Clinical Pancreatology for Practising Gastroenterologists and Surgeons

of Chronic Pancreatitis Introduction Pancreatic Function Tests for the Diagnosis of Chronic Pancreatitis in Patients with Inconclusive Imaging Findings Evaluation of Pancreatic Function as Screening Test for Patients with Clinical Symptoms Suggestive of Chronic Pancreatitis References 34 Follow‐up of Patients with Chronic Pancreatitis in Clinical Practice Introduction Pain Nutritional Deficiencies Diabetes Exocrine Insufficiency Final Considerations Conclusion References 35 Quality of Life in Chronic Pancreatitis Introduction Assessment Factors Affecting QOL Treatment Conclusions References 36 Medical Treatment of Pain in Chronic Pancreatitis Introduction Pathogenesis of Pain Medical Pain Management Pharmacological Considerations Conclusion References 37 Endoscopic Treatment of Pain in Chronic Pancreatitis Introduction Selecting the Right Patient for Endoscopic Therapy: Who and When? Treatment of Pancreatic Duct Stones Treatment of Pancreatic Duct Strictures EUS‐guided Pancreaticogastrostomy Celiac Plexus Block Summary References 38 Diagnosis and Management of Pancreatic Exocrine Insufficiency in Chronic Pancreatitis Concept of Pancreatic Exocrine Insufficiency Pathophysiology Clinical Manifestations Diagnosis Diagnosis in Clinical Practice Prevention and Prognosis References 39 Surgical Treatment of Pain in Chronic Pancreatitis Introduction Indications and Contraindications for Surgical Treatment Diagnostic Work‐up Optimal Timing Clinical Considerations in Selecting the Surgical Approach Technical Approaches Tips and Tricks for Surgical Interventions Outcomes and Quality of Life after Surgery Follow‐up Conclusion References 40 Management of Chronic Pancreatic Pseudocyst Introduction Definition of Pseudocyst When to Observe or Drain Important Preprocedure Considerations Procedural Technique: How to Drain Postprocedure Care Adverse Events Conclusions References 41 Vascular Complications in Chronic Pancreatitis Introduction Arterial Complications Venous Complications References 42 Surgical Therapy of Local Complications of Chronic Pancreatitis The Role of the Surgeon in the Treatment of Local Complications in Chronic Pancreatitis Pancreatic Duct Strictures Pancreatic Pseudocyst Vascular Complications Bile Duct Obstruction Duodenal Obstruction Pancreatic Cancer Pancreatic Ascites and Pleural Effusion Conclusions Acknowledgment References 43 Endoscopic Treatment of Complications of Chronic Pancreatitis other than Pseudocyst Introduction Pancreatic Calculi Pancreatic Duct Strictures Biliary Strictures EUS‐guided Celiac Block Pancreatic Duct Leaks EUS‐guided Access to MPD References

10 Section III: Autoimmune Pancreatitis 44 Autoimmune Pancreatitis Definition and Classification Clinical Presentation Diagnosis Treatment Outcome and Follow‐up in Patients with AIP References 45 Diagnosis of Autoimmune Pancreatitis A Protocol for Clinical Practice Introduction Diagnostic Approach References 46 Treatment and Follow‐up of Autoimmune Pancreatitis in Clinical Practice Introduction Clinical Characteristics Serology Pathology Pancreatic Imaging Diagnosis Definition of Treatment Outcomes Principles of Management of AIP Patient Follow‐up Summary References

11 Section IV: Cystic Fibrosis (CFTR)-associated Pancreatic Disease 47 CFTR‐associated Pancreatic Disease Introduction CFTR Gene and Protein CFTR Mutation Classes Genotype–Phenotype Correlations in CF Genotype–Phenotype Correlations in Exocrine Pancreas Status in CF Pancreatic Insufficiency Prevalence Score and Genotype–Phenotype Correlations in Pancreatitis in CF The Pancreas in Cystic Fibrosis and CFTR‐related Disorders Pathogenesis of CFTR‐related Pancreatitis Pancreatic cystosis CFTR‐modifying Therapies Conclusion References 48 Nutritional Therapy, Pancreatic Exocrine Insufficiency, and Pancreatic Enzyme Replacement Therapy in Cystic Fibrosis Introduction Mechanisms of Pancreatic Exocrine Insufficiency Diagnosis of Pancreatic Exocrine Insufficiency Nutritional Consequences and Treatment of Pancreatic Exocrine Insufficiency Follow‐up Care of Patients with Pancreatic Exocrine Insufficiency Future of CF Nutrition Care References

12 Section V: Pancreatic Cancer 49 Epidemiological Impact of Pancreatic Cancer Current Burden of Pancreatic Cancer Time Trends Risk Factors for Pancreatic Cancer Attributable Fraction of Pancreatic Cancer due to Potentially Modifiable Risk Factors Future Burden of Pancreatic Cancer Conclusion References 50 Molecular and Genetic Basis of Pancreatic Carcinogenesis Introduction Individual Therapy Based on the Genomic and Transcriptomic Traits of Pancreatic Cancer Organoids for Response Prediction Enhancing the Activation of Immune Surveillance and Inhibition of Immune Suppression Exploiting the Metabolic Alterations in Pancreatic Cancer Cells Targeting the Tumor Stroma Summary References 51 New‐onset Diabetes as a Harbinger of Pancreatic Cancer: is Early Diagnosis Possible? Introduction Epidemiology of DM in PDAC Using NOD for Early Detection of PDAC Methods to Enrich the NOD Cohort to Screen for PDAC Current Research Endeavors Conclusions and Recommendations to Practitioners Acknowledgments References 52 Pancreatic Cancer Screening Introduction Target Populations Screening Modality Screening Protocol Outcomes of Screening and Surveillance Programs Cost‐effectiveness of Pancreatic Cancer Screening Programs Conclusion Acknowledgments References 53 Clinical Usefulness of Biological Markers in Pancreatic Cancer Introduction Challenges in Early Detection of Pancreatic Cancer Role of Clinically Established Biomarkers of Pancreatic Cancer Early Cancer Detection by Novel Biomarkers Summary References 54 Staging Classification and Stratification of Pancreatic Cancer for Clinical Practice Introduction Clinical Staging Clinically Relevant Molecular Features Imaging Classification of Non‐metastatic Disease Imaging for Staging Evaluating Response to Neoadjuvant Therapy Future Directions Acknowledgments References 55 Imaging Diagnosis and Staging of Pancreatic Cancer Introduction CT Technique Anatomy Pancreatic Adenocarcinoma Conclusion References 56 The Role of Endoscopic Ultrasound and Associated Methods (Elastography, Contrast Enhancement) in the Diagnosis and Assessment of Resectability of Pancreatic Cancer Introduction Endoscopic Ultrasound for the Diagnosis and Staging of Pancreatic Cancer EUS‐guided Fine Needle Biopsy EUS Elastography Contrast‐enhanced EUS Conclusion References 57 EUS‐Guided FNA/FNB for Pancreatic Solid Lesions Introduction Indications for Performing EUS‐guided Tissue Acquisition Optimal Technical Approach to EUS Tissue Acquisition General Rules for Performing EUS‐TA Conclusions Acknowledgment References 58 Surgical Treatment of Resectable Pancreatic Cancer Introduction Standard Resections and Lymphadenectomy for Resectable Pancreatic Cancer Minimally Invasive Surgery Extended Resections Future Perspectives References 59 Complications After Pancreatic Surgery Introduction Postoperative Pancreatic Fistula Post‐pancreatectomy Hemorrhage Delayed Gastric Emptying Biliary Leakage Chyle Leak Enhanced Recovery After Surgery Policies and Centralization Conclusion References 60 Neoadjuvant Treatment of Pancreatic Cancer Background Neoadjuvant Therapy Conclusions References 61 Adjuvant Therapy in Pancreatic Cancer Introduction Brief History and Development of Adjuvant Therapy Recent Phase III Trials Evaluating Combination Chemotherapy Current Standards and Choices in Adjuvant Therapy Future Perspectives Summary References 62 Management of Pain in Pancreatic Cancer Relevance of Abdominal Pain in Pancreatic Cancer Approach to Pain Management in Pancreatic Cancer Nutritional Management and Treatment of Pancreatic Exocrine Insufficiency Pain Therapy in Pancreatic Cancer Management of Pain in Pancreatic Cancer: An Algorithm for Clinical Routine References 63 EUS‐guided Celiac Plexus Neurolysis for Pain in Pancreatic Cancer Introduction When EUS‐CPN Should be Considered Safety of EUS‐CPN Celiac Ganglia Neurolysis How to Inject and What to Expect: Unilateral vs. Bilateral Injection Is the Future of EUS‐CPN Neurolysis with a Different Neurolytic? Summary References 64 The Role of Endoscopy in the Management of Unresectable Pancreatic Cancer Background Malignant Biliary Obstruction Gastroduodenal Outlet Obstruction Tumor‐related Bleeding The Future Conclusions References 65 Chemotherapy for Nonresectable Pancreatic Cancer Introduction First Line Second Line Genetic Testing Conclusions References 66 Diagnosis and Management of Pancreatic Exocrine Insufficiency in Pancreatic Cancer Mechanisms of Pancreatic Exocrine Insufficiency in Pancreatic Cancer Symptoms of PEI Diagnosis of PEI in Pancreatic Cancer Treatment of PEI with PERT Key Recommendations References 67 Nutrition and Pancreatic Cancer Introduction Impact of Pancreatic Ductal Adenocarcinoma on Nutrient Metabolism Pancreatic Exocrine Insufficiency Cancer Cachexia and PDAC Treatment Strategies for Malnutrition in Pancreatic Cancer Conclusion References 68 Present and Future of Local Therapies for Unresectable Pancreatic Cancer Introduction Direct Antitumor Therapy Indirect Antitumor Therapy Future Directions References 69 New Pharmacological Approaches for Pancreatic Cancer Therapy Introduction Pancreatic Cancer: Challenges in the Field Overcoming Challenges: Therapy against Pancreatic Cancer Conclusion Acknowledgments Disclosures References

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