Introduction

Eosinophilic esophagitis (EoE) is a complex disease that often coexists with different conditions. Given the complexity of this pathology, a multidisciplinary approach, with gastroenterologist, allergist, dietitian, psychologist, and endoscopist may benefit to diagnosis and management of patients, reducing time to diagnosis as well.

Aims & Methods

To evaluate impact of multidisciplinary team in diagnosis and management of eosinophilic esophagitis disease. A retrospective study was conducted to include all patients referred to Fondazione Policlinico Universitario A. Gemelli between September 2016 and April 2023. Prevalence of allergic, nutritional, and psychological disturbs was evaluated. Referral for each patient was reviewed. Diagnostic delay (time interval between first occurrence of EoE symptoms and confirmed diagnosis with endoscopy) was analyzed in patients with suspected eosinophilic esophagitis and diagnosis made in our center, compared to data reported in literature. Publications from 2014 to 2023 were reviewed.

Results

A total of 98 patients, 76 males and 22 females, with a mean age at diagnosis of 25 years, were included in the study. For all patients, each visit was conducted in team with gastroenterologist, allergist, dietitian, and psychologist. 81 patients presented allergic diseases (82 %), 51 patients (52 %) needed nutritional support by a dietitian and 63 patients (64 %) presented psychological implication by the disease to necessitate clinical support. 42 patients (43%) were referred by team members. 13 patients (13%) presented to our center with suspect eosinophilic esophagitis. For these patients, ab initio evaluated with multidisciplinary approach, mean time to diagnosis was 2.25 months. Diagnostic delay reported in literature was 3 years.

Conclusion

Multidisciplinary team is needed to manage patients with eosinophilic esophagitis because its several associated diseases. In fact, most of our patients presented allergic, nutritional, and psychological disturbs. This approach assures more appropriate medical management through shared decision making. Almost half of patients was referred by team members. Thank to awareness of each physician of the team and his early referral, we assisted in a reduction of diagnostic delay in our center compared to data reported in literature.

References

Lenti MV, Savarino E, Mauro A, Penagini R, Racca F, Ghisa M, Laserra G, Merli S, Arsiè E, Longoni V, de Bortoli N, Sostilio A, Marabotto E, Ziola S, Vanoli A, Zingone F, Barberio B, Tolone S, Docimo L, Pellegatta G, Paoletti G, Ribolsi M, Repici A, Klersy C, Di Sabatino A. Diagnostic delay and misdiagnosis in eosinophilic oesophagitis. Dig Liver Dis. 2021 Dec;53(12):1632-1639. doi: 10.1016/j.dld.2021.05.017. Epub 2021 Jun 8. PMID: 34116974
Sauer BG, West A, McGowan EC. Multidisciplinary Eosinophilic Esophagitis Care: A Model for Comprehensive Patient-Centered Care Through Shared Decision Making Between Gastroenterology, Allergy, and Nutrition. Clin Gastroenterol Hepatol. 2021 Nov;19(11):2226-2229. doi: 10.1016/j.cgh.2021.07.025. Epub 2021 Jul 16. PMID: 34280551.
Murray FR, Kreienbuehl AS, Greuter T, Nennstiel S, Safroneeva E, Saner C, Schindler V, Schlag C, Schoepfer AM, Schreiner P, Straumann A, Biedermann L. Diagnostic Delay in Patients With Eosinophilic Esophagitis Has Not Changed Since the First Description 30 Years Ago: Diagnostic Delay in Eosinophilic Esophagitis. Am J Gastroenterol. 2022 Nov 1;117(11):1772-1779. doi: 10.14309/ajg.0000000000001950. Epub 2022 Aug 12. PMID: 35971224.

Introduction

Pancreatic cancer (PC) screening can improve survival in high-risk patients by detecting preneoplastic lesions or early-stage tumors.
Surveillances is mainly based on annual magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). However, little has been described regarding the possibility of finding other morphological changes that may be also important.

Aims & Methods

The aim of the study is to evaluate all the findings described in screening test and to analyze the correlation between these two screening techniques.
Descriptive observational single-center study that includes high-risk PC patients either due to family history (familial pancreatic cancer) or because they belong to hereditary syndromes, who have been undergone pancreatic cancer screening at our center from 2015 to 2023. Demographic variables and findings described in the EUS or MRI were collected.

Results

Thirty-five patients were included, with a mean age of 57.3 ± 8.2 years and a predominance of females (65.7%). Four patients (11.4%) were smokers, two were diabetic (5.7%), and one had a history of chronic pancreatitis (2.9%). The median follow-up time was 23 months (interquartile range 8-59 months).
The most frequent hereditary syndrome was hereditary breast and ovarian cancer syndrome (n=19, 54.3%), followed by familial atypical multiple mole melanoma syndrome (n=4; 11.4%). The BRCA2 mutation was the most common identifiable genetic factor (34.8%).
Regarding screening test findings, solid tumors were detected in three patients (8.6%) (Two stage I and IV adenocarcinomas and one stage I neuroendocrine tumor). In two individuals (5.7%) branch-duct intraductal papillary mucinous neoplasm were observed. Other pancreatic abnormalities were detected in 18 patients (51.4%) that include chronic pancreatitis-like parenchymal changes (34.3%), peripancreatic lymph nodes and fatty pancreas (5.7%). Finally, in 12 patients (34.3%) the screening tests were normal.
In relation to the concordance between MRI and EUS, in ten patients (28.6%) there was no agreement between these two techniques. EUS detected more parenchymal changes (n=5), pancreatic steatosis (n=2) and one neuroendocrine tumor that were not described on MRI. In contrast, MRI detected a cystic lesion and a pseudonodular enhancement that were not found on EUS.

Conclusion

Pancreatic cancer screening in high-risk individuals, detects neoplastic and preneoplastic lesions at a high rate.
Other findings, such as chronic pancreatitis-like parenchymal changes, peripancreatic lymph nodes or fatty pancreas, were also common in these patients
MRI and EUS have a good correlation, but EUS detects more parenchymal changes.

References

1. Goggins M, Overbeek KA, Brand R et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut 2020; 69 (1): 7-17
2. Bogdanski AM, van Hooft JE, Boekestijn B, Bonsing BA, Wasser MNJM, Klatte DCF, van Leerdam ME. Aspects and outcomes of surveillance for individuals at high‑risk of pancreatic cancer. Fam Cancer 2024; 23(3):323-339.
3. Blackford AL, Canto MI, Dbouk M, Hruban RH, Katona BW, Chak A et al. Pancreatic Cancer Surveillance and Survival of High-Risk Individuals. JAMA Oncol. 2024;10(8):1087-1096.
4. Maurer E, Lehman B, Matthäi E, Denzer U, Figiel J, Jseinghaus M et al. Pancreatic cancer screening is effective in individuals at risk with predisposing germline gene variants, but not in gene variant‐negative familial pancreatic cancer families. United European Gastroenterol J 2024; 12 (9): 1211-1221

Introduction

Gallbladder cancer (GBC) has a poor prognosis due to its aggressive nature and limited treatment options. Although early diagnosis through imaging is critical, it remains difficult—particularly in cases of focal gallbladder wall thickening (FGWT), which can mimic benign conditions such as adenomyomatosis or chronic cholecystitis.

Aims & Methods

This study aimed to identify lesions that progressed to GBC (precancerous lesions of GBC; PLGBC) by evaluating prior imaging and to describe their clinical characteristics and outcomes. Patients diagnosed with GBC at Iwata City Hospital between 2014 and 2024 were retrospectively reviewed. Those who had prior imaging—defined as abdominal ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI) performed more than three months before GBC diagnosis—were included for analysis. PLGBC was defined as a lesion identifiable on prior imaging but not diagnosed as GBC, and corresponding to the site of subsequently diagnosed GBC. Imaging features and clinical outcomes were compared between patients with and without PLGBCs.

Results

Among 140 patients diagnosed with GBC, 66 (47%) had prior imaging available for review and were included in the analysis. The median age at GBC diagnosis was 80 years (interquartile range [IQR]: 71–86), with 33 male patients (50%). The median interval between prior imaging and GBC diagnosis was 753 days (IQR: 404–1796). The modalities of prior imaging included CT only in 42 patients, US only in 7, MRI only in 1, US and CT in 6, CT and MRI in 6, US and MRI in 3, and all three modalities in 1 patient.
PLGBCs were identified in 32 patients (48%). Regarding lesion morphology, 28 patients presented with FGWT, 2 patients with diffuse gallbladder wall thickening (DGWT), and 2 patients with gallbladder polyps. Lesion locations were the neck in 5 patients, the body/fundus in 25 patients, and the entire gallbladder in 2 patients. Features such as intramural stones or Rokitansky–Aschoff sinuses (RAS) were observed in 15 patients, and gallstones in 7 patients.
No significant differences were found between patients with and without PLGBCs regarding resectability (36% vs. 35%, P = 1.00), radical resection rates (13% vs. 13%, P = 1.00), or survival from diagnosis (median: 640 vs. 791 days, P = 0.96). Six patients with PLGBC were diagnosed with GBC during observation of gallbladder lesions (median follow-up: 406 days, range: 350–552 days), and all underwent successful radical resection of GBC.

Conclusion

PLGBCs were identified in approximately half of the patients who had undergone imaging before their GBC diagnosis, with FGWT being the predominant imaging feature. Recognizing PLGBCs and ensuring appropriate follow-up may enable timely surgical intervention, offering a potential opportunity to improve outcomes in patients with GBC.