American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

Vege, Santhi Swaroop; Ziring, Barry; Jain, Rajeev; Moayyedi, Paul; Adams, Megan A.; Dorn, Spencer D.; Dudley-Brown, Sharon; Flamm, Steven L.; Gellad, Ziad F.; Gruss, Claudia; Kosinski, Lawrence R.; Lim, Joseph K.; Romero, Yvonne; Rubenstein, Joel H.; Smalley, Walter E.; Sultan, Shahnaz; Weinberg, David S.; Yang, Yu‐Xiao

doi:10.1053/j.gastro.2015.01.015

Cited by 896 publications

(776 citation statements)

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“…Nonetheless, the more recent American Gastroenterological Association (AGA) guideline on the management of pancreatic cysts [29] issues a conditional recommendation: "pancreatic cystswithatleasttwohigh-riskfeatures,suchassize≥3cm,adilatedmainpancreaticduct, or the presence of an associated solid component, should be examined with endoscopic ultrasonographywithfine-needleaspiration(EUS-FNA)" (Figure 5). …”

Section: Eus-fnamentioning

confidence: 99%

“…Metabolic abundances for both were significantlylowerinmucinouscystscomparedwithnon-mucinouscysts.Theclinicalutilityof Figure 5. UseofEUS-FNAaccordingto2012InternationalConsensusGuidelines [28] and AGA Guidelines [29].…”

Section: Biomarkersmentioning

confidence: 99%

“…To date, three consensus guidelines have been proposed to manage pancreatic cystic lesionsbeginningwiththeoriginal2006Sendaiguideline,whichwasrevisedin2012bythe InternationalAssociationofPancreatology(IAP)inFukuoka,andtherecentAGAguideline [43][44][45].…”

Section: Managementmentioning

confidence: 99%

“…In such cases, no further work-up will be needed; however, follow-up is still recommended [43][44][45][46].Forbettercharacterizationofthelesions,pancreaticprotocolCTor gadolinium-enhanced MRI with magnetic resonance cholangiopancreatography (MRCP) is recommended for cysts >10 mm [47]. The most recent consensus among radiologists [10] suggests that MRI is preferable for evaluating cysts due to its high-contrast resolution, the identificationofseptum,nodules,andductcommunications.Also,MRIisthepreferable follow-up test because it avoids excessive exposure to radiation [47].…”

Section: Allguidesagreethatduetothehigherriskofmalignancyallsymptomamentioning

confidence: 99%

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Intraductal Papillary Mucinous Neoplasms of the Pancreas: Challenges and New Insights

Carroll¹,

Reyes²,

Vázquez³

2017

Challenges in Pancreatic Pathology

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Cystic lesions of the pancreas are a common entity with almost a 25% incidence of the general population. These types of lesions are being increasingly diagnosed partly explained due to the technological advances over the past years. The management and treatment varies per cyst type. However, the most threatening cyst lesions are intraductal papillary mucinous neoplasms (IPMNs). These lesions represent nowadays a relatively new clinical entity and in many aspects remain poorly understood. The aim of this chapteristoprovideacomprehensivereviewoftheclassification,diagnosis,treatment and follow-up strategy.

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Section: Eus-fnamentioning

confidence: 99%

Section: Biomarkersmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Allguidesagreethatduetothehigherriskofmalignancyallsymptomamentioning

confidence: 99%

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Intraductal Papillary Mucinous Neoplasms of the Pancreas: Challenges and New Insights

Carroll¹,

Reyes²,

Vázquez³

2017

Challenges in Pancreatic Pathology

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“…Prolonged cyst stability is recommended as an indication for stopping surveillance in both the American College of Radiology and American Gastroenterology Association(AGA) guidelines ( 15,16 ). Th e rational for the well-intentioned AGA guidelines recommending stopping surveillance aft er stability or minimal change aft er 5 years stems from the overall very low risk of malignant progression, the assumption that the majority of pancreatic malignancy and mortality related to neoplastic cysts occur within the fi rst 5 years of cyst discovery, and the observation that most of the surgical resections for pancreatic cysts are performed within 2 years of surveillance, suggesting that there may be a fi nite time for follow-up aft er which the surgical yield is low.…”

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confidence: 99%

Editorial: Stopping Pancreatic Cyst Surveillance?

Farrell¹

2017

American Journal of Gastroenterology

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Abstract:The management of patients with pancreatic cysts, especially presumed branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), remains a challenge. BD-IPMNs carry a very low risk of malignancy and occur in predominantly older individuals who often die from causes not related to their pancreatic disease. The specifi c decision to stop surveillance of presumed low risk BD-IPMNs (those without either worrisome features (WF) or high risk stigmata (HRS)) is controversial, and needs to balance the real risk of malignancy or developing malignancy and IPMNrelated mortality, with the patient's life expectancy, quality of life expectations, and mortality from non-pancreatic-related causes. With improved life expectancy, improved survival from non-pancreatic malignancies, rising health costs, and growing detection of ever smaller presumed BD-IPMNs, this issue is becoming ever more critical. Am J Gastroenterol 2017; 112:1162-1164 doi: 10.1038/ajg.2017 Th e management of patients with pancreatic cysts, especially presumed branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), remains a challenge ( 1 ). BD-IPMNs carry a very low risk of malignancy and occur in predominantly older individuals who oft en die from causes not related to their pancreatic disease. Th e specifi c decision to stop surveillance of presumed low risk BD-IPMNs (those without either worrisome features (WF) or high risk stigmata (HRS)) is controversial, and needs to balance the real risk of malignancy or developing malignancy (0.007 per person-years of follow-up) and IPMN-related mortality (0.9%), with the patient's life expectancy, quality of life expectations, and mortality from non-pancreatic-related causes ( 2,3 ). With improved life expectancy, improved survival from non-pancreatic malignancies, rising health costs, and growing detection of ever smaller presumed BD-IPMNs, this issue is becoming ever more critical.Factors favoring ongoing indefi nite surveillance for presumed BD-IPMNs include the persistence of the malignant risk, the unpredictable natural history of an individual pancreatic cyst, the lack of understanding about the biology driving malignant progression, and the growing concern for concomitant pancreatic ductal adenocarcinoma elsewhere in the pancreatic gland ( 1,3 ). However, the arguments in favor of stopping surveillance are oft en equally strong, including the overall likely low rates of malignant change, economic and social cost off sets associated with indefi nite surveillance imaging, lack of eff ective treatment, and good outcomes for patients who develop malignancy during surveillance, risks associated with invasive surveillance imaging such as endoscopic ultrasound, and the high rates of morbidity and mortality associated with surgical resection. Putting aside that BD-IPMNs are diffi cult to accurately diagnose, and that there is currently no standardization for measuring them during surveillance, several factors do exist to help guide decision making about cessation of low risk presumed BD-IPMN sur...

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