Using CE-EUS to measure MN height provides a highly accurate method for differentiating benign from malignant BD-IPMN.

<b><i>Background:</i></b> Although serum carbohydrate antigen 19-9 (CA19-9) is widely used as a useful biomarker of pancreatic cancer for monitoring the response to therapy, it is not recommended for screening of early pancreatic cancer because of its limited sensitivity for small tumors. Thus, it is critical to discover novel serum biomarkers to complement CA19-9 in order to improve sensitivity. Although methylated runt-related transcription factor 3 (<i>RUNX3</i>) is a biomarker of pancreatic cancer, its detection by conventional bisulfite-based methylation assays from a small serum sample amount is very difficult. Therefore, we developed a new methylation assay, the combined restriction digital PCR (CORD) assay, that enables counting of even one copy of a methylated gene in a small DNA sample amount without DNA bisulfite treatment. <b><i>Objectives:</i></b> We evaluated the sensitivity and specificity of serum DNA testing of methylated <i>RUNX3</i> by the CORD assay in combination with and without CA19-9 for the detection of pancreatic cancer in 55 patients with pancreatic cancer, 12 patients with benign pancreatic disease, and 80 healthy individuals. <b><i>Results:</i></b> The CORD assay of methylated <i>RUNX3</i> had a sensitivity of 50.9% (28/55) and specificity of 93.5% (86/92). Combination of the CORD assay of methylated <i>RUNX3</i> and CA19-9 resulted in a sensitivity of 85.5% (47/55) and specificity of 93.5% (86/92) for all stages of pancreatic cancer and a sensitivity of 77.8% (7/9) for stage I pancreatic cancer. <b><i>Conclusions:</i></b> ombination of the CORD assay and CA19-9 may provide an alternative screening strategy for detecting early-stage pancreatic cancer.

Background/Aims:Distinguishing pancreatic ductal carcinoma (DC) from other pancreatic masses remains challenging. This study aims at evaluating the efficacy of contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) in the diagnosis of DC.Patients and Methods:Forty-nine patients with solid pancreatic mass lesions underwent CEH-EUS. EUS (B-mode) was used to evaluate the inner echoes, distributions, and borders of the masses. The vascular patterns of the masses were evaluated with CEH-EUS at 30–50 s (early phase) and 70–90 s (late phase) after the administration of Sonazoid®.Results:The final diagnoses included DCs (37), mass-forming pancreatitis (6), endocrine neoplasms (3), a solid pseudopapillary neoplasm (1), a metastatic carcinoma (1), and an acinar cell carcinoma (1). The sensitivity, specificity, and accuracy of the diagnoses of DC in hypoechoic masses using EUS (B-mode) were 89.2%, 16.7%, and 71.4%, respectively. The sensitivity, specificity, and accuracy for the diagnosis of DC in hypovascular masses using CEH-EUS were 73.0%, 91.7%, and 77.6% in the early phase and 83.8%, 91.7%, and 85.7% in the late phase, respectively.Conclusions:CEH-EUS for the diagnosis of DC is superior to EUS. CEH-EUS in the late phase was particularly efficacious in the diagnosis of DC.

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Abstract. Background/Aim: Gemcitabine (GEM) Pancreatic cancer shows one of the worst prognoses among all malignant tumors since it progresses quickly and is difficult to diagnose at an early stage. Advances in chemotherapy are considered to be important for improving the prognosis of unresectable cases.Burris et al.(1) reported that gemcitabine (GEM) can significantly prolong survival in comparison to 5-FU for unresectable pancreatic cancer. Recently, FOLFIRINOX (L-OHP, CPT-11, 5-FU, LV) therapy (2) and GEM combined with nab-paclitaxel therapy (3) were shown to prolong survival. FOLFIRINOX was associated with strong toxicity, because it has not been established whether the combination therapy can be safely administered. It is thought that GEM based-chemotherapy will also be a key to the treatment of unresectable pancreatic cancer. It has been reported that recent advances in genetic analysis technology have revealed the factors involved with GEM sensitivity in pancreatic cancer cells (4, 5), and tailored therapies are expected.We identified GEM resistance-related proteins in pancreatic cancer by a proteomic analysis. We compared the expression levels of proteins in GEM-resistant pancreatic cancer cell lines with the expression in GEM-sensitive cell lines using twodimensional electrophoresis and liquid chromatography-mass spectrometry. Among them, the expression of Heat shock protein 27 (HSP27) was found to be increased in the GEMresistant cell line. Furthermore, we confirmed that GEM sensitivity was restored when the HSP27 expression in the GEM-resistant cell line was reduced (6, 7). Additionally, we clarified that the expression of phosphorylated HSP27 (p-HSP27) increased in the GEM-resistant cell line (8).In addition, the ability to predict the treatment effects using endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) samples may help in the selection of appropriate medicines for unresectable pancreatic cancer.No previous studies have evaluated the rates of HSP27 and p-HSP27 expression in pancreatic cancer cells from EUS-FNA samples. The purpose of this study was to evaluate the rates of HSP27 and p-HSP27 expression in EUS-FNA samples, and to demonstrate their association with GEM sensitivity. Materials and Methods Subjects, Examination itemsThe comparison of the rates of HSP27 expression in the EUS-FNA samples and the resected specimens. We compared the rates of HSP27 expression in EUS-FNA samples and resected specimens and evaluated the relationship with the resected specimens. The study population included 19 patients who had been diagnosed with 637 This article is freely accessible online.Correspondence to: Michitaka Kawano,

Introduction: We previously developed a novel methylation assay, the combined restriction digital PCR (CORD) assay, consisting of treatment of DNA with methylation-sensitive restriction enzymes and droplet digital PCR. Methods: In this study, we assessed the diagnostic performance of serum methylated Homeobox A1 (mHOXA1) and methylated somatostatin (mSST) using the CORD assay in combination with CA19-9 for pancreatic cancer using serum samples from 82 healthy individuals, 13 patients with benign pancreatic disease, 3 patients with branched-duct intraductal papillary mucinous neoplasm, and 91 patients with pancreatic cancer. Results: For the single marker tests, sensitivity for all stages of pancreatic cancer, stage I cancer, and specificity were, respectively, 71.4%, 50.0%, and 94.9% for CA19-9; 51.6%, 68.8%, and 90.8% for mHOXA1; and 50.1%, 68.8%, and 94.9% for mSST. Those for the combined marker tests were, respectively, 86.8%, 81.3%, and 85.7% for combined mHOXA1 and CA19-9; 86.8%, 87.5%, and 89.8% for combined mSST and CA19-9; and 89.0%, 87.5%, and 85.7% for all three markers combined. Conclusion: The combination of mHOXA1 and mSST with CA19-9 appears to be useful to detect pancreatic cancer even at an early stage.

Postoperative biliary strictures are usually complications of cholecystectomy. Endoscopic plastic stent prosthesis is generally undertaken for treating benign biliary strictures. Recently, fully covered metal stents have been shown to be effective for treating benign distal biliary strictures. We present the case of a 53-year-old woman with liver injury in which imaging studies showed a common hepatic duct stricture. Endoscopic retrograde cholangiopancreatography also confirmed the presence of a common hepatic duct stricture. Temporally fully covered metal stents with dilated diameters of 6 mm were placed in a side-by-side fashion in the left and right hepatic ducts, respectively. We removed the stents 2 months after their placement. Subsequent cholangiography revealed an improvement in the biliary strictures. Although we were apprehensive about the fully covered metal stents obstructing the biliary side branches, we noted that careful placement of the bilateral metal stents did not cause any complications. Side-by-side deployment of bilateral endoscopic fully covered metal stents can be one of the safe and effective therapies for postoperative biliary stricture.