My Treatment Approach: Pancreatic Cysts

Abstract

Our treatment approach for either symptomatic or incidentally found pancreatic cysts continues to improve. The true incidence of pancreatic cysts is not known, and pancreatic cystic neoplasms, especially intraductal papillary mucinous neoplasms, are currently most commonly diagnosed and resected. This is a result of increasing awareness, widespread availability of imaging, and better understanding of the nature of pancreatic cysts as well. Recent studies on molecular analysis and devices such as microbiopsy forceps help us better define and select the treatment approach to alleviate symptoms and to prevent malignant tumors while avoiding unnecessary surgery.

Mucinous cystic neoplasm diagnosed by EUS-guided microforceps biopsy

“…Mucinous cystic neoplasms of the pancreas occur almost exclusively in women, are diagnosed most often in the fifth decade of life, and account for approximately 11 % to 23 % of pancreatic cystic neoplasms 1 . These cysts are typically located in the body or tail of the pancreas (> 97 % of cases) and are generally asymptomatic 1 . Given the malignant potential of MCNs, surgical resection is typically recommended.…”

Pancreatic Cysts: Diagnostic Role of EUS-Guided Microforceps Biopsy and Confocal Laser Endomicroscopy

“…Moray microforceps are 230 cm in length with a jaw opening width of 4.3 mm and a sheath of 0.8 mm in diameter that easily passes through a 19-gauge EUS-FNA needle [38]. The role of Moray microforceps in the preoperative diagnosis has been acknowledged subsequently [42–44].…”

Diagnosis and management of pancreatic cystic neoplasms

“…If symptomatic, the classical presentation is of recurrent acute pancreatitis in a patient with a dilated MPD without features of, or risk factors for, chronic pancreatitis 23 28 29. IPMNs are seen on up to 20% of MRI scans visualising the pancreas 31. MD-IPMN can be suspected in patients with focal or diffuse ectasia of the MPD (>5 mm).…”