Introduction

Aims & Methods

The aim of the current study was to investigate trends in survival and treatment patterns by analyzing German health claims data.
Pancreatic cancer patients diagnosed between 2010 and 2017 were identified from the German Pharmacoepidemiological Research Database (GePaRD, approximately 20% of the German population). Data on demographics, tumor treatment within one year after diagnosis and survival were extracted.

Results

The study population comprised 23,339 patients with a median age of 74 years (IQR 66-80) and 44% with localized and 56% with metastatic disease. Overall, 52.4% received any chemotherapy and curative intended resection was performed in 28.3%. Neoadjuvant and adjuvant therapy were performed in 4.4% and 58.7% of the cases, respectively. The median overall survival of the whole study population was 7.84 months.
Patients diagnosed in the most recent period (2014-2017) had a significantly better prognosis (8.20 months (95%CI 7.97-8.43)) than patients who were diagnosed in the earlier period (2010-2013) (7.54 months (95%CI 7.31-7.70)), with an age-, sex- and stage-adjusted hazard ratio of 0.87 (95% CI 0.85-0.9). Over time, the most pronounced treatment trends have affected patients with localized disease, with increasing frequency of resection and neoadjuvant therapy and decreasing frequency of best supportive care.

Conclusion

This comprehensive insight into survival and treatment of pancreatic cancer in Germany shows presumably medically beneficial therapy trends with, however, only marginal improvements in prognosis to date.

Introduction

Acute pancreatitis (AP) is closely intricately linked to electrolyte disturbances. Such imbalances can exacerbate the instability of the intracellular environment, subsequently accelerating the progression of AP. This study aimed primarily to develop a simplified electrolyte scoring system (CC score) to determine AP exacerbation.

Aims & Methods

A new CC score was established in this study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) v3.1 database, and it was validated using the digestive department database of the First Affiliated Hospital of Nanchang University. The primary endpoint considered was the exacerbation of the disease post-admission in AP patients. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) plots were used to assess the predictive value and clinical applicability of the new CC score. Improvements were implemented on the acute physiology and chronic health evaluation II (APACHE II) and systemic inflammatory response syndrome (SIRS) scoring systems, and their performance was compared with that of traditional predictive scoring systems.

Results

This study incorporates data from 1413 AP patients drawn from the MIMIC-IV database, supplemented by a further 1040 AP patients in an external validation group. Of these, 178 and 70 AP patients were respectively transferred to the Intensive Care Unit (ICU). The multivariate adjustment model indicates that a significant negative correlation between serum Ca²⁺ levels and severe progression in AP patients, while serum Cl^- levels showed a J-shaped association with severe progression. Through node analysis of the restricted cubic splines (RCS) model, combined with the clinical grading standards for hyperchloremia and hypocalcemia, the critical values for Cl^- and Ca²⁺ were determined to be 110 mmol/L and 1.77 and 2.1 mmol/L, respectively. Based on these findings, we established a new CC score and optimized the APACHE II and SIRS scoring systems. The results indicated that the predictive power of the optimized APACHE II score (AUC=0.83) and SIRS score (AUC=0.87) for severe progression in AP patients surpassed that of the original APACHE II score (AUC=0.74) and SIRS score (AUC=0.71).

Conclusion

The new CC score not only effectively predicts the risk of severe progression in AP patients but also enhances the predictive performance of both SIRS and APACHE II scores for assessing severe progression risk in these patients.

Introduction

In the late stage of acute pancreatitis, the occurrence of pancreatic walled-off necrosis (WON) can be life-threatening, especially in the presence of infection. EUS-guided transgastric drainage is currently a minimally invasive treatment modality for the clinical treatment of WON. However, there is no consensus in international guidelines on the choice between lumen-apposing metal stents (LAMS) and traditional double-pigtail plastic stents (DPT).

Aims & Methods

Objective To investigate the differences in drainage effectiveness and complications among different stents, we included currently published randomized controlled trials (RCTs) for a meta-analysis. Methods We systematically searched the PubMed, Embase, and Cochrane Library databases for studies published between 1 January 2010 to 1 March 2023, and updated the search on March 1, 2025. The observed indicators included: primary outcome indicators (clinical success rate, re-intervention), other observation indicators (total adverse events, mortality, adverse events, procedural duration). Binary variables were analyzed using relative risk (RR) and 95% CI, while continuous variables were analyzed using mean difference (MD). The selection of a random effects model or fixed effects model depended on the situation.

Results

Six RCTs with a total of 325 patients were included for analysis, with 177 patients in the LAMS group and 175 patients in the DPT group. There was similar in the primary outcome indicators of clinical success rate (RR=1.05; 95% CI 0.93 - 1.17; P=0.46), the number of patients requiring debridement of necrotic tissue (RR=0.95; 95% CI 0.62 - 1.47; P=0.83), and percutaneous drainage (RR=0.98; 95% CI 0.27 - 3.5; P=0.97). There were also no significant differences in terms of mortality rate (RR=0.86; 95% CI 0.32 - 2.33; P=0.77), total adverse events (RR=0.87; 95% CI 0.59 - 1.29; P=0.48), adverse events related to bleeding (RR=1.48; 95% CI 0.67 - 3.28; P=0.34), procedural time (MD=-9.44; 95% CI, -15.27 - -3.61, P=0.002).

Conclusion

In comparison to DPT, LAMS could shorten procedural duration. However, there was no significant difference clinical success rate, re-intervention and adverse events. Therefore, future studies with large samples and high quality are needed for further confirmation. Meanwhile, due to the high heterogeneity among studies, conclusions should be considered with caution. Clinicians need to make the most suitable treatment decisions based on the actual situation to ensure patients get the best treatment effect and prognosis.

Introduction

Pancreatic cystic lesions (PCLs) are common and could vary from a simple benign cyst to a highly malignant cyst.¹ Mixed lesions with a solid part and a cystic part are very uncommon. They could be a sign of malignant transformation of a cyst.² Recently the awareness of these lesions has increased, especially with the increased incidence of asymptomatic pancreatic cysts worldwide primarily due to improved detection by different advanced imaging modalities.³Therefore, the proper diagnosis, differentiation and staging of these lesions are crucial for proper management and avoiding unnecessary treatment of benign ones and missing early treatment of the pre-malignant lesions.⁴ EUS-guided fine needle biopsy (EUS-FNB) may overcome these limitations of EUS-FNA through acquisition of core tissue samples that provide the ability to assess cyst wall architecture via histology. At this point, ESGE does not recommand use of EUS-FNB for diagnosis of cystic lesions.⁵

Aims & Methods

Aim: Based to the literature, there are few reports regarding the role of EUS-FNB replacing EUS-FNA in the diagnosis of PCL. This work aims to study the feasibility and safety of EUS-FNB 22G in diagnosis of PCLs.
Methods: Of 640 consecutive EUS-FNB 22G for different lesions between January,2019 and December,2023 at our center. 60 EUS-FNB 22G were done for the patients who underwent EUS-guided sampling of pancreatic cystic or mixed lesions diagnosed by abdominal MRI and/or CT scan. The patients were retrospectively and prospectively followed. All the solid lesions, pancreatic pseudocysts (round, non-septated lesions, presence of internal debris, recent acute pancreatitis or radiologic imaging of chronic pancreatitis) and lesions interposed vessels or main pancreatic duct are excluded from this study.Patients with history of severe hemorrhagic risk (platelet count <50,000 /Lor prothrombin activity <50%) are excluded. We statistically analyse the clinical and technical success rates, in addition to evaluate the diagnostic accuracy of EUS-FNB in differentiating benign and malignant pancreatic cystic lesions. Evaluation of the cyst location, primary diagnosis, adverse events, and comparison between the cytologic fluid analyses and histopathology was performed. Technical success was defined as visible tissue present after biopsy. Clinical success was defined as the presence of a specimen adequate to make a histologic or cytologic diagnosis.

Results

A total of 60 patients (mean age 65.0 ± 12.1, 36.6% females) with 60 PCLs consecutively were referred for EUS-FNB 22G and enrolled in a prospective study. 41/60 (68.3%) lesions were mixed (cystic and tissue) and 19/60 (31.7%) lesions are cystic lesions. The mean lesion size was 32.4 ± 16.6mm. The EUS-FNB 22G procedure was technically and clinically successful in all patients (100%). The mean number of needle passes, as defined as unique transluminal needle insertions into the cystic compartment, was 1.9 ± 0.6. No immediate adverse events were developed after the procedure. In 57/60 (95.0%) pancreatic cystic lesions, the specimens were adequate for cyto-histologic assessment. Among the 10 patients who had surgical teatment, the concordance of FNB compared to surgical pathology was noticed.

Conclusion

The diagnosis of pancreatic cystic and mixed lesions with a solid and liquid component can be achieved with fine needle biopsy using a 22-gauge needle in a safe and practicable manner. This method has a great diagnostic yield and does not increase the rate of complications.

References

1. Basturk O, Coban I, Adsay NV. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med. 2009;133:423–438.
2.Da Silva RJ, Oliveira INF, Ribeiro TC da R, Chebli LA, Pace FH de L, Chebli JMF. A Rare Presentation of a Solid Pseudopapillary Neoplasm of the Pancreas. GE Port J Gastroenterol. mars 2022;29(2):135‑8.
3. De Jong K, Bruno MJ, Fockens P. Epidemiology, diagnosis, and management of cystic lesions of the pancreas. Gastroenterol Res Pract. 2012;2012:147465.
4. Okasha H, E Behiry M, Ramadan N, Ezzat R, Yamany A, El-Kholi S, Ahmed G. Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions. Arab J Gastroenterol. 2019;20:86–90.
5.Polkowski M, Jenssen C, Kaye P, Carrara S, Deprez P, Gines A, et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. Endoscopy. oct 2017;49(10):989‑1006.

Introduction

Pancreatic pseudocysts (PPs), common complications of acute or chronic pancreatitis, are often managed with endoscopic ultrasound-guided double pigtail stent (EUS-DPS) drainage. However, the relationship between stent indwelling duration and PPs recurrence remains poorly defined.

Aims & Methods

We aimed to investigate whether shorter stent dwelling duration is associated with a higher risk of PPs recurrence. Patients diagnosed with PPs who underwent EUS-DPS drainage at Peking Union Medical College Hospital between June 2006 and December 2024 were retrospectively reviewed. Clinical outcomes including technical success, clinical success, postoperative complications, and recurrence were analyzed. Furtherly, the stent indwelling duration-recurrence relationship and risk factors were evaluated.

Results

A total of 116 patients were included (84 males, 72.4%), with a mean age of 48.29±13.56 years. The most common etiologies were biliary pancreatitis (28.4%) and alcoholic pancreatitis (25.9%). PPs were primarily located in the pancreatic body and tail (78.4%), with a mean diameter of 10.23±4.17 cm. Regarding drainage success, technical success was achieved in 106 cases (91.4%), and clinical success in 81 cases (69.8%). Postoperative adverse events occurred in 33.6% of patients, including infections (n=31), bleeding (n=3), perforation (n=2), and cardiopulmonary events (n=3). Patients with clinical success were stratified by stent indwelling duration (0-2 months, 2-6 months, >6 months), while PPs recurrence was significantly higher in the short-duration group compared to the intermediate- and long-duration groups (p-value < 0.05). No postoperative adverse events occurred beyond 30 days in any group, suggesting that prolonged stent indwelling duration does not increase the risk of long-term complications. Meanwhile, multivariate regression analysis identified longer stent dwelling duration and elevated high-sensitivity C-reactive protein as independent protective factors for clinical success.

Conclusion

EUS-DPS placement represents a safe and effective modality for internal drainage and therapeutic approach for PPs. Our findings support that maintaining stent placement for more than six months to significantly reduce recurrence risk and improve long-term clinical outcomes, with manageable adverse events.

Introduction

The optimal management of small (≤2 cm) low-grade pancreatic neuroendocrine neoplasms (PNENs) remains a subject of ongoing debate. While surgical resection has traditionally been the standard treatment, its invasiveness and potential for long-term complications, such as pancreatic insufficiency, have driven interest in less invasive alternatives. Recently, endoscopic ultrasonography-guided ethanol injection (EUS-EI) has emerged as a promising treatment option, offering the potential for localized tumor control with minimal impact on surrounding pancreatic tissue.

Aims & Methods

This study was conducted at a single academic center between 2014 and 2024, and the data were retrospectively analyzed. Eligibility criteria included patients with pathologically confirmed grade 1 PNENs ≤2 cm who were either poor surgical candidates or declined surgery. The procedure was carefully planned to minimize complications and improve treatment outcomes. A 25-gauge needle was used to reduce the risk of ethanol leakage. Pure ethanol was injected under EUS guidance until hyperechoic bubbles fully surrounded the tumor margin. To ensure complete coverage while minimizing ethanol exposure, ethanol was injected from multiple sites if needed. Importantly, the maximum ethanol volume per session was limited to 2 mL to prevent overexposure and reduce adverse events. To optimize treatment efficacy, contrast-enhanced computed tomography (CE-CT) was performed on postoperative day 3. If residual enhancement was detected, an additional ablation session was scheduled during the same hospitalization, allowing for planned, staged treatment.

Results

A total of 41 patients including four patients with insulinoma underwent EUS-EI, The median tumor size of 10 mm (range: 6–15 mm). The median ethanol volume in the initial session was 0.9 mL (range: 0.3–2.0 mL), and the total median volume was 1.0 mL (range: 0.3–3.2 mL), reflecting the effectiveness of carefully distributed, low-volume injections. Fifteen patients (37%) required an additional planned ablation session based on CE-CT findings. Mild pancreatitis occurred in 6 patients (14%), and the median hospital stay was 5 days (range: 4–8 days), suggesting a favorable safety profile. Complete ablation was confirmed in 37 patients (90%) at one month post-procedure. All patients with insulinomas experienced an improvement in hypoglycemia-related symptoms. During a median follow-up of 36 months, local recurrence was observed in only 2 patients (5%), occurring at 22 and 51 months, respectively. Notably, no cases of new-onset diabetes mellitus were reported.

Conclusion

Planned, staged EUS-guided ethanol injection using low per-session ethanol volumes is a safe and effective treatment strategy for patients with small, low-grade PNENs. This approach appears to reduce procedure-related complications while enhancing the rate of complete tumor ablation.

References

Matsumoto K, Kato H, Itoi T et al. Efficacy and safety of endoscopic ultrasonography-guided ethanol injections of small pancreatic neuroendocrine neoplasms: a prospective multicenter study. Endoscopy. 2025 Apr;57(4):321-329. doi: 10.1055/a-2452-4607. Epub 2024 Oct 25. PMID: 39454635; PMCID: PMC11997695.

Introduction

IgG4-related disease (IgG4-RD) is a chronic fibro-inflammatory multi-systemic disease. Pancreato-biliary involvement is reported in up to 60%, which can lead to exocrine and endocrine pancreatic insufficiency. Glucocorticoids can be used to control active inflammation but are associated with substantial toxicity. B-cell depletion with anti-CD20 chimeric Rituximab (RTX) and anti-CD19 humanised Inebilizumab (INEB) are steroid-sparing and used to control disease flares. INEB is the only FDA-approved medication for the treatment of IgG4-RD.

Aims & Methods

Our aim was to compare B-cell depleting agents for the treatment of IgG4-RD. We searched PubMed, Cochrane Central Register of Clinical Trials and Embase databases for studies of maintenance therapy in IgG4-RD with a pre-defined strategy and performed a network meta-analysis to assess relapse at 12 months, occurrence of infections and infusion-related reactions.

Results

96 out of 2545 manuscripts underwent full text review after exclusions. Three studies met eligibility for the meta-analysis, two reporting the use of RTX and one of INEB (Table 1).

For the primary outcome of disease relapse at 12 months, INEB had a risk ratio (RR) of 5.8 (95% CI 0.29 - 115.02) and RTX had an RR of 2.29 (95% CI 0.19 - 28.21), with INEB being superior in preventing relapses. The RR for infections with INEB was 0.81 (95% CI 0.19 - 3.41) whilst with RTX was 0.62 (95% CI 0.13 - 3.04). The RR for infusion-related reactions with INEB was 1.27 (95% CI 0.09 - 18.76) and for RTX was 0.93 (95% CI 0.11 - 8.19). These must be interpreted in the context of study design; INEB in a phase 3 randomised trial following a stringent safety protocol for reporting of adverse events, and RTX in retrospective observational studies.

Conclusion

This Network Meta-analysis demonstrates that INEB is superior to RTX at preventing disease relapses in patients with IgG4-RD at 12 months. Adverse events, such as infection and infusion-related reactions, were comparable in lieu of the methodological differences between studies.

Disclosure

Emma L Culver has received speaker fees from Albireo/IPSEN, Advanz/Intercept, Dr Falk, Amgen, GSK, Mirum Pharma, Gilead, Chemomab, Zenus Bio, and Advisory/consultancy fees from Advanz/Intercept, IPSEN, Mirum, GSK, Dr Falk Pharma, Amgen, Zenus Bio, Sanofi, Moderna and Sail BioPharma. MC has received speaker fees from Albireo/IPSEN, Advanz/Intercept, Amgen, GSK, Mirum Pharma, Gilead, and Advisory/consultancy fees from Advanz/Intercept, Alphasigma, Albireo/IPSEN, Mirum, GSK, Dr Falk Pharma, Amgen, Mayoly, Echosens, Kowa, Moderna, Zydus.