Evidence map›Paper›PMID 40729532›Full record

GuidelineUnited European gastroenterology journal2025

The Brescia International Multidisciplinary Consensus Guidelines on the Optimal Pathology Assessment and Multidisciplinary Pathways of Non-Pancreatic Neoplasms in and Around the Ampulla of Vater (PERIPAN).

Mohammad Abu Hilal, Bas A Uijterwijk, Daniël H L Lemmers, Boris V Janssen, Marc G Besselink, Denise Bianchi, Arantza Fariña, Noriyoshi Fukushima, Anthony J Gill, Seung-Mo Hong and 46 more

Abstract readPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in United European gastroenterology journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Article
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

56 authors.

Mohammad Abu HilalDepartment of Surgery, School of Medicine, The University of Jordan, Amman, Jordan.
Bas A UijterwijkAmsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, the Netherlands.ORCID https://orcid.org/0000-0003-2479-2092
Daniël H L LemmersAmsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, the Netherlands.
Boris V JanssenAmsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, the Netherlands.
Marc G BesselinkAmsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, the Netherlands.ORCID https://orcid.org/0000-0003-2650-9350
Denise BianchiDepartment of Pathology, Fondazione Poliambulanza, Brescia, Italy.
Arantza FariñaCancer Center Amsterdam, Amsterdam, the Netherlands.
Noriyoshi FukushimaDepartment of Pathology, Jichi Medical University, Shimotsuke, Japan.
Anthony J GillSydney Medical School, University of Sydney, Sydney, Australia.
Seung-Mo HongDepartment of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Alyssa KrasinskasDepartment of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA.
Claudio LuchiniDepartment of Pathology and Diagnostics, University of Verona, Verona, Italy.
Laura MelocchiDepartment of Pathology, Fondazione Poliambulanza, Brescia, Italy.
Giulio RossiDepartment of Pathology, Fondazione Poliambulanza, Brescia, Italy.
Aldo ScarpaDepartment of Pathology and Diagnostics, University of Verona, Verona, Italy.
Olca BasturkDepartment of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Deyali ChatterjeeDepartment of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Angela ChouSydney Medical School, University of Sydney, Sydney, Australia.
Irene EspositoInstitute of Pathology, Medical Faculty of Heinrich Heine University Düsseldorf, University Hospital Düsseldorf, Düsseldorf, Germany.
Roger FeakinsDepartment of Cellular Pathology, Royal Free Hospital, London, UK.
Bas Groot KoerkampDepartment of Surgery, Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Ralph H HrubanDepartment of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Stefano La RosaUnit of Pathology, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy.ORCID https://orcid.org/0000-0003-1941-2403
Chanjuan ShiDepartment of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
Aatur SinghiDepartment of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Joanne VerheijDepartment of Pathology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
Huamin WangDepartment of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Sergio AlfieriDigestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Fabio AusaniaHospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Adnan AlseidiDepartment of Surgery, University of California, San Francisco, California, USA.
Marco J BrunoDepartment of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, the Netherlands.
Ugo BoggiDepartment of Surgery, University of Pisa, Pisa, Italy.
Claudio BnàDepartment of Radiology, Fondazione Poliambulanza, Brescia, Italy.
Christos DervenisDepartment of Surgery, Medical School, University of Cyprus, Nicosia, Greece.
Massimo FalconiDepartment of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Michele GhidiniDepartment of Medical Oncology, Policlinico di Milano, Fondazione IRCCS Ca' Granda, Milano, Italy.
Jakob W KistAmsterdam UMC, Department of Radiology, Location University of Amsterdam, Amsterdam, the Netherlands.
Giovanni MarchegianiHepato Pancreato Biliary and Liver Transplant Surgery, Department of Surgery, Oncology and Gastroenterology (DiSCOG), Padua University, Padova, Italy.ORCID https://orcid.org/0000-0002-6824-4533
Michele MilellaDepartment of Medical Oncology, University and Hospital Trust of Verona, Verona, Italy.
Roberto SalviaDepartment of General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
Ajith SiriwardenaDepartment of Surgery, Manchester Royal Infirmary, Manchester, UK.
Hanneke WilminkDepartment of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Alberto ZaniboniDepartment of Medical Oncology, Fondazione Poliambulanza, Brescia, Italy.
Shaimaa Al-JanabiDepartment of Pathology, Jichi Medical University, Shimotsuke, Japan.
Maia Blomhoff HolmDepartment of Pathology, University of Oslo and Oslo University Hospital, Oslo, Norway.
Eva RoosDepartment of Pathology, Jichi Medical University, Shimotsuke, Japan.
Naoki SanoDepartment of Pathology, Jichi Medical University, Shimotsuke, Japan.
In Hye SongDepartment of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.ORCID https://orcid.org/0000-0001-6325-3548
Zeynep TarcanDepartment of Pathology, Koç University Hospital and Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey.
Gianpaolo BalzanoDepartment of General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
Isabella FrigerioDepartment of Surgery, Pederzoli Hospital, Peschiera del Garda, Italy.
Alfredo GuglielmiDepartment of General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
Giuseppe MalleoDepartment of General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
Horacio AsbunDivision of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA.
Volkan AdsayDepartment of Pathology, Koç University Hospital and Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey.
Caroline VerbekeDepartment of Pathology, University of Oslo and Oslo University Hospital, Oslo, Norway.

Funding

Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The NetherlandsAssociazione Italiana per la Ricerca sul Cancro AIRC IG 25864Associazione Italiana per la Ricerca sul Cancro AIRC IG 26343
6 · The paper itself

Abstract

importanceThe lack of multidisciplinary workflow guidelines and clear definitions and classifications for neoplasms in and around the ampulla of Vater results in inconsistencies affecting patient care and research.

objectiveThe PERIPAN international multidisciplinary consensus group aimed to standardize the multidisciplinary diagnostic workflow and achieve consensus on definitions and classifications in order to ensure proper classification and optimal diagnostic assessment and consequently to improve patient care and future research.

designAn international team of 43 experts (pathologists, surgeons, radiologists, gastroenterologists, oncologists) from 12 countries identified knowledge gaps, reviewed 37061 articles, and proposed recommendations using the Scottish Intercollegiate Guidelines Network methodology (SIGN), including the Delphi methodology and the AGREEII tool for quality assessment and external validation.

resultsThe 38 consensus questions and 51 recommendations provide guidance on the following key aspects: I. More specific anatomic criteria for the definition of what qualifies as "ampullary" neoplasms, their distinction from duodenal and common bile duct tumors, and clinicopathologic characteristics of anatomic subsets; II. Avoidance of the confusing term "periampullary" for final classification; III. Refined definitions of intestinal, pancreatobiliary and mixed subtypes, and introduction of rare histologic subtypes; IV. The use and limitations of immunohistochemical and molecular profiling; V. Biopsy acquisition; VI. Clinical information required for accurate pathology assessment of biopsies and ampullectomy specimens; VII. Key items to be included in pathology reports of endoscopic specimens. CONCLUSIONS AND RELEVANCE: Recognition of the Brescia PERIPAN guidelines will allow a more accurate classification of true ampullary cancers and their differentiation from other "periampullary" tumors. This will have significant implications for endoscopic interpretation and management, staging, pathologic diagnosis and therapeutic evaluation as well as oncologic treatment of various anatomic and histologic subsets of ampullary tumors. This will enhance the quality of both clinical care and future research in this complex medical field.

Indexed as

Ampulla of VaterCommon Bile Duct NeoplasmsDuodenal NeoplasmsConsensusDelphi TechniqueHumansampulla of Vaterbile duct tumorclassificationconsensusduodenal tumorguidelinesneoplasmpancreatobiliaryperiampullary

Identifiers

PMID40729532
PMCPMC12463731

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