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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: 25 April 2026 | Viewed by 3240

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Special Issue Editors

Dr. Madalina Ilie

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Guest Editor

Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
Interests: interventional endoscopic ultrasound; colorectal cancer; Helicobacter pylori

Dr. Mihai Ciocîrlan

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Guest Editor

Gastroenterology Clinic, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
Interests: endoscopic submucosal dissection; endoscopic ultrasound; pancreatic cancer

Special Issue Information

Dear Colleagues,

We are pleased to announce the launch of this Special Issue, entitled “Endoscopic Diagnosis and Treatments of Gastrointestinal Diseases”.

In recent years, the management of gastrointestinal diseases has gradually shifted from a surgical approach to endoscopic diagnosis and treatment. This is due to two main factors. Firstly, advances in optical endoscopic techniques for macroscopic and microscopic imaging have led to the precise diagnosis of premalignant lesions or early cancers. Secondly, the endoscopic field has seen the rapid advent of novel techniques (such as endoscopic mucosal dissection, endoscopic ultrasound-guided drainage, and digestive anastomosis) for the treatment of gastrointestinal diseases.

Our aim for this Special Issue is to provide a broad overview of the state of the art, as well as knowledge from personal experience, of endoscopic diagnosis, techniques, and novel minimally invasive treatments in various gastrointestinal diseases. In this way, we hope to expand the knowledge in this field, enabling endoscopy to cure patients or improve survival and quality of life.

We welcome the submission of original articles and reviews related to challenges encountered in the endoscopic management of digestive diseases.

Dr. Madalina Ilie
Dr. Mihai Ciocîrlan
Guest Editors

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Keywords

esogastric lesions
pancreatic diseases
colorectal lesions
hepatobiliary diseases
optical endoscopy
endoscopic ultrasound
upper and lower endoscopy
endoscopic retrograde cholangiopancreatography

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Published Papers (5 papers)

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11 pages, 336 KB

Open AccessArticle

Clinical Benefits of KRAS/GNAS Gene Mutation Analysis in Addition to Morphology and Conventional Cyst Fluid Testing in Differentiating Pancreatic Cysts

by György Gyimesi, Bánk Keczer, Péter Rein, Miklós Horváth, Bálint Gellért, Tamás Marjai, Enikő Tóth, Ákos Szűcs, Attila Szijártó, Tamás Barbai, Eszter Székely and István Hritz

J. Clin. Med. 2025, 14(24), 8671; https://doi.org/10.3390/jcm14248671 - 7 Dec 2025

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Abstract

Objectives: Pancreatic cystic lesions (PCLs) are increasingly detected due to the widespread use of imaging techniques. The identification of pancreatic mucinous cysts is especially important since these carry a risk of malignant transformation and require follow-up or surgical resection. The aim of this study was to determine the diagnostic yield of the molecular analysis of K-RAS (Kirsten RAt Sarcoma virus) and GNAS (Guanine Nucleotide-binding protein, Alpha Stimulating protein activity) gene mutations in pancreatic cyst fluid (PCF) obtained by endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA). Methods: In this prospective trial, we assessed the sensitivity, specificity, and positive and negative predictive values of K-RAS and GNAS mutation analysis in differentiating mucinous versus non-mucinous cysts and the subsequent impact on decision-making in daily clinical practice. The reference standard used comprised the combination of morphology on cross-sectional imaging and EUS, string sign, cyst fluid cytology, intracystic carcinoembryonic antigen (CEA), and glucose levels, with subsequent correlation of surgical pathology in resected cases. Fluid samples of 47 cysts obtained by EUS-FNA over a 39-month period were analyzed. Mutation analysis of KRAS (exon 2) was performed in all cases, and additionally, GNAS (exon 8) in 28 cases using Sanger sequencing. Results: 33 out of 47 PCLs were classified as mucinous cysts and 14 as non-mucinous cysts defined using conventional standards, including morphological characteristics, string-sign, cytology, cyst fluid testing, and histology in resected cases. Of these 33 mucinous cysts, KRAS mutation was detected in 14 samples. A further 23 mucinous lesions were additionally tested for GNAS mutation, which was detected in 10 of the 23 cysts. A 42.4% sensitivity for KRAS and 43.5% for GNAS mutation analysis was calculated, with a specificity of 92.9% and 100%, respectively, for detecting mucinous lesions. The clinical management was altered through the genetic testing results in one single case. Conclusions: In this cohort, K-RAS and GNAS mutational analysis in cyst fluid did not improve the detection of mucinous pancreatic cysts significantly after conventional testing. However, the method may be useful due to its high specificity in uncertain cases. Full article

(This article belongs to the Special Issue Endoscopic Diagnosis and Treatments of Gastrointestinal Diseases)

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10 pages, 3950 KB

Open AccessArticle

Choosing Wisely: Tailored Drainage Strategies for Peripancreatic Fluid Collections—A Tertiary Center’s Experience

by Raluca-Ioana Dascalu, Madalina Ilie, Claudiu Stefan Turculet, Bogdan Valeriu Popa, Gabriel Constantinescu, Christopher Pavel, Vlad Rizescu, Cosmin-Viorel Bogu, Teodor Cabel and Oana-Mihaela Plotogea

J. Clin. Med. 2025, 14(22), 8018; https://doi.org/10.3390/jcm14228018 - 12 Nov 2025

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Abstract

Introduction: The management of symptomatic peripancreatic fluid collections (PFCs), including pancreatic pseudocysts (PPs) and walled-off necrosis (WON), remains a clinical challenge. Methods: We conducted a single-center retrospective cohort study to compare the efficacy, safety, and cost of endoscopic drainage (lumen-apposing metal stent vs. double pigtail stent) and percutaneous drainage for PFCs. From an initial cohort of 75 patients with symptomatic PFCs between 2020 and 2025, 63 underwent drainage procedures. Primary endpoints were the clinical success, defined as >50% collection size reduction, and the need for direct endoscopic necrosectomy (DEN). Secondary endpoints included adverse events, recurrence rates, length of hospital stay (LOS), and procedural costs. Results: In our study, endoscopic drainage proved high clinical efficacy for PFCs, especially PPs. Once a technique was chosen, complication rates were comparable, indicating no clear safety advantage for either approach. While percutaneous drainage relieved symptoms and reduced collection size in half of the cases, the other half had only transient or partial improvement. When comparing endoscopic drainage techniques, median costs and length of hospital stay trended higher for lumen-apposing metal stent (LAMS) than double pigtail stent (DPS), but the differences were not statistically significant. However, the “other” group proved markedly higher costs and the longest mean hospital stay. Conclusions: The choice of drainage technique impacts short-term outcomes and safety profile in managing PFCs. Our findings support a tailored, step-up approach, prioritizing endoscopic ultrasound-guided drainage based on PFC characteristics to optimize clinical outcomes. Full article

(This article belongs to the Special Issue Endoscopic Diagnosis and Treatments of Gastrointestinal Diseases)

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13 pages, 1362 KB

Open AccessArticle

Establishing the Clinical Utility of Glucagon-Enhanced MRCP for Improved Hepatopancreatobiliary Assessment

by Abdel-Rauf Zeina, Oren Shibolet, Mohamed Garra, Randa Taher, Oren Gal, Michael Oster, Rawi Hazzan, Ahmad Mahamid and Fadi Abu Baker

J. Clin. Med. 2025, 14(17), 5962; https://doi.org/10.3390/jcm14175962 - 23 Aug 2025

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Background: Magnetic Resonance Cholangiopancreatography (MRCP) has continuously evolved to enhance visualization capabilities. However, diagnosing biliary ductal system pathology, particularly early primary sclerosing cholangitis (PSC), remains challenging. This study investigates the influence of intramuscular glucagon (IMG) administration on final image quality and pancreatobiliary ductal system diameter in MRCP. Methods: Forty patients (57.5% female; average age 34.45 ± 8.2) referred for Magnetic Resonance Enterography (MRE) underwent MRCP before and 8–12 min after IMG administration. Two independent MRI specialists analyzed Coronal T2-weighted fast spin-echo high-resolution 3D MRCP images quantitatively and qualitatively. Quantitative assessments involved measuring the transverse diameter of five specific biliary duct structures (inferior, mid, and upper common bile duct; right and left hepatic ducts) and three pancreatic duct segments (head, body, and tail). The qualitative evaluation used a five-point Likert-type scale (1 = perfect visualization; 5 = not visible) for the predefined segments. Interobserver variation was assessed using the Intraclass Correlation Coefficient (ICC). Results: Following IMG administration, the diameters of all corresponding biliary and pancreatic segments significantly increased, with consistently strong interobserver agreement demonstrated pre- and post-IMG administration. Moreover, in qualitative analysis, post-IMG administration scores indicated a significant decrease (p < 0.01) in visualization scores, signifying improved visualization at all corresponding points for both radiologists compared to the pre-glucagon administration scores. The ICC scores pre- and post-IMG administration demonstrated moderate to strong agreement. Conclusions: IMG administration improves MRCP imaging parameters by increasing ductal diameters and enhancing biliary tree visualization, underscoring its potential to detect subtle or early pathological changes. Full article

(This article belongs to the Special Issue Endoscopic Diagnosis and Treatments of Gastrointestinal Diseases)

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9 pages, 383 KB

Open AccessArticle

Site of Biopsy and Its Accuracy in Preoperative Diagnosis of Superficial Nonampullary Duodenal Epithelial Tumors: Retrospective Study

by Yukihisa Fujinaga, Akira Mitoro, Hitoshi Mori, Satoshi Iwai, Takahiro Kubo, Misako Tanaka, Aritoshi Koizumi, Fumimasa Tomooka, Shohei Asada, Koh Kitagawa, Norihisa Nishimura, Shinya Sato, Kosuke Kaji, Tadashi Namisaki and Hitoshi Yoshiji

J. Clin. Med. 2025, 14(8), 2579; https://doi.org/10.3390/jcm14082579 - 9 Apr 2025

Viewed by 833

Abstract

Background/Objectives: As endoscopy is increasingly being used to diagnose superficial nonampullary duodenal epithelial tumors (SNADETs), there is a growing need for their early detection and minimally invasive treatment. This study investigated the diagnostic accuracy of biopsy specimens for SNADETs. Methods: We conducted a retrospective analysis of clinicopathologic data from 98 patients with SNADETs who had undergone endoscopic resection. The presurgical diagnosis, based on biopsy specimens, was compared with the histological diagnosis of the excised specimens. Results: Herein, preoperative biopsies were performed on 98 SNADETs specimens from 91 patients. Of the 68 adenomas and 30 carcinomas, 22.4% adenomas were later found to be carcinomas. Carcinoma biopsy diagnosis sensitivity, specificity, and accuracy were 54.6%, 80.0%, and 71.4%, respectively. Biopsy accuracy for carcinoma differed significantly by location to the papilla of Vater (p = 0.0455). The preoperative biopsy diagnostics’ sensitivity, specificity, and accuracy for oral and anal carcinomas to Vater papilla were 69.2%, 92.0%, and 84.2% and 42.1%, 73.2%, and 63.3%, respectively. Conclusions: The diagnostic accuracy of biopsy for SNADETs was low; however, it was higher on the oral side than the anal side of the papilla of Vater. The biopsy of duodenal lesions should be performed after an endoscopic examination, considering their location and reducing the risks of fibrosis. Full article

(This article belongs to the Special Issue Endoscopic Diagnosis and Treatments of Gastrointestinal Diseases)

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14 pages, 2332 KB

Open AccessCase Report

Fungal Infections in Severe Acute Pancreatitis: Insights from a Case Series

by Andreea Iacob, Gheorghe G. Balan, Mihaela Blaj, Adi-Ionut Ciumanghel, Vasile Sandru and Elena Toader

J. Clin. Med. 2026, 15(2), 790; https://doi.org/10.3390/jcm15020790 - 19 Jan 2026

Viewed by 91

Abstract

Background: Fungal infection of pancreatic fluid collections (PFCs) in severe acute pancreatitis (SAP) is under-recognized and associated with poor outcomes. Overlap with bacterial infections and the need for invasive sampling often delay diagnosis, leading to prolonged antibiotic use without the use of antifungal agents. Methods: We report three cases of SAP complicated by fungal infection of PFCs. Two patients, one with alcohol-related pancreatitis and the other with biliary pancreatitis, developed symptomatic encapsulated necrosis. Both were successfully managed with endoscopic drainage and targeted antifungal therapy against Candida albicans, achieving full resolution. The third patient, with necrotizing biliary pancreatitis, underwent multiple surgical and endoscopic interventions and developed an infection with a non-albicans Candida species. Reduced susceptibility requires individualized antifungal adjustment guided by susceptibility testing. Despite aggressive multimodal therapy, the patient progressed to multiorgan failure and died subsequently. Results: These cases emphasize the clinical impact of fungal infections in patients with SAP, particularly their association with severe disease, prolonged hospitalization, and prior antibiotic exposure. These findings highlight the prognostic value of early microbiological sampling, species-level identification, and prompt initiation of antifungal therapy. Infections caused by non-albicans species pose additional challenges due to their reduced sensitivity to standard antifungal agents. Conclusions: Fungal infection of PFCs is a clinically significant and frequently underestimated complication of SAP. Early recognition and species-directed antifungal therapy are critical for improving outcomes in high-risk patients. Full article

(This article belongs to the Special Issue Endoscopic Diagnosis and Treatments of Gastrointestinal Diseases)

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