Conventionally, disconnected pancreatic duct syndrome is treated surgically. Endoscopic management is associated with lesser morbidity and mortality than that observed with surgery and shows similar success rates. However, limited data are available in this context. We evaluated the efficacy of endotherapeutic management for this syndrome. We prospectively obtained data of patients with disconnected pancreatic duct syndrome between September 2008 and January 2016. Demographic and clinical data were assessed, and factors affecting clinical outcomes were statistically analyzed. Thirty-one patients underwent 40 endoscopic transpapillary procedures, and 1 patient developed an infection after prosthesis insertion. Etiological contributors to disconnected pancreatic duct syndrome were abdominal trauma (52%) and acute necrotizing pancreatitis (48%). The median interval between the appearance of pancreatic leaks and disconnected pancreatic duct syndrome was 6.6 months (range 0.5–84 months). The median follow-up after the last treatment procedure was 38 months (range 17–99 months). Patients with complete main pancreatic duct disruption in the body/tail showed a low risk of pancreatic atrophy (P = 0.009). This study highlighted the significant correlation between endoscopic transpapillary drainage and clinical success (P = 0.014). Disconnected pancreatic duct syndrome is not an uncommon sequel of pancreatic injury, and much of the delayed diagnosis is attributable to a lack of knowledge regarding this disease. Endoscopic transpapillary intervention with ductal stenting is an effective and safe treatment for this condition.

Objective: To prepare a set of practice guidelines to standardize the entire process, from diagnosis to treatment and follow-up, for pancreatic pseudocysts and walled-off necrosis. Methods: Thirty-six experts in the fields of digestive endoscopy, pancreatic surgery, interventional radiology, and others presented their opinions via discussions in online conferences by referring to the patient, intervention, comparison, and outcomes principles and then reviewed the evidence and statements using the Delphi method to reach a consensus. The consensus of >80% was finally achieved for the items. Results: The experts discussed and reached a consensus on 29 statements including 10 categories: (1) definition and classification, (2) imaging and endoscopic diagnosis, (3) therapeutic implications, (4) surgical therapy, (5) percutaneous catheter drainage, (6) endoscopic retrograde cholangiopancreatography, (7) EUS-guided drainage, (8) stent selection for EUS-guided drainage, (9) complication related to stents for cyst drainage, and (10) drug treatment and follow-up. Conclusion: This consensus based on the clinical experience of experts in various fields and international evidence-based medicine further standardizes the multidisciplinary diagnosis and treatment processes for pancreatic pseudocysts and walled-off necrosis.

Endoscopic ultrasonography (EUS)-guided drainage has become the first-line therapy for late peri-pancreatic fluid collection (PFC). Double pigtail plastic stents (DPPS) and lumen-apposing metal stents (LAMS) are commonly used for PFC drainage. Recently, a multi-institutional consensus on PFC drainage has recommended that LAMS should be the standard care for patients with walled-off necrosis (WON). However, given the poor quality of evidence, we aim to perform a large-scale randomized controlled trial to determine whether LAMS is superior to DPPS for WON drainage. The study is an open-label, prospective, parallel-group, superiority, multicenter randomized controlled trial. Two hundred and fifty-six patients with WON who will attend 18 tertiary hospitals in China will be randomly allocated to the LAMS or DPPS group before the procedure. The primary endpoint is the clinical success at one month after drainage (reduction in the size of WON to < 2 cm). Secondary endpoints include technical success, operation time, recurrence, adverse events, and secondary interventions. The LVPWON trial is designed to determine whether LAMS is effective, safe, and superior to DPPS for WON drainage. ClinicalTrials.gov, NCT03027895 . Registered on 14 January 2017.

Current diagnosis of autoimmune pancreatitis (AIP) is challenging and often requires combining multiple dimensions. There is a need to explore new methods for diagnosing AIP. The development of artificial intelligence (AI) is evident, and it is believed to have potential in the clinical diagnosis of AIP. This article aims to list the current diagnostic difficulties of AIP, describe existing AI applications, and suggest directions for future AI usages in AIP diagnosis.

Background And Aims. Differentiating small bowel ulcerative diseases (SBUDs) on double-balloon enteroscopy(DBE) is challenging. We aimed to develop an artificial intelligence model using DBE images for accurate SBUD identification and classification. Methods. We retrospectively analyzed 1791 double-balloon endoscopy (DBE) images from 283 patients diagnosed with five types of SBUDs at a single center from August 2020 to May 2023. The cohort included Crohn’s disease ( n = 187), cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) ( n = 37), intestinal tuberculosis ( n = 15), non-specific ulcer ( n = 31), and primary small intestinal lymphoma ( n = 13). Ulcerative lesions were delineated by three endoscopists and finalized by consensus from at least two experts. A novel cascade network, Cascade-E-Yolov7 (EfficientNet-B1 and ESFC-Yolov7), was developed for the classification and precise localization of these lesions. Results. For classification, the model achieved an overall accuracy of 82.35%. The area under the curve was 0.90 for CD, 0.96 for CMUSE, 0.83 for ITB, 0.91 for non-specific ulcers, and 0.95 for PSIL. For lesion detection, the model yielded a mean average precision (mAP@0.5) of 81.35%, a precision of 82.15%, and a recall of 72.67%. Conclusions. The Cascade-E-Yolov7 model accurately detected and classified SBUDs, showing potential as a clinical tool to facilitate diagnosis and reduce experience-dependent variability.

Background and Objectives: Various lumen-apposing metal stents (LAMSs) were used for pancreatic fluid collection (PFC) drainage for many years. The structural design of LAMS needs to be improved to reduce the occurrence of adverse events. This trial assessed the efficacy and safety of a novel modified LAMS for the drainage of PFCs. Methods: This open-label, multicenter, prospective trial was done at 11 tertiary care hospitals. This study enrolled patients (18–75 years old) with confirmed diagnosis of PFC with cyst diameter no less than 6 cm. Novel LAMS (Micro-Tech Co, Ltd, Nanjing, China) was used. The primary end point was the 1-month postoperative drainage success rate. The secondary end points were technical success rate and adverse events. This study is registered with Chictr.org.cn, ChiCTR2000039955. Results: Between December 9, 2020, and December 27, 2021, 100 patients with PFC were assessed for eligibility, and 94 patients met the criteria and agreed to participate in the trial. The median size of PFC cyst was 11.23 ± 3.84 cm. The drainage success rate was 90.48% (95% CI, 83.6%–97.3%) and achieved the prespecified target value of 75% ( P < 0.0001). In subgroup analysis, the clinical success rates of pancreatic pseudocyst (PPC) and walled-off necrosis (WON) were 95.45% and 85%, respectively ( P = 0.143). The overall technical success rate was 98.94%. Postoperative early adverse events occurred in 57 (60.64%) of 94 patients, and late adverse events were encountered in 16 (17.02%) of 94 patients. The overall rate of serious adverse event (bleeding-related death) was 2.13% (2/94). Patients with WON had a significantly higher rate of early adverse events compared to those with PPC (77.78% vs . 44.90%, P = 0.001). Conclusions: The novel LAMS used in this trial was technically feasible, efficient, and safe for the treatment of PFCs. Comparable with WON, the usage of LAMS in PPC achieved a high drainage success rate and acceptable adverse events.