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Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 9 July 2026 | Viewed by 8437

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Dr. Francesca Lodato

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Department of Gastroenterology and Interventional Endoscopy, AUSL Bologna Bellaria, Maggiore Hospital Bologna, 40133 Bologna, Italy
Interests: endoscopy; EUS; biliary diseases; pancreatology
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Special Issue Information

Dear Colleagues,

This Special Issue is the second edition of “Advances in Diagnosis and Management of Pancreatobiliary Disorders” (https://www.mdpi.com/journal/jcm/special_issues/8H3J192QOL).

In recent years, the management of many diseases of the biliary tract and pancreas has undergone great changes due to the rapid progression of diagnostic and therapeutic technologies.

For biliary diseases, the constant technological evolution of endoscopic methods such as EUS, ERCP, and cholangioscopy has changed the diagnostic and therapeutic approach and management of many common pathologies, such as biliary lithiasis and its complications. Pancreatology is also constantly evolving, both from a clinical and diagnostic-instrumental point of view, such as in the approach to solid and cystic lesions of the pancreas, due to the increasingly routine use of EUS, both diagnostic and therapeutic, and the new knowledge regarding rarer neoplasms such as neuroendocrine tumors. Beyond that, new technologies based on artificial intelligence are beginning to make their way into gastroenterology. The evaluation of patients with biliopancreatic pathology is becoming increasingly complex and challenging, imposing a multidisciplinary medical, surgical, radiological, and anatomopathological approach.

These innovations often make it difficult to properly manage the gastroenterological patient in internist settings, which are settings that patients with pancreatic and biliary tract diseases often attend.
This Special Issue focuses on the latest innovations in the management of pancreatic and biliary tract diseases with the goal of providing the internal medicine physician with a state-of-the-art update and insights into the most current innovations.

Dr. Francesca Lodato
Guest Editor

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Keywords

pancreas diseases
pancreatic tumors
biliary tract diseases and neoplams
ERCP
EUS
cholangioscopy

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Related Special Issue

Advances in Diagnosis and Management of Pancreatobiliary Disorders in Journal of Clinical Medicine (12 articles)

Published Papers (8 papers)

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Research

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13 pages, 743 KB

Open AccessArticle

Skeletal Muscle Density as an Independent Predictor of Prolonged Postoperative Hospital Stay After Surgery for Acute Cholecystitis

by Hanbaro Kim, Min Ju Kim, Jeong Mok Lee and Han Zo Choi

J. Clin. Med. 2026, 15(7), 2473; https://doi.org/10.3390/jcm15072473 - 24 Mar 2026

Viewed by 337

Abstract

Background/Objectives: Prolonged postoperative length of stay (LOS) is associated with increased morbidity and healthcare utilization following surgery for acute cholecystitis. The prognostic value of skeletal muscle density (SMD), a marker of muscle quality, is unclear. We aimed to evaluate the association between SMD and prolonged LOS and to compare the predictive performance of SMD with that of skeletal muscle index (SMI). Methods: A retrospective study of 382 patients who underwent surgery for acute cholecystitis was conducted. LOS was defined using mean- and median-based cut-offs. Multivariate logistic regression was used to identify independent predictors. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and Akaike information criterion (AIC). Robustness was assessed using count-based modeling, spline analysis, and model calibration. Results: Patients with prolonged LOS were older, had lower body mass index and serum albumin levels, higher inflammatory markers, and more comorbidities, and had significantly lower SMD. Higher SMD was independently associated with a reduced risk of prolonged LOS (adjusted OR per 1-HU increase, 0.93; 95% CI, 0.88–0.97; p = 0.002). The SMD-based model showed acceptable discrimination (AUC 0.78) and slightly better model fit than the SMI-based model (AIC 365.1 vs. 371.2). In secondary analyses, patients in the lowest SMD quartile had significantly higher postoperative complication rates than the remaining patients (10.5% vs. 2.8%; p = 0.004). Conclusions: Overall, lower SMD was independently associated with prolonged LOS after surgery for acute cholecystitis and may serve as a readily available imaging biomarker for perioperative risk stratification. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition)

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13 pages, 404 KB

Open AccessArticle

Endoscopic Ultrasound for Nodal Staging in Patients with Resectable Cholangiocarcinoma

by David M. de Jong, Lydi M. J. W. van Driel, Sundeep Lakhtakia, Mohan Ramchandani, Sana Fathima Memon, Abhishek Tyagi, Parathasarathy Kumaraswamy, Shreeyash Modak, Anuradha Sekaran, Marco J. Bruno, Duvvur Nageshwar Reddy and Hardik Rughwani

J. Clin. Med. 2025, 14(21), 7545; https://doi.org/10.3390/jcm14217545 - 24 Oct 2025

Cited by 2 | Viewed by 1036

Abstract

Background: Lymph node (LN) involvement is a negative prognostic factor for patients with cholangiocarcinoma (CCA). Preoperative assessment of the LN could potentially aid therapy decision making. Endoscopic ultrasound (EUS) can be used to sample suspicious LN. The aim of this study was to evaluate the clinical impact of EUS for suspicious LN in patients with presumed resectable CCA. Methods: In this single-center cohort study, patients with potentially resectable CCA who underwent preoperative linear EUS between 2019 and 2024 were retrospectively included. The primary aims were the percentage of malignant LN detected and the clinical impact of EUS, which was defined as the percentage of patients who were precluded from surgical exploration due to pathologically confirmed LN metastases found with EUS tissue acquisition (EUS-TA). The secondary aim was the complication rate of EUS-TA. Results: A total of 135 patients were included, of whom 12 (8.9%) had intrahepatic CCA (iCCA), 65 (48.1%) had perihilar CCA (pCCA), 13 had (9.6%) middle bile duct CCA (mCCA), and 45 (33.3%) had distal CCA (dCCA). Across 148 EUS procedures, 139 LNs were identified, and EUS-TA was performed on 63 LNs among 55 patients. LN metastases were detected by EUS-TA for iCCA, pCCA, mCCA, and dCCA, in 25%, 6.2%, 15.4%, and 4.4%, respectively. EUS and EUS-TA influenced surgical work-up for iCCA, pCCA, mCCA, and dCCA in 25%, 1.5%, 15.4%, and 0.0%, respectively. No complications associated with EUS were noted. Conclusions: Preoperative EUS for nodal staging had an important clinical impact in patients with presumed resectable iCCA and mCCA, but less for pCCA and dCCA. Further prospective studies should investigate whether systematic nodal staging with EUS could improve preoperative decision making even further. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition)

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10 pages, 1629 KB

Open AccessArticle

Evaluating Novel Braided Metal Stent for Bilateral Simultaneous Side-by-Side Stenting in Malignant Hilar Biliary Obstruction: A Multicenter, Single-Arm Prospective Study

by Jungnam Lee, Seok Jeong, Eui Joo Kim, Huapyong Kang, Dong Uk Kim and Chang-Il Kwon

J. Clin. Med. 2025, 14(18), 6557; https://doi.org/10.3390/jcm14186557 - 18 Sep 2025

Viewed by 1139

Abstract

Background: While the side-by-side stenting technique-characterized by the parallel placement of stents offers procedural simplicity, the augmented radial force exerted by the initial stent may complicate subsequent deployment. This multicenter study evaluated the practicality and safety of bilateral side-by-side stenting using novel braided self-expandable metal stents (Benefit^TM; M.I.Tech Co., Ltd., Pyeongtaek, Republic of Korea). Statistical analysis included survival analysis (Kaplan–Meier) and Cox proportional hazards regression to identify predictive factors. Patients and Methods: In this multicenter study, patients with inoperable malignant hilar biliary obstruction (Bismuth type II–IV) underwent simultaneous side-by-side endoscopic placement of two braided self-expandable metal stents. The primary outcome was stent patency. The secondary outcomes included technical and clinical success, and adverse events monitored for up to one year. Results: A total of 27 patients were included in the final analysis. The technical success rate was 92.6% (25/27), and the clinical success rate was 88.0% (22/25). The median stent patency was 93 days, with cumulative patency rates of 87.4% at 3 months and 49.7% at 12 months. Tumor ingrowth was the most common cause of stent occlusion (66.7%). Early adverse events occurred in 2 patients (one cholangitis and one stent migration), supporting the favorable safety profile of this approach. Conclusions: The simultaneous side-by-side placement of novel braided self-expandable metal stents yielded high technical success and favorable clinical outcomes in patients with inoperable malignant hilar biliary obstruction. This approach provided substantial stent patency with a low complication rate, supporting its utility as a safe and effective palliative strategy for the management of malignant hilar biliary obstruction. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition)

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Review

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18 pages, 1095 KB

Open AccessReview

EUS-Anchored Multimodal Evaluation of Pancreatic Cystic Lesions: Toward a Conceptual Diagnostic Framework

by Enshuo Liu and Fei Yang

J. Clin. Med. 2026, 15(10), 3893; https://doi.org/10.3390/jcm15103893 - 18 May 2026

Abstract

Pancreatic cystic lesions (PCLs) represent a growing clinical challenge due to their diverse biological behaviors and the substantial overlap in imaging features between benign, premalignant, and malignant entities. Traditional diagnostic approaches relying on cross-sectional imaging or isolated morphologic criteria frequently fail to achieve adequate risk discrimination. Advances in endoscopic ultrasound (EUS) now permit detailed morphologic assessment complemented by cyst-fluid biochemical markers, proteomic signatures, and comprehensive genomic profiling using next-generation sequencing. Parallel progress in artificial intelligence (AI) further strengthens diagnostic precision by integrating EUS features with multimodal biomarker data to reduce subjectivity and support individualized clinical decision-making. This review introduces an EUS-based multimodal diagnostic framework of PCLs that integrates morphological evaluation, cyst-fluid biochemical testing, molecular profiling, and AI-assisted analysis. By synthesizing current evidence, we outline how the integrative approach enhances diagnostic accuracy, biological interpretability, and individualized risk stratification for PCLs. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition)

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11 pages, 235 KB

Open AccessReview

Current Perspectives on Endoscopic Nasobiliary Drainage: Optimizing Patient Management and Preventing Complications

by Angelica Toppeta, Mattia Corradi, Beatrice Mantia, Adelaide Randazzo, Mario Schettino, Stefania De Lisi, Stefania Carmagnola and Raffaele Salerno

J. Clin. Med. 2026, 15(1), 169; https://doi.org/10.3390/jcm15010169 - 25 Dec 2025

Viewed by 1279

Abstract

Endoscopic nasobiliary drainage (ENBD) is a well-established technique for biliary decompression in both benign and malignant conditions. Over the past decades, its role has been extensively evaluated in comparison with endoscopic biliary stenting and percutaneous transhepatic biliary drainage. ENBD provides distinct clinical advantages, including real-time monitoring of bile output, the possibility to perform irrigation, and the ability to collect bile samples for cytological analysis. However, it also presents specific challenges such as patient discomfort, tube dislodgement, and the need for careful maintenance. This narrative review synthesizes current evidence from randomized controlled trials, retrospective cohorts, systematic reviews, and meta-analyses, highlighting the main indications, technical innovations, comparative outcomes with alternative drainage techniques, and strategies to prevent complications. Furthermore, it discusses emerging approaches aimed at improving patient tolerance, procedural efficiency, and environmental sustainability, offering an updated framework for optimizing patient management in both benign and malignant biliary obstruction. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition)

14 pages, 597 KB

Open AccessReview

Endoscopic Ultrasound-Guided Pancreatic Cystic Fluid Biochemical and Genetic Analysis for the Differentiation Between Mucinous and Non-Mucinous Pancreatic Cystic Lesions

by Angelo Bruni, Luigi Tuccillo, Giuseppe Dell’Anna, Francesco Vito Mandarino, Andrea Lisotti, Marcello Maida, Claudio Ricci, Lorenzo Fuccio, Leonardo Henry Eusebi, Giovanni Marasco and Giovanni Barbara

J. Clin. Med. 2025, 14(11), 3825; https://doi.org/10.3390/jcm14113825 - 29 May 2025

Cited by 2 | Viewed by 2794

Abstract

Pancreatic cystic lesions (PCLs) are increasingly identified via computerized tomography (CT) and magnetic resonance (MR), with a prevalence of 2–45%. Distinguishing mucinous PCLs (M-PCLs), which include intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) that can progress to pancreatic ductal adenocarcinoma, from non-mucinous PCLs (NM-PCLs) is essential. Carcinoembryonic antigen (CEA) remains widely used but often demonstrates limited sensitivity and specificity. In contrast, endoscopic ultrasound-guided measurement of intracystic glucose more accurately differentiates PCL subtypes, as tumor-related metabolic changes lower cyst fluid glucose in mucinous lesions. Numerous prospective and retrospective studies suggest a glucose cut-off between 30 and 50 mg/dL, yielding a sensitivity of 88–95% and specificity of 76–91%, frequently outperforming CEA. Additional benefits include immediate point-of-care assessment via standard glucometers and minimal interference from blood contamination. DNA-based biomarkers, including KRAS and GNAS mutations, enhance specificity (up to 99%) but exhibit moderate sensitivity (61–71%) and necessitate specialized, expensive platforms. Molecular analyses can be crucial in high-risk lesions, yet their uptake is constrained by technical challenges. In practice, combining glucose assessment with targeted molecular assays refines risk stratification and informs the choice between surgical resection or active surveillance. Future investigations should establish standardized glucose thresholds, improve the cost-effectiveness of genetic testing, and integrate advanced biomarkers into routine protocols. Ultimately, these strategies aim to optimize patient management, limit unnecessary interventions for benign lesions, and ensure timely therapy for lesions at risk of malignant transformation. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition)

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Other

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14 pages, 938 KB

Open AccessSystematic Review

Feasibility and Safety of Endoscopic Peroral Cholangioscopy in Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

by Noemi Gualandi, Pablo Cortegoso Valdivia, Giuliano Francesco Bonura, Tommaso Gabbani, Paola Soriani and Mauro Manno

J. Clin. Med. 2026, 15(9), 3514; https://doi.org/10.3390/jcm15093514 - 4 May 2026

Viewed by 311

Abstract

Background/Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) presents significant technical challenges due to altered bowel reconstructions. Endoscopic peroral cholangioscopy (POC) offers a less invasive alternative to percutaneous or transmural techniques, but robust evidence validating its performance in SAA is lacking. This systematic review and meta-analysis (SRMA) aims to evaluate the feasibility and safety of endoscopic POC as a primary strategy in SAA. Methods: A systematic search was performed on PubMed and Embase up to December 2025 for studies reporting cholangioscopic outcomes in SAA patients utilizing an endoscopic approach. The primary outcome was the cholangioscopic access rate (AR). Secondary outcomes included endoscopic success rate (SR), technical SR, and adverse events. Pooled rates were calculated using Generalized Linear Mixed Models (GLMM). Results: Eight studies comprising 469 patients were included. The pooled endoscopic SR was 86.7% (95% CI, 74.4–93.6%) but showed high heterogeneity (I² = 79.9%), largely driven by the variation in anatomical reconstructions. Subgroup analysis revealed higher endoscopic SR in short-limb anatomies (86.5%) compared to long-limb configurations (76.2%). Conversely, once biliary cannulation was achieved, the procedure was highly reliable: the pooled cholangioscopic AR was 95.9% (95% CI, 78.7–99.3%), with no significant difference across anatomical subgroups. The pooled adverse event rate was 3.1% (95% CI, 1.3–6.8%), predominantly characterized by mild complications. Conclusions: Endoscopic POC is a feasible and safe technique for managing biliary disease in SAA. The procedure’s overall success appears to be strictly dependent on the ability to navigate the altered anatomy (endoscopic phase), whereas the cholangioscopic phase itself proves highly effective and reproducible once biliary access is secured. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition)

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23 pages, 2718 KB

Open AccessSystematic Review

Bridging Imaging and Pathohistology in Pancreatic Hamartoma: A Systematic Review of the Literature with an Integrated Case Report

by Dunja Stankic, Nina Rajovic, Nikola Grubor, Jelena Rakocevic, Aleksandar Ninic, Marjan Micev, Jelena Vladicic Masic, Luka Joksimovic, Natasa Milic, Kristina Davidovic and Nikica Grubor

J. Clin. Med. 2026, 15(1), 136; https://doi.org/10.3390/jcm15010136 - 24 Dec 2025

Viewed by 693

Abstract

Background: Pancreatic hamartoma (PH) is an exceptionally rare, benign, mass-forming lesion accounting for less than 1% of all pancreatic tumors. Its rarity and non-neoplastic nature contribute to significant diagnostic challenges, often leading to misclassification as malignant disease. This study presents a case of PH and a systematic review of all reported cases, with emphasis on histopathological and imaging characteristics. Methods: A comprehensive electronic search of PubMed, Scopus, and Web of Science was conducted up to 1 April 2025, to identify eligible case reports and series. Results: We describe a 37-year-old woman with a cystic lesion of the pancreatic tail, ultimately confirmed histologically as a cystic pancreatic hamartoma following distal pancreatectomy with splenectomy, with an uneventful postoperative course. Of 687 screened studies, 51 met the inclusion criteria, comprising 77 cases (68 adults, 9 pediatric). PHs occurred most frequently in males (52.9%), with a mean age of 59.5 ± 12.9 years, and were often asymptomatic (57.4%). The pancreatic head was the most common site (52.9%). On MRI, PHs typically exhibited low T1-weighted and high T2-weighted signal intensity, with no FDG uptake (82%) and moderate or no restriction on DWI, distinguishing them from neuroendocrine tumors (NETs). Histologically, most lesions were solid (64.7%) or solid–cystic (35.3%), with low spindle cell cellularity and absent Langerhans islets. Conclusions: Low T1WI signal and moderate DWI signal are the key features distinguishing PHs from NETs. Incorporating these findings with EUS-FNA and immunohistochemistry can support a provisional diagnosis and help avoid unnecessary radical surgery. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition)

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