Background/Objectives: Pancreatic cancer (PC) should be diagnosed in its early stages. Therefore, it is necessary to identify high-risk individuals of PC. Methods: Between 2001 and 2017, 1542 PC cases were diagnosed at two tertial care institutions. Of these, 117 cases had undergone abdominal contrast-enhanced computed tomography (CE-CT) 1-10 years before PC diagnosis and were classified as the PC group. Meanwhile, 43,102 cases underwent abdominal CE-CT for close examination of non-pancreatic diseases in the same period, of which 1170 were randomly selected. Of these, 117 cases were matched to the PC group with the propensity score and designated the non-PC group. Pancreatic volumetry was performed using the 3D image analysis system for abdominal CE-CT in both groups and various measurements were compared. In PC group, CE-CT taken 1-10 years before the onset of PC was analyzed. Results: After propensity score matching, baseline characteristics did not significantly differ between the two groups. The whole pancreatic volume/body surface area (BSA) (p = 0.014), volume of main pancreatic duct (MPD) plus cystic lesion/BSA (p < 0.001), volume of pancreatic parenchyma/BSA (p = 0.002), ratio of cross-sectional areas (p = 0.033), and MPD diameter/BSA (p < 0.001) significantly differed between the two groups. In subgroup analysis of patients without cystic lesions, the whole pancreatic volume/BSA, volume of MPD/BSA, volume of pancreatic parenchyma/BSA, ratio of cross-sectional areas, and MPD diameter/BSA significantly differed between the two groups. Conclusions: Pancreatic volumetry could identify patients at high risk of PC.

ABSTRACT Aims Tofacitinib (TOF), an oral pan‐Janus kinase (JAK) inhibitor, is a therapeutic option for moderate to severe ulcerative colitis (UC). While short‐term efficacy has been reported, its long‐term real‐world outcomes—particularly in Asian populations—and optimal dose reduction timing are incompletely understood. Methods and Results This single‐center, retrospective study included 63 patients with UC treated with TOF between October 2018 and April 2025. Clinical outcomes—response, remission, steroid‐free remission, and adverse events—were assessed at Weeks 26, 52, and 104. The impact of dose reduction (20–10 mg/day) was analyzed, focusing on endoscopic mucosal healing (Mayo endoscopic subscore 0–1). At Week 26, clinical response and remission rates were 63% and 53%, respectively; 43% of patients achieved steroid‐free remission by Week 52, and 41% maintained it at Week 104. Early responders were associated with treatment efficacy in a lower partial Mayo score (OR = 1.724, 95% CI: 0.994–2.988, p = 0.052). Among 26 patients with dose reduction, relapse occurred in 5.6% with mucosal healing versus 62.5% without. Significant factors associated with relapse/exacerbation were TOF dose reduction based on clinical remission alone without endoscopic confirmation ( p = 0.003, OR = 5.26) and disease duration ( p = 0.019, OR = 0.86). Adverse events were infrequent and manageable, with no malignancies or deaths reported. Conclusion TOF demonstrated sustained effectiveness and safety in UC. Mucosal healing was strongly associated with successful dose de‐escalation, representing a key treatment target. These findings support treat‐to‐target strategies incorporating endoscopic assessment to guide TOF dose reduction.

BACKGROUND & AIMS:The optimal timing for direct endoscopic necrosectomy (DEN) after endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic necrotizing pancreatitis remains unknown. We hypothesized that immediate DEN after EUS-guided drainage might reduce the time to disease resolution compared with a drainage-oriented step-up approach. METHODS:This study was a multicenter, open-label, superiority randomized trial (WONDER-01). Among patients who received EUS-guided treatment for symptomatic necrotizing pancreatitis, eligible patients were randomly assigned 1:1 to receive either immediate DEN or the drainage-oriented step-up approach. The primary endpoint was the time from randomization to clinical success, defined as a decrease in collection size to ≤3 cm and an improvement in inflammatory markers. RESULTS:Seventy patients were enrolled in this study: 33 in the immediate DEN arm and 37 in the step-up arm. Immediate DEN was associated with a shorter time to clinical success than the step-up approach (P = .009), with median times (95% confidence interval) of 29 (19-34) and 44 (38-52) days, respectively. All patients in the immediate DEN arm received DEN compared with 46% in the step-up approach arm, but the rates of procedure-related adverse events were comparable (24% vs 22%, respectively; P = .79). No significant differences were noted between the treatment arms in terms of technical success (100% vs 97%; P > .99) and mortality (12% vs 5.4%; P = .41). CONCLUSIONS:Compared with the step-up approach, immediate DEN after EUS-guided drainage of necrotizing pancreatitis reduced time to clinical success without increasing adverse outcomes but required more DEN procedures (ClinicalTrials.gov, NCT05451901).

BACKGROUND/OBJECTIVES:Ulcerative colitis (UC)-associated neoplasia (UCAN) often presents as flat lesions with indistinct margins, and biopsy sensitivity is limited. Therefore, we evaluated endoscopic criteria to distinguish UCAN from sporadic neoplasia, assessing the accuracy of endoscopic ultrasonography (EUS) for invasion depth and the role of endoscopic submucosal dissection (ESD) as a "total biopsy." METHODS:We reviewed 212 endoscopically treated neoplastic lesions in UC-affected mucosa (April 2016-January 2025). We compared preoperative diagnoses using macroscopic type, pit pattern, and the Japan Narrow-Band Imaging Expert Team classification with final histology. We compared depth estimates with pathology in 10 UCAN-suspected lesions undergoing EUS. Lesions < 2 cm underwent conventional endoscopic resection, whereas those ≥ 2 cm underwent ESD. RESULTS:No UCAN was found in 189 lesions < 2 cm. Among 23 ESD lesions, 8 suspected sporadic lesions were non-UCAN. Of 15 UCAN-suspected lesions, 8 were UCAN, 6 sporadic, and 1 inflammatory. For positive T1b or deeper invasion, the sensitivity, specificity, positive and negative predictive values, and overall accuracy of EUS were 50.0%, 100%, 100%, 88.9%, and 90.0%, respectively. EUS depth assessment agreed with pathology in 9/10 cases; nine lesions were T1a or shallower, and one was T1b. Third-layer thickening occurred in two lesions-both UCAN-including the T1b cancer. In ESD cases, redness and a VI pit pattern were independent predictors of UCAN. CONCLUSIONS:EUS-based depth assessment is useful for determining optimal treatment strategies. Beyond therapy, ESD enables comprehensive histologic assessment of the entire lesion, functioning as a total biopsy to guide management while preserving bowel function.