BACKGROUND AND AIM:Peroral endoscopic myotomy is a standard treatment for achalasia (AC). The conventional approach involves circular muscle myotomy (CMM), but full-thickness myotomy (FTM) may offer more profound lower esophageal sphincter (LES) reduction. This randomized controlled noninferiority trial primarily determined whether FTM achieved clinical success noninferior to CMM. METHODS:This single-center, randomized noninferiority trial enrolled 69 patients with type I or II AC assigned to the FTM group (n = 34) or the CMM group (n = 35). The primary outcome was clinical success (Eckardt score ≤3) at 6 months after the procedure. A noninferiority margin of -10% was prespecified. Secondary outcomes included procedure-related metrics, safety outcomes or adverse events, physiological and anatomical outcomes, and GERD-related outcomes. RESULTS:In the intention-to-treat analysis, clinical success rates were 91.2% in the FTM group and 85.7% in the CMM group, with a group difference of 5.5% (90% CI, -7.1% to 18.1%). Because the lower CI bound (-7.1%) was above -10%, FTM was noninferior to CMM. FTM was associated with significantly higher insufflation-related events (32.35% vs 11.43%; P = .035). There was a trend toward more frequent moderate-to-severe intraoperative bleeding in the FTM group (41.18% vs 22.86%; P = .103). FTM resulted in significantly lower basal LES pressure than CMM (6.85 vs 11.70 mm Hg; P = .024). Postoperative esophagitis showed a numerical trend toward an increase in the FTM group (36.36% vs 18.18%; P = .097). CONCLUSIONS:FTM was noninferior to CMM in short-term efficacy. However, FTM was associated with a significantly higher incidence of insufflation-related events and demonstrated a potential increase in postprocedural reflux. Despite the comparable efficacy, the disadvantages in the safety of FTM limit its recommendation as a routine alternative to CMM in the management of AC.

Background/objective Prophylactic endoloop or hemoclip application and endoscopic mucosal resection (EMR) have been usually performed for large pedunculated colorectal polyps. However, their comparison remains unclear. This study aimed to compare the efficacy and safety of the prophylactic pretreatment and EMR in the large pedunculated polyps. Methods We reviewed 1994 pedunculated polyps detected in Peking Union Medical College Hospital from 2012 to 2024. Large pedunculated polyps (head size ≥2.0 cm) receiving EMR or prophylactic closure before polypectomy were included. Polyp morphology, endoscopic procedural variables, and adverse events were compared using propensity score matching and inverse probability of treatment weights. Logistic regression was performed to analyze the risk factors of adverse events. Results 204 pedunculated polyps undergoing prophylactic pretreatment and 262 polyps resected via EMR were included. Less clips (P = 0.002) and lower operational material-related costs (P < 0.001) presented in the prophylactic closure group than the EMR group, while the procedural time was comparable (prophylactic closure vs. EMR: median 13.0 vs. 10.0 min, P = 0.059). There were no differences in postpolypectomy bleeding (15.2% vs. 12.5%, P = 0.466) and postpolypectomy coagulation syndrome (1.5% vs. 0.7%, P = 0.509) between the two groups. Stalk width ≥0.6 cm (OR = 2.34, P = 0.02), number of hemoclips (OR = 1.44, P < 0.01), procedure time ≥10 min (OR = 2.03, P = 0.08), and malignant lesion (OR = 1.74, P = 0.08) were associated with high risks of immediate bleeding. The endoscopic procedure did not affect the risks of immediate or delayed bleeding. Conclusion The prophylactic closure with hemoclip or endoloop and conventional EMR are both effective and safe methods for large pedunculated colorectal polyps. Prophylactic closure has advantages in the hemoclips demand and average procedure costs compared to EMR.

BACKGROUND AND AIMS:Differentiating autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC) remains a diagnostic challenge. Although there is limited evidence that endoscopic ultrasound (EUS) is useful for diagnosing AIP, its full potential has yet to be leveraged in practice. This study aimed to develop an interpretable and accurate multi-modal AIP diagnostic model with clinical applicability by combining EUS features with clinical parameters. METHODS:This was a retrospective study of 577 patients attending six centers in China undergoing EUS and diagnosed with AIP or PDAC between January 2013 and April 2024. AIP and PDAC cases were randomly divided 1:1 into primary (n=289) and validation (n=288) cohorts. LASSO regression with five-fold cross-validation was used to determine the optimal clinical (n=5) and EUS (n=17) features discriminating AIP from PDAC. Multivariable logistic regression analysis was performed to develop a predictive model assessed in primary and validation cohorts with ROC-AUC and calibration curves. Comparator models based on clinical and EUS features alone were also evaluated using the same framework. Logistic regression coefficients were scaled to develop a clinical nomogram. RESULTS:Most clinical and endoscopic ultrasound features differed significantly between patients with AIP and PDAC. Patients with AIP were slightly younger, were much more likely to have elevated IgG4, and their ultrasound features were more consistent with a diffuse pancreatic parenchymal pathology. LASSO regression identified 16 non-zero coefficients, from which the top four features with the largest, non-collinear coefficients (elevated IgG4, elevated CA19-9, vascular involvement, and diffuse reduced echogenicity) produced a highly discriminative and well-calibrated model for AIP, with an AUC of 0.994 (95% CI 0.986-0.999; 97.2% accuracy, 96.7% sensitivity, 97.8% specificity) for the primary cohort and an AUC of 0.984 (95% CI 0.972-0.994; 95.5% accuracy, 93.5% sensitivity, 97.8% specificity) for the validation cohort. The integrated model showed more balanced diagnostic performance than clinical- or EUS-only models, particularly with respect to validation sensitivity. CONCLUSIONS:Combining EUS features with clinical and serological variables yields more balanced diagnostic performance for differentiating AIP from PDAC than either modality alone. Given the retrospective design, risk of overfitting, and lack of independent external validation, prospective validation is required prior to routine clinical implementation.

BackgroundAllgrove syndrome is a rare autosomal recessive disorder characterized by the triad of alacrima, adrenal insufficiency, and achalasia. Although corticosteroid replacement and artificial tears effectively manage adrenal insufficiency and alacrima, the optimal treatment for achalasia in this syndrome remains challenging and poorly defined.MethodsAll patients diagnosed with Allgrove syndrome were identified between 2009 and 2025 at Peking Union Medical College Hospital, which is a national rare disease center in China. Clinical characteristics and genetic mutations were collected and analyzed, and the long-term safety and efficacy of peroral endoscopic myotomy (POEM) in Allgrove syndrome were evaluated through follow-up telephone interviews. A comparison cohort of idiopathic achalasia (IAC) patients undergoing POEM, matched for follow-up duration, was enrolled to delineate disease-specific features.ResultsSeven patients were diagnosed with Allgrove syndrome at our institution over the past 16 years, and all of them had homozygous or compound heterozygous mutations in the AAAS gene. The patients presented with alacrima from infancy developed adrenal insufficiency during childhood and were diagnosed with Allgrove syndrome at a mean age of 17. Compared to 12 matched idiopathic achalasia patients, Allgrove patients exhibited a significantly earlier onset of achalasia symptoms (mean age: 12.5 vs. 33.8 years, p = 0.004), with similar intervals from symptom onset to intervention. Interestingly, despite comparable objective severity based on manometric and endoscopic assessments, Allgrove patients reported significantly lower subjective symptom scores (Eckardt score 5.3 vs. 7.6, p = 0.046). Over a median follow-up of 5.8 years, the mean Eckardt score decreased from 5.3 to 0.8 in Allgrove patients and from 7.6 to 1.9 in idiopathic achalasia patients at the last follow-up.ConclusionAllgrove syndrome should be taken into consideration in patients with early-onset achalasia. POEM provides effective and sustained symptom relief for achalasia in Allgrove syndrome, with a favorable safety profile.

The diagnosis of autoimmune pancreatitis (AIP) is multidisciplinary. Pathological diagnosis is pivotal when distinguishing AIP from malignancies. In this study, we aim to compare the diagnostic performance and sample adequacy of 19-gauge endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) needles with 20-gauge endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needles in patients with suspected AIP. We conducted a single-centre, parallel-group, prospective, randomized controlled trial at Peking Union Medical College Hospital (Beijing, China). Patients with suspected AIP were enrolled between October 2018 and August 2023 and were randomly assigned to undergo tissue specimen collection using either a 19-gauge EUS-FNA needle or a 20-gauge EUS-FNB needle. The primary endpoint was the diagnostic accuracy against International Consensus Diagnostic Criteria, with secondary endpoints including histologic sensitivity, technical success rate, tissue adequacy, and adverse event rate. 46 patients were enrolled and 45 underwent EUS (FNB n = 23, FNA n = 22), amongst 42 had a final diagnosis of AIP. Diagnostic accuracy, as the primary endpoint, was 52.2

BACKGROUND Immune-mediated mechanisms are implicated in the pathogenesis of achalasia of cardia (AC), which is characterized by inflammation-driven degeneration of myenteric neurons. Circulating autoantibodies targeting the enteric nervous system may serve as potential biomarkers reflecting this underlying neurodegeneration. However, the clinical significance of anti-enteric neuronal antibodies (AENAs) in disease progression and treatment outcomes remains unexplored. AIM To evaluate the prevalence of AENA in AC and its correlation with clinical characteristics and treatment outcomes. METHODS This prospective cohort study included 97 patients with AC diagnosed according to the Chicago Classification version 4.0 and 98 age- and sex-matched healthy subjects (HS). Indirect immunofluorescence was used to detect AENA and antinuclear antibodies. Multivariable linear regression analyses were performed to explore associations between AENA intensity and clinical parameters in patients with AC. RESULTS The AENA-positive rate was significantly higher in patients with AC than HS (60.8% vs 25.5%, P < 0.001). AENA-positive patients had higher endoscopic CARS (contents, anatomy, resistance, and stasis) than AENA-negative patients (5.0 vs 4.0, P = 0.045), whereas Eckardt scores and manometric parameters did not differ between groups. Multivariable regression identified strong AENA positivity as independently associated with higher CARS (β = 0.95, 95% confidence interval: 0.37-1.53, P = 0.002), demonstrating a dose-response relationship (P for trend = 0.005). Patients with strong AENA intensity also exhibited greater barium column width and higher integrated relaxation pressure than those with moderate intensity. After peroral endoscopic myotomy and overlap weighting, AENA-positive patients had worse Eckardt scores at 1- and 6-month follow-up than AENA-negative patients (P = 0.031 and P = 0.005, respectively). CONCLUSION Serum AENA is prevalent in AC and correlates with disease severity in a dose-dependent manner and with early treatment response, potentially identifying patients with more severe disease characteristics and poorer outcomes.

Pancreatic head-type autoimmune pancreatitis (PH-AIP) with elevated CA19-9 is sometimes difficult to distinguish from pancreatic head cancer (PHC) with elevated CA19-9. At times, IgG4 proves inadequate in offering assistance. The study aimed to elucidate the performance of CA19-9/DBil in distinguishing between the two conditions. This was a retrospective study. We collected serologic indicators from participants in PH-AIP and PHC Group. Three logistic regression equations were established ranging from non-adjustment (Model 1, only CA19-9/DBil included) to adjusting for sex, age, and CEA (Model 2 and Model 3) to explore the relationship between CA19-9/DBil and PH-AIP probability. ROC, Decision Curve Analysis (DCA), calibration curve were conducted. P for AUCs and net reclassification improvements (NRI) were computed to evaluate differences in discrimination and the improvement in risk reclassification between models. The study included 90 PHC and 35 PH-AIP patients, all with elevated CA19-9. The ORs for CA19-9/DBil in three models were similar (0.915 to 0.921). ROC revealed that Model 1 had an AUC of 0.772. The sensitivity, specificity, and accuracy at the best threshold were all > 0.7. Model 1, although simple, was not inferior in its discriminative ability compared to complex models: the difference in discrimination between Model 1 and each of two adjusted models was not statistically significant (P > 0.05, both AUC and NRI). Additionally, calibration curve and DCA suggested that Model 1 had good calibration and clinical utility. CA19-9/DBil exhibited promising diagnostic performance in differentiating between CA19-9-elevated PH-AIP and PHC.

Background:Type 1 autoimmune pancreatitis (AIP) is more prevalent among males, a significant proportion of whom are known to smoke and consume alcohol, both of which can cause damage to the pancreas. AIP is associated with the new-onset impaired glucose metabolism (NO-IGM). However, it remains unclear whether smoking and alcohol consumption exacerbate this risk. Objectives:The present study aims to clarify the potential impact of smoking and alcohol consumption on the risk of NO-IGM in male patients with type 1 AIP. Design:A retrospective cohort study. Methods:This retrospective cohort study included 305 male patients with type 1 AIP. The participants were categorized into four groups based on smoking and drinking status: neither, smoking-only, drinking-only, and both group. The impact of smoking and heavy drinking on AIP-related IGM was analyzed using multivariate modified Poisson regression. Results:The prevalence of NO-IGM was 40.66% in the study. In the multivariate modified Poisson regression analysis, smoking-only group (relative risk (RR), 2.44; 95% CI, 1.70-3.51) and both smoking and drinking (RR, 2.84; 95% CI, 1.93-4.19) were associated with an increased risk of type 1 AIP-related NO-IGM. Drinking only (estimated RR >1) also appeared to elevate this risk. Conclusion:In male patients with type 1 AIP, smoking and heavy drinking may increase the risk of AIP-related NO-IGM.

Autoimmune pancreatitis (AIP) is a distinct inflammatory pancreatic disorder characterized by its responsiveness to glucocorticoid therapy and association with autoimmune features. AIP primarily consists of type 1 and type 2, with relapse being a significant problem mainly associated with type 1 AIP, which has a high relapse rate of approximately 40%, whereas type 2 AIP has significantly lower relapse rates. This narrative review comprehensively examines the multifaceted factors influencing AIP relapse, particularly focusing on type 1 AIP. Dynamic changes in serum IgG4 levels-particularly insufficient decline, relative increase, or persistently elevated levels after steroid therapy-consistently correlate with relapse risk. Other serological markers including immunoglobulin E and autotaxin may serve as potential relapse predictors. Imaging features associated with relapse include diffuse pancreatic swelling, persistent post-treatment pancreatic enlargement, and elevated fluorodeoxyglucose positron emission tomography metabolic parameters. Extrapancreatic involvement, especially proximal biliary and renal manifestations, significantly increases relapse risk. Therapeutic considerations reveal that prolonged maintenance of glucocorticoid therapy reduces relapse rates, whereas immunosuppressants and rituximab show promise in managing refractory cases. This review synthesizes current evidence to guide clinicians in developing effective management strategies for this challenging pancreatic disorder.

BACKGROUND:As a heterogeneous group of lesions, pancreatic cystic lesions (PCLs) vary enormously in malignant potential, mandating different treatment strategies. Despite significant advances in diagnostic imaging and laboratory tests, the accurate diagnosis of PCLs remains challenging, leading to overtreatment or delayed/missed surgical timing in patients with PCLs. CASE SUMMARY:We present a case of a 64-year-old female patient in whom an asymptomatic, incidental cystic mass was found in the pancreatic tail on a routine abdominal ultrasound. After a comprehensive work-up with laboratory examinations, contrast-enhanced computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography, a pancreatic pseudocyst was suspected. Subsequent endoscopic ultrasound with fine-needle aspiration and needle-based confocal laser endomicroscopy supported a benign diagnosis. Follow-up computed tomography and magnetic resonance imaging examinations five months later showed significant cyst shrinkage without any abnormalities. However, three years after being lost to follow-up, the patient was readmitted and diagnosed with pancreatic adenocarcinoma with multiple metastases, suggesting that the initial lesion was a mucinous cystic neoplasm misdiagnosed as a pancreatic pseudocyst. CONCLUSION:Comprehensive integration of all available information (e.g., cyst features, abnormal imaging findings, cyst biochemistry, clinical history, and patient demographics) rather than over-reliance on imaging or endoscopic findings is pivotal to diagnosing PCLs, and patients with concerning features should undergo strict surveillance.

Esophageal stricture is a common complication after esophageal endoscopic submucosal dissection (ESD). Pathological scars may predict stricture development, but clinical studies exploring their relationship are limited. This study aimed to investigate the link between concurrent pathological scarring and post-ESD esophageal stricture and develop a predictive risk model. This retrospective single-center study included patients who underwent ESD for superficial esophageal lesions (SELs) over the past decade. Data on demographics, endoscopy, pathology, and concurrent scarring were collected. Multivariate logistic regression identified risk factors, followed by validation using subgroup analysis and propensity score matching. A nomogram was developed and internally validated. Of 255 patients, 28 (11.0

OBJECTIVES:The association between reflux events and esophageal motility abnormality is unclear. We aimed to determine the relevance between reflux events and esophageal motility in proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD). METHODS:Patients with PPI-refractory or PPI-responsive GERD were enrolled. Ambulatory 24-h esophageal pH-impedance-pressure monitoring was performed. Reflux symptoms, reflux events, and esophageal motility during acid reflux episodes were recorded and compared between the two groups. RESULTS:Sixty patients with PPI-refractory GERD and 18 with PPI-responsive GERD were included, all of whom had pathological gastroesophageal reflux. There were no significant differences in the major acid reflux parameters (DeMeester score and proportion of patients with acid exposure time > 6%) between the two groups. However, the number of long acid reflux episodes and the time length of the longest reflux episodes were significantly higher in the PPI-refractory GERD group than in the PPI-responsive GERD group (both p < 0.05). Moreover, patients with PPI-refractory GERD had higher rates of ineffective primary (62.0% vs. 36.0%, p < 0.001) and secondary peristalsis (83.5% vs. 57.0%, p = 0.001) during long acid exposure (LAE) than those with PPI-responsive GERD. Patients with PPI-refractory GERD having LAE had a significantly lower frequency of primary and secondary peristalsis per minute and required a longer time to initiate secondary peristalsis than those without during their longest acid reflux period in the upright position (all p < 0.001). CONCLUSION:Longer acid reflux episodes in patients with PPI-refractory GERD might result from frequent ineffective primary esophageal peristalsis and delayed initiation of effective secondary peristalsis.

Background: Rectal neuroendocrine tumors (NETs) ≤ 10 mm are commonly managed by endoscopic resection. However, the optimal technique remains controversial. We aimed to compare the efficacy and safety of a simplified endoscopic mucosal resection (sEMR) technique, performed without submucosal injection, with conventional endoscopic submucosal dissection (ESD) for small rectal NETs. Methods: This retrospective, single-center study included 74 patients with histologically confirmed rectal NETs ≤ 10 mm treated with sEMR (n = 37) or ESD (n = 37) between January 2022 and January 2025. Patients in the ESD group were matched 1:1 by age and gender. Baseline characteristics, procedural outcomes, histopathologic findings, and cost were analyzed. The primary outcome was histological complete resection (R0) rate; secondary outcomes included en bloc resection, intraoperative bleeding, tumor-to-margin distance, operation time, and material costs. Results: The R0 resection rate was significantly higher in the sEMR group compared to the ESD group (91.9% vs. 67.6%; p = 0.019). Tumor-to-margin distance was also significantly greater in the sEMR group [median (IQR): 0.2 (0.1–0.3) mm vs. 0.1 (0–0.2) mm; p = 0.024]. Intraoperative bleeding was less frequent in the sEMR group (2.7% vs. 21.6%; p = 0.028). Median operation time (409 vs. 1469 s; p < 0.001) and material cost (1486 vs. 6390 CNY; p < 0.001) were both significantly lower in the sEMR group. Conclusions: Compared with ESD, the simplified EMR technique without submucosal injection demonstrated higher R0 resection rates, lower bleeding risk, shorter operation time, and lower costs for small rectal NETs. sEMR may offer a safe, efficient, and cost-effective alternative in selected patients.

BACKGROUND:Autoimmune pancreatitis (AIP) is a rare disease and sometimes difficult to make a diagnosis. This study aimed to identify exosomal miRNAs that could serve as novel biomarkers of type 1 AIP. METHODS:We extracted miRNAs from the exosomes of patients with AIP, chronic pancreatitis (CP), pancreatic cancer, and healthy control individuals. To identify differentially expressed miRNAs (DEmiRNAs) associated with AIP, second-generation sequencing and differential expression analysis were performed. Target gene prediction, immune correlation analysis, functional annotation, and construction of lncRNA-miRNA-mRNA and transcription factor (TF)-miRNA-mRNA networks were then performed. Finally, qPCR analysis and ROC evaluation were performed for hub DEmiRNA. RESULTS:Exosomal miRNAs exhibited specific expression profiles in patients with type 1 AIP. The differentially expressed target genes PLXNA2 and PGM3, and the differentially expressed lncRNA MALAT1 associated with hsa-miR-30b-5p were identified. KEGG analysis showed that PLXNA2 was enriched in the axon guidance. Pearson's correlation analysis showed that PLXNA2 and PGM3 were significantly negatively correlated with activated CD4 T cells, type 1 T helper cells and other immune cells. The TF-miRNA-mRNA regulatory network showed that FOXA1 was a TF for PLXNA2 and PGM3, and RUNX2 was a TF for PLXNA2. Moreover, FOXA1 and RUNX2 were also the target genes of hsa-miR-30b-5p. CONCLUSION:Hsa-miR-30b-5p identified from exosomes may be a miRNA marker specific to type 1 AIP and therefore has the potential to serve as a novel biomarker.

BACKGROUND:Type 1 autoimmune pancreatitis (AIP) is a rare, immune-mediated pancreatic disease prone to relapse. The influence of age on relapse risk remains unclear. This study aimed to determine whether age at diagnosis is associated with disease relapse. METHODS:We retrospectively analyzed 413 patients with type 1 AIP with over 2 years of follow-up. Patients were divided into two groups based on age at diagnosis: <60 years (n = 221) and ≥60 years (n = 192). Relapse rates were compared between groups. Logistic regression was used to assess the association between age group and relapse risk. Subgroup analyses by sex, diabetes, smoking, and heavy drinking were performed to test the stability of this association. RESULTS:The median age was 58.0 years, with 79.4 % male patients and a median follow-up of 4.6 years. The overall relapse rate was 41.9 %, being higher in the <60 years group (46.2 %) than in the ≥60 years group (37.0 %). Age <60 years was significantly associated with increased relapse risk (OR = 1.7; 95 % CI: 1.1-2.7, P = 0.022) in multivariate logistic analysis. This effect was consistent across all subgroups examined. CONCLUSIONS:In type 1 AIP, age<60 years increases the risk of disease relapse. Age should be considered in long-term disease management.

BACKGROUND:A high prevalence of diabetes mellitus (DM) coexisting with autoimmune pancreatitis (AIP) is observed. However, evidence on the circumstances under which corticosteroid therapy (CST) for AIP improves or worsens DM is scarce. This study aimed to demonstrate and identify predictors of DM control under the influence of CST.METHODS:Patients diagnosed with type 1 AIP were enrolled from a prospectively maintained cohort and were classified into three groups according to the chronology in which AIP and DM were diagnosed: pre-existing DM (pDM), concurrent DM (cDM), and non-DM (nDM). The responses of DM to CST were assessed when corticosteroid was ceased or tapered to a maintenance dose and classified as 'improvement' and 'non-improvement' (including 'no change' and 'exacerbation').RESULTS:Among 101 patients with type 1 AIP, 52 (51.5%) patients were complicated with DM at the time of AIP diagnosis, with 36 patients in the cDM group and 16 patients in the pDM group. The incidences of diffuse pancreatic swelling (72.2%) and pancreatic body/tail involvement (91.7%) were significantly higher in the cDM group than in both the pDM and nDM groups. Of the 52 patients with DM, CST was administered in 48 cases. Multivariate logistic analysis identified that elevated serum gamma-glutamyl transferase (GGT) level at AIP diagnosis [odds ratio (OR) = 0.032, 95% confidence interval (CI): 0.003-0.412, P = 0.008] and pancreatic atrophy after CST (OR = 0.027, 95% CI: 0.003-0.295, P = 0.003) were negatively associated with DM control improvement.CONCLUSIONS:Patients with diffuse pancreatic swelling and pancreatic body/tail involvement in pancreatitis tended to be complicated with cDM at AIP diagnosis. CST exerted a beneficial effect on the clinical course of DM in nearly half of the AIP patients complicated with DM at diagnosis, particularly in those without elevated serum GGT levels at diagnosis and who did not experience pancreatic atrophy after CST.

ObjectiveTo explore the application value of endoscopic ultrasound fine-needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment ofpatients with pancreatic cancer combined with obstructive jaundice.MethodsClinical data of patients hospitalized in the Department of Gastroenterology of Peking Union Medical College Hospital who underwent ERCP biliary stent drainage for pancreatic cancer combined with obstructive jaundice from January 1, 2023 to February 26, 2024 were retrospectively collected. They were categorized into the fusion technology group and the simple ERCP group according to whether EUS-FNA was performed in the same endoscopic unit. The differences in pathologic diagnosis rate, ERCP drainage success rate, postoperative complication rate and patients' single hospitalization time were compared between the two groups.ResultsA total of 161 patients with pancreatic cancer combined with obstructive jaundice who underwent ERCP biliary stent drainage meeting the inclusion and exclusion criteria were enrolled, of which 80 were in the fusion technique group and 81 were in the simple ERCP group. The pathological diagnosis rate in the fusion technique group was higher than that in the simple ERCP group[92.50%(74/80) vs. 46.15%(12/26), P < 0.001], and the ERCP drainage success rate[82.50%(66/80) vs. 86.42%(70/81), P=0.360], the overall postoperative complication rate[5.00%(4/80) vs. 2.47%(2/81), P=0.443], and single hospitalization time[4 (4, 7)d vs. 5 (3, 9)d, P=0.397] were not statistically different from simple ERCP groups.ConclusionThe fusion of EUS-FNA and ERCP enhances the efficiency of diagnosis and treatment for pancreatic carcinoma, warranting widespread adoption and further research.