Pancreatic cyst dilemma: Between physical and biochemical markers

doi:10.3748/wjg.v27.i41.7207

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Nov 7, 2021 (publication date) through Feb 23, 2026

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World Journal of Gastroenterology

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1007-9327

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Letter to the Editor

World J Gastroenterol. Nov 7, 2021; 27(41): 7207-7209
Published online Nov 7, 2021. doi: 10.3748/wjg.v27.i41.7207

Pancreatic cyst dilemma: Between physical and biochemical markers

Iyad Khamaysi, Eyal Zussman

Iyad Khamaysi, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel

Iyad Khamaysi, Department of Gastroenterology, Rambam Health Care Campus, Haifa 3109601, Israel

Eyal Zussman, NanoEngineering Group, Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, Haifa 3109601, Israel

Author contributions: Khamaysi I designed and wrote the letter; and Eyal Zussman revised the letter; the manuscript has been read and approved by all the authors.

Conflict-of-interest statement: The authors declare no conflicts of interest.

Corresponding author: Iyad Khamaysi, MD, Assistant Professor, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, POB 9602, Haifa 3109601, Israel. k_iyad@rmc.gov.il

Received: June 6, 2021
Peer-review started: June 6, 2021
First decision: June 30, 2021
Revised: July 1, 2021
Accepted: September 30, 2021
Article in press: September 30, 2021
Published online: November 7, 2021
Processing time: 152 Days and 14.1 Hours

Abstract

Physical analysis of the pancreatic cystic lesions (PCLs) fluid as expressed by the rheological behavior (“string sign”) can improve the diagnostic yield and should be integrated in every multimodal PCLs workup.

Keywords: Pancreatic cyst; Fluid analysis; String sign; Rheology

Core Tip: No single optimal test reliably determines the pancreatic cyst subtype including all imaging modalities and biochemical fluid analysis. Physical analysis of the fluid as expressed by the string sign can improve the diagnostic yield and should be integrated in every multimodal pancreatic cystic lesions workup. The string sign as it is currently performed, suffers from significant shortcoming due to its subjective nature. Rheological (physical) properties, instead, can overcome the disadvantages of the standard string sign and replace it in clinical practice.