Letter to the Editor
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
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
Core Tip

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.