the NDS group had a high caliber of the Wirsung duct and frequently presented with a hard pancreas(P<0.001).A lower rate of grade C POPF was observed in the EDS(1.6%)compared to the NDS(9.1%)and IDS group(14.1%)(P=0.009).The groups showed similar findings for delayed gastric emptying,postoperative hemorrhage,reoperation,and 5-year survivals.Ninety-day mortality rate was significantly higher in the IDS group(5.6%)compared to the EDS(1.6%)and NDS(4.5%)groups(P=0.046).Multivariate analysis showed that the use of EDS was a protective factor for grade B/C POPF(P=0.034),and 90-day mortality(P=0.018).Additionally,a Wirsung duct diameter<3 mm was the only risk factor for grade B/C POPF(P=0.001),and 90-day mortality(P=0.031).CONCLUSION The use of the EDS was a protective factor for grade B/C POPF and 90-day mortality,and the Wirsung duct<3 mm was a risk factor for grade B/C POPF and 90-day mortality.
文摘BACKGROUND Middle pancreatectomy(MP)is a surgical procedure that removes non-invasive lesions in the pancreatic neck and body,allowing for the preservation of pan-creatic function.However,MP is associated with a higher risk of postoperative complications,and there’s no clear consensus on which anastomotic method is preferable.In recent years,our team has developed a new method called inter-locking main pancreatic duct-jejunal(IMPD-J)internal bridge drainage to MP.AIM To compare perioperative and postoperative outcomes in patients who underwent IMPD-J bridge drainage and those underwent traditional duct-to-mucosa pancreatojejunostomy.METHODS Patients who underwent MP in our hospital between October 1,2011 and July 31,2023 were enrolled in this study.Patients were divided into two groups based on their pancreatojejunostomy technique:IMPD-J bridge drainage group and duct-to-mucosa pancreatojejunostomy group.Demographic data(age,gender,body mass index,hypertension,diabetes,etc.)and perioperative indicators[operation time,intraoperative bleeding,clinically relevant postoperative pancreatic fistula(CR-POPF),delayed gastric emptying,etc.]were recorded and analyzed statist-ically.RESULTS A total of 53 patients were enrolled in this study,including 23 in the IMPD-J Bridge Drainage group and 30 in the traditional duct-to-mucosa pancreatojejun-ostomy group.There were no significant differences in demographic or preope-rative characteristics between the groups.Compared to traditional duct-to-mucosa pancreaticojejunostomy,IMPD-J bridge drainage had a significant shorter operation time(4.3±1.3 hours vs 5.8±1.8 hours,P=0.002),nasogastric tube retention days(5.3±1.7 days vs 6.5±2.0 days,P=0.031),lower incidence of delayed gastric emptying(8.7%vs 36.7%,P=0.019),and lower incidence of CR-POPF(39.1%vs 70.0%,P=0.025).Multivariate logistic regression analysis showed that pancreaticojejunostomy type(odds ratio=4.219,95%confidence interval=1.238-14.379,P=0.021)and plasma prealbumin(odds ratio=1.132,95%confidence interval=1.001-1.281,P=0.049)were independent risk factor for CR-POPF.In IMPD-J bridge drainage group,only one patient experienced recurrent pancreatitis due to the large diameter of the silicone tube and had it removed six months after surgery.CONCLUSION Compared to traditional duct-to-mucosa pancreatojejunostomy,IMPD-J bridge drainage has the advantages of simplicity and fewer perioperative complications,with favorable long-term outcomes.
文摘Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon enti-ty,revealing striking geographical variations and questioning current treatment paradigms.This editorial commentary analyzes the study's key findings,inclu-ding the predominance of solid pseudopapillary neoplasms and their younger age of onset,which contrast sharply with Western data.It explores the implications for clinical practice and research,emphasizing the need for population-specific approaches to diagnosis and treatment.The revealed limited institutional expe-rience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases,suggesting benefits of centralizing healthcare services.Furthermore,the commentary advocates for international collaborative studies to elucidate the genetic,environmental,and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations.It also outlines future directions,calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes.Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.
文摘This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.
文摘BACKGROUND Pancreatic fibrosis,which decreases risk of postoperative pancreatic fistula(POPF),can be estimated using extracellular volume fraction(ECVf).AIM To investigate the correlation between ECVf and pancreatic histology,as well as the usefulness of ECVf in predicting POPF.METHODS In 71 patients who underwent pancreatic resection,we caluculated pancreatic ECVf by comparing absolute enhancements of the pancreas and aorta between pre-contrast and equilibrium phases.Areas of fibrosis,fat,acini,and islets were calculated based on resection specimens.RESULTS ECVf correlated with fibrosis(r=0.724;P<0.001)and negatively correlated with acini(r=-0.510;P<0.001).Among 48 patients who underwent pancreatoduoden ectomy,21 developed POPF.Main pancreatic duct diameter≤2 mm and ECVf<36%were selected as risk factors by multivariate analysis[respective odds ratios(OR)and P values,4.26 and P=0.048;OR=11.07 and P=0.036].Using these factors as a risk score(0-2 points),POPF occurred in 0%,50%,and 70%of patients with 0,1,and 2 points,respectively.CONCLUSION ECVf is useful in predicting acinar loss and pancreatic fibrosis,and ECVf<36%may be a risk factor for POPF.
基金Supported by Mexican Association of Gastroenterology 2023 for the scholarship warded.
文摘Acute pancreatitis(AP)remains a clinical challenge due to its heterogeneous presentation and potential for rapid progression to severe disease.In their editorial,Wang et al highlight phospholipase D2(PLD2)as a novel candidate biomarker,proposing its involvement in key inflammatory pathways and its inverse correlation with disease severity.While this represents a promising improvement in precision diagnostics,significant gaps remain that require further investigation.Specifically,the functional role of PLD2 in the molecular cascade of AP is not yet fully understood.Questions still remain,such as:Is the observed downregulation of PLD2 a causal factor or an epiphenomenon?Does PLD2 modulation offer a tangible therapeutic benefit beyond a mere correlation?These questions highlight the necessity of mechanistic in vivo studies to validate the role and therapeutic potential of PLD2.Furthermore,interindividual variability in inflammatory responses raises concerns regarding PLD2’s predictive consistency across genetically diverse populations.The temporal dynamics of PLD2 expression in AP also remain unclear;establishing whether its variations precede clinical deterioration is essential for its use in early risk stratification,integrating multiomics research(proteomics,metabolomics,transcriptomics,and lipidomics),which can clarify the biological interactions and regulatory pathways of PLD2 under complex mechanisms.Likewise,well-designed,multicenter,prospective studies will be essential in determining its true clinical value.The research by Wang et al initiates an intriguing direction in the quest for AP biomarkers,but further research is required before PLD2 can be established as a clinically applicable tool.Additional efforts are required to close this gap and define whether its role transcends a mere association in order for it to become a therapeutic target.
文摘Pancreatic cancer is still one of the neoplasms with the worst prognosis.Late presentation at an unresectable or metastatic stage precluding surgery,aggressive biology,and resistance to antiblastic drugs make this disease a formidable foe.The authors,following the path already traced by the previous review,investigate and summarize the breakthroughs of recent years concerning this lethal disease.Areas of progress include improving prevention and early detection strategies,refining molecular understanding of pancreatic cancer,identifying more effective systemic therapies,and improving quality of life and surgical outcomes.No less important is the technological aspect that looks primarily at artificial intelligence.
文摘Copyright 2025,Hepatobiliary&Pancreatic Diseases International.All rights reserved.www.hbpdint.com,Aims and Scope Hepatobiliary&Pancreatic Diseases International publishes peerreviewed original papers,reviews(meta-analysis,systematic review)and editorials concerned with clinical practice and research in the fields of hepatobiliary and pancreatic diseases.Papers cover the medical,surgical,radiological,pathological,biochemical,physiological and histological aspects of the subject areas under the headings Liver,Biliary,Pancreas,Transplantation,Research,Editorials,Review Articles,New Techniques,Clinical Images,Viewpoints and Letters to the Editor.
文摘Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct.Its relevance has grown in recent years with the introduction of novel technologies,allowing for both diagnosis and treatment within a single procedure.In therapeutic applications,it facilitates interventions such as stone fragmentation,stone retrieval,and tumor-related obstruction management.In diagnostic applications,it improves the accuracy of biopsies for suspicious lesions,particularly in cases of cystic neoplasms,indeterminate strictures,and pancreatic fistula assessments.The most common complications include postprocedural pancreatitis and self-limited abdominal pain,with their incidence mitigated by prophylactic anti-inflammatory drugs and pancreatic stent placement.Despite being limited by the need for specialized equipment and trained personnel,technological advancements may position pancreatoscopy as a first-line tool in modern clinical practice.
