tbuckley/cabot-search huggingface dataset:
EUS-GUIDED GASTROJEJUNOSTOMY VERSUS DUODENAL STENTS FOR MALIGNANT GASTRIC OUTLET OBSTRUCTION: AN INTERNATIONAL MULTICENTER PROPENSITY SCORE MATCHED COMPARISON
Authors: P. de Gooyer, G. Vanella, M. van Bronswijk, F. Mandarino, P. Fockens, W. Laleman, H. van Malenstein, G. Dell'Anna, R. van Wanrooij, P. Arcidiacono, S. van der Merwe, R.P. Voermans
Journal: Endoscopy (2022)

Aims Duodenal self-expendable metal stents (SEMS) for malignant gastric outlet obstruction(GOO) are prone for recurrent GOO. EUS-guided gastrojejunostomy(EUS-GJ) is emerging as a novel technique which potentially leads to less recurrent GOO. Advantages over SEMS have been evaluated in retrospective studies with poor control for confounders. Our aim was to compare efficacy, safety and dysfunction rate of EUS-GJ and SEMS in patients with GOO using propensity-score matching.
Happy Heart Syndrome
Authors: Thomas Stiermaier, Alexandra Walliser, Ibrahim El-Battrawy, Toni Pätz, Matthias Mezger, Elias Rawish, Mireia Andrés, Manuel Almendro-Delia, Manuel Martinez-Sellés, Aitor Uribarri, Alberto Pérez-Castellanos, Federico Guerra, Giuseppina Novo, Enrica Mariano, Maria Beatrice Musumeci, Luca Arcari, Luca Cacciotti, Roberta Montisci, Ibrahim Akin, Holger Thiele, Natale Daniele Brunetti, Ivan J. Núñez-Gil, Francesco Santoro, Ingo Eitel
Journal: JACC Heart Failure (2022)
The bacteriology of pleural infection (TORPIDS): an exploratory metagenomics analysis through next generation sequencing
Authors: Nikolaos I Kanellakis, John M Wrightson, Stephen Gerry, Nicholas Ilott, John P Corcoran, Eihab O Bedawi, Rachelle Asciak, Andrey Nezhentsev, Anand Sundaralingam, Rob J Hallifax, Greta M Economides, Lucy R Bland, Elizabeth Daly, Xuan Yao, Nick A Maskell, Robert F Miller, Derrick W Crook, Timothy S C Hinks, Tao Dong, Ioannis Psallidas, Najib M Rahman
Journal: The Lancet Microbe (2022)
Risk assessment with low-pass whole-genome sequencing of cell-free DNA before CD19 CAR T-cell therapy for large B-cell lymphoma
Authors: Hua-Jay J. Cherng, Ryan Sun, Bryant Sugg, Russell Irwin, Haopeng Yang, Cao Cuong Le, Qing Deng, Luis Fayad, Nathan H. Fowler, Simrit Parmar, Raphael Steiner, Fredrick Hagemeister, Ranjit Nair, Hun Ju Lee, Maria Rodriguez, Felipe Samaniego, Swaminathan P. Iyer, Christopher R. Flowers, Linghua Wang, Loretta J. Nastoupil, Sattva S. Neelapu, Sairah Ahmed, Paolo Strati, Michael R. Green, Jason Westin
Journal: Blood (2022)

Patients with relapsed or refractory large B-cell lymphomas (rrLBCL) can achieve long-term remission after CD19 chimeric antigen receptor T-cell therapy (CART19). However, more than half of recipients will experience treatment failure. Thus, approaches are needed to identify high-risk patients who may benefit from alternative or consolidative therapy. We evaluated low-pass whole-genome sequencing (lpWGS) of cell-free DNA (cfDNA) before CART19 as a new approach for risk stratification. We performed lpWGS on pretreatment plasma samples from 122 patients at time of leukapheresis who received standard-of-care CART19 for rrLBCL to define DNA copy number alterations (CNAs). In multivariable selection, high focal CNA score (FCS) denoting genomic instability was the most significant pretreatment variable associated with inferior 3-month complete response rates (28% vs 56%, P = .0029), progression-free survival (PFS; P = .0007; hazard ratio, 2.11), and overall survival (OS; P = .0026; hazard ratio, 2.10). We identified 34 unique focal CNAs in 108 (89%) patients; of these, deletion 10q23.3 leading to loss of FAS death receptor was the most highly associated with poor outcomes, leading to inferior PFS (P < .0001; hazard ratio, 3.49) and OS (P = .0027; hazard ratio, 2.68). By combining FCS with traditional markers of increased tumor bulk (elevated lactate dehydrogenase and >1 extranodal site), we built a simple risk model that could reliably risk stratify patients. Thus, lpWGS of cfDNA is a minimally invasive assay that could rapidly identify high-risk patients and may guide patient selection for and targeted therapies to evaluate in future clinical trials.
EFFECT OF BLOOD CONTAMINATION ON EUS GUIDED SAMPLING OF BILIO-PANCREATIC MASSES: MULTICENTER STUDY
Authors: M. El-Nady, A. Altonbary, H. Hakim, A. Abou-Elmagd, W. Abbas
Journal: Endoscopy (2022)

Aims Endoscopic ultrasonography (EUS) is an established tool for the detection, staging, sampling and optimal management of pancreatic and hepatobiliary tumors. Sampling of vascular rich lesions may carry increased risk of hemorrhage with its subsequent complications. The present study aimed to evaluate the role of EUS guided sampling of vascular rich pancreatic lesions and demonstration of the effect of blood contamination on accurate diagnosis.
DIGITAL SINGLE-OPERATOR CHOLANGIOSCOPY IN DIAGNOSTIC AND THERAPEUTIC BILIO-PANCREATIC DISEASES: A PROSPECTIVE, MULTICENTER STUDY
Authors: A. Fugazza, R. Gabbiadini, A. Tringali, C. De Angelis, P. Mosca, A. Maurano, R. Di Mitri, M. Manno, A. Mariani, F. Cereatti, H. Bertani, S. Sferrazza, G. Donato, I. Tarantino, L. Cugia, G. Aragona, P. Cantu', A. Mazzocchi, M.L. Canfora, L. Venezia, E. Bendia, L. Maroni, C. Zulli, E. Conte, P. Soriani, D. Ligresti, E. Vilardo, R. Penagini, A. Benedetti, P.G. Arcidiacono, K. Khalaf, E. Troncone, G. Costamagna, A. Repici, A. Anderloni
Journal: Endoscopy (2022)

Aims Digital single-operator cholangioscopy (D-SOC) is an endoscopic procedure that is increasingly used for the management of bilio-pancreatic diseases.
SAFETY INCIDENTS IN ENDOSCOPY – A HUMAN FACTORS ANALYSIS
Authors: S. Ravindran, M. Matharoo, C. Healey, M. Coleman, H. Ashrafian, A. Darzi, S. Thomas-Gibson
Journal: Endoscopy (2022)

Aims Outside of procedural adverse events and complications, there is little understanding of wider patient safety incidents (PSIs) in endoscopy. The aim of this study was to quantify endoscopy PSIs and identify their contributory human factors utilising a national data set.
COLD SNARE POLYPECTOMY (CSP)/COLD EMR (C-EMR) FOR MEDIUM-SIZED (10-19MM) SESSILE COLONIC POLYPS: A PROSPECTIVE MULTICENTRE STUDY
Authors: D. Mangira, S. Raftopoulos, I. Hartley, A. Mack, K. Gazelakis, K. Nalankilli, A. Trinh, A. Metz, M. Appleyard, F. Grimpen, T. Elliott, G. Brown, A. Moss
Journal: Endoscopy (2022)

Aims CSP is the standard of care for resecting small (<10mm) colonic polyps. However, limited data exists for its efficacy for medium-sized (10-19mm) sessile polyps. This study evaluated the efficacy and safety of CSP/C-EMR for medium-sized sessile colonic polyps.
135P Real-time genotyping-based breast cancer risk assessment in MyPeBS, an international randomized trial in the general population comparing risk-stratified to standard breast cancer screening (BCS)
Authors: S. Delaloge, P. Giorgi Rossi, C. Balleyguier, M. Guindy, F.J. Gilbert, J-B. Burrion, M. Roman, S. de Montgolfier, L. Giordano, D. Drubay, D.G. Evans, D. Keatley, E. Gauthier, A. du Bois d'Aische, C. Baron, A. Boland, H. Blanché, D. Couch, J-F. Deleuze, S. Michiels
Journal: Annals of Oncology (2022)
Effectiveness of a COVID-19 Additional Primary or Booster Vaccine Dose in Preventing SARS-CoV-2 Infection Among Nursing Home Residents During Widespread Circulation of the Omicron Variant — United States, February 14–March 27, 2022
Authors: Namrata Prasad, Gordana Derado, Srinivas Acharya Nanduri, Hannah E. Reses, Heather Dubendris, Emily Wong, Minn Minn Soe, Qunna Li, Philip Dollard, Suparna Bagchi, Jonathan Edwards, Nong Shang, Dan Budnitz, Jeneita Bell, Jennifer R. Verani, Andrea Benin, Ruth Link-Gelles, John Jernigan, Tamara Pilishvili
Journal: MMWR Morbidity and Mortality Weekly Report (2022)

Nursing home residents have experienced disproportionally high levels of COVID-19-associated morbidity and mortality and were prioritized for early COVID-19 vaccination (1). Following reported declines in vaccine-induced immunity after primary series vaccination, defined as receipt of 2 primary doses of an mRNA vaccine (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) or 1 primary dose of Ad26.COV2 (Johnson & Johnson [Janssen]) vaccine (2), CDC recommended that all persons aged ≥12 years receive a COVID-19 booster vaccine dose.* Moderately to severely immunocompromised persons, a group that includes many nursing home residents, are also recommended to receive an additional primary COVID-19 vaccine dose.† Data on vaccine effectiveness (VE) of an additional primary or booster dose against infection with SARS-CoV-2 (the virus that causes COVID-19) among nursing home residents are limited, especially against the highly transmissible B.1.1.529 and BA.2 (Omicron) variants. Weekly COVID-19 surveillance and vaccination coverage data among nursing home residents, reported by skilled nursing facilities (SNFs) to CDC's National Healthcare Safety Network (NHSN)§ during February 14-March 27, 2022, when the Omicron variant accounted for >99% of sequenced isolates, were analyzed to estimate relative VE against infection for any COVID-19 additional primary or booster dose compared with primary series vaccination. After adjusting for calendar week and variability across SNFs, relative VE of a COVID-19 additional primary or booster dose was 46.9% (95% CI = 44.8%-48.9%). These findings indicate that among nursing home residents, COVID-19 additional primary or booster doses provide greater protection against Omicron variant infection than does primary series vaccination alone. All immunocompromised nursing home residents should receive an additional primary dose, and all nursing home residents should receive a booster dose, when eligible, to protect against COVID-19. Efforts to keep nursing home residents up to date with vaccination should be implemented in conjunction with other COVID-19 prevention strategies, including testing and vaccination of nursing home staff members and visitors.
ENDOSCOPIC SPECTRUM OF ISCHEMIC COLITIS
Authors: K. Mönkemüller, A. Martínez-Alcalá
Journal: Endoscopy (2022)

The endoscopic spectrum of ischemic colitis is broad. Key elements are sparing of the rectum and segmental distribution, mainly in the left colon (at the arc of Riolan). In mild ischemic colitis there is segmentally distributed patchy erythema, edema and subepithelial hemorrhages. In moderate colitis, in addition to changes seen in mild disease, there are localized erosions and ulcers, which may be confluent. Often, a linear ulcer in the mesenteric border of the colon is seen, known as colon single strip sign or Zuckerman’s sign. In severe colitis there are deep ulcers, luminal narrowing and strictures and frank necrosis.
ENDOSCOPIC EXTRACTION OF 80 COMMON BILE DUCT (CBD) STONES
Authors: I. Ferchichi, A. Khsiba, K. Ben Abdallah, M. Mahmoudi, A. Ben Mohamed, M. Yakoubi, M. Medhioub, M.L. Hamzaoui, M.M. Azouz
Journal: Endoscopy (2022)

Most common bile duct (CBD) stones can be removed with standard techniques using endoscopic retrograde cholangiopancreatography (ERCP), but in some cases CBD stones cannot be extracted using standard techniques, which are termed as “difficult stones.” One of the properties of difficult stones is a number of stones>3. We hereby report the case of an endoscopic extraction of 80 CBD stones. After CBD cannulation, sphincterotomy was performed with an endoscopic sphincterotome placed using a guidewire. Balloon dilation was performed. Then, Existing stones (80 stones) were extracted with an extraction balloon, and biliary clearance was confirmed by injecting radio-contrast
Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study
Authors: Mika Kivimäki, Timo Strandberg, Jaana Pentti, Solja T Nyberg, Philipp Frank, Markus Jokela, Jenni Ervasti, Sakari B Suominen, Jussi Vahtera, Pyry N Sipilä, Joni V Lindbohm, Jane E Ferrie
Journal: The Lancet Diabetes & Endocrinology (2022)

The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases).
Acute cholangitis after over-the-scope clip placement involving the duodenal papilla that was rescued by antegrade stenting via the percutaneous transhepatic biliary drainage route
Authors: Kosuke Iwano, Haruka Toyonaga, Tsuyoshi Hayashi, Tatsuya Ishii, Toshifumi Kin, Kuniyuki Takahashi, Akio Katanuma
Journal: Endoscopy (2022)

The over-the-scope (OTS) clip (Ovesco Endoscopy, Tübingen, Germany) has been developed and is widely used for the treatment of gastrointestinal perforations and fistulas [1]. However, when the perforation or fistula is located near the duodenal papilla, the use of OTS clips poses a potential risk of acute obstructive cholangitis or pancreatitis from involvement of the papilla [2]. Herein, we report a case of acute cholangitis after OTS clip placement involving the duodenal papilla, which was rescued by antegrade stenting via the percutaneous transhepatic biliary drainage (PTBD) route.
SOME ENDOSCOPIC TECHNICAL MODIFICATIONS IN THE TREATMENT OF ZENKER'S DIVERTICULUM
Authors: J. Espinel, E. Pinedo
Journal: Endoscopy (2022)

The original diverticuloscope has a 4 cm long esophageal flap and, a 2.5 cm long diverticular flap. Instead, on purpose, the length of the diverticular flap is reduced from 2.5 cm to 1 cm long through a manual semicircular cut. Thus, we achieve a progressive exposure of the septum, regardless of the size of the ZD.
REAL-TIME COMPUTER-AIDED DIAGNOSIS SYSTEM FOR OPTICAL DIAGNOSIS OF DIMINUTIVE COLORECTAL POLYPS INCLUDING SESSILE SERRATED LESIONS: A PROSPECTIVE, MULTICENTER STUDY WITH BENCHMARKING AGAINST SCREENING ENDOSCOPISTS
Authors: B.B. Houwen, Y. Hazewinkel, I. Giotis, J.L. Vleugels, N.S. Mostafavi, P. van Putten, P. Fockens, E. Dekker
Journal: Endoscopy (2022)

Aims We aimed to develop and validate a robust computer-aided diagnosis (CAD) system, designed to use in real-time colonoscopy, to improve the accuracy of endoscopic characterization of diminutive polyps, including sessile serrated lesions (SSLs).
AUTOMATIC TEXTUAL DESCRIPTION OF COLORECTAL POLYP FEATURES: EXPLAINABLE ARTIFICIAL INTELLIGENCE BASED ON THE BASIC CLASSIFICATION
Authors: A. Thijssen, R.-M. Schreuder, R. Fonollà, Q.E. van der Zander, T. Scheeve, S. Subramaniam, P. Bhandari, P.H. de With, A.A. Masclee, F. van der Sommen, E.J. Schoon
Journal: Endoscopy (2022)

Aims Computer-aided diagnosis (CADx-)systems could improve optical diagnosis of colorectal polyps (CRPs) by endoscopists. For integration into clinical practice, better understanding of artificial intelligence (AI) is needed. A branch of deep learning and explainable AI is automatically generating textual descriptions from images to improve understanding. We aimed to develop a CADx-system generating automatic textual descriptions for CRPs based on Blue Light Imaging (BLI) Adenoma Serrated International Classification (BASIC)[1].
87P EPClin vs OncotypeDx in invasive lobular cancer (ILC)
Authors: I. Leao, E. Zamora, P. Gomez Pardo, M.A. Arumi de Dios, I. Pimentel, S. Escriva de Romani, C. Ortiz Velez, M. Cruellas Lapena, L. Sanz, M. Borrell, K.S. Vega Cano, D. Gómez-Puerto, J. De La Torre, M. Espinosa-Bravo, M. Oliveira, R. Fasani, P.G. Nuciforo, C. Saura, V. Peg, M. Bellet
Journal: Annals of Oncology (2022)
PROXIMAL SERRATED POLYP DETECTION RATE IS ASSOCIATED WITH REDUCED RISK FOR CRC MORTALITY IN SCREENING PATIENTS
Authors: J. Zessner-Spitzenberg, E. Waldmann, L. Jiricka, L.-M. Rockenbauer, A. Hinterberger, B. Majcher, M. Trauner, M. Ferlitsch
Journal: Endoscopy (2022)

Aims Patients with serrated polyps (SP) are at increased risk for colorectal cancer (CRC), however, evidence for a dedicated SP detection rate is lacking. The aim of this study was to investigate whether screening patients with low PSDR endoscopists are at increased risk for CRC mortality.
A DIFFICULT Z-POEM DUE TO SEVERE FIBROSIS WAS AIDED BY A PARTIAL SEPTOTOMY WITH AN SB KNIFE AND COMPLETED WITH THE Z-POEM TECHNIQUE
Authors: M. Lajin
Journal: Endoscopy (2022)

A 60-year-old male presented with dysphagia and was found to have a 3 cm Zenker diverticulum. He was referred for endoscopic treatment.
Strategic Opportunities to Improve Stroke Systems of Care
Authors: Kori S. Zachrison, Lee H. Schwamm
Journal: JAMA (2022)

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EUS GUIDED COIL EMBOLIZATION FOR SAFE AND EFFECTIVE TREATMENT OF A LARGE SPLENIC ARTERY PSEUDOANEURYSM
Authors: H. Gadhikar, A. Gandhi, J. Ansari, H. Raina, T. Nikumbh, A. Bapaye
Journal: Endoscopy (2022)

34-y-male,CCP; Presentation–on-off melena for 3 weeks;symptomatic anemia requiring blood transfusions. EGD–failed bleed localization;CECT–large(40mm)splenic artery pseudoaneurysm(SAA)+adjacent peri-pancreatic fluid collection(PFC). Multi-disciplinary decision–EUS guided coil embolization planned.Procedure–left lateral; propofol sedation;prophylactic ceftriaxone;Linear EUS–SAA with surrounding PFC,trans-gastric puncture using 19G needle without stylet under doppler control–three coils (10mm,8mm,5mm) deployed, Doppler-confirmed complete flow obliteration. Ultrasound Doppler after 48hours–complete obliteration of SAA flow.Oral diet resumed after 24 hours.No further bleed. Hemoglobin–stable;No further need of transfusions.Discharged 3 days later.Asymptomatic at 3-month follow up. This minimally invasive approach can be a suitable alternative to more invasive interventional radiological/surgical approach.
M6A-mediated upregulation of circMDK promotes tumorigenesis and acts as a nanotherapeutic target in hepatocellular carcinoma
Authors: Ashuai Du, Shiqin Li, Yuzheng Zhou, Cyrollah Disoma, Yujie Liao, Yongxing Zhang, Zongpeng Chen, Qinglong Yang, Pinjia Liu, Sixu Liu, Zijun Dong, Aroona Razzaq, Siyi Tao, Xuan Chen, Yuxin Liu, Lunan Xu, Qianjun Zhang, Shanni Li, Jian Peng, Zanxian Xia
Journal: Molecular Cancer (2022)

Abstract Background Emerging evidence suggest the critical role of circular RNAs (circRNAs) in disease development especially in various cancers. However, the oncogenic role of circRNAs in hepatocellular carcinoma (HCC) is still largely unknown. Methods RNA sequencing was performed to identify significantly upregulated circRNAs in paired HCC tissues and non-tumor tissues. CCK-8 assay, colony formation, transwell, and xenograft mouse models were used to investigate the role of circRNAs in HCC proliferation and metastasis. Small interfering RNA (siRNA) was used to silence gene expression. RNA immunoprecipitation, biotin pull-down, RNA pull-down, luciferase reporter assay and western blot were used to explore the underlying molecular mechanisms. Results Hsa_circ_0095868 , derived from exon 5 of the MDK gene (named circMDK), was identified as a new oncogenic circRNA that was significantly upregulated in HCC. The upregulation of circMDK was associated with the modification of N6-methyladenosine (m 6 A) and poor survival in HCC patients. Mechanistically, circMDK sponged miR-346 and miR-874-3p to upregulate ATG16L1 (Autophagy Related 16 Like 1), resulting to the activation of PI3K/AKT/mTOR signaling pathway to promote cell proliferation, migration and invasion. Poly (β-amino esters) (PAEs) were synthesized to assist the delivery of circMDK siRNA (PAE-siRNA), which effectively inhibited tumor progression without obvious adverse effects in four liver tumor models including subcutaneous, metastatic, orthotopic and patient-derived xenograft (PDX) models. Conclusions CircMDK could serve as a potential tumor biomarker that promotes the progression of HCC via the miR-346/874-3p-ATG16L1 axis. The PAE-based delivery of siRNA improved the stability and efficiency of siRNA targeting circMDK. The PAE-siRNA nanoparticles effectively inhibited HCC proliferation and metastasis in vivo. Our current findings offer a promising nanotherapeutic strategy for the treatment of HCC. Graphical Abstract
NEWLY TRAINED ENDOSCOPISTS PERFORM HIGH QUALITY SCREENING COLONOSCOPIES AFTER INTENSIVE TRAINING AND EVEN OUTPERFORM EXPERIENCED GASTROENTEROLOGY CONSULTANTS
Authors: A.L. Schult, E. Botteri, G. Hoff, Ø. Holme, B. Seip, K.R. Randel, O. Darre-Næss, T. Owen, J.A. Nilsen, D.H. Nguyen, K. Johansen, T. de Lange
Journal: Endoscopy (2022)

Aims High quality performance is essential for patient outcome. The need for colonoscopies is increasing and new endoscopists need to be trained. Most endoscopy trainees are considered colonoscopy competent after 275 procedures. The aim of this study was to investigate whether trainees then achieve similar quality as gastroenterologist consultants.
COMPARING OUTCOMES OF ERCP UNDER CONSCIOUS SEDATION TO GENERAL ANESTHESIA
Authors: A. Bak, B. Parker, V.C. Nguyen, K. Harding, J. Perren, B. Yee, W. Richardson, M. Grey, G. Greaves, R. Perini
Journal: Endoscopy (2022)

Aims In Canada, ERCP performed under conscious sedation (CS) is the standard of care but is limited by patient movement and agitation, especially in the context of lengthy or technically complex cases. General anesthesia (GA) may optimize patient comfort and safety while reducing complications such as pancreatitis, perforation, and mortality. In October 2017, Kelowna General Hospital (KGH), in British Columbia, Canada, transitioned the standard anesthesia modality for ERCP from CS to GA. This study investigated differences in complications and patient outcomes for ERCP performed under CS (n=1334) before the practice change compared to GA (n=899) after the practice change.
TREATMENT OF A IATROGENIC PERFORATION OF A COLORECTAL ANASTOMOTIC STRICTURE USING A LUMEN APPOSING METAL STENT (LAMS) RELEASED WITHOUT EUS
Authors: T. Togliani, S. Pilati
Journal: Endoscopy (2022)

Aims LAMS are generally applied under EUS guide to treat pancreatic fluid collections, to drain the gallbladder or the common bile duct, to create gastro-entero anastomoses. The aim of this case report was to assess the possibility to release a LAMS during colonoscopy, without the EUS guide, in case of a iatrogenic perforation after a balloon dilation of a stenotic colorectal anastomosis.
PANCREATIC PLASMACYTOMA: INCIDENTAL DIAGNOSIS DURING EUS STAGING
Authors: B. Agudo, M. González-Haba, A. Martins, E. Tejerina, A. Herreros de Tejada
Journal: Endoscopy (2022)

A 75-year-old man underwent staging EUS for early esophageal neoplasia. A 20 mm heterogeneous mass in the pancreatic body was found, with non-diagnostic fine needle biopsy (FNB). MRI showed a 60 mm mass, suggestive of neuroendocrine tumour or lymphoproliferative process. Repeated EUS tissue acquisition demonstrated cells CD138+and kappa light chain. Multiple myeloma was ruled out. Finally, diagnosis of primary pancreatic plasmacytoma (PPP) was made and radiotherapy was started with a good response.