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Pancreatic Disorder, Pancreatitis, and Pancreatic Cancer: Interconnections, Clinical Challenges, and Therapeutic Advances

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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: 20 August 2026 | Viewed by 5447

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Dr. Cristian George Ţieranu

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1. Department of Gastroenterology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
2. Department of Gastroenterology, Elias Emergency University Hospital, 011461 Bucharest, Romania
Interests: pancreatic disorder; pancreatitis; pancreatic cancer; translational research; diagnosis; treatment
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Prof. Dr. Adrian Saftoiu

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Dear Colleagues,

The pancreas is a complex organ, integral to both exocrine and endocrine systems, through its binary functions of digestive enzyme secretion and hormone synthesis. Despite its physiological importance, it remains vulnerable to a range of severe diseases, most notably acute and chronic pancreatitis, and pancreatic ductal adenocarcinoma (PDAC), the latter being one of the deadliest cancers worldwide. The insidious nature of pancreatic diseases, coupled with diagnostic complexities and the often-inflamed tumor microenvironment of pancreatic cancer, underscores an urgent need for innovative research. The overlapping pathophysiological pathways among these diseases, their complex clinical presentations, and the limited efficacy of current diagnostic and therapeutic strategies render pancreatic diseases a persistent global health concern.

This Special Issue invites high-quality original research and comprehensive reviews that delve into the molecular and clinical connections between pancreatitis, pancreatic cancer, and other pancreatic disorders. We welcome contributions that address novel insights into disease pathogenesis, innovative diagnostic tools for early detection, and advances in treatment modalities—from precision oncology approaches and targeted therapies to immunotherapies and surgical and neoadjuvant strategies aimed at overcoming resistance. Generating interdisciplinary knowledge, this collection aspires to spark progress in translational research and ultimately improve outcomes for patients affected by pancreatic disease.

Dr. Cristian George Ţieranu
Prof. Dr. Adrian Saftoiu
Guest Editors

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Keywords

pancreatic disorder
pancreatitis
pancreatic cancer
translational research
diagnosis
treatment

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Published Papers (3 papers)

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Research

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15 pages, 288 KB

Open AccessArticle

Artificial Intelligence vs. Human Readers in Contrast-Enhanced Harmonic Imaging Endoscopic Ultrasound Interpretation of Solid Pancreatic Masses: A Multicenter Interobserver Study

by Nicoleta Podină, Lucian Gheorghe Gruionu, Anca Udriștoiu, Elena Codruța Gheorghe, Voicu Rednic, Alina Liliana Constantin, Maria Simona Badiu, Cristian George Țieranu, Nona Bejinariu, Cristina Pojoga, Claudia Hagiu, Andrada Seicean and Adrian Săftoiu

J. Clin. Med. 2026, 15(9), 3556; https://doi.org/10.3390/jcm15093556 - 6 May 2026

Viewed by 279

Abstract

Background/Objectives: Contrast-enhanced harmonic imaging endoscopic ultrasound (CHI-EUS) is a valuable tool for characterizing solid pancreatic tumors. However, interobserver variability remains a significant limitation in clinical interpretation. Artificial intelligence (AI) may offer objective, reproducible assessments, potentially enhancing diagnostic performance. This study compared the diagnostic accuracy and interobserver agreement of nine physicians with varying CHI-EUS experience levels vs. a dedicated AI system and a general-purpose large language model (ChatGPT) on the same 118 histologically confirmed cases. Methods: We conducted a prospective, multicenter, observer-blinded study involving 118 CHI-EUS video cases of histologically confirmed (EUS-FNB) focal pancreatic masses from three tertiary care centers in Romania. Nine readers were stratified into three groups: trainees (<5 years CHI-EUS experience), intermediates (5–10 years), and experts (>10 years). All readers and two AI models received standardized, anonymized 2 min CHI-EUS video clips. A dedicated AI system used a convolutional neural network (CNN) for lesion segmentation and time–intensity curve (TIC) extraction, followed by a feedforward neural network (FNN) for classification. ChatGPT was separately evaluated on the same videos. Diagnostic metrics (accuracy, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and AUROC) were calculated. Interobserver agreement was assessed using Fleiss’ and Cohen’s kappa statistics. Results: The dedicated AI system achieved an overall accuracy of 95.8% (sensitivity 96.6%; specificity 94.1%) in diagnosing pancreatic adenocarcinoma. Expert readers had a mean accuracy of 78.8% (sensitivity 86%, specificity 61%, and AUROC 0.74), intermediates 80.8% (sensitivity 83%, specificity 75%, and AUROC 0.84), and trainees had a mean accuracy of 67.2% (sensitivity 70%, specificity 60%, and AUROC 0.67). For the most-likely-diagnosis parameter, interobserver agreement was similar between intermediates (Fleiss’ κ = 0.407) and experts (κ = 0.389), while trainees showed lower agreement (κ = 0.203). ChatGPT correctly classified only 14.1% of PDAC cases. Conclusions: A specialized AI model for CHI-EUS video analysis can achieve expert-level performance and reduce diagnostic variability across experience levels. Integration of dedicated AI systems into CHI-EUS interpretation may enhance accuracy and serve as a valuable decision support tool in clinical and training settings. Full article

(This article belongs to the Special Issue Pancreatic Disorder, Pancreatitis, and Pancreatic Cancer: Interconnections, Clinical Challenges, and Therapeutic Advances)

13 pages, 818 KB

Open AccessArticle

Decoding the Natural History of Alcohol-Related Recurrent Acute Pancreatitis and Progression to Early Chronic Pancreatitis: Clinical, Biochemical, and Imaging Insights from a Single-Center Retrospective Study in France

by Alexandru-Ionut Coseru, Faiza Khemissa, Diana Elena Floria, Constantin Simiras, Mihai Catalina, Roxana Nemteanu, Alina Plesa and Vasile-Liviu Drug

J. Clin. Med. 2025, 14(21), 7830; https://doi.org/10.3390/jcm14217830 - 4 Nov 2025

Cited by 1 | Viewed by 1935

Abstract

Background: Recurrent acute pancreatitis (RAP) of alcoholic etiology is a major risk factor for chronic pancreatitis (CP). Early chronic pancreatitis (ECP) represents an intermediate stage where structural changes can be identified before advanced disease develops. The 2019 Japanese Pancreas Society (JPS) imaging criterion, defined as >3 dilated side branches on magnetic resonance imaging (MRI), provides a standardized approach for early diagnosis. Objective: To assess the prevalence of MRI-positive findings per JPS imaging criterion in patients with alcohol-related RAP and to identify clinical predictors of progression. Methods: We retrospectively analyzed 26 patients with alcohol-related RAP admitted between January 2023 and December 2024. All underwent MRI 4–8 weeks post-discharge. Patients were classified as MRI-positive or nonMRI-positive per JPS imaging criterion. Clinical, biochemical, and imaging parameters were compared using univariate and multivariate analyses. Results: Nine of twenty-six patients (34.6%) were MRI-positive per JPS imaging criterion. These patients had a significantly higher number of RAP episodes (p = 0.021). Disease duration also differed between groups (p = 0.034). No significant differences were observed in computer tomography severity scores or biochemical markers. In multivariate analysis, only the number of RAP episodes was associated with MRI-positive status (OR 4.00, 95% CI 0.79–20.3, p = 0.09). Conclusions: MRI-positive findings per JPS imaging criterion were present in one-third of alcohol-related RAP patients. Having ≥3 RAP episodes was the most consistent risk factor for structural progression. Systematic MRI during the inter-critical phase may allow early identification of high-risk patients and inform closer surveillance. Full article

(This article belongs to the Special Issue Pancreatic Disorder, Pancreatitis, and Pancreatic Cancer: Interconnections, Clinical Challenges, and Therapeutic Advances)

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Review

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15 pages, 817 KB

Open AccessReview

Understanding the Pathophysiology of Chronic Pancreatitis: A Comprehensive Review Unraveling Pain Mechanisms and the Role of Psychosocial Factors

by Aadhi C. Sekhar, Suganya Kandhi, Padmavathi Ramaswamy, Mohanapriya Thyagarajan, Manikya Kuriti and Appakalai N. Balamurugan

J. Clin. Med. 2026, 15(10), 3831; https://doi.org/10.3390/jcm15103831 - 15 May 2026

Viewed by 223

Abstract

Chronic pancreatitis (CP) is a fibro-inflammatory condition defined by permanent anatomical changes in the pancreas. The causes of CP are described by the TIGAR-O classification system: toxin-related, idiopathic, genetic mutations, autoimmune disorders, episodes of recurrent acute pancreatitis, and obstructions. Pain is multifactorial in nature, and common psychopathological consequences of CP, including depression and anxiety, complicate the clinical picture of chronic pancreatitis. As a result, the quality of life of patients with CP is decreased. This review describes the pathophysiology of pain and its relationship to underlying psychological consequences, with a focus on a long-term, holistic management approach. Strategies that combine physical and psychological management align with SDG 3 (Good Health and Well-being). CP predominantly affects patients from low socioeconomic backgrounds due to disparities in medical care, underscoring the relevance of achieving SDG 10 (Reduced Inequalities). This review emphasizes the importance of targeted research in developing a holistic care model for CP that aligns with the SDGs. Full article

(This article belongs to the Special Issue Pancreatic Disorder, Pancreatitis, and Pancreatic Cancer: Interconnections, Clinical Challenges, and Therapeutic Advances)

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