IPBM 2025

Background A new circulating biomarker superior to carbohydrate antigen 19–9 (CA19-9) is needed for diagnosing pancreatobiliary cancer (PBca). The aim of this study was to identify serum microRNA (miR...

Gahyun “Gigi” Gim, MD, discovered her calling in gastrointestinal oncology during the third month of her internal medicine residency when she experienced a…

Background Intraductal papillary mucinous neoplasms (IPMNs) are classified into three epithelial types with distinct biological behaviors. However, their effects on the postoperative outcomes remain unclear. Methods This multicenter retrospective study included 556 patients with IPMNs who underwent surgical resection. The epithelial types were categorized into the gastric (n = 323), intestinal (n = 160), and pancreatobiliary (n = 73) types. Their associations with the development of extrapancreatic lesions; remnant high-risk lesions (HRLs), including metachronous pancreatic ductal adenocarcinoma (PDAC); and disease-specific survival (DSS) were analyzed. Results Fifty-one patients (9.2%) developed extrapancreatic lesions. The 10-year cumulative incidence rates for the gastric, intestinal, and pancreatobiliary types were 9.3%, 9.1%, and 32.0%, respectively (P < 0.001). Multivariate analysis identified invasive carcinoma, the gastric, and pancreatobiliary types as independent predictors. Among 516 patients who did not undergo total pancreatectomy, 40 (7.8%) and 13 (2.5%) developed HRLs and metachronous PDAC, respectively. The 10-year cumulative incidence rates of HRLs and metachronous PDAC for the gastric, intestinal, and pancreatobiliary types were 7.0%, 16.2%, and 37.2% and 1.8%, 3.7%, and 22.7%, respectively (P = 0.001 and P = 0.012). In multivariate analysis, the pancreatobiliary type was an independent predictor of metachronous PDAC. Five-year DSS rates for the gastric, intestinal, and pancreatobiliary types were 92.5%, 96.0%, and 76.1% (P < 0.001), respectively. Multivariate analysis identified invasive carcinoma, the gastric, and pancreatobiliary types as independent prognostic factors for DSS. Conclusions IPMN epithelial type can independently affect postoperative outcomes. In particular, the pancreatobiliary type has significant impact on the development of metachronous PDAC. Therefore, postoperative surveillance should be tailored according to the epithelial type.

Gastrointestinal and pancreatobiliary cancers can be difficult to detect early, creating a need for practical, noninvasive approaches for early detection and risk assessment. The gut microbiome has emerged as a potential source of cancer biomarkers, offering practical opportunities for noninvasive testing, as microbial changes can be assessed in fecal samples.

PEI was diagnosed in a man presenting with unexplained generalized edema. IgG4-PBD was identified as the leading possible etiology of pancreatic atrophy and exocrine insufficiency, with prior…

This cohort study evaluates whether circulating tumor DNA and next-generation sequencing of tissue samples find the same actionable alterations among patients with pancreatic ductal adenocarcinoma and...

Background Obstructive jaundice from pancreatobiliary diseases represents a significant global health challenge, particularly in resource-limited settings like Rwanda. While endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are now available at tertiary centers in Kigali, there is limited local clinical data on the management and outcomes of these conditions. This study aims to assess the patterns, therapeutic approaches, and outcomes of obstructive jaundice in the Rwandan healthcare context. Methods A cross-sectional study was conducted across three tertiary hospitals (KFH, RMH, and CHUK) in Rwanda from July 2023 to June 2024. Using Fischer’s formula, 158 patients with obstructive jaundice from pancreatobiliary diseases were enrolled. Data collection involved chart reviews at admission, procedure, post-procedure, discharge, and 30-day follow-up. Analysis was performed using Stata version 13, with descriptive statistics, bivariate analysis using chi-square, and multivariate analyses examining predictors of 30-days mortality among the participants at 95% confidence interval and p value < 0.05 considered statistically significant. Multicollinearity assessment was also performed considering the target variance inflation factor (VIF) < 5. Results In this study of 158 patients with obstructive jaundice in Rwanda, ERCP was the predominant intervention (77.54%), followed by PTBD (17.39%) and surgical procedures (5.07%). The overall procedures technical success rate was 82.61%; with PTBD success rate of 91.67%, surgical procedures showed higher success rate 100%, while ERCP had a success rate of 79.44%. Post-procedure complications occurred in 16.67% of cases, including pancreatitis (5%), bleeding (3.62%), and mortality (4.34%). The 30-day survival rate was 92.41%, demonstrating generally favorable outcomes in managing pancreaticobiliary diseases. The multivariate analysis showed that weight loss increased mortality risk (aOR = 10.647, 95% CI: 1.190-95.256, p = 0.034), while the absence of CBD stones was protective (aOR = 0.087, 95% CI: 0.008–0.888, p = 0.039). Having a procedure performed significantly reduced mortality odds (aOR = 0.025, 95% CI: 0.006–0.117, p < 0.001). ICU/HDU admission was associated with higher mortality risk in 30 days (aOR = 13.051, 95% CI: 2.010-84.731, p = 0.007). Conclusion This study from Rwanda provides crucial insights into the management and outcomes of obstructive jaundice from pancreatobiliary diseases. PTBD was demonstrated high success. While post-procedure complications occurred, the 30-day survival rate was favorable. Weight loss and ICU admission were associated with increased mortality, while procedural interventions showed protective effects, highlighting the importance of timely management.

Background With better surgery and chemotherapeutic agents, borderline resectable or locally advanced pancreatobiliary tumours are being treated with curative intent. This study presents real-world evidence of porto-mesenteric vein resections (PVR) with pancreatectomy and generates predictive nomograms for postoperative mortality (POM) and major complications (MC). Methods A retrospective multicentre study, including 11 high-volume centres, evaluated patients undergoing PVR. Factors affecting 90-day POM and MC (Clavien-Dindo grades ≥ 3a) were assessed, and predictive nomograms were generated. Overall survival (OS) and disease-free survival (DFS) were estimated for patients with pancreatic ductal adenocarcinoma (PDAC). Cox regression analysis was performed to ascertain factors affecting OS and DFS. Results Among 389 patients, POM was 6.4%, and MCs were 32.6%. Charlson comorbidity index > 4, preoperative biliary drainage, preoperative radiotherapy (PRT), segmental PVR, and additional organ resection (AOR) were predictive of POM. The independent predictors of MCs were American Society of Anesthesiologists status 3/4, PRT, and AOR. The generated model had an area under the curve (AUC) of 0.757, cutoff > 1.79 to predict POM, and AUC of 0.669, cutoff > 0.678 for MCs. In the 263 patients with PDAC, the median OS was 25.01 months (95% confidence interval [CI] 21.9–28.11), and DFS was 16.72 months (95% CI 14.56–18.89). Perineural invasion, segmental PVR, and margin positivity predicted worse survival, while completing multi-modality treatment was protective. Conclusions The POM and MCs of PVR with pancreatectomy were at par with the world standards. The generated predictive nomograms for POM and MC revealed a good predictive potential. In patients with PDAC, completion of multimodality treatment offers better long-term survival.