Best Practice & Research Clinical Gastroenterology最新文献

{"title":"Reducing the burden of pancreatic cancer by surveilling mucinous cystic neoplasms: are we there yet?","authors":"Federico De Stefano ,&nbsp;Riccardo Pellegrini ,&nbsp;Giovanni Marchegiani ,&nbsp;Stefano Crippa","doi":"10.1016/j.bpg.2025.101998","DOIUrl":"10.1016/j.bpg.2025.101998","url":null,"abstract":"<div><div>Pancreatic cystic neoplasms are a common condition, with intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) being of particular concern due to their potential for malignant transformation. Resection of these lesions before progression to invasive cancer represents a crucial opportunity to reduce the burden of pancreatic cancer. However, the benefit of early-resection must be weighed against the risk of overtreatment. Applying current guidelines, nearly half of the patients who undergo resection for IPMN might not have required surgery, while malignancy is detected in only 16 % of resected MCNs. This raises concerns, particularly given the increasing detection of small cysts with the widespread use of radiological imaging and the significant postoperative risks, including exocrine and endocrine insufficiency. Emerging evidence suggests that surveillance strategies could be more broadly applied, reducing unnecessary surgeries. This review aims to reassess the current evidence regarding both surgical resection and surveillance of IPMNs and MCNs.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101998"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic retrograde cholangiopancreatography: A comprehensive review as a single diagnostic tool","authors":"Apostolis Papaefthymiou ,&nbsp;Rosario Landi ,&nbsp;Marianna Arvanitakis ,&nbsp;Andrea Tringali ,&nbsp;Paraskevas Gkolfakis","doi":"10.1016/j.bpg.2025.101976","DOIUrl":"10.1016/j.bpg.2025.101976","url":null,"abstract":"<div><div>Endoscopic retrograde cholangiopancreatography (ERCP) was initially introduced in clinical practice as diagnostic tool. However, the presence of adverse events and the development of non-invasive techniques, such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS), limited its role as a stand-alone diagnostic choice, modifying its role to the leader of therapeutic pancreatobiliary endoscopy. Despite technological advances, there are still conditions where non-invasive diagnostic modalities are inconclusive, such as indeterminate biliary and pancreatic duct strictures, primary sclerosing cholangitis functional stenoses, intraductal papillary mucinous neoplasms (IPMNs) and paediatric indications, such as congenital anatomical abnormalities. This narrative review aimed to identify and analyse indications of diagnostic ERCP, without the need for therapeutic manipulations.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101976"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ensuring timely detection of neoplastic transformation by surveilling chronic pancreatitis","authors":"Miroslav Vujasinovic ,&nbsp;Patrick Maisonneuve ,&nbsp;J.-Matthias Löhr","doi":"10.1016/j.bpg.2025.101985","DOIUrl":"10.1016/j.bpg.2025.101985","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101985"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Ultrasound armamentarium for precise and early diagnosis of biliopancreatic lesions","authors":"Julio Iglesias-Garcia ,&nbsp;Daniel de la Iglesia ,&nbsp;Pietro Fusaroli","doi":"10.1016/j.bpg.2025.101987","DOIUrl":"10.1016/j.bpg.2025.101987","url":null,"abstract":"&lt;div&gt;&lt;div&gt;The diagnostic paradigm for biliopancreatic lesions has been revolutionized by continuous advancements in endoscopic ultrasound (EUS) technologies and techniques. This review examines the expanding diagnostic toolkit available to clinicians, emphasizing innovations that have significantly enhanced precision and early detection capabilities.&lt;/div&gt;&lt;div&gt;One of the most transformative advancements is the development of fine-needle biopsy (FNB) needles. Modern designs, including Franseen, and fork-tip configurations, have optimized tissue sampling, achieving diagnostic accuracies exceeding 90 % while minimizing the number of needle passes required. These innovations facilitate the acquisition of high-quality histological specimens suitable for comprehensive molecular profiling, paving the way for personalized therapeutic approaches.&lt;/div&gt;&lt;div&gt;Concurrent advancements in sampling techniques have bolstered these needle design improvements. The fanning technique has been particularly effective, increasing diagnostic yields from 71 % to 88 %. Wet suction methods preserve tissue integrity better than traditional approaches, while standardized protocols for needle passes enhance procedural efficiency. For specimen evaluation, Rapid On-Site Evaluation (ROSE) offers 93 % sensitivity, while alternatives like Macroscopic On-Site Evaluation (MOSE) provide comparable accuracy while reducing dependency on specialized personnel and resources.&lt;/div&gt;&lt;div&gt;Image enhancement technologies have markedly improved the ability to characterize lesions. Contrast Harmonic EUS (CH-EUS) is particularly effective in differentiating pancreatic cancer from other solid lesions, with meta-analyses confirming sensitivity and specificity of 94 % and 89 %, respectively. Its ability to detect lesions as small as 15 mm makes it invaluable for early diagnosis. In cystic lesions, CH-EUS excels in identifying malignant mural nodules, with diagnostic accuracies reaching 96 %.&lt;/div&gt;&lt;div&gt;The integration of elastography and advanced digital imaging technologies has further expanded diagnostic capabilities. Strain elastography provides qualitative insights into tissue characteristics, while shear wave elastography offers quantitative measurements of stiffness, adding diagnostic precision. Similarly, technologies like detective flow imaging match the accuracy of contrast-enhanced techniques in pancreatic cancer detection and enhance vascular assessment.&lt;/div&gt;&lt;div&gt;For cystic lesions, diagnostics have progressed beyond traditional fluid analysis. Techniques such as through-the-needle biopsy (TTNB) have improved diagnostic yields to 74 %, albeit with a modest risk of complications. Incorporating molecular markers and next-generation sequencing allows differentiation between cystic lesion subtypes and more accurate assessment of malignant potential.&lt;/div&gt;&lt;div&gt;This array of diagnostic tools offers unprecedented potential for early and precise diagnosis of biliopancreatic lesions. Integrating th","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101987"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiomics in early detection of bilio-pancreatic lesions: A narrative review","authors":"Calogero Casà ,&nbsp;Daniel Portik ,&nbsp;Ahmed Nadeem Abbasi ,&nbsp;Francesco Miccichè","doi":"10.1016/j.bpg.2025.101997","DOIUrl":"10.1016/j.bpg.2025.101997","url":null,"abstract":"<div><div>Radiomics is transforming the field of early detection of bilio-pancreatic lesions, offering significant advancements in diagnostic accuracy and personalized treatment planning. By extracting high-dimensional data from medical images such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), radiomics reveals complex patterns that remain undetectable through traditional imaging evaluation. This review synthesizes recent developments in radiomics, particularly its application to early detection of pancreatic cancer (PC) and biliary duct cancer (BDC). It highlights the role of machine learning algorithms and multi-parametric models in improving diagnostic performance and discusses challenges such as standardization, reproducibility, and the need for larger, multicenter datasets. The integration of radiomics with genomic data and liquid biopsies also presents future opportunities for more individualized patient care.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101997"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing the incidence of pancreatic cancer through radiofrequency ablation of mucinous cystic neoplasms: What is the evidence?","authors":"Pujitha Kudaravalli ,&nbsp;Sahib Singh ,&nbsp;Rakesh Vinayek ,&nbsp;Ganesh Aswath ,&nbsp;Stefano Francesco Crinò ,&nbsp;Jorge Machicado ,&nbsp;Antonio Facciorusso","doi":"10.1016/j.bpg.2025.101986","DOIUrl":"10.1016/j.bpg.2025.101986","url":null,"abstract":"<div><div>Pancreatic cystic lesions are mostly discovered incidentally during cross-sectional imaging for other indications. They range from benign cysts to premalignant lesions, posing a risk for development of pancreatic cancer. Surveillance of cysts with low-risk features and surgical resection of high-risk ones has been the standard of care. However, the lack of consensus between national society guidelines results in discordant management and follow-up. One of the upcoming therapeutic modalities for pancreatic cysts, including mucinous cystic neoplasms (MCN), is endoscopic ultrasound (EUS)-guided interventions, including injection of chemotherapeutic agents or EUS-guided radiofrequency ablation (EUS-RFA). EUS-RFA is emerging as a promising minimally invasive tool with the need for further investigation to understand its clinical utility. This review discusses the physiology, clinical studies, adverse events, and future perspectives of RFA for various pancreatic lesions, with particular regard with MCN.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101986"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The exposome as a target for primary prevention and a tool for early detection of pancreatic cancer","authors":"Gaetano Lauri ,&nbsp;Krystal Mills ,&nbsp;Shounak Majumder ,&nbsp;Gabriele Capurso","doi":"10.1016/j.bpg.2025.101991","DOIUrl":"10.1016/j.bpg.2025.101991","url":null,"abstract":"<div><div>Pancreatic Ductal Adenocarcinoma (PDAC) is a highly aggressive malignancy with limited survival due to late stage diagnosis and scarce therapeutic options. Emerging evidence highlights the role of the \"exposome,\" which encompasses environmental, lifestyle, and metabolic exposures, as a crucial determinant in PDAC risk and a potential avenue for early detection. This review synthesizes findings on modifiable risk factors, including smoking, obesity, diabetes, diet, and alcohol consumption, and their interplay with genetic and metabolic profiles in PDAC development. Additionally, we explore cutting-edge approaches in exposomic research, such as biobanking, electronic health record analysis, and AI-driven predictive models, to identify early biomarkers and stratify high-risk populations. This integrated framework aims to inform prevention strategies and improve early detection of PDAC.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101991"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating artificial intelligence with endoscopic ultrasound in the early detection of bilio-pancreatic lesions: Current advances and future prospects","authors":"Matteo Tacelli ,&nbsp;Gaetano Lauri ,&nbsp;Daniela Tabacelia ,&nbsp;Cristian George Tieranu ,&nbsp;Paolo Giorgio Arcidiacono ,&nbsp;Adrian Săftoiu","doi":"10.1016/j.bpg.2025.101975","DOIUrl":"10.1016/j.bpg.2025.101975","url":null,"abstract":"<div><div>The integration of Artificial Intelligence (AI) in endoscopic ultrasound (EUS) represents a transformative advancement in the early detection and management of biliopancreatic lesions. This review highlights the current state of AI-enhanced EUS (AI-EUS) for diagnosing solid and cystic pancreatic lesions, as well as biliary diseases. AI-driven models, including machine learning (ML) and deep learning (DL), have shown significant improvements in diagnostic accuracy, particularly in distinguishing pancreatic ductal adenocarcinoma (PDAC) from benign conditions and in the characterization of pancreatic cystic neoplasms. Advanced algorithms, such as convolutional neural networks (CNNs), enable precise image analysis, real-time lesion classification, and integration with clinical and genomic data for personalized care.</div><div>In biliary diseases, AI-assisted systems enhance bile duct visualization and streamline diagnostic workflows, minimizing operator dependency. Emerging applications, such as AI-guided EUS fine-needle aspiration (FNA) and biopsy (FNB), improve diagnostic yields while reducing errors. Despite these advancements, challenges remain, including data standardization, model interpretability, and ethical concerns regarding data privacy. Future developments aim to integrate multimodal imaging, real-time procedural support, and predictive analytics to further refine the diagnostic and therapeutic potential of AI-EUS.</div><div>AI-driven innovation in EUS stands poised to revolutionize pancreatico-biliary diagnostics, facilitating earlier detection, enhancing precision, and paving the way for personalized medicine in gastrointestinal oncology and beyond.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101975"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early detection of pancreatobiliary cancers: How to unveil a silent epidemic to change the outcomes - Preface","authors":"Giuseppe Vanella MD, PhD,&nbsp;Paolo Giorgio Arcidiacono MD, FASGE","doi":"10.1016/j.bpg.2025.101993","DOIUrl":"10.1016/j.bpg.2025.101993","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101993"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations, evidence and sustainability of screening for pancreatic cancer in high-risk individuals","authors":"Aleksander M. Bogdanski ,&nbsp;Pilar Acedo ,&nbsp;Michael B. Wallace ,&nbsp;Monique E. van Leerdam ,&nbsp;Derk C.F. Klatte","doi":"10.1016/j.bpg.2025.101974","DOIUrl":"10.1016/j.bpg.2025.101974","url":null,"abstract":"<div><div>Pancreatic cancer is a highly lethal malignancy and is predicted to become the second leading cause of cancer-related deaths by 2030. Early detection significantly improves outcomes, but general population screening remains infeasible due to the low prevalence of the disease and lack of specific biomarkers. This review evaluates current recommendations for pancreatic cancer surveillance in high-risk individuals, synthesises evidence from recent studies and explores the sustainability of current imaging-based surveillance programmes. Challenges such as overdiagnosis, economic feasibility and disparities in access highlight the need for targeted, cost-effective strategies. Collaborative initiatives and consortia are needed to advance biomarker research and refine risk stratification. By integrating evidence-based recommendations with sustainable approaches, this review outlines pathways to improve early detection and reduce mortality from pancreatic cancer.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101974"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}