Background: Pancreatic ductal adenocarcinoma (PDAC) is deadly cancer with a poor prognosis. Molecular prognostic markers are needed to predict the patient’s survival. The cyclooxygenase-2 enzyme (COX-2) and its 2 major transcription factors––nuclear factorkappa B (NF-κB) and specificity protein 1 (Sp1)––are activated during inflammation caused by neoplasia. Several studies have investigated the association between the COX-2, NF-κB, and Sp1 tissue expressions with the patient’s overall survival. Therefore, we conducted this systematic review and meta-analysis to evaluate those studies. Methods: We searched for relevant articles from the MEDLINE database through June 2020. Studies were eligible if they included dichotomized tissue protein expression status and the overall survival as the outcome. We used RevMan and ProMeta programs to perform the meta-analysis. Results: We identified 11 eligible studies. The meta-analysis showed that COX-2 tissue expression was associated with decreased overall survival (crude HR = 1.35; 95% CI, 1.05-1.74), although the result was not significant when controlling for other covariates. The NF-κB tissue expression was associated with decreased overall survival (crude HR = 2.18; 95% CI, 1.49-3.18), although it was not significant when controlling for other covariates. The Sp1 tissue expression showed significantly decreased overall survival even when adjusted with other covariates (aHR = 3.47; 95% CI, 1.52-7.94). The limitations included searching only for English publications and the substantial heterogeneity among the studies. Conclusion: COX-2, NF-κB, and Sp1 tissue expressions have the potential to be used as prognostic markers in PDAC. Further studies are still needed to clarify the associations.

Chronic inflammation is a crucial driver of carcinogenesis in pancreatic ductal adenocarcinoma (PDAC). Several studies have investigated the prognostic significance of cyclooxygenase−2 (COX−2) expression in PDAC patients, obtaining conflicting results. Nuclear factor kappa−B (NF−κB), specificity protein 1 (Sp1), and c−Jun are known as the transcription factors of the COX2 gene. This exploratory observational study investigated the association of the NF−κB, COX−2, Sp1, and c−Jun expressions with patient survival in PDAC. We used the immunohistochemical method to detect the PDAC tissue expressions of NF−κB (RelA/p65), COX−2, Sp1, and c−Jun. The expressions of these proteins were correlated with the overall survival (OS) and other clinicopathological characteristics of PDAC patients. We obtained 53 PDAC specimens from resections and biopsies. There were significant correlations between the four proteins’ expressions in the PDAC tissues. The expression of the cytoplasmic (aHR = 0.31; 95% CI 0.11–0.90; p = 0.032) or nuclear NF−κB (aHR = 0.22; 95% CI 0.07–0.66; p = 0.007) was independently associated with a better prognosis in the PDAC patients. COX−2, Sp1, and c−Jun showed no significant association with a prognosis in the PDAC patients. The PDAC patients who expressed NF−κB had a better prognosis than the other patients, which suggests that the role of inflammation in PDAC is more complex than previously thought.

Recent studies have demonstrated the potential of artificial intelligence (AI) in diagnostic and therapeutic endoscopy for managing gastrointestinal diseases. However, there is limited knowledge of the perspective of endoscopists towards AI technology, particularly in the Asian community. This study aims to bridge this knowledge gap to guide policymakers, healthcare providers, and technology developers through an Asia AI Task Force. An online survey of 45 questions exploring (a) the perceived benefits of AI in endoscopy, (b) the barriers to adopting AI in endoscopy, (c) the priority areas and barriers to research in AI endoscopy, as well as (d) priorities for an Asia AI Task Force were distributed between November 2022 and May 2023 to endoscopists from sixteen medical institutes across ten Asian regions. A total of 293 participants completed the survey. Two-fifths (41.98%, n = 123) report no prior exposure to AI endoscopy. The majority (73.2%, n = 90/123) of those without prior AI exposure express concerns about the accountability of AI and its impact on working practices. Almost all participants agree that AI enhances quality improvement (90.8%, n = 266) and leads to better diagnosis (90.4%, n = 265). 69% (n = 202) identify "staying up to date with AI advances" as the top challenge towards clinical adoption of AI. Notably, those without prior AI exposure express high concern regarding accountability for the wrong diagnoses (73.2% vs. 60.6%, p = 0.03) and lack of clinical trials (76.4% vs. 57.1%, p = 0.001). Most respondents prioritise developing a reference paper guide for clinicians interested in AI (81.2%) and supporting funding applications for AI research (81.5%) as key areas that an Asia AI Endoscopy task force should address. The survey results from Asian endoscopists emphasise the pressing need for collaborative frameworks and educational initiatives, including establishing an Asia AI Task Force, to facilitate the successful integration of AI in endoscopy practice and research across the region.

Background In recent years, the incidence of early-onset pancreatic cancer (EOPC) has increased. Several studies comparing the survival of patients with EOPC to those with average-onset pancreatic cancer (AOPC) have reported mixed results. We aimed, therefore, to perform a meta-analysis summarizing the current evidence. Methods We searched the MEDLINE and EMBASE databases for relevant articles published through March 2024. Articles comparing the survival of patients with EOPC – defined as pancreatic ductal adenocarcinoma (PDAC) diagnosed at ≤ 50 years of age – and AOPC were included in the present meta-analysis. The primary outcome was the pooled adjusted hazard ratio (aHR), and the risk of bias analysis was performed using the Quality in Prognostic Factor Studies tool. The meta-analysis was performed using a random-effects model. Results A total of 17 studies were eligible for the primary analysis, the results of which indicated that patients with EOPC had a longer overall survival than those with AOPC (aHR = 0.80; 95% confidence interval [CI], 0.74–0.86; P < 0.001). The rate of distant metastasis was higher in EOPC than AOPC; however, patients with EOPC also received more treatments than those with AOPC. Conclusions Patients with EOPC had a better prognosis than those with AOPC. Clinicians must ensure that patients with PDAC receive early and appropriate treatment to improve their survival.

Background/Aims: Endoscopic ultrasound (EUS) has become an essential diagnostic and therapeutic tool. EUS was introduced in 2013 in Indonesia and is considered relatively new. This study aimed to describe the current role of interventional EUS at our hospital as a part of the Indonesian tertiary health center experience.Methods: This retrospective study included all patients who underwent interventional EUS (n=94) at our center between January 2015 and December 2020. Patient characteristics, technical success, clinical success, and adverse events associated with each type of interventional EUS procedure were evaluated.Results: Altogether, 94 interventional EUS procedures were performed at our center between 2015 and 2020 including 75 cases of EUS-guided biliary drainage (EUS-BD), 14 cases of EUS-guided pancreatic fluid drainage, and five cases of EUS-guided celiac plexus neurolysis. The technical and clinical success rates of EUS-BD were 98.6% and 52%, respectively. The technical success rate was 100% for both EUS-guided pancreatic fluid drainage and EUS-guided celiac plexus neurolysis. The adverse event rates were 10.6% and 7.1% for EUS-BD and EUS-guided pancreatic fluid drainage, respectively.Conclusions: EUS is an effective and safe tool for the treatment of gastrointestinal and biliary diseases. It has a low rate of adverse events, even in developing countries.