Intraductal Papillary Mucinous Neoplasm of the Pancreas

Abstract

With the widespread use and advances in radiographic imaging, Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas are identified with increasing frequency. Although many studies have addressed its biology and treatment, true understanding of its natural history continues to elude us. Its malignant potential places careproviders in a clinical dilemma of balancing the morbidity of pancreatectomy against the risk of malignant transformation while under continuous surveillance. Recently, there have been conflicting data published in the literature, generating more uncertainty in the field. In this article, we critically analyze the contrasting consensus guidelines from the International Association of Pancreatology and the American Gastroenterology Association, and address lingering questions and controversies. We also synthesize newly published data in the context of current standard of care, and provide a comprehensive review and recommendations for the clinical diagnosis, treatment, and follow-up strategy in the management of patients with Intraductal Papillary Mucinous Neoplasms.

Comparative Effectiveness of Resection vs Surveillance for Pancreatic Branch Duct Intraductal Papillary Mucinous Neoplasms With Worrisome Features

“…Risk of malignancy for IPMN varies by morphology. Those involving the main pancreatic duct have a 56% to 87% risk of malignancy, while branch duct variants (BD-IPMN) have a 6% to 46% risk . Given this disparity, consensus guidelines recommend early resection for all main duct IPMN, while treatment for BD-IPMN remains controversial.…”

“…Those involving the main pancreatic duct have a 56% to 87% risk of malignancy, while branch duct variants (BD-IPMN) have a 6% to 46% risk. [6][7][8][9][10] Given this disparity, consensus guidelines recommend early resection for all main duct IPMN, while treatment for BD-IPMN remains controversial. Contributing to the optimal management of BD-IPMN are clinical factors, morphologic features, and patient age.…”

Factors Associated With Invasive Intraductal Papillary Mucinous Carcinoma of the Pancreas

“…Prior to the concept of malignancy being changed in the 2012 international guideline, most previous reports categorized high-grade dysplasia (HGD) as well as invasive IPMC as malignant IPMN . Additionally, mixed IPMN was often included in BD IPMN or MD IPMN categories during analyses for factors associated with malignancy, which frequently caused disagreement and confusion over whether mixed IPMN should be classified as BD IPMN or MD IPMN . The aim of the current study was to identify the factors associated with invasive IPMC by analyzing clinical and imaging findings separately for BD, MD, and mixed IPMNs and to evaluate the accuracy of diagnoses by using identified predictors.…”

The clinical value of ERCP-guided cholangiopancreatoscopy using a single-operator system

“…In our experience the most common indication for pancreatoscopy was a cystic lesion of the pancreas, including IPMN, and in 66% of these procedures, diagnostic yield was high (grade 3–4). The malignant potential of cystic lesions of the pancreas is notoriously difficult to accurately determine from conventional investigation methods, leading to complex decision making when choosing a treatment strategy [34, 35]. In patients with established or suspected IPMN we observed that at the time of pancreatoscopy, intraductal accumulation of mucous was a consistent finding.…”