Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring 5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.

/pdf/european-evidence-based-guidelines-on-pancreatic-cystic-1wsge9ovyy.pdf

European evidence-based guidelines on pancreatic cystic neoplasms

The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After

https://www.giejournal.org/article/S0016-5107(14)02196-8/pdf

Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis

Intraductal neoplasms of the pancreas.

Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions (SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1 (DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (EUS-FNA) are critical for an accurate diagnosis of SELs. EUS-FNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.

Current clinical management of gastrointestinal stromal tumor

Background
This study is a systematic review and meta-analysis that compares the short- and long-term outcomes of laparoscopic gastric resection (LR) versus open gastric resection (OR) for gastric gastrointestinal stromal tumors (GISTs).

A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach.

This study was designed to compare the clinical outcomes of patients who underwent limited resection (LR) versus pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumors (GISTs). A systematic review of the literature was performed to identify studies analyzing the clinical outcomes of LR and PD for duodenal GISTs. Eleven studies were included, of which 7 that compared 162 patients who underwent LR versus 98 patients who underwent PD were suitable for meta-analysis. Patients who underwent PD were more likely to have tumors which were large (≥ 5 cm) [76.0 vs. 36.6 %, odds ratio (OR) 5.49, 95 % confidence interval (CI) 1.8–16.76], with high mitotic count ≥5/50 high-power field (HPF) (33.7 vs. 18.5 %, OR 2.23, 95 % CI 1.22–4.08), classified as high risk (60.3 vs. 32.0 %, OR 3.23, 95 % CI 1.65–6.34), and which were located at D2 (80.5 vs. 28.6 %, OR 10.33, 95 % CI 5.22–20.47) compared with LR. PD was associated with a higher postoperative morbidity rate than LR [48.3 vs. 20.7 %, relative risk (RR) 2.34, 95 % CI 1.61–3.42]. LR was not associated with an increased local recurrence rate, had a better DFS [hazard ratio (HR) 2.07, 95 % CI 1.07–4.01], and lower rate of distant metastasis (8.9 vs. 25.8 %, OR 0.28, 95 % CI 0.13–0.59) compared with PD. LR should be the procedure of choice for duodenal GIST whenever technically feasible, because it is associated with good oncologic outcomes and lower morbidity compared with PD. The oncologic outcome of GIST is more likely to be dependent on tumor biology rather that the type of surgical resection. The use of Imatinib in patients with duodenal GIST may potentially allow a proportion of patients who would otherwise require a PD to undergo LR instead.

A Systematic Review and Meta-analysis Comparing Pancreaticoduodenectomy Versus Limited Resection for Duodenal Gastrointestinal Stromal Tumors

Periodic Orthogonal Splines and Wavelets

A systematic review and meta-analysis of the clinicopathologic characteristics of cystic versus solid pancreatic neuroendocrine neoplasms

Background Minimally invasive hepatectomy (MIH) has become an important option for the treatment of various liver tumours A major concern is the learning curve required The aim of this study was to perform a systematic review and summarize current literature analysing the learning curve for MIH Methods A systematic review of the literature pertaining to learning curves in MIH to July 2019 was performed using PubMed and Scopus databases All original full-text articles published in English relating to learning curves for both laparoscopic liver resection (LLR), robotic liver resection (RLR), or a combination of these, were included To explore quantitatively the learning curve for MIH, a meta-regression analysis was performed Results Forty studies relating to learning curves in MIH were included The median overall number of procedures required in studies utilizing cumulative summative (CUSUM) methodology for LLR was 50 (range 25-58) and for RLR was 25 (16-50) After adjustment for year of adoption of MIH, the CUSUM-derived caseload to surmount the learning curve for RLR was 471 (95 per cent ci 12 to 716) per cent; P = 0046) less than that required for LLR A year-on-year reduction in the number of procedures needed for MIH was observed, commencing at 483 cases in 1995 and decreasing to 238 cases in 2015 Conclusion The overall learning curve for MIH decreased steadily over time, and appeared less steep for RLR compared with LLR

Ye-Xin Koh

Papers

A systematic review and meta-analysis comparing laparoscopic versus open gastric resections for gastrointestinal stromal tumors of the stomach.

A Systematic Review and Meta-analysis Comparing Pancreaticoduodenectomy Versus Limited Resection for Duodenal Gastrointestinal Stromal Tumors

Periodic Orthogonal Splines and Wavelets

A systematic review and meta-analysis of the clinicopathologic characteristics of cystic versus solid pancreatic neuroendocrine neoplasms

Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis.