Losurdo G, Gesualdo M, Iannone A, Castellano F, Mezzapesa M, Principi M. Letter to the Editor: Tumor markers in pancreatic juice: How and when to collect? World J Gastrointest Oncol 2026; 18(10): 121112 [DOI: 10.4251/wjgo.121112]
Corresponding Author of This Article
Giuseppe Losurdo, MD, PhD, Associate Professor, Gastroenterology Section, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy. giuseppelos@alice.it
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Gastroenterology & Hepatology
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letter
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Losurdo G, Gesualdo M, Iannone A, Castellano F, Mezzapesa M, Principi M. Letter to the Editor: Tumor markers in pancreatic juice: How and when to collect? World J Gastrointest Oncol 2026; 18(10): 121112 [DOI: 10.4251/wjgo.121112]
World J Gastrointest Oncol. Oct 15, 2026; 18(10): 121112 Published online Oct 15, 2026. doi: 10.4251/wjgo.121112
Letter to the Editor: Tumor markers in pancreatic juice: How and when to collect?
Giuseppe Losurdo, Marcantonio Gesualdo, Andrea Iannone, Fabio Castellano, Martino Mezzapesa, Mariabeatrice Principi
Giuseppe Losurdo, Marcantonio Gesualdo, Andrea Iannone, Fabio Castellano, Martino Mezzapesa, Mariabeatrice Principi, Gastroenterology Section, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari 70124, Italy
Co-first authors: Giuseppe Losurdo and Marcantonio Gesualdo.
Author contributions: Losurdo G and Gesualdo M planned the study and they contribute equally to this study as co-first authors; Mezzapesa M, Principi M, Iannone A and Castellano F performed literature searches; Losurdo G, Mezzapesa M and Gesualdo M wrote the paper.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Corresponding author: Giuseppe Losurdo, MD, PhD, Associate Professor, Gastroenterology Section, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy. giuseppelos@alice.it
Received: March 16, 2026 Revised: April 8, 2026 Accepted: May 7, 2026 Published online: October 15, 2026 Processing time: 184 Days and 14.1 Hours
Abstract
Pancreatic cancer is regarded as one of the most aggressive tumors, with approximately 80% of affected individuals diagnosed at an advanced stage. Its delayed diagnosis results in a 5-year survival rate of only 11%. Notably, only 20% of patients are eligible for surgical resection at the time of diagnosis. Therefore, a pre-operative assessment is critical for defining prognosis, predicting expected survival and guiding the most appropriate treatment. In their prospective case-control study, Trogrlić et al demonstrated that levels of carbohydrate antigen 19-9 in pancreatic juice, collected during endoscopic retrograde cholangio-pancreatography (ERCP) or during the Whipple procedure, were significantly higher in patients who did not survive beyond 5 years from surgery, than in long term survivors. However, collecting pancreatic juice by ERCP or during surgical procedures may not be ideal due to potential procedure-related adverse events. Endoscopic ultrasound constitutes a feasible alternative. Accurate timing of pancreatic juice collection is also crucial, as early prognostic evaluation should ideally represent the gold standard. Fecal samples may constitute a promising source for tumor marker identification. However, certain issues, such as protein stability in stools, remain unresolved. Liquid biopsies could serve as a promising diagnostic tool.
Core Tip: Analysis of pancreatic juice collection is an interesting way to predict prognosis and natural history of pancreatic cancer. In this article, we discuss some key problems, such as the best method for juice sampling and the best timing. Future perspectives have been discussed.
