Advances in endoscopic ultrasound for autoimmune pancreatitis: Tissue acquisition, imaging innovations, artificial intelligence, and multidisciplinary integrations

Journal article

Autoimmune pancreatitis (AIP) is an immune-mediated inflammatory condition of the pancreas that can be difficult to differentiate from pancreatic malignancy and therefore remains challenging to diagnose. Type 1 AIP is the pancreatic manifestation of immunoglobulin G subclass 4-related disease and can be associated with other systemic fibro-inflammatory conditions. Type 2 AIP is characterised histologically by granulocytic epithelial lesions and is frequently associated with inflammatory bowel disease. Over the previous years, endoscopic ultrasound (EUS) has become an important part of the diagnostic work-up of patients presenting with suspected AIP, particularly when imaging studies demonstrate focal pancreatic enlargement, or a mass-like lesion. Recent advances in EUS imaging, including contrast-enhanced harmonic EUS and EUS elastography, may improve characterisation of the pancreatic lesion and help distinguish an inflammatory pancreatic process from a pancreatic malignancy. Moreover, EUS-guided tissue acquisition plays an important role in this context by allowing histological assessment of the lesion and hence helping exclude a malignancy. EUS-guided fine-needle biopsy is currently the preferred tissue acquisition technique, as it allows the preservation of tissue architecture, which helps facilitate the diagnosis of AIP. A multidisciplinary approach involving a panel of specialists in hepatopancreatobiliary endoscopy, hepatology, rheumatology, radiology, cardiology, nephrology, and histopathology is valuable for integrating the different components of the diagnostic work-up and guiding subsequent management. Finally, emerging artificial intelligence algorithms for EUS may support the diagnostic process and facilitate recognition of AIP. This review discusses current and emerging EUS techniques, tissue acquisition options, safety considerations, multidisciplinary integration and the potential role of artificial intelligence in the diagnosis and management of AIP.

Authors: Braimakis, I; Fateen, W; Bekkali, NLH; Bailey, A; Culver, EL

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Baishideng Publishing Group
• Journal: World Journal of Gastrointestinal Endoscopy More from this journal
• Volume: 18
• Issue: 10
• Article number: 127148
• Publication date: 2026-10-13
• DOI: 10.4253/wjge.127148
• EISSN: 1948-5190
• ISSN: 1948-5190
• Language: English
• Keywords: type 2 autoimmune pancreatitis; type 1 autoimmune pancreatitis; granulocytic epithelial lesions; multidisciplinary diagnosis; inflammatory bowel disease; EUS elastography; EUS-guided fine-needle biopsy; contrast-enhanced harmonic EUS; endoscopic ultrasound; autoimmune pancreatitis