Comparison of Society Guidelines for the Management and Surveillance of Pancreatic Cysts

Abstract

There are 5 main guidelines related to the management of PCLs: the American Gastrointestinal Association (AGA) guidelines, the American College of Gastroenterology (ACG) guidelines, the American College of Radiology (ACR) recommendations, the European evidence-based guidelines, and the International Association of Pancreatology (IAP)/Fukuoka guidelines. These guidelines are based on retrospective studies that do not account or control for most tumor-and patient-specific factors. These guidelines also vary in scope, recommendations for surgical resection vs surveillance, as well as duration and type of follow-up.CONCLUSIONS AND RELEVANCE PCL guidelines should be viewed within the context of the data limitations on which they are based. PCL subtype-specific guidelines on surveillance and treatment are needed. In the future, the integration of cyst-specific genomic analysis, as well as evolutions in advanced diagnostic tools, such as cyst fluid next-generation sequencing and EUS-guided confocal laser endomicroscopy, may also better inform treatment guidelines. Owing to the current low-quality evidence on which many guidelines are based and the inherent morbidity of pancreas surgery, it is imperative that patients with PCLs are referred to institutions with advanced diagnostics and a multidisciplinary approach to patient surveillance and management.

Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

“…16,46 Notably, the guidelines for surveillance or resection are conflicting, with considerable variation in the recommendations of observation vs resection. 16,[46][47][48][49][50] However, individuals with cystic lesions represent a defined risk population for exploring biomarkers to assess risk and define progression from precursor to invasive cancer. 51,52 Biomarkers for Early Detection of PDAC…”

The Deception of Pancreas Cyst Surveillance

“…The american Gastroenterological association (aGa) developed pancreatic cyst guidelines in 2015, followed by the revised american College of Radiology (aCR) guidelines in 2017. In 2018, the american College of Gastroenterology (aCG) and the European Guidelines (out of Stockholm, Sweden) also developed guidelines (aziz, acher, Krishna, Cloyd, & Pawlik, 2022).…”

Pancreatic Cystic Neoplasms: Translating Guidelines into Clinical Practice

“…PCLs are classified into two major categories: mucinous and non-mucinous cysts. Mucinous neoplasms include intraductal papillary mucinous neoplasms (main duct (MD)-IPMNs, branched duct (BD)-IPMN, or mixed) and mucinous cystic neoplasms (MCNs) [5,6]. All mucinous neoplasms are considered premalignant.…”