Abstract Gastroparesis is a disorder characterized by delayed gastric emptying and is associated with significant impairment in patient quality of life. Although its pathogenesis is not fully understood, it is thought to arise from a combination of cellular, structural, and neuromuscular abnormalities involving the gastric body and pylorus. While established medical therapies target these underlying mechanisms, a subset of patients remain refractory to pharmacologic management and require procedural intervention. Per-oral pyloromyotomy (POP) has emerged as a minimally invasive therapeutic option that directly targets pyloric dysfunction. In this review, we examine the pathophysiology of gastroparesis, describe the technical aspects of the POP procedure, and summarize current clinical outcomes and safety data supporting its role in the management of medically refractory gastroparesis.
Abstract As incidentally discovered pancreatic cysts become increasingly common on cross-sectional imaging, understanding their diagnosis and management has grown in clinical importance. Pancreatic mucinous cystic neoplasms (MCNs) are mucin-producing cystic lesions characterized by pathognomonic ovarian-like stroma, almost exclusively identified in middle-aged women. While historically considered benign tumors with inherent malignant potential, the management of MCNs is currently evolving as recent data clarify the risks of high-grade dysplasia and invasive carcinoma. This review integrates current literature on MCN diagnosis and treatment, emphasizing the utility of cross-sectional imaging and endoscopic ultrasound. The surgical decision-making process is increasingly influenced by the risk of postoperative morbidity and long-term complications, such as diabetes. Furthermore, this review explores the potential of next-generation sequencing, cyst fluid proteomics, and confocal laser endomicroscopy to improve preoperative diagnostic accuracy. Ultimately, a shift toward personalized management is anticipated, utilizing multi-center trial data and molecular diagnostics to better distinguish between patients requiring definitive resection and those suitable for conservative surveillance.
