Pancreatic cystic neoplasms: management and unanswered questions.

Abstract:

:Approximately 10% of persons 70 years old or older are now diagnosed with pancreatic cysts, but it is not clear which ones require additional analysis, interventions, or follow-up. Primary care doctors rely on gastroenterologists for direction because no one wants to miss a diagnosis of pancreatic cancer, but meanwhile there is pressure to limit use of diagnostic tests and limit costs. We review the different cystic neoplasms of the pancreas and diagnostic strategies based on clinical features and imaging data. We discuss surgical and nonsurgical management of the most common cystic neoplasms, based on the recently revised Sendai guidelines. Intraductal papillary mucinous neoplasm (particularly the branch duct variant) is the lesion most frequently identified incidentally. We report what is known about its pathology, its risk of developing into pancreatic ductal adenocarcinoma, the pros and cons of current guidelines for management, and the potential role of endoscopic ultrasound in determining cancer risk. We also review surgical treatment and strategies for surveillance of pancreatic cysts.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Farrell JJ,Fernández-del Castillo C

doi

10.1053/j.gastro.2013.01.073

subject

Has Abstract

pub_date

2013-06-01 00:00:00

pages

1303-15

issue

6

eissn

0016-5085

issn

1528-0012

pii

S0016-5085(13)00193-5

journal_volume

144

pub_type

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