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Advances in Diagnosis and Management of Pancreatobiliary Disorders
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Advances in Diagnosis and Management of Pancreatobiliary Disorders

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: 30 November 2024 | Viewed by 2794

Special Issue Editor

Dr. Francesca Lodato

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

Special Issue Information

Dear Colleagues,

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

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

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

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Related Special Issue

Published Papers (3 papers)

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Research

10 pages, 1234 KiB  
Article
β1600 Q.Clear Digital Reconstruction of [68Ga]Ga-DOTANOC PET/CT Improves Image Quality in NET Patients
by Martina Di Franco, Emilia Fortunati, Lucia Zanoni, Norma Bonazzi, Cristina Mosconi, Claudio Malizia, Simona Civollani, Davide Campana, Elisa Andrini, Giuseppe Lamberti, Vincenzo Allegri, Stefano Fanti and Valentina Ambrosini
J. Clin. Med. 2024, 13(13), 3841; https://doi.org/10.3390/jcm13133841 - 29 Jun 2024
Viewed by 549
Abstract
Background: Image reconstruction is crucial for improving overall image quality and diagnostic accuracy. Q.Clear is a novel reconstruction algorithm that reduces image noise. The aim of the present study is to assess the preferred Q.Clear β-level for digital [68Ga]Ga-DOTANOC PET/CT reconstruction [...] Read more.
Background: Image reconstruction is crucial for improving overall image quality and diagnostic accuracy. Q.Clear is a novel reconstruction algorithm that reduces image noise. The aim of the present study is to assess the preferred Q.Clear β-level for digital [68Ga]Ga-DOTANOC PET/CT reconstruction vs. standard reconstruction (STD) for both overall scan and single-lesion visualization. Methods: Inclusion criteria: (1) patients with/suspected neuroendocrine tumors included in a prospective observational monocentric study between September 2019 and January 2022; (2) [68Ga]Ga-DOTANOC digital PET/CT and contrast-enhanced-CT (ceCT) performed at our center at the same time. Images were reconstructed with STD and with Q.Clear β-levels 800, 1000, and 1600. Scans were blindly reviewed by three nuclear-medicine experts: the preferred β-level reconstruction was independently chosen for the visual quality of both the overall scan and the most avid target lesion < 1 cm (t) and >1 cm (T). PET/CT results were compared to ceCT. Semiquantitative analysis was performed (STD vs. β1600) in T and t concordant at both PET/CT and ceCT. Subgroup analysis was also performed in patients presenting discordant t. Results: Overall, 52 patients were included. β1600 reconstruction was considered superior over the others for both overall scan quality and single-lesion detection in all cases. The only significantly different (p < 0.001) parameters between β1600 and STD were signal-to-noise liver ratio and standard deviation of the liver background. Lesion-dependent parameters were not significantly different in concordant T (n = 37) and t (n = 10). Among 26 discordant t, when PET was positive, all findings were confirmed as malignant. Conclusions: β1600 Q.Clear reconstruction for [68Ga]Ga-DOTANOC imaging is feasible and improves image quality for both overall and small-lesion assessment. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders)
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13 pages, 971 KiB  
Article
Implications of Serum IgG4 Levels for Pancreatobiliary Disorders and Cancer
by Ching-Tang Tseng, Yi-Jun Liao, Cheng-Li Lin and Yen-Chun Peng
J. Clin. Med. 2024, 13(13), 3651; https://doi.org/10.3390/jcm13133651 - 22 Jun 2024
Viewed by 572
Abstract
Background/Objectives: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated disorder presenting as mass-like lesions with obstructions. An elevated serum IgG4 level is identified in more than half of affected patients and is considered a diagnostic criterion. IgG4-RD is still easily misdiagnosed as neoplastic or [...] Read more.
Background/Objectives: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated disorder presenting as mass-like lesions with obstructions. An elevated serum IgG4 level is identified in more than half of affected patients and is considered a diagnostic criterion. IgG4-RD is still easily misdiagnosed as neoplastic or infectious disease. We aimed to conduct a hospital-based study to illuminate the association between serum IgG4 levels and pancreatobiliary disorders and cancer. Methods: In this study, serum IgG4 levels were assessed at our hospital’s immunology laboratory, utilizing data from the hospital’s computer center, and the diagnostic codes used were based on ICD-9-CM. We analyzed IgG4 level data collected between April 2013 and April 2020, including patients’ age, gender, and diseases, but excluding the rationale for IgG4 level assessment. Employing propensity score matching (PSM) at a 1:1 ratio to mitigate age and gender confounding, we analyzed 759 patients divided into groups by IgG4 levels (≤140 and >140 mg/dL; and ≤140, 141–280, >280 mg/dL). We explored associations between IgG4 levels and conditions such as pancreatobiliary cancer (the group included cholangiocarcinoma, pancreatic cancer, and ampullary cancer), cholangitis, cholangiocarcinoma, pancreatitis, pancreatic cancer, and ampullary cancer. Results: Our study analyzed the demographics, characteristics, and serum IgG4 levels of participants and found no significant differences in serum IgG4 levels across various pancreatobiliary conditions. Nevertheless, the crude odds ratios (ORs) suggested a nuanced association between a higher IgG4 level > 280 mg/dL and increased risks of cancer and pancreatitis, with crude ORs of 1.52 (p = 0.03) and 1.49 (p = 0.008), respectively. After PSM matching, the further analysis of 759 matched patients showed no significant differences in IgG4 levels > 140 mg/dL between cancerous and non-cancerous groups, nor across other pancreatobiliary conditions. A higher serum IgG4 level > 280 mg/dL was significantly associated with pancreatobiliary cancer and cholangiocarcinoma, with crude ORs of 1.61 (p = 0.026) and 1.62 (p = 0.044), respectively. In addition, IgG4 > 280 mg/dL showed a greater association with pancreatic cancer compared with 141–280 mg/dL, with crude OR of 2.18 (p = 0.038). Conclusions: Our study did not find a clear association between serum IgG4 levels (>140 mg/dL) and pancreatobiliary cancer. We observed that higher IgG4 levels (>280 mg/dL) may be associated with cholangiocarcinoma and pancreatic cancer, as indicated by crude ORs. However, the adjusted analysis did not demonstrate the significant association between IgG4 level > 280 mg/dL and cancer. Considering IgG4-RD as a chronic and persistent inflammatory status, it is more closely associated with inflammatory diseases than with cancer. Therefore, further long-term cohort studies are necessary to evaluate the potential role of IgG4 levels in cancer risk among these patients. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders)
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14 pages, 952 KiB  
Article
Sequencing Treatments in Patients with Advanced Well-Differentiated Pancreatic Neuroendocrine Tumor (pNET): Results from a Large Multicenter Italian Cohort
by Francesco Panzuto, Elisa Andrini, Giuseppe Lamberti, Sara Pusceddu, Maria Rinzivillo, Fabio Gelsomino, Alessandra Raimondi, Alberto Bongiovanni, Maria Vittoria Davì, Mauro Cives, Maria Pia Brizzi, Irene Persano, Maria Chiara Zatelli, Ivana Puliafito, Salvatore Tafuto and Davide Campana
J. Clin. Med. 2024, 13(7), 2074; https://doi.org/10.3390/jcm13072074 - 3 Apr 2024
Cited by 2 | Viewed by 1288
Abstract
Background: The optimal treatment sequencing for advanced, well-differentiated pancreatic neuroendocrine tumors (pNETs) is unknown. We performed a multicenter, retrospective study to evaluate the best treatment sequence in terms of progression-free survival to first-line (PFS1) and to second-line (PFS2), and overall survival among patients [...] Read more.
Background: The optimal treatment sequencing for advanced, well-differentiated pancreatic neuroendocrine tumors (pNETs) is unknown. We performed a multicenter, retrospective study to evaluate the best treatment sequence in terms of progression-free survival to first-line (PFS1) and to second-line (PFS2), and overall survival among patients with advanced, well-differentiated pNETs. Methods: This multicenter study retrospectively analyzed the prospectively collected data of patients with sporadic well-differentiated pNETs who received at least two consecutive therapeutic lines, with evidence of radiological disease progression before change of treatment lines. Results: Among 201 patients, 40 (19.9%) had a grade 1 and 149 (74.1%) a grade 2 pNET. Primary tumor resection was performed in 98 patients (48.8%). First-line therapy was performed in 128 patients with somatostatin analogs (SSA), 35 received SSA + radioligand therapy (RLT), 21 temozolomide-based chemotherapy, and 17 SSA + targeted therapy. PFS was significantly longer in patients with grade 1 pNETs compared to those with grade 2, in patients who received primary tumor surgery, and in patients treated with RLT compared to other treatments. At multivariate analysis, the use of upfront RLT was independently associated with improved PFS compared to SSA. Second-line therapy was performed in 94 patients with SSA + targeted therapy, 35 received chemotherapy, 45 SSA + RLT, and 27 nonconventional-dose SSA or SSA switch. PFS was significantly longer in patients treated with RLT compared to other treatments. At multivariate analysis, the type of second-line therapy was independently associated with the risk for progression. OS was significantly longer in patients who received primary tumor surgery, with Ki67 < 10%, without extrahepatic disease, and in patients who received SSA–RLT sequence compared to other sequences. Conclusions: In this large, multicenter study, RLT was associated with better PFS compared to other treatments, and the SSA–RLT sequence was associated with the best survival outcomes in patients with pNETs with Ki67 < 10%. Primary tumor surgery was also associated with improved survival. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders)
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