Guido Costamagna

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas is an extremely rare malignancy with nonspecific radiological features, often requiring histological confirmation. We report the case of a 57-year-old woman presenting with abdominal pain and cholestasis, in whom imaging revealed a pancreatic head mass. After an initial nondiagnostic endoscopic ultrasound sampling, endoscopic ultrasound–guided fine-needle biopsy performed at our tertiary referral center allowed definitive diagnosis by identifying characteristic osteoclast-like giant cells and undifferentiated neoplastic cells with a specific immunohistochemical profile. This case highlights the key role of endoscopic ultrasound–guided fine-needle biopsy in the preoperative diagnosis of undifferentiated carcinoma with osteoclast-like giant cells.

Introduction Fluid-filled intragastric balloon (FF-IGB) placement is an endoscopic bariatric procedure that effectively achieves short-term weight loss in patients affected by obesity. Comparative data among different balloon volumes are lacking. This study aimed to assess efficacy and safety of FF-IGB at different volumes. Methods A randomized single-center analysis over 156 patients undergoing FF-IGB at a volume of 500 ml, 600 ml, or 700 ml with 6-month follow-up was conducted. Outcomes included postprocedural adverse events (AEs), early device removal for intolerance, evaluation of percentage of total weight loss (TWL%), excess weight loss (EWL%), and quality of life (QoL) at 6-month follow-up. Results The mean age of our cohort was 46.2 years, and 69.2% were female. The mean BMI was 41.9 kg/m². Pain was the main adverse event being detected in 78.3% patients, followed by nausea (76.8%), and vomiting (50.7%). No serious AEs were reported. Ten patients required early balloon removal for epigastric pain, nausea, and vomiting. The FF-IGB volume was not associated with nausea (p = 0.657), vomiting (p = 0.487), pain (p = 0.182), or early removal (p = 0.988). Decrease in body mass index (BMI) after 6 months was significant (mean BMI 35.24 kg/m², SD 7.17, p < 0.001). Mean TWL% after 6 months was 14.16. No significant difference between the FF-IGB volume and TWL% (p = 0.412) was detected. At 6 months follow-up, the mean EWL% was 30.8 ± 23.3 with no differences among the three groups of different FF-IGB volumes (p = 0.733). A significant improvement of QoL was detected at 6 months unrelated to the FF-IGB volume (p = 0.849). Conclusion FF-IGB placement resulted in significant weight loss over a 6-month period. No differences in TWL%, EWL%, rate of AEs, percentage of early device removal, and QoL were detected among the three groups with a different IGB volume. A 500 ml filling volume could be “the magic number” as no significant benefits are achieved with a greater volume. Key Points • Fluid-filled intragastric balloon (FF-IGB) placement effectively achieves short-term weight loss in patients affected by obesity, but comparative data among different balloon volumes are lacking. • Weight-loss outcomes, adverse-event rates, and quality-of-life gains were identical across 500 ml, 600 ml, and 700 ml balloon volumes. • A 500 ml filling volume for fluid-filled intragastric balloons could be “the magic number,” as larger volumes confer no additional benefit.