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Mistakes in Pancreatobiliary Imaging and how to avoid them

Martina Pezzullo, Marianna Arvanitakis

Summary

AI Generated

This article addresses common mistakes in radiological investigation and interpretation of imaging findings in patients with suspected pancreatobiliary diseases, emphasizing the need for collaboration between gastroenterologists and radiologists.

  • Multidetector CT and MRI with MRCP are cross-sectional imaging modalities largely used for patients with pancreatobiliary diseases
  • Correct use and interpretation of radiological findings require good clinical judgment and collaboration between gastroenterologists and radiologists
  • The article highlights frequently made mistakes during radiological investigation and interpretation based on available literature and clinical experience
  • This material would benefit gastroenterologists and radiologists involved in the diagnostic evaluation of pancreatobiliary conditions
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Harrington KA, Shukla-Dave A, Paudyal R, et al. MRI of the pancreas. J Magn Reson Imaging Epub ahead of print April 17, 2020. DOI: 10.1002/jmri.27148. [Link]
2.
Zamboni GA, Ambrosetti MC, Pezzullo M, et al. Optimum imaging of chronic pancreatitis. Abdom Radiol (NY) 2020; 45: 1410–1419. [Link]
3.
Yam BL and Siegelman ES. MR imaging of the biliary system. Radiol Clin North Am 2014; 52: 725–755. [Link]
4.
Brunt LM, Deziel DJ, Telem DA, et al. Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg 2020; 272: 3–23. [Link]
5.
Rhaiem R, Piardi T, Renard Y, et al. Preoperative magnetic resonance cholangiopancreatography before planned laparoscopic cholecystectomy: is it necessary? J Res Med Sci 2019; 24: 107. [Link]
6.
Katabathina VS, Dasyam AK, Dasyam N, et al. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 2014; 34: 565–586. [Link]
7.
Novikov A, Kowalski TE and Loren DE. Practical management of indeterminate biliary strictures. Gastrointest Endosc Clin N Am 2019; 29: 205–214. [Link]
8.
Seo N, Kim SY, Lee SS, et al. Sclerosing cholangitis: clinicopathologic features, imaging spectrum, and systemic approach to differential diagnosis. Korean J Radiol 2016; 17: 25–38. [Link]
9.
Kamisawa T, Zen Y, Nakazawa T, et al. Advances in IgG4-related pancreatobiliary diseases. Lancet Gastroenterol Hepatol 2018; 3: 575–585. [Link]
10.
Fernandez YVM and Arvanitakis M. Early diagnosis and management of malignant distal biliary obstruction: a review on current recommendations and guidelines. Clin Exp Gastroenterol 2019; 12: 415–432. [Link]
11.
Vernuccio F, Borhani AA, Dioguardi Burgio M, et al. Common and uncommon pitfalls in pancreatic imaging: it is not always cancer. Abdom Radiol (NY) 2016; 41: 283–294. [Link]
12.
Klauss M, Maier-Hein K, Tjaden C, et al. IVIM DW-MRI of autoimmune pancreatitis: therapy monitoring and differentiation from pancreatic cancer. Eur Radiol 2016; 26: 2099–2106. [Link]
13.
Lee NJ, Hruban RH and Fishman EK. Pancreatic neuroendocrine tumor: review of heterogeneous spectrum of CT appearance. Abdom Radiol (NY) 2018; 43: 3025–3034. [Link]
14.
Renno A, Hill M, Abdel-Aziz Y, et al. Diagnosis of intrapancreatic accessory spleen by endoscopic ultrasound-guided fine-needle aspiration mimicking a pancreatic neoplasm: a case report and review of literature. Clin J Gastroenterol 2020; 13: 287–297. [Link]
15.
Coquia SF, Kawamoto S, Zaheer A, et al. Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor. J Comput Assist Tomogr 2014; 38: 874–878. [Link]
16.
Bronstein YL, Loyer EM, Kaur H, et al. Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol 2004; 182: 619–623. [Link]
17.
Prokesch RW, Chow LC, Beaulieu CF, et al. Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience. Radiology 2002; 225: 759–765. [Link]
18.
Wang W, Shpaner A, Krishna SG, et al. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc 2013; 78: 73–80. [Link]
19.
Yu J, Turner MA, Fulcher AS, et al. Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: Part 2, pancreatic duct and pancreas. AJR Am J Roentgenol 2006; 187: 1544–1553. [Link]
20.
Crippa S, Arcidiacono PG, De Cobelli F, et al. Review of the diagnosis and management of intraductal papillary mucinous neoplasms. United European Gastroenterol J 2020; 8: 249–255. [Link]
21.
Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524–546. [Link]
22.
Keil R, Kozeluhova J, Dolina J, et al. Acute portal vein thrombosis in noncirrhotic patients - different prognoses based on presence of inflammatory markers: a long-term multicenter retrospective analysis. Scand J Gastroenterol 2019; 54: 1379–1384. [Link]
23.
Junare PR, Udgirkar S, Nair S, et al. Splanchnic venous thrombosis in acute pancreatitis: does anticoagulation affect outcome? Gastroenterology Res 2020; 13: 25–31. [Link]

Abstract

Multidetector computed tomography (CT) and magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) are cross-sectional imaging modalities largely used for patients with pancreatobiliary diseases.1–3 Despite recent technological advances, correct use and interpretation of related radiological findings require good clinical judgment and collaboration between gastroenterologists and radiologists. In this article, we highlight mistakes frequently made during the radiological investigation and interpretation of findings in patients with suspected pancreatobiliary diseases, based on the available literature and on our clinical experience.


Topics

Endoscopy Pancreas

Citation

 Arvanitakis M and Pezzullo M. Mistakes in pancreatobiliary imaging and how to avoid them. UEG Education 2020; 20: 12–16.

Published

2020

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UEG Mistakes In Articles
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Mistakes in transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis and how to avoid them

Kymentie Ferdinande, Alberto Zanetto, Virginia Hernández-Gea, Marco Senzolo

Summary

AI Generated

Summary is not available for this content yet.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Harrington KA, Shukla-Dave A, Paudyal R, et al. MRI of the pancreas. J Magn Reson Imaging Epub ahead of print April 17, 2020. DOI: 10.1002/jmri.27148. [Link]
2.
Zamboni GA, Ambrosetti MC, Pezzullo M, et al. Optimum imaging of chronic pancreatitis. Abdom Radiol (NY) 2020; 45: 1410–1419. [Link]
3.
Yam BL and Siegelman ES. MR imaging of the biliary system. Radiol Clin North Am 2014; 52: 725–755. [Link]
4.
Brunt LM, Deziel DJ, Telem DA, et al. Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg 2020; 272: 3–23. [Link]
5.
Rhaiem R, Piardi T, Renard Y, et al. Preoperative magnetic resonance cholangiopancreatography before planned laparoscopic cholecystectomy: is it necessary? J Res Med Sci 2019; 24: 107. [Link]
6.
Katabathina VS, Dasyam AK, Dasyam N, et al. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 2014; 34: 565–586. [Link]
7.
Novikov A, Kowalski TE and Loren DE. Practical management of indeterminate biliary strictures. Gastrointest Endosc Clin N Am 2019; 29: 205–214. [Link]
8.
Seo N, Kim SY, Lee SS, et al. Sclerosing cholangitis: clinicopathologic features, imaging spectrum, and systemic approach to differential diagnosis. Korean J Radiol 2016; 17: 25–38. [Link]
9.
Kamisawa T, Zen Y, Nakazawa T, et al. Advances in IgG4-related pancreatobiliary diseases. Lancet Gastroenterol Hepatol 2018; 3: 575–585. [Link]
10.
Fernandez YVM and Arvanitakis M. Early diagnosis and management of malignant distal biliary obstruction: a review on current recommendations and guidelines. Clin Exp Gastroenterol 2019; 12: 415–432. [Link]
11.
Vernuccio F, Borhani AA, Dioguardi Burgio M, et al. Common and uncommon pitfalls in pancreatic imaging: it is not always cancer. Abdom Radiol (NY) 2016; 41: 283–294. [Link]
12.
Klauss M, Maier-Hein K, Tjaden C, et al. IVIM DW-MRI of autoimmune pancreatitis: therapy monitoring and differentiation from pancreatic cancer. Eur Radiol 2016; 26: 2099–2106. [Link]
13.
Lee NJ, Hruban RH and Fishman EK. Pancreatic neuroendocrine tumor: review of heterogeneous spectrum of CT appearance. Abdom Radiol (NY) 2018; 43: 3025–3034. [Link]
14.
Renno A, Hill M, Abdel-Aziz Y, et al. Diagnosis of intrapancreatic accessory spleen by endoscopic ultrasound-guided fine-needle aspiration mimicking a pancreatic neoplasm: a case report and review of literature. Clin J Gastroenterol 2020; 13: 287–297. [Link]
15.
Coquia SF, Kawamoto S, Zaheer A, et al. Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor. J Comput Assist Tomogr 2014; 38: 874–878. [Link]
16.
Bronstein YL, Loyer EM, Kaur H, et al. Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol 2004; 182: 619–623. [Link]
17.
Prokesch RW, Chow LC, Beaulieu CF, et al. Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience. Radiology 2002; 225: 759–765. [Link]
18.
Wang W, Shpaner A, Krishna SG, et al. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc 2013; 78: 73–80. [Link]
19.
Yu J, Turner MA, Fulcher AS, et al. Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: Part 2, pancreatic duct and pancreas. AJR Am J Roentgenol 2006; 187: 1544–1553. [Link]
20.
Crippa S, Arcidiacono PG, De Cobelli F, et al. Review of the diagnosis and management of intraductal papillary mucinous neoplasms. United European Gastroenterol J 2020; 8: 249–255. [Link]
21.
Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524–546. [Link]
22.
Keil R, Kozeluhova J, Dolina J, et al. Acute portal vein thrombosis in noncirrhotic patients - different prognoses based on presence of inflammatory markers: a long-term multicenter retrospective analysis. Scand J Gastroenterol 2019; 54: 1379–1384. [Link]
23.
Junare PR, Udgirkar S, Nair S, et al. Splanchnic venous thrombosis in acute pancreatitis: does anticoagulation affect outcome? Gastroenterology Res 2020; 13: 25–31. [Link]

Abstract

TIPS success is rarely about the procedure alone. It depends on decisions made across the entire clinical pathway.

New in the UEG "Mistakes in…" series: Ferdinande et al., present 10 common mistakes in TIPS for cirrhosis, from referral to long-term follow-up.

Key themes:
• Screen the heart first: cardiac decompensation follows TIPS in up to 20% of patients.
• Refer early: delay costs survival in refractory ascites and high-risk variceal bleeding.
• Prevent encephalopathy by design: careful selection, nutrition, rifaximin, and controlled underdilation.
• Individualise haemodynamic targets and follow up structurally.

Topics

Hepatobiliary Surgery

Published

2026

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Summary

AI Generated

Summary is not available for this content yet.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Pancreas

Published

2025

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What's new in Rome V? Part 1 with Maura Corsetti

Maura Corsetti, Pradeep Mundre

Summary

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Abstract

Topics

Neurogastroenterology & Motility

Published

2026

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What are the steps for a successful clinical research career? The voyage to Ithaca

Katarzyna Pawlak 1, Enrique de-Madaria 2

Affiliations

1 Department Gastroenterology, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland

2 Hospital General Universitario de Alicante, Alicante, Spain

Summary

AI Generated

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Education & Training

Published

2021

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UEG Standards and Guidelines
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Clinical Practice Guideline
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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

Summary

AI Generated

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

  • Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.

  • This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.

  • With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

2026

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UEG Mistakes In Articles
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Mistakes in enteral stenting and how to avoid them

Jeanin van Hooft, Paul Fockens, Joyce Valerie Veld

Summary

AI Generated

Summary is not available for this content yet.

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Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Harrington KA, Shukla-Dave A, Paudyal R, et al. MRI of the pancreas. J Magn Reson Imaging Epub ahead of print April 17, 2020. DOI: 10.1002/jmri.27148. [Link]
2.
Zamboni GA, Ambrosetti MC, Pezzullo M, et al. Optimum imaging of chronic pancreatitis. Abdom Radiol (NY) 2020; 45: 1410–1419. [Link]
3.
Yam BL and Siegelman ES. MR imaging of the biliary system. Radiol Clin North Am 2014; 52: 725–755. [Link]
4.
Brunt LM, Deziel DJ, Telem DA, et al. Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg 2020; 272: 3–23. [Link]
5.
Rhaiem R, Piardi T, Renard Y, et al. Preoperative magnetic resonance cholangiopancreatography before planned laparoscopic cholecystectomy: is it necessary? J Res Med Sci 2019; 24: 107. [Link]
6.
Katabathina VS, Dasyam AK, Dasyam N, et al. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 2014; 34: 565–586. [Link]
7.
Novikov A, Kowalski TE and Loren DE. Practical management of indeterminate biliary strictures. Gastrointest Endosc Clin N Am 2019; 29: 205–214. [Link]
8.
Seo N, Kim SY, Lee SS, et al. Sclerosing cholangitis: clinicopathologic features, imaging spectrum, and systemic approach to differential diagnosis. Korean J Radiol 2016; 17: 25–38. [Link]
9.
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Abstract

Indications include stenosis (oesophageal and colonic) and gastric outlet obstruction

Topics

Radiology & Imaging Surgery

Citation

Veld JV, Fockens P and van Hooft JE. Mistakes in enteral stenting and how to avoid them. UEG Education 2019; 19: 5–8

Published

2019

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