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Introduction

Malnutrition is an early yet frequently overlooked dimension of pancreatic cancer, often present at diagnosis due to systemic inflammation, cachexia, or silent pancreatic exocrine insufficiency (PEI). Low body mass index (BMI) and hypoalbuminemia are individually recognized as risk factors for poor outcomes, but their combined evaluation may offer a more robust tool for risk stratification. The Nutritional Risk Index (NRI), which integrates both parameters, is a simple, validated score that remains underused in pancreatic oncology.

Aims & Methods

This study aimed to evaluate whether undernutrition at diagnosis, assessed by BMI, albumin, and NRI, predicts non-resectability and early mortality in patients with pancreatic cancer.
We retrospectively analyzed all pancreatic cancer cases diagnosed at a tertiary center between January 2020 and December 2024. BMI was categorized as <20 vs. ≥20 kg/m². Serum albumin levels were collected, and NRI was calculated using the simplified formula: 1.519 × albumin (g/L), due to unavailable weight loss data. Patients were stratified according to NRI into no risk (≥97.5), moderate risk (83.5–97.4), and severe risk (<83.5). Tumor stage and resectability were assessed through imaging (resectable) or histology (non-resectable). A subgroup analysis was performed on patients with available 3-month survival data. Statistical comparisons used chi-square and non-parametric tests.

Results

Among 293 patients (mean age 64±11 years; 55% male), BMI data were available for 248 cases. Of these, 101 (38.4%) had a BMI <20 kg/m². This group showed lower rates of curative surgery (8.8% vs. 16.9%; p=0.04), more frequent metastatic disease (52.7% vs. 34.2%; p=0.01), and higher rates of hypoalbuminemia (44% vs. 21%; p<0.01).
Serum albumin was available for 289 patients. According to NRI, 39% had severe nutritional risk (NRI <83.5) and 42% had moderate risk. Severe NRI was strongly associated with metastatic disease (61% vs. 28%; p=0.002) and early mortality.
Among 112 patients with 3-month survival data, 83 (74%) had died. Mortality was significantly higher in patients with BMI <20 (82.6% vs. 66.1%; p=0.03) and was even more pronounced in those with NRI <83.5 (87.1% vs. 58.2%; p<0.01).

Conclusion

Undernutrition at diagnosis—whether assessed by BMI, albumin, or NRI—is a strong and early indicator of poor prognosis in pancreatic cancer. The NRI, by combining two simple and routinely available markers, could serve as a practical triage tool to support early nutritional interventions and treatment decisions. Its integration into initial staging workflows may improve outcomes, especially if pancreatic exocrine insufficiency is also considered. Further multivariate analyses are needed to validate NRI as an independent predictor and to facilitate its routine use in multidisciplinary care planning.

TOO WEAK FOR THE FIGHT? UNDERNUTRITION AND EARLY MORTALITY IN PANCREATIC CANCER: REVISITING BMI AND ALBUMIN THROUGH THE NRI LENS

Mouloudi Aymane 1, Youness Dendane 1, Fakhrddine Amri 1, Ouiam Elmqaddem 1, Hajar Koulali 1, Zazour Abdelkrim 1, Zahi Ismaili 2, Ghizlane Kharrasse 1

1 Faculty of Medicine and Pharmacy of Oujda/University Hospital Center Mohammed VI, Oujda, Morocco

2 Medical School, Oujda, Morocco

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Pancreatic neuroendocrine tumors (NETs) are rare neoplasms that are classified as functional (F-NET) or nonfunctional (NF-NET) depending on the presence or absence of excess hormone production. Endoscopic Ultrasound guided fine needle aspiration (EU-FNA) is often used to diagnose NETs but there are limited data on its sensitivity for this purpose.

Aims & Methods

To determine the sensitivity of EUS-FNA for the diagnosis of a NET.
A prospective randomized trial study, from May 2013 to Abril 2025 was performed in a referred Gastrointestinal hospital in Brazil. A total of 184 patients underwent EUS for suspected NETS and collected materials from fine needle aspiration and sent to histopathology analyzes. The diagnosis of a NET was confirmed by: 1) EUS-FNA with or without confirmatory immune chemistry (ICC) with synaptophysin and chromogranin form pancreatic mass or metastatic site; or 2) an alternative biopsy method and/or surgical resection of the pancreas or other metastatic site

Results

184 patients (112 male; median age: 54 yrs, range: 21-78 yrs) with 68 (37%) F-NETs and 116 (63%) NF-NETs were identified. By EUS, the tumors were located in the pancreas head, body, tail or were multifocal in 76 (41%), 54 (29%), 38 (21%) and 16 (18%), respectively. Of these 184, 152 (83%) underwent EUS-FNA of a pancreatic mass, 72 (47%) of whom also had a EUS-FNA of an alternative (nonpancreatic) site including liver (n=30; 16%), another lesion in the pancreas (n=14; 8%), or lymph node (n=18; 10% peripancreatic in 10, celiac in 6 and mediastinal in 2). Immunohistochemistry was performed in 102/152 (67%) EUS-FNA specimens and the result were: ICC-positive (n=88), ICC-negative (n=10), not interpretable (n=2) or inadequate for interpretation (n=2), Surgery was performed in 82 (54%): distal pancreatectomy (n=32), Whipple procedure (n=20), enucleation (n=20) and subtotal (n=4) and total pancreatectomy (n=2). The remaining four who underwent surgery had an exploration laparotomy only. 132 patients had a confirmed diagnosis of NET and the sensitivity of EUS-FNA was respectively: all patients 84%, F-NET 78%, NF-NET (89%) and lesions less than or equal to 13 mm (62%). The results of the false-negative EUS-FNA biopsies of pancreas (n=24) were interpreted as: normal in 4; suspicious in 4, nondiagnostic in 10, adenocarcinoma in 4, and a solid pseudopapillary tumor in 2.

Conclusion

EUS-FNA is a sensitive method for the diagnosis of pancreatic NETS but yield is lower in tumor smaller than 13mm in diameter.

SENSITIVITY OF ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION (EUS-FNA) IN THE DIAGNOSIS OF PANCREATIC NEUROENDOCRINE TUMORS: A PROSPECTIVE RANDOMIZED TRIAL

Spencer Vaiciunas 1, Karla Nocrato Loiola Vaiciunas 2, Bryan Loiola Vaiciunas 3

1 Afya - Sao Lucas Medical School, Porto Velho, Brazil

2 University of Sao Paulo - UNIFESP, Sao Paulo, Brazil

3 Windermere Prep School, Windermere, United States

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Pancreatic fluid collection (PFC) often necessitates drainage or necrosectomy. Recently, minimally invasive endoscopic treatments have emerged as the first-line approach. However, limited data are available on the outcomes of such treatments in elderly patients.

Aims & Methods

This study aimed to evaluate the clinical outcomes of endoscopic treatment for PFC in elderly patients using a large-scale, multicenter cohort from Japan. This retrospective analysis included 349 patients who underwent endoscopic ultrasound-guided pancreatic fluid drainage (EUS-PFD) for PFC. The study cohort, derived from 11 institutions within the WONDERFUL study group between 2010 and 2021, was stratified into an elderly group (n = 54, aged ≥75 years) and a non-elderly group (n = 295). Treatment outcomes were compared between the two groups.

Results

The Charlson Comorbidity Index (CCI) of ≥2 was significantly more prevalent in the elderly group (28.4% vs. 10.1%, p < 0.001). No significant differences were observed between the groups in terms of gender, BMI, etiology of pancreatitis, or indications for treatment. PFC characteristics, including lesion proportion, size, morphology, and the prevalence of walled-off necrosis (WON), were comparable between the groups. However, pre-treatment white blood cell counts were significantly higher in the elderly group (10,250/μL vs. 8,060/μL, p= 0.003), and pre-treatment albumin levels were significantly lower (2.35 g/dL vs. 2.85 g/dL, p < 0.001). Clinical success rates of endoscopic treatment were similar between the elderly and non-elderly groups (82% vs. 87%, p = 0.29), as were rates of endoscopic necrosectomy (24.1% vs. 31.9%, p = 0.54), adverse events (16.7% vs. 17.6%, p = 0.99), surgical conversion (1.9% vs. 7.1%, p = 0.22), PFC recurrence (1.9% vs. 9.4%, p = 0.10), time to clinical success (41 days vs. 46 days, p = 0.49), number of endoscopic treatments (2 vs. 3, p = 0.19), and total treatment duration (86 minutes vs. 114 minutes, p = 0.54). However, the mortality rate was significantly higher in the elderly group (16.7% vs. 5.1%, p = 0.005). Multivariate analysis identified a statistically significant association between CCI ≥2 and mortality (odds ratio [OR]: 5.37, 95% confidence interval [CI]: 1.59–11.4, p = 0.007), while the elderly group showed a trend toward significance (OR: 3.31, 95% CI: 0.93–11.7, p = 0.06).

Conclusion

Elderly patients undergoing endoscopic treatment for PFC exhibited higher comorbidity burdens compared to their younger counterparts, as reflected by higher CCI scores. Despite comparable safety and clinical efficacy outcomes, mortality was significantly higher in the elderly cohort. These findings underscore the importance of comprehensive risk assessment, particularly considering systemic comorbidities, prior to initiating endoscopic treatment for PFC in elderly patients.

CLINICAL OUTCOMES OF ENDOSCOPIC TREATMENT FOR PANCREATIC FLUID COLLECTION IN ELDERLY PATIENTS (WONDERFUL STUDY GROUP)

Arata Sakai 1, Atsuhiro Masuda 1, Tomotaka Saito 2, Tsuyoshi Hamada 2, Masahiro Tsujimae 1, Tomohiro Yamazaki 3, Shunsuke Omoto 3, Mamoru Takenaka 3, Ryota Nakano 4, Hideyuki Shiomi 4, Sho Takahashi 5, Toshio Fujisawa 5, Suda Kentaro 6, Keito Nakagawa 6, Saburo Matsubara 6, Shinya Uemura 7, Takuji Iwashita 7, Akinori Maruta 8, Kensaku Yoshida 9, Yuhei Iwasa 10, Keisuke Iwata 10, Nobuhiko Hayashi 11, Tsuyoshi Mukai 12, Hiroyuki Isayama 5, Ichiro Yasuda 11, Yousuke Nakai 13

1 Kobe University Graduate School of Medicine, Kobe, Japan

2 Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

3 Kindai University, Faculty of Medicine, Osakasayama, Japan

4 Hyogo Medical University, Nishinomiya, Japan

5 Juntendo University, Graduate School of Medicine, Tokyo, Japan

6 Saitama Medical Center, Saitama Medical University, Kawagoe, Japan

7 Gifu University Hospital, Gifu, Japan

8 Gifu Prefectural General Medical Center, Gifu, Japan|||Gifu University Hospital, Gifu, Japan

9 Gifu Prefectural General Medical Center, Gifu, Japan

10 Gifu Municipal Hospital, Gifu, Japan

11 University Of Toyama, Toyama City, Japan

12 Kanazawa Medical University, Uchinada, Japan

13 Graduate School of Medicine, The University of Tokyo, Tokyo, Japan|||Tokyo Women's Medical University, Tokyo, Japan

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

A scope, a needle and a stent: All you need in treating pancreatitis (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

We aimed to assess the role of islet autoimmunity and family history of diabetes in the presence of CFRD in children with CF.

Aims & Methods

Data from 78 children were analysed from the CF-related Pancreatic Disorders Registry. Pancreatic islet autoantibodies (AABs) (glutamic acid decarboxylase (GAD), insulin (IAA), islet antigen-2 (IA-2) and zinc transporter 8 (ZnT8) were measured and family history of diabetes was collected in a cross-sectional manner. Family history of T1DM and T2DM was assessed using the criterion by Blackman et al., 2009 and Ferrat et al., 2020. Fischer, Kruskal-Wallis and Mann-Witney U test were used.

Results

Males comprised 55% of the study population, with a median age of 8.7 years (IQR: 5.4–14.0 years). 51 children were on CFTR modulator therapy. Children with CFRD were significantly older with a median age of 15.9 years (IQR: 7.5–18.7) for any AAB-positive CFRD compared to 8.0 years (IQR: 6.2–12.4) for non-CFRD, and 12.1 years (IQR: 9.9–13.5) for AAB-negative CFRD compared to 7.9 years (IQR: 4.0–13.6) for non-CFRD. Any AAB and single AAB positivity was significantly associated with CFRD (Table 1). Only two children reported T1DM in any relative. Family history of diabetes showed no association with CFRD. Any AAB positivity frequency was comparable among children with positive and negative family history (Blackman criteria p=0.136; Ferrat criteria p=0.133).

Variables	CFRD (n=14)	non-CFRD (n=64)	p-value
any AAB positivity	5/14 (36%)	8/64 (13%)	0.0499
single AAB positivity	5/14 (36%)	6/64 (9%)	0.0225
multiple AAB positivity	0/14 (0%)	2/64 (3%)	1.0000
GAD positivity	0/14 (0%)	4/64 (6%)	0.2925
IA-2 positivity	2/14 (14%)	2/64 (3%)	0.1456
IAA positivity	3/14 (21%)	4/64 (6%)	0.1049
ZnT8 positivity	0/14 (0%)	1/64 (2%)	1.0000

Conclusion

Islet AAB positivity is associated with CFRD in children with CF. CFRD, regardless of autoantibody status, is more common in older individuals, which aligns with known disease progression in cystic fibrosis. The usefulness of family history of diabetes as a prognostic factor in the development of CFRD is limited.

CYSTIC FIBROSIS-RELATED DIABETES IS ASSOCIATED WITH ISLET AUTOANTIBODY POSITIVITY, BUT NOT WITH FAMILY HISTORY OF DIABETES IN CHILDREN

Boróka Borbála Varga 1, Regina Molnár 2, Marcell Imrei 3, Andrea Párniczky 3, Klementina Ocskay 4

1 Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

2 Heim Pál National Pediatric Institute, Budapest, Hungary|||Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Uzsoki Street Hospital Budapest, Budapest, Hungary

3 Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary|||Heim Pál National Pediatric Institute, Budapest, Hungary

4 Heim Pál National Pediatric Institute, Budapest, Hungary|||Pharmaceutical Sciences and Health Technologies Division, Doctoral School, Semmelweis University, Budapest, Hungary

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

Chronic pancreatic disease: Pancreatitis and cystic fibrosis (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

The rs7057398 mutation in the CLDN2-MORC4 locus on the X chromosome has been linked to chronic pancreatitis according to several recent publications and a meta-analysis. However, the mutation itself is located very far from both genes (CLDN2 and MORC4), and according to our current knowledge, the protein products of CLDNS and MORC4 genes are not functionally related to the development of chronic pancreatitis.

Aims & Methods

Our aim was to investigate the frequency of the rs7057398 mutation in Hungarian patients with alcoholic and non-alcoholic pancreatitis and controls. Our study included 139 non-alcoholic (NACP) and 161 alcoholic chronic pancreatitis (ACP) patients and 509 controls recruited by the Hungarian Pancreatic Study Group (HPSG). The rs7057398 mutation (CLDN2 c.-26930T>C) status in DNA samples was examined by conventional PCR amplification and Sanger sequencing.

Results

The “C” allele of the rs7057398 mutation showed significant accumulation in patients with chronic pancreatitis (p<0.0001, OR 1.96, 95% CI 1.6-2.4), especially in the alcoholic group (p<0.0001, OR 2.56, 95% CI 1.98-3.3). When women are grouped separately, it is seen that the significant accumulation of the “C” allele is only significant in alcoholic chronic pancreatitis (p<0.005, OR: 2.5, CI: 1.3-4.8), which is also confirmed by the genotype distribution in the same group containing only women (dominant model: p 0.017, OR 3.55, 95% CI 1.3-10, recessive model: p 0.049, OR 3.01, 95% CI: 1.01-9.01).

Conclusion

The rs7057398 mutation located in the CLDN2-MORC4 locus on the X chromosome predisposes to the development of chronic pancreatitis in the Hungarian population, which association is particularly true in chronic pancreatitis of alcoholic etiology.

FREQUENCY ANALYSIS OF THE RS7057398 MUTATION AT THE CLDN2-MORC4 LOCUS IN CHRONIC PANCREATITIS

Brigitta Kazi 1, Boglarka Bako 1, Peter Hegyi 2, Balazs Nemeth 1

1 University of Szeged, Szeged, Hungary|||Hungarian Centre of Excellence for Molecular Medicine – University of Szeged, Szeged, Hungary

2 Interdisciplinary Centre of Excellence for Research Development and Innovation, University of Szeged, Szeged, Hungary|||Semmelweis University, Budapest, Hungary|||University of Pecs Medical School, Pecs, Hungary

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Early diagnosis of pancreatic cancer is crucial for improving patient outcomes. High-grade pancreatic intraepithelial neoplasia (HG-PanIN), considered a carcinoma in situ of the pancreas, can lead to long-term survival when surgically resected—even in the absence of detectable lesions on conventional imaging such as CT or MRI. In this study, we analyzed resected cases of HG-PanIN collected through the Japanese Early-stage Diagnosis Project of Pancreatic Cancer (JEDPAC), focusing on correlations between histopathological findings and preoperative imaging to identify potential diagnostic indicators.

Aims & Methods

Fifty cases (32 males, 18 females; age range 52–89 years, mean age 69.8 years) of surgically resected HG-PanIN, confirmed via central pathological review by two expert pathologists, were selected from JEDPAC-affiliated centers between 2011 and 2018. Preoperative imaging findings—including CT, MRI (MRCP), EUS, and ERCP—were retrospectively compared with pathological data.

Results

Lesions were located in the pancreatic head in 11 cases and in the body/tail in 39 cases. Sixteen cases involved only the main pancreatic duct (MPD, Group A), 27 involved both MPD and branch ducts (Group B), and 7 were confined to branch ducts (Group C). In Groups A and B, 40 cases showed longitudinal intraductal spread of ≥10 mm, and 14 exhibited skip lesions with discontinuous HG-PanIN components. MPD stenosis was frequently observed in cases with ≥10 mm ductal spread, particularly in Groups A and B, and was often accompanied by focal parenchymal atrophy corresponding to the lesion. In skip lesions, however, HG-PanIN foci did not consistently correspond to areas of ductal stenosis, making precise preoperative localization by imaging difficult. In Group C, round or oval-shaped cystic lesions near branch ducts were frequently identified, and associated parenchymal atrophy was minimal.

Conclusion

HG-PanIN often involves both main and branch pancreatic ducts, with MPD stenosis and localized parenchymal atrophy serving as important imaging clues for diagnosis. However, skip lesions challenge accurate localization with current imaging modalities. In cases confined to branch ducts, subtle atrophy and the presence of small, round cystic lesions may aid early detection.

COMPARATIVE STUDY OF HISTOPATHOLOGICAL AND IMAGING FINDINGS IN HIGH-GRADE PANCREATIC INTRAEPITHELIAL NEOPLASIA (PANCREATIC CARCINOMA IN SITU)

Keiji Hanada 1, Akinori Shimizu 1, Unknown Unknown 1, Akira Kurita 1, Toshifumi Kin 1, Yukiko Takayama 1, Koji Yoshida 1, Masayuki Kitano 1, Mamoru Takenaka 1, Masahiro Serikawa 1, Tamito Sasaki 1, Reiko Ashida 1, Satoru Yasukawa 1, Akio Yanagisawa 1, Toru Furukawa 1, Atsushi Kanno 1, Takao Otsuka 1, Hiroyuki Maguchi 1, Masao Tanaka 1

1 Japan Study Group on the Early Detection of Pancreatic Cancer, Hiroshima, Japan

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Pancreatic fluid collections (PFCs) are significant local complications that can arise from acute pancreatitis, and its management often involves drainage, although the benefits of metal stents over plastic stents remain uncertain. This meta-analysis compared the efficacy and safety of metal stents versus plastic stents for endoscopic ultrasound (EUS)-guided drainage of PFCs.

Aims & Methods

We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing metal with plastic stents for drainage of PFCs. The odds ratio (OR) was used for binary outcomes and the mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI).

Results

This study included eight RCTs and over 500 patients. Procedure duration was shorter in the metal stent arm compared with the plastic stent arm (MD -10.63; 95%CI -16.12 to -5.15, p<0.001). However, there was no statistically significant difference between metal and plastic stents in clinical success (p=0.78), technical success (p=0.65), overall mortality (p=0.48), recurrence (p=0.23), number of interventions (p=0.85), need of necrosectomy (p=0.35), need of surgery (p=0.35), length of hospitalization (p=0.86), exocrine insufficiency (p=0.54), endocrine insufficiency (p=0.77), and AEs (p=0.36).

Conclusion

Metal stents for EUS-guided drainage of PFCs are associated with a shorter procedure duration. Besides that, it did not improve other clinically relevant outcomes in comparison with plastic stents.

SAFETY AND EFFICACY OF METAL STENTS VERSUS PLASTIC STENTS FOR ENDOSCOPIC ULTRASOUND (EUS)-GUIDED DRAINAGE OF PANCREATIC FLUID COLLECTIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED STUDIES WITH TRIAL SEQUENTIAL ANALYSIS

Erica Holanda 1, Andrew Fondelli 2, Rafael Kleimmann 3, Paula Pauperio 4, Julia Tschaen 5, Matheus Fernandes 6

1 General Hospital Dr Waldemar De Alcantara, Fortaleza, Brazil

2 University of Taubate (UNITAU), Sao Paulo, Brazil

3 Federal University of Paraná (UFPR), Curitiba, Brazil

4 Bahiana School of Medicine and Public Health, Salvador, Brazil

5 Superior School of Sciences of Santa Casa of Victoria, Vitoria, Brazil

6 UFCSPA, Balneário Camboriú, Brazil

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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