Expanding indications for neoadjuvant chemotherapy (NAC) for resectable pancreatic cancer prolong the period from diagnosis to surgery. In resectable pancreatic cancer with malignant biliary obstru...

The specimen collection and subsequent pathological diagnosis of malignant biliary stricture (MBS) are difficult. This study aimed to determine whether the cell block (CB) method using overnight-stored bile is useful in the diagnosis of MBS. This trial was a single-arm prospective study involving a total of 59 patients with suspected MBS. The primary endpoint was cancer detectability and accuracy using the CB method, and a comparison with the detectability and accuracy achieved with bile cytology was made. The immunohistochemical sensitivity for maspin and p53 was also investigated in the CB and surgical specimens. We were able to collect bile from all 59 patients, and 45 of these patients were clinically diagnosed with MBS. The cancer detectability using the CB method (62.2%) was significantly higher than that using cytology (37.8%) (p = 0.0344). When CB was combined with biopsy, the rates of cancer detectability (75.6%) and accuracy (81.4%) increased. In eight patients who received surgical therapy, maspin- and p53-immunohistochemistry was applied to the surgical and CB specimens, and cancer cells in both specimens showed positive cytoplasmic and nuclear staining for maspin and nuclear staining for p53. The CB method is, thus, useful for detecting malignancy (UMIN000034707).

Background/Objectives: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is a useful procedure for obtaining histological specimens. However, its utility in diagnosing autoimmune pancreatitis (AIP) has not yet been well studied. This study aimed to assess the diagnostic capability of EUS-FNB for AIP by comparing a 19-gauge Franseen needle (19FR) and a 22-gauge Franseen needle (22FR). Methods: This study included patients with a final diagnosis of AIP undergoing EUS-FNB for pancreatic lesions between January 2014 and February 2023. All patients underwent EUS-FNB with either 19FR or 22FR. Histological findings were evaluated according to the International Consensus Diagnostic Criteria (ICDC). The primary outcome was the diagnostic yield of Level 1 (≥3 ICDC items) or Level 2 (2 ICDC items). Results: The 19FR group included 31 patients, and the 22FR group included 36 patients. The Level 1 diagnostic rate was significantly higher in the 19FR group than in the 22FR group (90.3% vs. 61.1%, p = 0.010). No significant difference was observed in the Level 2 diagnostic rate. The 19FR group yielded significantly larger histological tissue samples than the 22FR group (median area: 9.19 mm²/session vs. 3.36 mm²/session, p < 0.001). The analysis demonstrated a positive correlation between tissue area and the number of histological diagnostic items obtained. Conclusions: EUS-FNB performed with the 19FR provided larger histological specimens and a higher histological diagnostic yield than the 22FR in the diagnosis of AIP. Obtaining a larger amount of tissue may facilitate a definitive diagnosis of AIP.

Background: Steroid therapy is the first-line treatment for autoimmune pancreatitis (AIP) with high response rates, although steroids can cause adverse events (AEs), such as diabetes mellitus (DM). The optimal initial steroid dose has not been well studied, and initiating high-dose steroid treatment may cause worsening of DM. Aims: The aim of this study was to evaluate the effect of the initial steroid dosage on treatment efficacy and diabetes mellitus in the management of autoimmune pancreatitis. Methods: A total of 81 AIP patients treated with steroids were divided into two groups based on the starting steroid dosage: a high-dose group (HD group; >0.4 mg/kg) and a low-dose group (LD group; ≤0.4 mg/kg). Treatment efficacy (response rate, pancreatic volume), relapse rate, and DM worsening rate were analyzed. Results: Among the 81 patients, 58 received HD steroids, and 23 received LD steroids. The treatment response rate was 100% in both groups (58 vs. 23, p = 1), and the overall relapse rate was 29% vs. 26% (17 vs. 6, p = 0.79), with no significant difference. At 1 year, DM worsening occurred in 50% vs. 16% (25 vs. 3, p = 0.007), significantly more in the HD group. The risk factors for DM worsening were starting HD steroid treatment (OR 6.52, 95% CI 1.41–30.2, p = 0.01) and older age (OR 1.10 per year, 95% CI 1.01–1.19, p = 0.03). Conclusions: No significant difference in treatment efficacy was found between HD and LD steroid treatment for AIP. LD treatment may prevent DM worsening.

Intraductal papillary mucinous neoplasm (IPMN) is a well-recognized precursor of pancreatic cancer; however, the optimal surveillance strategy for IPMN remains controversial. This study aimed to evaluate the clinical impact of semiannual surveillance using endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) for the detection of malignant transformation, including IPMN-derived and concomitant carcinoma. This multicenter prospective observational study included 360 patients with branch-duct or mixed-type IPMN enrolled between April 2018 and December 2025. Patients underwent surveillance every 6 months with blood tests and EUS or MRI. The primary endpoint was the curative resection rate among patients diagnosed with IPMN-derived or concomitant carcinoma. Secondary endpoints included the incidence of newly developed worrisome features (WF) and high-risk stigmata (HRS), as well as the cumulative incidence of malignancy. During a median follow-up period of 69 months, newly developed WF and HRS were observed in 30.3% and 2.5% of patients, respectively. Malignant transformation was confirmed in 12 patients (3.3%), including nine with IPMN-concomitant carcinoma and three with IPMN-derived carcinoma. Curative resection was performed in 9 of these patients, resulting in a surgical transition rate of 75.0%. All malignant pancreatic lesions were detected at a resectable or borderline-resectable stage at diagnosis. Semiannual surveillance using EUS and MRI facilitated the detection of malignant pancreatic lesions at a surgically treatable stage in patients with IPMN. This surveillance strategy may be clinically valuable for identifying IPMN-derived and concomitant carcinoma at stages amenable to surgical treatment in high-risk populations.