Innovations in diagnosis and management of pancreatobiliary diseases

Pancreatobiliary diseases compromise a heterogeneous group of lesions, ranging from benign to malignant entities. The aim of this thesis is to improve diagnosis and management in these patients, with a specific focus on pancreatic cystic neoplasms (PCN). This thesis therefore describes the results of an international study on the outcomes of spleen-preserving distal pancreatectomy (SPDP) in patients with intraductal papillary mucinous neoplasm (IPMN). Although current guidelines recommend DP including splenectomy in these patients, this study found that SPDP appears to be oncologically safe in patients without preoperative suspicion of malignancy, and improved short-term outcomes after surgery. This thesis also includes the results of a nationwide registry-based study investigating overall survival after resection in patients with PCN-associated pancreatic cancer compared to patients with pancreatic cancer without this association. This study found that patients with PCN-associated pancreatic cancer had better estimated median overall survival when compared to patients with pancreatic cancer not associated with PCN. This thesis also describes the results of the randomised controlled BRIX-trial, which investigates the sensitivity of brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected malignant pancreatobiliary strictures. Brush cytology is commonly performed during ERCP, yet its sensitivity to diagnose malignancy remains poor. This study therefore compared the sensitivity of a dense brush cytology device to a conventional brush device. The dense brush did not yield higher sensitivity when compared to the conventional brush in diagnosing suspected malignant pancreatobiliary strictures. As a consequence, the study was ended prematurely because of futility.