Published online Dec 28, 2022. doi: 10.3748/wjg.v28.i48.6867
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
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.
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.