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EUS-GUIDED DETECTIVE FLOW IMAGING (DFI) ALLOWS EVALUATING PANCREATIC MICROVASCULARIZATION IN NONCALCIFIC CHRONIC PANCREATITIS: A PROSPECTIVE, SINGLE-CENTRE OBSERVATIONAL STUDY

Julio Iglesias-Garcia 1,2, Patricia Miguez-Sanchez 1,2, Daniel De la Iglesia-García 1,2, José Lariño-Noia 1,2, Yessica Dominguez-Novoa 1,2, J. Enrique Domínguez Muñoz 1,2

Affiliations

1 University Hospital of Santiago de Compostela, Santiago de Compostela, Spain

2 Research Health Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain

Summary

AI Generated

A prospective observational study of 81 patients found that endoscopic ultrasound Detective Flow Imaging (EUS-DFI) grades of pancreatic microvascularization correlated significantly with Rosemont classification categories of chronic pancreatitis.

EUS-DFI is a contrast-free technique that evaluates pancreatic microvascularization and low-velocity blood flow using four grades (0 to 3) based on the presence and degree of reticular microvascular patterns.
Among 81 patients (mean age 54 years), EUS-DFI grade 0 was seen only in normal pancreas (n=18), grade 1 was associated with indeterminate findings in 86.6% of cases (n=15), grade 2 with suggestive findings in 97.5% (n=40), and grade 3 with suggestive or consistent findings (n=8, p<0.001).
The authors conclude that EUS-DFI can be a useful tool for evaluating the inflammatory process in chronic pancreatitis, though further studies are needed to determine diagnostic accuracy.
This material is relevant to gastroenterologists and endosonographers interested in advanced imaging techniques for noncalcific chronic pancreatitis diagnosis.

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Abstract

Introduction

Diagnosis of noncalcific chronic pancreatitis (CP) remains a clinical challenge. Together with morphological changes, evaluation of pancreatic microvascularization could be useful in these patients, since the pancreatic inflammatory process could alter it. The development of techniques allowing the evaluation of microvascularization (Detective Flow Imaging, DFI) guided by endoscopic ultrasound (EUS) opens a new area of interest in this setting. EUS-DFI allows the evaluation of microvascularization and low-velocity blood flow without the need of contrast agents. There are no data on the potential usefulness of this technique in the evaluation of CP.

Aims & Methods

Aim of our study was to evaluate the findings of EUS-DFI in patients with clinically suspected CP.
Methods: A prospective, single-centre, observational study was designed. Patients undergoing EUS with advanced imaging for the evaluation of CP were included. Procedures were performed with a linear echoendoscope (Fujifilm 740UT) attached to the ultrasound system Arietta 850. EUS criteria of CP according to Rosemont classification were evaluated. EUS-DFI findings were classified into 4 grades (grade 0- absence of microvascularization; grade 1- reticular pattern with minimal microvascularization; grade 2- reticular pattern with moderate microvascularization; grade 3- reticular pattern with marked microvascularization. Correlation between EUS-DFI grades and the different groups of the Rosemont classification was analysed by chi-squared test.

Results

81 patients were included (mean age 54 years, range 21-85, 40 males). Eighteen patients (22.2%) presented a normal pancreas, 14 (17.3%) indeterminate findings for CP, 45 (55.6%) suggestive of CP and 4 (3.6%) consistent with CP. A EUS-DFI grade 0 (n=18) was just seen in normal pancreas. A EUS-DFI grade 1 (n=15) was associated with indeterminate findings of CP in 86.6% of the cases. A grade 2 (n=40) was associated with suggestive findings of CP in 97.5% of the cases, whereas a grade 3 (n=8) was seen in patients with suggestive (n=4) and consistent (n=4) findings of CP (p<0.001).

Conclusion

The evaluation of pancreatic microvascularization by EUS-DFI can be a useful tool for the evaluation of the inflammatory process in CP. Further studies are needed to evaluate the accuracy of this new technology for the diagnosis and activity evaluation of CP.

Disclosure

Julio Iglesias-Garcia: Advisor: Pemtax, FujiFilm, Mediglobe

Conference

UEG Week Copenhagen 2023

Topics

Pancreas

Submission format

Abstract

Session

Biliary endoscopy: What's new? (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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REAL-LIFE CLINICAL VALIDATION OF AI-ASSISTED EVALUATION OF PANCREATIC SOLID LESIONS IN ENDOSCOPIC ULTRASOUND: A TRANSCONTINENTAL MULTICENTRIC STUDY

Mariano Gonzalez Haba

Unsolved problems with imaging in pancreatic cancer

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PREVALENCE AND NATURAL COURSE OF MRI-DIAGNOSED DILATED MAIN PANCREATIC DUCT: A LONGITUDINAL, POPULATION-BASED PROSPECTIVE COHORT STUDY WITH A TEN-YEAR FOLLOW-UP

Fabian Yazdi

UEG Presentation

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REAL-LIFE CLINICAL VALIDATION OF AI-ASSISTED EVALUATION OF PANCREATIC SOLID LESIONS IN ENDOSCOPIC ULTRASOUND: A TRANSCONTINENTAL MULTICENTRIC STUDY

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REAL-LIFE CLINICAL VALIDATION OF AI-ASSISTED EVALUATION OF PANCREATIC SOLID LESIONS IN ENDOSCOPIC ULTRASOUND: A TRANSCONTINENTAL MULTICENTRIC STUDY

Miguel Martins 1, Miguel Mascarenhas-Saraiva 1, Francisco Mendes 1, Jessica Widmer 2, Tiago Ribeiro 1, Belén Agudo Castillo 3, António Miguel Martins Pinto da Costa 4, Tamas Gonda 5, Emil Agarunov 5, Grace E. Kim 6, Maria Plaza González 3, Ana Pérez-González 3, Maria Ferreira 7, Tomazo Prince 7, Maria Almeida 8, Joana Mota 8, Joana Frias 1, Catarina Araujo 1, Maria Moris 9, Ana Garcia Garcia de Paredes 10, Luiza Bicudo de Oliveira 11, Larissa Assis 11, Matheus Ferreira de Carvalho 11, Fauze Maluf-Filho 11, Felipe de La Morena López 12, Raquel Herranz Pérez 12, Marta Hermida Lario 12, Concepción García Robledo 13, Manuel Vázquez Romero 13, Ignacio Moratorio 14, Daniel Luna Rodriguez 15, Joan B. Gornals 15, Mathew Keegan 16, Khoon Sheng Kok 17, Nicholas Mingos 18, Marcos Eduardo Lera dos Santos 19, Carolina Olano 14, Mason Adams 20, Andrew Metz 18, Uzma D. Siddiqui 6, Cecilio Santander 12, Jack Di Palma 20, João Ferreira 21, Eduardo De Moura 11, Benjamin Niland 20, Guilherme Macedo 22, Mariano Gonzalez Haba 3

Affiliations

1 Centro Hospitalar Universitário São João, Porto, Portugal

2 New York University Long Island School of Medicine, New York, United States

3 Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

4 Hospital Universitario Puerta de Hierro Majadahonda (Madrid), Madrid, Spain

5 New York University Grossman School of Medicine, New York, United States

6 The University of Chicago Medicine Center for Endoscopic Research and Therapeutics, Chicago, United States

7 Hospital Nove de Julho, São Paulo, Brazil

8 São João Univeristy Hospital, Porto, Portugal

9 Hospital Universitario Marqués de Valdecilla, Santander, Spain

10 Hospital Universitario Ramon y Cajal, Madrid, Spain

11 Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil

12 Hospital Universitario de la Princesa, Madrid, Spain

13 Hospital Clinico San Carlos, Madrid, Spain

14 Hospital de Clinicas Doctor Manuel Quintela, Montevideo, Uruguay

15 Hospital Universitari de Bellvitge, Barcelona, Spain

16 Northern Beaches Hospital, Leeds, Australia

17 Royal Liverpool University Hospital, Liverpool, United Kingdom

18 The Royal Melbourne Hospital, Melbourne, Australia

19 Hospital São Luiz Jabaquara, São Paulo, Brazil

20 University of South Alabama, Alabama, United States

21 Faculdade de Engenharia da Universidade do Porto, Porto, Portugal

22 São João University Hospital, Porto, Portugal

Summary

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Abstract

Introduction

Pancreatic solid lesions (PSLs) are increasingly identified in asymptomatic individuals, yet pancreatic ductal adenocarcinoma (PDAC) is commonly detected at advanced and unresectable stages. Endoscopic ultrasound (EUS) remains the gold standard for lesion evaluation and sampling, but its diagnostic accuracy is suboptimal. Artificial intelligence (AI) has shown potential in distinguishing and characterizing PSLs at the frame and video level; however, clinical validation studies remain limited.

Aims & Methods

This multicenter prospective study aimed to clinically validate an AI model for EUS image analysis. It included 354 EUS exams across 16 centers in the United States, Spain, Brazil, Australia, Uruguay, and the United Kingdom, using different EUS devices. For each exam, up to 25 clinically relevant frames were selected and uploaded to a Web-based platform. The model performed both detection and differentiation of PSLs: detection was assessed using intersection-over-union (IoU) against expert bounding boxes, while characterization was benchmarked against histopathology using diagnostic yield, accuracy, sensitivity and specificity.

Results

At the frame level, the AI model detected PSLs with a mean IoU of 0.54 and 81.8% accuracy. For characterization, the model achieved a diagnostic yield of 80.2% and sensitivity of 96.9% for PDAC.

Conclusion

This study represents the first real-life multicentric validation of an AI model for detection and differentiation of PSL. By incorporating data from four continents and multiple EUS systems, it confirms consistent and reliable performance across diverse clinical and demographic settings. It supports AI-assisted EUS as a transformative tool to identify smaller, earlier-stage lesions, potentially improving PDAC detection and prognosis.

Event

UEG Week Barcelona 2026

Topics

Surgery Pancreas Mechanisms & Personalised Medicine Digestive Oncology

Submission format

Abstract

Session

Pancreatic cyst: Beyond the incidental findings

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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REAL-LIFE CLINICAL VALIDATION OF AI-ASSISTED EVALUATION OF PANCREATIC SOLID LESIONS IN ENDOSCOPIC ULTRASOUND: A TRANSCONTINENTAL MULTICENTRIC STUDY

Mariano Gonzalez Haba

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Maria Antonietta Bali

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CLINICAL IMPACT OF PERORAL PANCREATOSCOPY WITH MAPPING BIOPSY ON SURGICAL DECISION-MAKING IN MAIN DUCT AND MIXED TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS

Ichiro Yasuda

CLINICAL IMPACT OF MULTIPLE EUS-FNA DURING PANCREATIC CYST SURVEILLANCE

Nadim Haddad

PREVALENCE AND NATURAL COURSE OF MRI-DIAGNOSED DILATED MAIN PANCREATIC DUCT: A LONGITUDINAL, POPULATION-BASED PROSPECTIVE COHORT STUDY WITH A TEN-YEAR FOLLOW-UP

Fabian Yazdi

UEG Presentation

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Unsolved problems with imaging in pancreatic cancer

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Unsolved problems with imaging in pancreatic cancer

Maria Antonietta Bali 1

Affiliations

1 Jules Bordet Institut, Université Libre de Bruxelles, Brussels, Italy

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Surgery Radiology & Imaging Pancreas Mechanisms & Personalised Medicine Digestive Oncology

Session

What’s new in… Locally advanced pancreatic cancer

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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REAL-LIFE CLINICAL VALIDATION OF AI-ASSISTED EVALUATION OF PANCREATIC SOLID LESIONS IN ENDOSCOPIC ULTRASOUND: A TRANSCONTINENTAL MULTICENTRIC STUDY

Mariano Gonzalez Haba

Unsolved problems with imaging in pancreatic cancer

Maria Antonietta Bali

MULTI-RESOLUTION SPATIAL TRANSCRIPTOMICS REVEALS CELL-LEVEL INVASION MECHANISMS AND DRUGGABLE TARGETS IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS OF THE PANCREAS

YUSUKE MIZUKAMI

CLINICAL IMPACT OF PERORAL PANCREATOSCOPY WITH MAPPING BIOPSY ON SURGICAL DECISION-MAKING IN MAIN DUCT AND MIXED TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS

Ichiro Yasuda

CLINICAL IMPACT OF MULTIPLE EUS-FNA DURING PANCREATIC CYST SURVEILLANCE

Nadim Haddad

PREVALENCE AND NATURAL COURSE OF MRI-DIAGNOSED DILATED MAIN PANCREATIC DUCT: A LONGITUDINAL, POPULATION-BASED PROSPECTIVE COHORT STUDY WITH A TEN-YEAR FOLLOW-UP

Fabian Yazdi

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

MULTI-RESOLUTION SPATIAL TRANSCRIPTOMICS REVEALS CELL-LEVEL INVASION MECHANISMS AND DRUGGABLE TARGETS IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS OF THE PANCREAS

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MULTI-RESOLUTION SPATIAL TRANSCRIPTOMICS REVEALS CELL-LEVEL INVASION MECHANISMS AND DRUGGABLE TARGETS IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS OF THE PANCREAS

Taito Itoh 1,2,3, Hiroki Tanaka 1, Yuko Omori 1,4,5, Yusuke Ono 1,2,6, Kazuya Koyama 2, Kenji Takahashi 2,1, Minoru Takeda 5, Yoshiyasu Ambo 5, Toshifumi Kin 7, Kenzui Taniue 2,8, Yutaka Suzuki 8, Mishie Tanino 9, Hidenori Karasaki 1, Toru Furukawa 3, Takuya Yamamoto 1, YUSUKE MIZUKAMI 1,2

Affiliations

1 National Institutes of Biomedical Innovation, Health and Nutrition, Ibaraki, Japan

2 Asahikawa Medical University, Asahikawa, Japan

3 Tohoku University, Graduate School of Medicine, Sendai, Japan

4 Sapporo Kosei General Hospital, Sapporo, Japan

5 Teine-Keijinkai Hospital, Sapporo, Japan

6 Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan

7 Teine Keijinkai Hospital, Sapporo, Japan

8 The University of Tokyo, Tokyo, Japan

9 Asahikawa Medical University Hospital, Asahikawa, Japan

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Abstract

Introduction

Intraductal papillary mucinous neoplasms (IPMNs) are precursors of pancreatic cancer with subtype-dependent malignant potential. Previous histopathological studies have suggested that invasive carcinoma may arise not only from mural nodules but also through progression from flat high-grade IPMNs¹. However, the cell-level spatial architecture, invasion mechanisms, and therapeutic vulnerabilities of these distinct routes remain unclear. We therefore applied multi-resolution spatial transcriptomics integrating Visium and VisiumHD to characterize IPMN progression and identify actionable targets.

Aims & Methods

We sought to identify invasion mechanisms and druggable targets in IPMNs using spatial transcriptomics. Spatial profiling was performed on 22 Visium libraries from 15 cases and 4 matched VisiumHD samples from adjacent sections of the same blocks (intestinal subtype). For Visium, we performed cell type deconvolution², CNV inference, transcription factor activity, spatial communication, and pseudotime analysis within and across subtypes. For VisiumHD, reference-based annotation with SingleR and rare-cell-type exclusion identified 12 cell types³. Ductal epithelial cells were subclustered by Harmony integration and ordered by pseudotime. Cancer-associated fibroblasts (CAFs) were classified into iCAF and myCAF status⁴, and macrophage polarization was scored using M1/M2 module signatures. Spatial communication was further analyzed using 9 refined groups (Duct_early/mid/late, iCAF, myCAF, Mac_M1/M2, Plasma, and T cell). Druggable targets were annotated via the Open Targets Platform.

Results

Visium revealed subtype-specific CNV burden, highest in the intestinal subtype (p<2.2e-16). UMAP-based trajectory analysis showed that flat-type high-grade lesions were molecularly closer to invasive regions, whereas mural nodules occupied a divergent branch, supporting distinct progression routes. VisiumHD recapitulated all top 25 dynamic genes identified by Visium and further resolved cell-level features: (1) pseudotime analysis across 10 ductal subclusters demonstrated progression from MUC5AC+/MUC2+ goblet-like cells to MMP7+/CD55+ invasive-epithelial cells, with a 7.4-fold decrease in MUC5AC and a 16-fold increase in MMP7; (2) two invasion programs were identified: a protease-driven program (MMP7/CD55/SLC2A1) and a partial EMT program (SPARC/COL1A1/VIM), consistent with hybrid epithelial-mesenchymal states; (3) four microenvironmental phenotypes were defined: immune-hot/iCAF-rich with tertiary lymphoid structure-like regions, macrophage-hot/M2-dominant, plasma cell-rich/TLS-like, and immune-cold/fibrotic-excluded; (4) close proximity of iCAF (<100 µm) was associated with a shift toward M1 polarization, with CXCL12-CXCR4 signaling consistently detected across samples; and (5) druggability analysis identified 26 clinically relevant candidates, including sacituzumab govitecan (TROP2-directed ADC), plerixafor (CXCR4 antagonist), and simtuzumab (LOXL2 inhibitor), highlighting case-specific therapeutic vulnerabilities.

Conclusion

Multi-resolution spatial transcriptomics revealed that IPMN invasion proceeds through two parallel invasion programs that were detectable only at cellular resolution. The tumor microenvironment showed case-specific immune-stromal architectures associated with corresponding therapeutic vulnerabilities. Integration of cell-level spatial transcriptomics with pharmacogenomic annotation identified actionable targets, providing a framework for personalized therapeutic strategies in IPMN-derived pancreatic cancer.

References

1- Karasaki H, Mizukami Y, Tokusashi Y, et al. Localization of the most severely dysplastic/invasive lesions and mucin phenotypes in intraductal papillary mucinous neoplasm of the pancreas. Pancreas. 40:588–594, 2011.
2- Chijimatsu R, Kobayashi S, Takeda Y, et al. Establishment of a reference single-cell RNA sequencing dataset for human pancreatic adenocarcinoma. iScience. 25:104659, 2022.
3- Peng J, Sun BF, Chen CY, et al. Single-cell RNA-seq highlights intra-tumoral heterogeneity and malignant progression in pancreatic ductal adenocarcinoma. Cell Res. 29:725–738, 2019.
4- Elyada E, Bolisetty M, Laise P, et al. Cross-Species Single-Cell Analysis of Pancreatic Ductal adenocarcinoma reveals antigen-presenting cancer-associated fibroblasts. Cancer Discov. 9:1102–1123, 2019.

Event

UEG Week Barcelona 2026

Topics

Radiology & Imaging Pancreas Endoscopy Digestive Oncology

Submission format

Abstract

Session

Pancreatic cyst: From molecular insights to clinical care

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

REAL-LIFE CLINICAL VALIDATION OF AI-ASSISTED EVALUATION OF PANCREATIC SOLID LESIONS IN ENDOSCOPIC ULTRASOUND: A TRANSCONTINENTAL MULTICENTRIC STUDY

Mariano Gonzalez Haba

Unsolved problems with imaging in pancreatic cancer

Maria Antonietta Bali

MULTI-RESOLUTION SPATIAL TRANSCRIPTOMICS REVEALS CELL-LEVEL INVASION MECHANISMS AND DRUGGABLE TARGETS IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS OF THE PANCREAS

YUSUKE MIZUKAMI

CLINICAL IMPACT OF PERORAL PANCREATOSCOPY WITH MAPPING BIOPSY ON SURGICAL DECISION-MAKING IN MAIN DUCT AND MIXED TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS

Ichiro Yasuda

CLINICAL IMPACT OF MULTIPLE EUS-FNA DURING PANCREATIC CYST SURVEILLANCE

Nadim Haddad

PREVALENCE AND NATURAL COURSE OF MRI-DIAGNOSED DILATED MAIN PANCREATIC DUCT: A LONGITUDINAL, POPULATION-BASED PROSPECTIVE COHORT STUDY WITH A TEN-YEAR FOLLOW-UP

Fabian Yazdi

UEG Presentation

New

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CLINICAL IMPACT OF PERORAL PANCREATOSCOPY WITH MAPPING BIOPSY ON SURGICAL DECISION-MAKING IN MAIN DUCT AND MIXED TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS

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CLINICAL IMPACT OF PERORAL PANCREATOSCOPY WITH MAPPING BIOPSY ON SURGICAL DECISION-MAKING IN MAIN DUCT AND MIXED TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS

Toshiki Entani 1, Hiroki Kawanaka 1, Kazuki Kitamura 1, Banri Ogino 1, Jun Sakamoto 1, Nobuhiko Hayashi 1, Ichiro Yasuda 1

Affiliations

1 Third department of internal medicine, University of Toyama, Toyama, Japan

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Abstract

Introduction

Intraductal papillary mucinous neoplasms (IPMN), particularly main duct (MD) and mixed type (MX), are associated with a substantial risk of malignant transformation and are therefore frequently treated surgically. However, accurate preoperative assessment of tumor extent within the main pancreatic duct (MPD) remains challenging. Conventional imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS) often fail to detect skip lesions or accurately delineate intraductal spread, which may lead to either insufficient resection or unnecessarily extensive surgery. Peroral pancreatoscopy (POPS) enables direct visualization of the pancreatic duct and allows targeted biopsy, thereby potentially improving diagnostic accuracy. Nevertheless, the clinical impact of POPS-guided mapping biopsy on surgical planning remains unclear.

Aims & Methods

This study aimed to evaluate the clinical impact of preoperative POPS with mapping biopsy on surgical decision-making in patients with MD- and MX-IPMN. We retrospectively analyzed 40 patients who underwent POPS followed by pancreatectomy at Toyama University Hospital between July 2018 and November 2024. All patients were diagnosed with MD- or MX-IPMN based on conventional imaging. POPS was performed using digital pancreatoscopy systems, and targeted mapping biopsies were obtained throughout the MPD to assess tumor extent and confirm negative margins. We examined technical success, findings from POPS visualization and biopsy, concordance with final pathology, changes in surgical plans before and after POPS, and procedure-related adverse events.

Results

POPS successfully reached the primary lesion in 31 of 40 patients (77.5%). POPS identified previously undetected intraductal lesions in 8 patients (20.0%). Based on POPS findings and mapping biopsies, surgical plans were altered in 8 patients (20.0%). Among these, 5 patients underwent less extensive surgery than initially planned, after confirming no tumor involvement in the MPD, while 3 patients required more extensive resection because POPS identified broader tumor spread than suggested by conventional imaging. Concordance between preoperative POPS-guided biopsy and final pathology was limited, with an overall diagnostic accuracy of 19.3%. POPS-related adverse events occurred in 6 patients (15%), including post-ERCP pancreatitis and one case of retroperitoneal perforation, all managed conservatively.

Conclusion

Preoperative POPS with mapping biopsy provide additional information beyond conventional imaging in patients with MD- and MX-IPMN and lead to clinically meaningful modifications in surgical planning. This approach may help avoid unnecessarily extensive pancreatic resection and identify otherwise undetected tumor spread, including skip lesions. Despite limitations in biopsy accuracy and procedural risks, POPS-guided mapping biopsy may be a useful method for preoperative evaluation of IPMN.

Event

UEG Week Barcelona 2026

Topics

Radiology & Imaging Pancreas Endoscopy Digestive Oncology

Submission format

Abstract

Session

Pancreatic cyst: From molecular insights to clinical care

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

REAL-LIFE CLINICAL VALIDATION OF AI-ASSISTED EVALUATION OF PANCREATIC SOLID LESIONS IN ENDOSCOPIC ULTRASOUND: A TRANSCONTINENTAL MULTICENTRIC STUDY

Mariano Gonzalez Haba

Unsolved problems with imaging in pancreatic cancer

Maria Antonietta Bali

MULTI-RESOLUTION SPATIAL TRANSCRIPTOMICS REVEALS CELL-LEVEL INVASION MECHANISMS AND DRUGGABLE TARGETS IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS OF THE PANCREAS

YUSUKE MIZUKAMI

CLINICAL IMPACT OF PERORAL PANCREATOSCOPY WITH MAPPING BIOPSY ON SURGICAL DECISION-MAKING IN MAIN DUCT AND MIXED TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS

Ichiro Yasuda

CLINICAL IMPACT OF MULTIPLE EUS-FNA DURING PANCREATIC CYST SURVEILLANCE

Nadim Haddad

PREVALENCE AND NATURAL COURSE OF MRI-DIAGNOSED DILATED MAIN PANCREATIC DUCT: A LONGITUDINAL, POPULATION-BASED PROSPECTIVE COHORT STUDY WITH A TEN-YEAR FOLLOW-UP

Fabian Yazdi

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

CLINICAL IMPACT OF MULTIPLE EUS-FNA DURING PANCREATIC CYST SURVEILLANCE

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CLINICAL IMPACT OF MULTIPLE EUS-FNA DURING PANCREATIC CYST SURVEILLANCE

Srikar Reddy 1, Carlos Guarner-Argente 2, Abdalla Khouqeer 1, Dimitrios Moris 1, Meggin Sabatino 1, Alexander Kroemer 1, Priyanka Kanth 1, Walid Chalhoub 1, Nadim Haddad 1

Affiliations

1 MedStar Georgetown University Hospital, Washington, United States

2 Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

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Abstract

Introduction

Pancreatic cystic lesions (PCLs) are increasingly detected incidentally. While endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with cyst fluid analysis is central to diagnosis and risk stratification, the clinical utility of repeated EUS-FNA during long-term surveillance remains poorly defined. This study aimed to evaluate whether multiple EUS-FNA procedures during pancreatic cyst surveillance provide clinically meaningful information that influences diagnosis or management decisions.

Aims & Methods

We conducted a retrospective cohort study of patients who underwent at least two EUS-FNA procedures for pancreatic cyst diagnosis and surveillance at a tertiary academic center between January 2009 and December 2024. The primary outcome was change in cyst diagnosis and/or management resulting from multiple FNA procedures. Secondary outcomes included diagnostic accuracy, complication rates, and identification of predictive factors to benefit from repeat sampling. Cyst fluid biomarkers analyzed included carcinoembryonic antigen (CEA), amylase, glucose, and molecular markers (KRAS and GNAS mutations).

Results

A total of 151 patients (66.3±13.2 years, 63% female) underwent a median of 3 EUS-FNA procedures (IQR 2-4; range 2-11), with a median interval of 14 months (IQR 11-23), over a median follow-up of 89 months (IQR 52-122). A change in diagnosis occurred in 19 patients (12.6%), determined primarily by multiple EUS-FNA findings in 11 (7.3%). Multiple EUS-FNA resulted in a relative increase of CEA, KRAS, and GNAS sensitivity of 42.4, 71.8 and 90.1%, respectively, while maintaining a high specificity (Table).
Multiple FNA led to a change in diagnosis or management in 20 patients (13.2%) after a median of 61.5 months (IQR 23-92) and 2.5 FNAs (IQR 2-4). The characteristics of the cyst fluid that led to the change were only biochemical in 6 (CEA in 2, amylase in 1, glucose in 1, and a combination of factors in 2), only molecular in 9 (KRAS 7 and GNAS in 2), and a combination of biochemical and molecular in 5 (3 KRAS and 2 GNAS).
Factors independently associated to a lower benefit of repeating FNA were older age (OR 0.96 per year increase, 95% CI 0.91–1.00; p=0.036), initial positive GNAS and/or KRAS (OR 0.15, 95% CI 0.03–0.6; p<0.01), CEA <30 (OR 0.08, 95% CI 0.01–0.3; p<0.01), and amylase <36000 (OR 0.14, 95% CI 0.01–0.64; p<0.01). Most patients (62.9%) fulfilled at least one low-benefit criterion for multiple FNA, and only 5.6% of these patients derived benefit, compared with 25.5% of patients without such characteristics (OR 6.6, 95% CI 2.2–19.3; p<0.01).

Conclusion

Multiple EUS-FNA with biochemical and molecular testing during pancreatic cyst surveillance can provide clinically meaningful information that influences diagnosis and management. Repeating FNA is less valuable in older patients with diagnostically uncertain baseline findings, particularly those with CEA higher than 30, amylase lower than 36,000, and negative molecular markers. These findings support a selective approach to repeat EUS-FNA rather than routine repeated sampling in all patients under surveillance.

Event

UEG Week Barcelona 2026

Topics

Radiology & Imaging Pancreas Endoscopy Digestive Oncology

Submission format

Abstract

Session

Pancreatic cyst: From molecular insights to clinical care

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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PREVALENCE AND NATURAL COURSE OF MRI-DIAGNOSED DILATED MAIN PANCREATIC DUCT: A LONGITUDINAL, POPULATION-BASED PROSPECTIVE COHORT STUDY WITH A TEN-YEAR FOLLOW-UP

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PREVALENCE AND NATURAL COURSE OF MRI-DIAGNOSED DILATED MAIN PANCREATIC DUCT: A LONGITUDINAL, POPULATION-BASED PROSPECTIVE COHORT STUDY WITH A TEN-YEAR FOLLOW-UP

Daniel Schmitz 1, Ali Alexander Aghdassi 2, Mark Wielpütz 3, Henry Völzke 3, Robin Bülow 3, Fabian Yazdi 1

Affiliations

1 Medical School Hamburg-Helios Kliniken Schwerin, Schwerin, Germany

2 Medizin. Universität Greifswald, Greifswald, Germany

3 Universität Greifswald, Greifswald, Germany

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Abstract

Introduction

Pancreatic main duct dilation (PMDD) may indicate an increased risk of developing pancreatic cancer. Little is known about the prevalence and natural course of PMDD in the general population. Therefore, this study aimed to analyse PMDD using magnet resonance imaging (MRI).

Aims & Methods

Longitudinal MRI combined with magnetic resonance cholangiopancreatography was performed between 2008 and 2021 as part of the prospective population-based Study of Health in Pomerania (SHIP), with 2,2 ± 0,6 MRI per participant on average performed within an average of 10,8 ± 1,2 yrs. PMDD was defined as ≥ 5 mm, and was correlated with clinical and epidemiological data.

Results

The prevalence of PMDD was 81/2985 individuals (2.7%). The mean age of these was 55.1 ± 13.2 yrs. Cumulative 5 yr-incidence of newly developed PMDD was 1.1% (22/1935) and 3.0% (15/ 496) after 10 yrs. Poisson regression analysis revealed strong associated factors of PMDD: active smoking (PR 2.93), diabetes (PR 2.58) and frequent alcohol abuse (PR 1.78) After a median follow-up period of 4.5 years, pancreatic cancer and chronic pancreatitis were diagnosed more frequently in the PMDD group: 2/81 (2.5%) vs. 24/2904 (0.8%) and 8/81 (9.9%) vs. 46/2904 (1.6%). Pancreatic cancerspecific survival was lower in cases of PMDD (HR = 4.96 (95% CI 1.31–18.84)).

Conclusion

A PMDD ≥5 mm is a frequent incidental MRI finding in the general population (2.7%). The risk of malignant transformation was higher with PMDD (2.5%) than without (0.8%). Chronic pancreatitis was diagnosed four times as often than pancreatic cancer in follow-up.

References

[1] Schmitz D, Stenzinger A, Grützmann R, et al. The differential diagnosis and management of pancreatic cystic neoplasms. Dtsch Arztebl Int 2025;122(22): 617–22.
[2] John U, Greiner B, Hensel E, et al. Study of health in Pomerania (SHIP): a health examination survey in an east German region: objectives and design. Sozial- Praventivmed € 2001;46(3):186–94.
[3] Aghdassi AA, Schauer B, Duscha D, et al. Comparability of size measurements of the pancreas in magnetic resonance imaging and transabdominal ultrasound. Clin Anat 2020;33(3):431–9.
[4] Volzke € H, Alte D, Schmidt CO, et al. Kohortenprofil: die Erforschung der Gesundheit in Pommern. Int J Epidemiol 2011;40(2):294–307.
[5] Hegenscheid K, Kühn JP, Volzke € H, Biffar R, Hosten N, Puls R. Whole-body magnetic resonance imaging of healthy volunteers: pilot study results from the population-based SHIP study. Rofo € 2009;181(8):748–59.
[6] Hosten N, Bülow R, Volzke € H, et al. SHIP-MR and radiology: 12 years of whole-body magnetic resonance imaging in a single center. Healthcare (Basel) 2021;10(1):33.
[7] Volzke € H, Schossow € J, Schmidt CO, et al. Cohort profile update: the study of health in Pomerania (SHIP). Int J Epidemiol 2022;51(6):e372–83.

Disclosure

All authors declare that they have no conflict of interest with regard to the content of the presented study

Event

UEG Week Barcelona 2026

Topics

Radiology & Imaging Pancreas Endoscopy Digestive Oncology

Submission format

Abstract

Session

Pancreatic cyst: From molecular insights to clinical care

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

REAL-LIFE CLINICAL VALIDATION OF AI-ASSISTED EVALUATION OF PANCREATIC SOLID LESIONS IN ENDOSCOPIC ULTRASOUND: A TRANSCONTINENTAL MULTICENTRIC STUDY

Mariano Gonzalez Haba

Unsolved problems with imaging in pancreatic cancer

Maria Antonietta Bali

MULTI-RESOLUTION SPATIAL TRANSCRIPTOMICS REVEALS CELL-LEVEL INVASION MECHANISMS AND DRUGGABLE TARGETS IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS OF THE PANCREAS

YUSUKE MIZUKAMI

CLINICAL IMPACT OF PERORAL PANCREATOSCOPY WITH MAPPING BIOPSY ON SURGICAL DECISION-MAKING IN MAIN DUCT AND MIXED TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS

Ichiro Yasuda

CLINICAL IMPACT OF MULTIPLE EUS-FNA DURING PANCREATIC CYST SURVEILLANCE

Nadim Haddad

PREVALENCE AND NATURAL COURSE OF MRI-DIAGNOSED DILATED MAIN PANCREATIC DUCT: A LONGITUDINAL, POPULATION-BASED PROSPECTIVE COHORT STUDY WITH A TEN-YEAR FOLLOW-UP

Fabian Yazdi