Minireviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2022; 28(48): 6867-6874
Published online Dec 28, 2022. doi: 10.3748/wjg.v28.i48.6867
Recent advances in the management of autoimmune pancreatitis in the era of artificial intelligence
Sahar Mack, Yves Flattet, Philippe Bichard, Jean Louis Frossard
Sahar Mack, Yves Flattet, Philippe Bichard, Jean Louis Frossard, Division of Gastroenterology, Department of Medical Specialties, University Hospital of Geneva, Geneva 1205, Switzerland
Author contributions: Mack S and Flattet Y performed research and wrote the paper; Bichard P and Frossard JL contributed critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jean Louis Frossard, MD, Associate Professor, Division of Gastro-enterology, Department of Medical Specialties, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland. jean-louis.frossard@hcuge.ch
Received: August 18, 2022
Peer-review started: August 18, 2022
First decision: September 8, 2022
Revised: October 31, 2022
Accepted: November 16, 2022
Article in press: November 16, 2022
Published online: December 28, 2022
Processing time: 130 Days and 17 Hours
Abstract

Autoimmune pancreatitis (AIP) is a type of immune-mediated pancreatitis subdivided into two subtypes, type 1 and type 2 AIP. Furthermore, type 1 AIP is considered to be the pancreatic manifestation of the immunoglobulin G4 (IgG4)-related disease. Nowadays, AIP is increasingly researched and recognized, although its diagnosis represents a challenge for several reasons: False positive ultrasound-guided cytological samples for a neoplastic process, difficult to interpret levels of IgG4, the absence of biological markers to diagnose type 2 AIP, and the challenging clinical identification of atypical forms. Furthermore, 60% and 78% of type 1 and type 2 AIP, respectively, are retrospectively diagnosed on surgical specimens of resected pancreas for suspected cancer. As distinguishing AIP from pancreatic ductal adenocarcinoma can be challenging, obtaining a definitive diagnosis can therefore prove difficult, since endoscopic ultrasound fine-needle aspiration or biopsy of the pancreas are suboptimal. This paper focuses on recent innovations in the management of AIP with regard to the use of artificial intelligence, new serum markers, and new therapeutic approaches, while it also outlines the current management recommendations. A better knowledge of AIP can reduce the recourse to surgery and avoid its overuse, although such an approach requires close collaboration between gastroenterologists, surgeons and radiologists. Better knowledge on AIP and IgG4-related disease remains necessary to diagnose and manage patients.

Keywords: Autoimmune pancreatitis; Pancreatic ductal adenocarcinoma; Immunoglobulin G4-related disease; Prednisone; Rituximab; Artificial intelligence; Plasmablasts

Core Tip: The diagnosis of autoimmune pancreatitis (AIP) is challenging. Indeed, 60% and 78% of type 1 and type 2 AIP, respectively, are retrospectively evaluated on surgical specimens of resected pancreas for suspected cancer. Obtaining a definitive diagnosis can thus prove difficult, since endoscopic ultrasound fine-needle aspiration or biopsy of the pancreas are suboptimal. This paper focuses on recent innovations in the management of AIP using artificial intelligence, new serum markers, and new therapeutic approaches and outlines the current recommendations. Improved knowledge of AIP can reduce the recourse to surgery, although this requires collaboration between gastroenterologists, surgeons and radiologists.