Visceral Medicine最新文献

Background: Pancreatic ductal adenocarcinoma (PDA) is a highly lethal malignancy, often diagnosed at an advanced stage due to its insidious progression and the absence of effective early detection strategies. Accurate diagnosis and staging are critical for optimizing treatment selection and improving patient survival. Contrast-enhanced computed tomography (CT) remains the diagnostic standard for PDA; however, its sensitivity is limited by interobserver variability and the frequent absence of overt morphological abnormalities in early stage disease.

Summary: Artificial intelligence (AI) has emerged as a promising tool for overcoming the inherent limitations of conventional radiologic assessment by leveraging radiomics and deep learning models to extract subtle imaging signatures of PDA that are imperceptible to the human eye. AI-driven models have demonstrated the ability to detect pre-diagnostic PDA on CT scans months to years before clinical presentation by identifying textural and structural changes in the pancreas. Furthermore, automated volumetric pancreas segmentation enhances reproducibility and facilitates the discovery of imaging biomarkers associated with early carcinogenesis. Despite these advances, key challenges remain, including dataset heterogeneity, model interpretability, and prospective validation in real-world clinical settings.

Key messages: AI-driven approaches offer a transformative opportunity to augment CT-based PDA detection, reduce diagnostic uncertainty, and facilitate earlier intervention. However, robust external validation, integration into clinical workflows, and prospective trials are essential to establish AI as a reliable adjunct in PDA diagnosis and staging.

Background: Pediatric surgical complications and their endoscopic treatment approaches share a unique challenge of small anatomy, highly volatile situations and the need to be flexible with instruments which have been designed for older and bigger patients. In the last few decades, endoscopic interventions have emerged as a minimally invasive alternative approach to standard open closure procedures for the treatment of postsurgical complications.

Summary: This review summarizes the most common situations and techniques in pediatric endoscopy taking on postsurgical complications, including opportunities to improve outcome and overcome barriers of individualized therapy as compared to adult strategies.

Key message: Endoscopic management of postsurgical complications is highly effective and associated with high success rates, low mortality, and minimal recurrence of the underlying pathology.

Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with early detection and surgical resection being the only potentially curative treatment option. Despite advancements in diagnostics and surgical techniques, the prognosis of early-stage PDAC remains poor. Understanding the indications, approaches and perioperative management are crucial for improving patient survival.

Summary: Surgical resection remains the only curative treatment for early-stage PDAC. Different surgical procedures are performed depending on tumor location and local extent. Advances in minimally invasive surgery (MIS) yielded promising results regarding postoperative recovery and oncologic outcomes. The implementation of neoadjuvant therapy has improved resection and survival rates. Still, pancreatic surgery is associated with significant morbidity.

Key messages: Surgical resection remains the only curative option for early-stage pancreatic cancer. Neoadjuvant chemotherapy plays a crucial role in improving resection and survival rates. Perioperative care has been refined by MIS, optimized surgical techniques, and structured complication management.

Introduction: Texture analysis can provide quantitative imaging markers and better characterize tumor tissue in oncological imaging. The present analysis investigated the diagnostic benefit of computed tomography (CT)-derived texture analysis to categorize and stage lymph nodes in patients with colon cancer.

Methods: In this study, 85 patients were included (n = 39 females, 45.9%) with a mean age of 70.3 ± 14.8 years. All patients were surgically resected, and the lymph nodes were histopathologically analyzed. All investigated lymph nodes were further investigated with texture analysis using the MaZda package.

Results: Out of a total of 279 extracted CT texture features, 7 parameters independently showed statistically significant differences between lymph node positive to negative ones. For instance, the texture parameter S(1,0)AngScMom showed statistically significant differences regarding lymph node metastasis status (0.007 ± 0.004 for N0 vs. 0.005 ± 0.001 for N1-2, p = 0.001). A multivariate model was developed based on n = 7 independent texture parameters. The diagnostic accuracy reached an area under the curve of 0.79 (95% CI: 0.69-0.89) with a sensitivity of 0.77 and a specificity of 0.70, resulting in an accuracy of 0.73.

Discussion: Texture analysis can improve the diagnostic accuracy for nodal CT staging in patients with colon cancer. Further validation studies are needed to confirm the present results.

Background: Following metabolic and bariatric surgery (MBS), a wide range of symptoms may indicate postoperative complications, all of which can prompt endoscopic inspection and multidisciplinary management of potential complications. Therefore, an anatomical and technical understanding of the previous surgical procedure and its forms of reconstruction especially after MBS is crucial for the attending endoscopist to optimize endoluminal therapy. A selective literature review has been performed. This overview of endoscopic complication management aims to outline the available options after MBS.

Summary: Postoperative complication rates vary widely depending on the antecedent procedure and have been reported to be relevant after specific procedures such as laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass in the context of MBS. There is a timeline of 30 days in the postoperative course that divides early from late complications. While anastomotic leaks or endoluminal bleeding are considered typical early complications, late complications include problems such as strictures and anastomotic ulcers. Management of complications in the immediate postoperative period (very early complications) may require a multidisciplinary approach to optimize the outcome of complication management, involving the surgeon, the endoscopist and the ward physician who manages the patient round-the-clock. This hand-in-hand approach enables the best possible treatment for the patient, with endoscopy playing a crucial role in solving endoluminal problems in a much less invasive way than repeated surgical intervention, thereby contributing significantly to an easier postoperative course.

Key messages: The surgical approach, in cooperation with endoluminal complication management, constitutes comprehensive visceral medicine, as endoscopy is the helping hand of surgery in the context of MBS.

Background: Alveolar echinococcosis (AE) is a rare, potentially fatal zoonosis. In recent years, imaging diagnostics have become increasingly important compared to serologic diagnostics in AE. We will provide an overview of the importance of ultrasound diagnostics in AE in the detection of the disease and its significance in follow-up, as well as the typical sonographic presentation patterns and pitfalls.

Summary: The use of the ultrasound classification developed by us and the use of contrast-enhanced ultrasound (CEUS) helps make the diagnosis faster and better. Without CEUS, the hemangioma-like pattern and the metastasis-like pattern in particular cannot be diagnosed with certainty. The limitations of ultrasound diagnostics on the patient side, in terms of examiner experience and equipment, remain.

Key messages: Ultrasound is an important procedure in the detection and follow-up of AE. Contrast-enhanced sonography is indispensable. Fundamental limitations of ultrasound diagnostics such as examiner experience remain.

Background: Pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor prognosis, with a high mortality rate often attributed to its late-stage diagnosis. Early detection remains paramount in improving survival outcomes for affected individuals.

Summary: The prognosis of PDAC can be significantly improved if the cancer is diagnosed at an early stage, specifically when it remains localized to the ductal epithelium. This early stage is commonly referred to as high-grade pancreatic intraepithelial neoplasia (HG-PanIN) or carcinoma in situ (CIS, stage 0). At this stage, metastasis has not yet occurred, offering the potential for more effective therapeutic interventions. Focal pancreatic parenchymal atrophy (FPPA) has emerged as a crucial radiological and pathological feature suggestive of HG-PanIN/CIS.

Key message: Accurate identification of FPPA is critical for diagnosing HG-PanIN and CIS, both of which represent preinvasive stages of PDAC. Given the implications of early detection, serial pancreatic juice cytologic examination is recommended for patients exhibiting FPPA to facilitate timely diagnosis and intervention.

Background: Biliary leakages are notable complications that can occur following hepatobiliary surgery, traumatic injury, or iatrogenic causes related to medical interventions. The management of biliary leaks is critical as untreated leaks can result in severe complications such as biliary peritonitis, abscess formation, and sepsis.

Summary: Treatment approaches for biliary leaks are highly variable and depend on the severity and anatomical location of the leak. Options range from conservative management and endoscopic interventions to surgical repair in more severe cases. A clear understanding of the classification of biliary leaks - whether anatomical, etiological, or severity-based - is essential to guide appropriate treatment strategies and improve clinical outcomes. Notably, several endoscopic techniques are now available and have significantly enhanced patient outcomes, even in complex surgical anatomies.

Key messages: The management of biliary duct leaks requires a comprehensive approach that includes endoscopic, percutaneous, and surgical interventions. The choice of treatment is determined by the severity of the leak, the patient's overall condition, and the specific context of the injury. Endoscopic retrograde cholangiopancreatography in combination with sphincterotomy and stent placement is widely regarded as the first-line treatment when the papilla is conventionally accessible.

Background: The shift in surgery is taking place in two directions. On the one hand, it is shifting from open surgery to minimally invasive surgery which will ultimately morph into robot-assisted surgery. On the other hand, the therapeutic possibilities of flexible endoscopy have developed enormously in recent years. Various procedures, such as the debridement of pancreatic necrosis, the resection of early neoplasms, the treatment of achalasia, or the resection of numerous submucosal tumors, have passed into the hands of the interventional endoscopist. Endoscopic procedures have also become established in the management of complications of major intestinal procedures. Despite the fact that endoscopic therapy requires time to heal, for example, in VAC therapy, it being less invasive reduces patient morbidity.

Summary: The most common complications in modern pancreatic surgery are pancreatogenic fistulas and fluid collections, as well as insufficiencies of pancreatointestinal or biliodigestive anastomoses. Such complications can be treated endoscopically using methods such as stent placement in the pancreatic or bile duct, endosonographically guided drainage of fluid collections, and even VAC therapy.

Key messages: Endoscopic intervention is the first procedure of choice offered in the treatment of complications in pancreatic surgery. It primarily reduces morbidity in the recovery phase of patients.