Best Practice & Research Clinical Gastroenterology最新文献

{"title":"Endoscopic ultrasound through-the-needle biopsy of pancreatic cystic neoplasms: Update on indications, safety profile, and research directions","authors":"Joana Mota ,&nbsp;Tiago Ribeiro ,&nbsp;Maria Cristina Conti Bellocchi ,&nbsp;Nicolò De Pretis ,&nbsp;Luca Frulloni ,&nbsp;Joanne Lopes ,&nbsp;Sokol Sina ,&nbsp;Jahnvi Dhar ,&nbsp;Jayanta Samanta ,&nbsp;Guilherme Macedo ,&nbsp;Filipe Vilas-Boas ,&nbsp;Stefano Francesco Crinò","doi":"10.1016/j.bpg.2025.102058","DOIUrl":"10.1016/j.bpg.2025.102058","url":null,"abstract":"<div><div>Pancreatic cystic lesions (PCLs) are often benign; however, a subset carries malignant potential, making accurate diagnosis essential to avoid both missed malignancies and overtreatment. Conventional tools, such as cyst fluid cytology and biochemical analysis, have limited sensitivity, often leading to misdiagnosis.</div><div>This review summarizes the role of endoscopic ultrasound-guided through-the-needle biopsy (EUS-TTNB) for PCL diagnosis, incorporates recent ESGE recommendations, and discusses future directions.</div><div>EUS-TTNB enables direct histologic sampling of pancreatic cysts, improving tissue adequacy and diagnostic accuracy, while maintaining a low complication rate. Studies report diagnostic yields exceeding 80 % and strong concordance with surgical histology. The integration with next-generation sequencing may further enhance diagnostic precision and risk stratification.</div><div>In conclusion, EUS-TTNB is a valuable tool within current diagnostic pathways for PCLs. Its broader implementation may enhance clinical decision-making and ultimately improve patient outcomes. Nonetheless, multicenter studies and standardized protocols are still needed to validate its role in routine practice.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"81 ","pages":"Article 102058"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147979321","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-guided treatment of pancreatic lesions","authors":"Daniel Marino ,&nbsp;Prahan Chetlur ,&nbsp;Kimberly Ho ,&nbsp;Tamas Gonda","doi":"10.1016/j.bpg.2026.102098","DOIUrl":"10.1016/j.bpg.2026.102098","url":null,"abstract":"<div><div>Endoscopic ultrasound (EUS) guided ablation is an evolving minimally invasive approach for treating pancreatic lesions. While current guidelines do not yet recommend routine use, EUS ablation offers targeted, organ-sparing therapy that bridges the gap between surveillance and surgical resection. Techniques are evolving but data is available for ethanol ablation, intralesional chemoablation, radiofrequency ablation, among many others. For pancreatic cystic lesions and neuroendocrine tumors, EUS ablation achieves promising complete and partial response rates and favorable safety profile. Early studies in unresectable pancreatic adenocarcinoma show technical feasibility, safety, and potential synergy with systemic therapy. This review summarizes the current literature on EUS-guided ablation, highlighting clinical outcomes, limitations, and techniques, while emphasizing the need for further research to define optimal patient selection and long-term efficacy.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"81 ","pages":"Article 102098"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147979381","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":"Surgical indications and management of pancreatic cystic neoplasms","authors":"Riccardo Pellegrini,&nbsp;Giampaolo Perri,&nbsp;Giovanni Marchegiani","doi":"10.1016/j.bpg.2025.102062","DOIUrl":"10.1016/j.bpg.2025.102062","url":null,"abstract":"<div><div>In recent years, the detection of pancreatic cystic neoplasms (PCNs) has significantly increased, revealing a spectrum of biologically distinct entities with widely variable malignant potential. In this complex and heterogeneous landscape, a multidisciplinary approach is essential not only to correctly identify lesions at risk of malignancy, but also to determine their appropriate therapeutic window, avoiding unnecessary resections of benign cysts while ensuring timely intervention before progression to invasive cancer. Despite the development of several guidelines worldwide, the rates of misdiagnosis and overtreatment remain high across all cysts subtypes, raising concerns about the appropriateness of current surgical indications. This is particularly relevant in the context of incidental detection of small cysts due to the widespread use of cross-sectional imaging. This review critically examines the current evidence and limitations in the surgical management of PCNs, highlighting the need for improved risk stratification tools and more individualized treatment strategies.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"81 ","pages":"Article 102062"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147979382","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":"Epidemiology, classification and clinical burden of pancreatic cystic lesions","authors":"Sara Nikolic ,&nbsp;Riccardo Pellegrini ,&nbsp;Marco Del Chiaro ,&nbsp;Gabriele Capurso","doi":"10.1016/j.bpg.2025.102074","DOIUrl":"10.1016/j.bpg.2025.102074","url":null,"abstract":"<div><div>Pancreatic cystic neoplasms (PCNs), once considered rare, are increasingly detected due to advances in imaging, with prevalence estimates ranging from 13 % to nearly 50 % and rising with age. They comprise a heterogeneous group, including intraductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), solid pseudopapillary neoplasms (SPNs), cystic neuroendocrine tumors, and pseudocysts. Their biological behavior differs substantially: SCNs and pseudocysts are usually benign, MCNs and IPMNs may progress to cancer, and SPNs generally require resection. Accurate classification is therefore essential, as misdiagnosis may lead to overtreatment with surgical complications or undertreatment with missed malignant transformation.</div><div>Epidemiological studies link PCNs to age, metabolic syndrome, diabetes, and smoking, with emerging associations to autoimmune pancreatitis, chronic kidney disease, and fatty pancreas. IPMNs are the most frequent subtype, with risk of progression influenced by cyst size, multifocality, obesity, and tobacco exposure. Management requires balancing oncological risk with patient-specific factors such as comorbidities, age, and life expectancy. While surgery eliminates malignant potential, it carries relevant morbidity and mortality. Conversely, long-term surveillance imposes psychological stress, healthcare resource use, and financial costs.</div><div>As their incidence grows, PCNs have become a major clinical and healthcare challenge. Cost-effectiveness analyses favor risk-adapted surveillance over systematic resection, emphasizing the importance of personalized strategies that reduce overtreatment while ensuring timely intervention for high-risk lesions.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"81 ","pages":"Article 102074"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147979325","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 imaging of pancreatic cysts","authors":"Simone Segato ,&nbsp;Stefano Mazza ,&nbsp;Letizia Veronese ,&nbsp;Davide Scalvini ,&nbsp;Alessandro Cappellini ,&nbsp;Francesca Torello Viera ,&nbsp;Aurelio Mauro ,&nbsp;Marco Bardone ,&nbsp;Anna Gallotti ,&nbsp;Alessandro Vanoli ,&nbsp;Valentina Ravetta ,&nbsp;Lorenzo Cobianchi ,&nbsp;Andrea Anderloni","doi":"10.1016/j.bpg.2025.102065","DOIUrl":"10.1016/j.bpg.2025.102065","url":null,"abstract":"<div><div>Endoscopic ultrasound (EUS) plays a fundamental role in the diagnostic pathway of pancreatic cystic lesions (PCLs), particularly by providing high spatial resolution and real-time assessment. Technological advances, including contrast-enhanced harmonic EUS and high-sensitivity Doppler techniques, further improve the characterization of various subtypes of PCLs, especially by helping to estimate their malignant potential. This review aims to describe the role of EUS in the assessment of the main pancreatic cysts, according to the latest literature, and to provide practical tables to support its integration into clinical practice.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"81 ","pages":"Article 102065"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147979328","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":"Evidence-based approach to the diagnosis, management and surveillance of pancreatic cystic lesions: from the guidelines to the clinical practice","authors":"Rodica Gincul,&nbsp;Bertrand Napoleon","doi":"10.1016/j.bpg.2026.102104","DOIUrl":"10.1016/j.bpg.2026.102104","url":null,"abstract":"<div><div>Pancreatic cystic lesions are increasingly detected in routine practice, yet their management remains difficult because diagnosis is often presumptive, malignant potential is heterogeneous, and pancreatic surgery carries substantial morbidity. This review critically compares the major international guidelines for mucinous pancreatic cystic lesions, focusing on diagnostic strategy, indications for surgery, operative management, surveillance, postoperative follow-up, and the risk of concomitant pancreatic ductal adenocarcinoma. Across guidelines, broad agreement exists on the central role of MRI/MRCP, the selective use of EUS, and the need to individualize decisions according to surgical fitness. However, important differences persist regarding the weight assigned to worrisome features, the role of contrast-enhanced EUS and cytology, thresholds for surgery, and the possibility of stopping surveillance. Recent evidence supports a more risk-adapted approach for selected low-risk branch-duct IPMNs, but the practical application of guidelines remains limited by divergent frameworks, modest evidence quality, and unequal access to advanced diagnostics. Overall, the field is moving toward more multimodal and individualized care, while still requiring stronger evidence and greater pragmatism to improve real-world applicability.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"81 ","pages":"Article 102104"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147979329","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 fine-needle aspiration and cystic fluid analysis in patients with pancreatic cystic lesions","authors":"Anuraag Jena ,&nbsp;Jahnvi Dhar ,&nbsp;Giuseppe Dell’Anna ,&nbsp;Vikramjit Mitra ,&nbsp;Antonio Facciorusso ,&nbsp;Stefano Francesco Crinò ,&nbsp;Jayanta Samanta","doi":"10.1016/j.bpg.2026.102107","DOIUrl":"10.1016/j.bpg.2026.102107","url":null,"abstract":"<div><div>Pancreatic cystic lesions have been increasingly detected with the widespread use of cross-sectional imaging. As these lesions are heterogeneous, differentiating benign from (potentially) malignant cystic lesions is important as well as challenging. Endoscopic ultrasound assessment, combined with cyst fluid analysis, forms the cornerstone of the diagnostic algorithm. Biochemical markers such as carcinoembryonic antigen (CEA), amylase, and glucose have been shown to distinguish mucinous from non-mucinous cystic lesions. Each parameter has its own advantages and its own limitations. Novel molecular markers, such as DNA-based assays and next-generation sequencing, have shown promise. The various guidelines have incorporated cyst fluid analysis in their recommendations. A standardized multimodal approach is essential, incorporating all aspects. This review synthesizes evidence on the utility of endoscopic ultrasound (EUS)-guided cyst fluid analysis in the management of pancreatic cystic lesions.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"81 ","pages":"Article 102107"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147979323","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":"Evidence-based decision analysis guiding clinical guidelines for an organized population-based screening for colorectal cancer","authors":"Beate Jahn ,&nbsp;Gaby Sroczynski ,&nbsp;Júlia Santamaria ,&nbsp;Ursula Rochau ,&nbsp;Silke Siebert ,&nbsp;Nikolai Mühlberger ,&nbsp;Sibylle Puntscher ,&nbsp;Monika Ferlitsch ,&nbsp;Monika Hackl ,&nbsp;Herbert Tilg ,&nbsp;Friedrich Renner ,&nbsp;Michael Gschwantler ,&nbsp;Irmgard Schiller-Fruehwirth ,&nbsp;Timo Fischer ,&nbsp;Herbert Bachler ,&nbsp;Barbara Fröschl ,&nbsp;Christina Dietscher ,&nbsp;Eva Schernhammer ,&nbsp;Gerald Gartlehner ,&nbsp;Uwe Siebert","doi":"10.1016/j.bpg.2025.102045","DOIUrl":"10.1016/j.bpg.2025.102045","url":null,"abstract":"<div><h3>Background</h3><div>This study includes the long-term benefit-harm analysis of population-wide colorectal cancer (CRC) screening strategies commissioned by the Austrian National Committee for Cancer Screening (ANCCS). In addition, we present the related cost-effectiveness analysis.</div></div><div><h3>Methods</h3><div>Using a validated decision-analytic Markov state transition model, we evaluated 17 by the ANCCS suggested CRC-screening strategies differing in tests (fecal-immunochemical test (FIT), guaiac-based fecal occult blood test (gFOBT), colonoscopy (COL)), age at start (40,45,50 years) and end (COL: 65,70,75 years, FIT/gFOBT 75 years), and intervals (2,5,10 years). Positive FIT/gFOBT tests are followed by colonoscopy. Evaluated outcomes included health benefits (life-years gained (LYG), CRC-cases/CRC-deaths avoided), harms (severe colonoscopy complications, psychological harms due to positive test results (PTR), additional colonoscopies), stepwise evaluated incremental harm-benefit ratios (IHBR), and incremental cost-effectiveness ratios (ICER). We applied the Austrian healthcare system perspective, a lifelong-time horizon and conducted sensitivity analyses.</div></div><div><h3>Results</h3><div>The most effective colonoscopy-based screening strategy is colonoscopy at age 40/50/60/70 (449 LYG per 1000 individuals) with an IHBR of 3 PTR/LYG compared to COL45/55/65 (ICER: 13,032 Euro/LYG vs. COL45/55/65/75). The most effective fecal blood-test-based strategy is annual FIT testing starting at age 40 years (488 LYG per 1000 individuals) and an IHBR of 30 PTR/LYG compared to FIT40+2y (biennial FIT starting age 40). All biennial FIT-based screening strategies represent alternative options on the harm-benefit efficiency frontier with IHBR of PTR/LYG: 2 (FIT50+2y vs. no screening), 5 (FIT45+2y vs. FIT50+2y), and 7 (FIT40+2y vs. FIT45+2y). The cost-effectiveness analyses provided stepwise ICERs ranging from 3391 Euro/LYG (FIT45+2y vs. FIT50+2y) to 47,812 Euro/LYG (FIT40+1y vs. FIT40+2y).</div></div><div><h3>Conclusions</h3><div>Our decision analysis shows benefit-harm and cost-effectiveness trade-offs. In the consensus meeting of the ANCCS, colonoscopy- and FIT-based screening starting at age 45 were selected as suggested screening strategies, accounting for benefit-harm balance, evidence level, and implementation aspects.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102045"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273782","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":"Optical diagnosis of colorectal neoplasms from an Eastern perspective","authors":"Katsuro Ichimasa ,&nbsp;Shin-Ei Kudo ,&nbsp;Yuta Kouyama ,&nbsp;Taishi Okumura ,&nbsp;Yasuharu Maeda ,&nbsp;Takemasa Hayashi ,&nbsp;Kunihiko Wakamura ,&nbsp;Khay Guan Yeoh ,&nbsp;Tetsuo Nemoto ,&nbsp;Masashi Misawa","doi":"10.1016/j.bpg.2025.102016","DOIUrl":"10.1016/j.bpg.2025.102016","url":null,"abstract":"<div><div>This review provides an overview of optical biopsy for colorectal lesions, focusing on the Eastern perspective—particularly recent advancements in Japan. Optical biopsy aims to predict the histopathology<span> of colorectal lesions in real time during colonoscopy<span><span>, distinguishing neoplastic from non-neoplastic lesions and assessing invasion depth. This paper examines various image-enhanced endoscopy<span> techniques: narrow-band imaging (NBI) with the Japan NBI Expert Team classification, pit pattern analysis, and endocytoscopy using NBI and </span></span>methylene blue staining. Additionally, it explores the evolving role of optical diagnosis in guiding expanded endoscopic treatment strategies for T1 and even selected T2 colorectal cancers, outlining future prospects for optical biopsy.</span></span></div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102016"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273804","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":"Quality assurance in colonoscopy – how to interpret and implement various quality indicators related to neoplasia detection rates?","authors":"Querijn N.E. van Bokhorst ,&nbsp;Nanette S. van Roermund ,&nbsp;Manon van der Vlugt ,&nbsp;Evelien Dekker","doi":"10.1016/j.bpg.2025.102008","DOIUrl":"10.1016/j.bpg.2025.102008","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102008"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273812","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}