Targeted endoscopic approaches offer symptom relief in chronic pancreatitis but surgery is preferred for long-term outcomes. Endoscopy is effective for small pancreatic duct stones; larger stones require extracorporeal shock wave lithotripsy or pancreatoscopy. Main pancreatic duct strictures should be treated with dilation and single large-caliber plastic stents; avoid fully covered metal stents due to higher […]

Preoperative biliary drainage (PBD) using self-expanding metal stents (SEMS) is noninferior to early surgery for pancreatic cancer patients, impacting surgical timing decisions. Serious adverse events were similar: 29.0% in PBD vs. 26.5% in early surgery (p = 0.011 for noninferiority). 82.6% of PBD patients had curative surgery versus 88.5% in the early surgery group. Surgeons […]

A novel endoscopic approach improves biliary drainage outcomes for patients with altered anatomy. Technical success rate: 87.3%, clinical success: 93.8%. Adverse event rate: 20%, with 30.6% persistent fistula rate within 3 months. Consider this technique for patients with complex anatomy, especially when multiple biliary interventions are needed. Most common indication: benign strictures (58.2%). Multicenter Study […]

EUS-guided radiofrequency ablation is a safe alternative for patients with branch-duct IPMNs showing worrisome features who cannot undergo surgery. Technical success was 100% in 62 procedures, with 98% achieving local control. Adverse events occurred in 27%, primarily mild abdominal pain; no deaths reported. This procedure effectively prevents cancer progression in patients unsuitable for traditional surgery. […]

Immediate necrosectomy for infected walled-off pancreatic necrosis offers no advantages over an on-demand approach. Clinical success rates were similar: 92% (immediate) vs. 88% (on-demand), p = .5. On-demand patients required fewer necrosectomy sessions (1 vs. 2, p ≤ .01) and had fewer adverse events (24% vs. 40%, p = .2). This suggests that a selective […]