New insights in the management of pancreatic diseases

The primary objective of this thesis is to enhance diagnostic and therapeutic approaches for patients with pancreatic diseases. In Part I, we focused on novel insights for the early detection of pancreatic cancer (PDAC). We conducted two case-control studies involving PDAC patients who had undergone imaging before PDAC diagnosis (Chapter 2 and 3). Skilled radiologists retrospectively analyzed the data, revealing that a notable portion of prediagnostic PDAC patients exhibited suspected pancreatic masses in imaging, while controls showed minimal occurrences. Additional features such as pancreatic duct dilation, pancreatic atrophy, and pancreatic steatosis were also associated with PDAC.
Part II centers on the challenges in diagnosing and managing pancreatic cystic neoplasms (PCN). CEA in cyst fluid is a commonly applied biomarker for distinguishing mucinous from non-mucinous PCN, and Chapter 4 of this thesis demonstrated that a revised cutoff of ≥20 ng/mL had optimal diagnostic accuracy. In Chapter 5, we examined four biomarkers in pancreatic juice to differentiate CP and IPMN with main-duct involvement. Mutated KRAS exhibited high sensitivity for IPMN but limited specificity, whereas GNAS mutation displayed the opposite pattern. The assessment of CEA and glucose did not significantly contribute. Chapter 6 compared three guidelines for managing mucinous PCN, with the European and IAP guidelines outperforming AGA but potentially leading to excessive surgeries. Chapter 7 showcased that large BD-IPMN without other risk factors had a low prevalence of advanced neoplasia.
In Part III, Chapter 8 described that the Pancreas Elastase 1 Quick Test™ was found to be less accurate than conventional methods for diagnosing exocrine pancreatic insufficiency. Chapter 9 examined vitamin D deficiency in CP patients, revealing a high prevalence but no clear difference between CP patients and controls.