The detection of pancreatic cystic lesions (PCLs) has significantly increased over the past twenty years, mainly due to the widespread use of high-resolution cross-sectional imaging. Among these lesions, intraductal papillary mucinous neoplasms (IPMNs) have become one of the most clinically important entities because they serve as macroscopic precursors in the multistep process leading to pancreatic ductal adenocarcinoma. Their importance stems from their broad biological diversity: while some IPMNs, especially main-duct or mixed-type lesions, carry a high risk of high-grade dysplasia or invasive cancer, most small branch-duct lesions remain stable on imaging over time and may never progress. Over the past decade, international guidelines and more advanced clinical evidence have improved algorithms for risk assessment, monitoring and surgical decisions. Recent research has enhanced our understanding of their long-term natural history, clarified the balance between careful monitoring and unnecessary surveillance, and introduced personalized models that consider cyst stability, growth rate, age, overall health, and economic factors. This review combines current evidence on the epidemiology, pathology, diagnosis, natural progression, monitoring strategies, surgical results, prognostic differences among IPMN subtypes and suggests a modern approach for personalized, value-based care.

Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease that, if untreated or inadequately treated, may progress to advanced fibrosis, cirrhosis, and liver-related complications. Although ursodeoxycholic acid (UDCA) remains the cornerstone of first-line therapy and improves transplant-free survival, an important proportion of patients show an inadequate biochemical response, and many continue to experience substantial symptoms, particularly pruritus and fatigue, with a major impact on quality of life. In recent years, the therapeutic landscape of PBC has evolved following the withdrawal of obeticholic acid and the availability of selective PPAR agonists, including elafibranor and seladelpar. At the same time, disease management has shifted beyond a dichotomous definition of biochemical response toward a risk-based and holistic approach integrating biochemical response, fibrosis stage, liver stiffness, and patient-reported outcomes. Therapeutic targets should be individualized according to age, disease stage, symptom burden, and risk of progression, distinguishing between "adequate" and "complete" biochemical response and supporting earlier treatment escalation in high-risk and symptomatic patients. This updated AISF guidance provides an evidence-based framework for PBC management in 2026 and beyond, reviewing therapeutic goals, response criteria, second-line therapies, and management in specific settings, including cirrhosis, pregnancy, variant syndromes, and metabolic comorbidities, emphasizing a patient-centred approach and highlighting unmet needs and future directions.