106 Management of Branched Duct Intraductal Papillary Mucinous Neoplasms: a Large Single Center Study to Assess Predictors of Malignancy and Recurrence on Long Term Follow-Up

Ridtitid, Wiriyaporn; Schmidt, C. Max; DeWitt, John M.; Roch, Alexandra M.; Stuart, Jennifer S.; Sherman, Stuart; Al‐Haddad, Mohammad

doi:10.1016/j.gie.2015.03.012

Cited by 2 publications

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“…A retrospective study of 364 patients with branch‐duct (BD) IPMN attempted to identify predictors of malignancy and recurrence at long‐term follow up . In this study, 135 of 364 patients underwent surgical resection and 229 underwent imaging surveillance.…”

Section: Evaluation and Treatment Of Pancreatic Cyst Lesionsmentioning

confidence: 99%

“…Second, although some cysts do become malignant, we are not doing an optimal job at identifying and surveying the correct lesions . EUS morphology, cytology and markers that we currently use appear to lack sensitivity and accuracy . Third, some patients who are triaged to no surveillance because of low‐risk EUS morphology or cyst fluid characteristics may, at a later time, progress to malignant cysts.…”

Section: Evaluation and Treatment Of Pancreatic Cyst Lesionsmentioning

confidence: 99%

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Digestive Disease Week (DDW) 2015: Pancreaticobiliary update

Varadarajulu

Bang

2015

Digestive Endoscopy

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This update critiques the key abstracts relevant to endoscopic evaluation or interventions in pancreatic and biliary diseases that were presented at Digestive Disease Week (DDW) 2015. We selected 20 abstracts based on their clinical significance, relevance to endoscopic practice and impact on patient management Key words: biliary drainage, endoscopic retrograde cholangio pancreatography (ERCP), endoscopic ultrasonography (EUS), interventional EUS, pancreatic cysts EVALUATION AND TREATMENT OF PANCRE-ATIC CYST LESIONS S EVERAL ABSTRACTS WERE presented on the endoscopic evaluation and treatment of pancreatic cyst lesions. In a retrospective study of 321 patients with pancreatic cyst lesions who were followed for a mean duration of 31 months, only 10 patients were referred for surgery.1 In eight of 10 patients, the presumed diagnosis was found to be correct at surgery and no disease progression was found in any patient at follow up.In another study of 535 asymptomatic high-risk patients with intraductal papillary mucinous neoplasm (IPMN) who either had pancreatic cysts >5 mm or dilated main pancreatic duct >2.5 mm in diameter, surveillance was undertaken using pancreatic protocol ultrasound every 3 months, computed tomography (CT) or magnetic resonance imaging (MRI) every 12 months, and then endoscopic ultrasonography (EUS) if there were changes in the size of the cyst or duct morphology. 2 Thirteen (2.4%) cases of IPMN with malignancy were confirmed over a median follow-up duration of 34 months and seven of these 13 patients had multiple cysts <2 cm in size. The authors observed that cyst size alone may not be a major determinant in predicting cancer risk; multiple small cysts may be another feature that is predictive of progression to malignancy.A retrospective study of 364 patients with branch-duct (BD) IPMN attempted to identify predictors of malignancy and recurrence at long-term follow up.3 In this study, 135 of 364 patients underwent surgical resection and 229 underwent imaging surveillance. Among patients who underwent surgery, the presence of main pancreatic duct (MPD) dilation (5-9 mm) was more frequently associated with malignant lesions (P = 0.01). Following surgery, patients with malignant BD-IPMN had higher tumor recurrence rates (17 vs 7%, P = 0.03). Moreover, EUS features such as mural nodules, suspicious MPD (thick walls, mucin or mural nodule), suspicious or malignant cytology and MPD size of 5-9 mm on CT/MRI were strongly associated with malignant BD-IPMN. The accuracy of cytology, carcinoembryonic antigen (CEA) and amylase were evaluated in a cohort of 1167 patients with IPMN who underwent EUS-guided fine-needle aspiration (EUS-FNA).4 Sensitivity, specificity and accuracy of cytology for differentiating benign from malignant IPMN were 39%, 88% and 64%, respectively. At a cut-off value of 129 ng/mL, the sensitivity and specificity of CEA was only 76.9% and 83.3%, respectively, and cyst amylase analysis was diagnostically unhelpful.A retrospective study compared the clinical outcomes of pancreatic ...

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Section: Evaluation and Treatment Of Pancreatic Cyst Lesionsmentioning

confidence: 99%

Section: Evaluation and Treatment Of Pancreatic Cyst Lesionsmentioning

confidence: 99%