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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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Mistakes in the management of hepatocellular carcinoma and how to avoid them

Spyridon Pantzios, Ioannis Elefsiniotis, Christos Triantos

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

Liver cancer is the sixth most common cancer and the third leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for about 90% of cases and mostly arises in chronic liver disease, especially cirrhosis. Viral hepatitis remains a leading cause, but alcohol-related disease and MASLD are rising. With immune checkpoint inhibitors transforming HCC management, it is timely to highlight common mistakes across screening, staging, diagnosis and treatment.

Topics

Digestive Oncology Hepatobiliary

Published

2026

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Family history of Colorectal cancer- what's next?

Pradeep Mundre 1, Kevin John Monahan 2

Affiliations

1 Bradford Teaching Hospitals NHS trust, Leeds, United Kingdom

2 West Middlesex Hospital, London, United Kingdom

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

Digestive Oncology

Published

2023

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Clinical Practice Guideline
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European Interdisciplinary Guidelines on Pain Management in Acute Pancreatitis: UEG, EPC, EDS, ESDO, EAGEN, ESPGHAN, ESGAR, and ESPCG Evidence-Based Recommendations

Sanjay Pandanaboyana

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.

Guideline

ABSTRACT

Pain is often the presenting symptom of acute pancreatitis (AP) and has a prognostic significance, with poorly treated pain affecting patient outcomes. Despite this, there are currently no international recommendations for pain management in patients admitted with AP. This current guideline was developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. Nine working groups were formed to develop statements on pain management in AP from admission to discharge. After systematic literature reviews, the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted using three rounds of Delphi method. The guidelines concluded that acute postoperative pain management guidelines are applicable for treating acute pain due to AP. The numerical rating scale is preferred for pain assessment because of better compliance. Opioids currently form the cornerstone of severe pain management. Potent opioids such as buprenorphine and pentazocine provide superior pain relief over non-opioid medications and decrease the need for rescue analgesia. Current evidence does not consistently demonstrate harm from opioids in AP. In patients with severe pain, safety concerns should not delay the timely use of opioids to ensure adequate pain management. Specific recommendations concerning the use of epidural analgesia, acupuncture and management of pain in the paediatric population and during pregnancy are provided based on evidence and expert opinions. Finally, the unmet needs for future research were discussed and proposed.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026

Published

2026

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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

Pancreas

Published

2025

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Mistakes in enteral stenting and how to avoid them

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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.
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.
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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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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

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Abstract

Topics

Education & Training

Published

2021

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