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In patients with localized high\u2010grade pancreatic intraepithelial neoplasia (HG\u2010PanIN), whose tumorous lesion is undetectable on cross\u2010sectional images such as computed tomography or magnetic resonance image, long\u2010term survival is expected. Pancreatic cystic lesions or main pancreatic duct (MPD) dilatation are important indirect findings for the initial diagnosis of HG\u2010PanIN. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) should play important roles in detecting abnormal image findings, such as local irregular MPD stenosis, caliber MPD changes, small cystic lesions, or branch duct dilatation. Additionally, EUS could detect hypoechoic areas around the MPD stenosis in some patients with HG\u2010PanIN. Subsequently, endoscopic retrograde cholangiopancreatography (ERCP) and its associated pancreatic juice cytology, including serial pancreatic juice aspiration cytologic examination (SPACE) after placement of an endoscopic nasopancreatic drainage (ENPD) tube, may have high diagnostic accuracy for confirming the malignancy in HG\u2010PanIN. Although ERCP and its associated pancreatic cytology, including SPACE, may be associated with post\u2010ERCP pancreatitis (PEP), a recent randomized trial suggested that a 4\u2010Fr ENPD tube may reduce the incidence of PEP. In the future, further prospective multicenter studies are required to establish a standard method of SPACE. Additionally, further studies for novel biomarkers could help to establish evolutionary methods with duodenal fluid and pancreatic juice for the early and accurate diagnosis of early\u2010stage PDAC.<\/jats:p>","DOI":"10.1111\/den.14240","type":"journal-article","created":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T01:16:10Z","timestamp":1642641370000},"page":"927-937","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Endoscopic approach in the diagnosis of high\u2010grade pancreatic intraepithelial neoplasia"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3196-8551","authenticated-orcid":false,"given":"Keiji","family":"Hanada","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Onomichi General Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Onomichi General Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Kurihara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Onomichi General Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morito","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Onomichi General Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Onomichi General Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Okuda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Onomichi General Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susumu","family":"Tazuma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Onomichi General Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,2,14]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199202133260706"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)05523-7"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpath.2018.10.004"},{"key":"e_1_2_14_5_1","first-page":"307","volume-title":"WHO Classification of Tumours of the Digestive System","author":"Basturk O","year":"2019"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000126675.59108.80"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0b013e318258055c"},{"key":"e_1_2_14_8_1","volume-title":"Classification of Pancreatic Carcinoma","author":"Japan Pancreas Society","year":"2017"},{"key":"e_1_2_14_9_1","unstructured":"American Cancer Society.Pancreatic cancer early detection diagnosis and staging [Internet]. 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