Guideline review: diagnosis and management of pancreatic cysts

  • Nat Rev Gastroenterol Hepatol

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Overview of US, European, and international guidelines on treatment and/or surveillance for mucinous cystic neoplasms (MCN) and intraductal papillarymucinous neoplasms (IPMN).

Why this matters

  • Pancreatic cyst neoplasms are heterogeneous and increasingly being discovered during routine cross-sectional imaging, presenting clinicians with the dilemma of how to balance cancer prevention with the risk for surgical overtreatment.

Key points

  • Most pancreatic cysts are benign, but some can develop into pancreatic cancer.
  • Revised guidelines suggest that the following characteristics are absolute indications for resection in patients with IPMN:
    • obstructive jaundice,
    • a contrast-enhanced mural nodule or solid component ≥5 mm,
    • a dilated pancreatic duct, and
    • positive cytology for advanced neoplasia.
  • European guidelines suggest conservative treatment of an MCN and IPMN
  • International and US guidelines suggest any MCN is an absolute indication of resection. International guidelines suggest IPMN >30 mm is a relative indication for resection.
  • Patients with IPMN and MCN should undergo lifelong surveillance as long as they are willing and able to undergo surgery if needed.
  • Patients with IPMN should be followed-up after pancreatectomy because of risk of recurrence. The optimal surveillance interval has not been determined.

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