Management of Intraductal Papillary Mucinous Neoplasms: Controversies in Guidelines and Future Perspectives

Abstract

Purpose of reviewManagement of intraductal papillary mucinous neoplasm (IPMN) is currently based on consensus, in the absence of evidence-based guidelines. In recent years, several consensus guidelines have been published, with distinct management strategies. In this review, we will discuss these discrepancies, in order to guide treating physicians in clinical management.Recent findingsThe detection rate of pancreatic cysts has increased substantially with the expanded use of high-quality imaging techniques to up to 45%. Of these cysts, 24–82% are IPMNs, which harbour a malignant potential. Timely detection of high-risk lesions is therefore of great importance. Surgical management is based on the presence of clinical and morphological high-risk features, yet the majority of resected specimens appear to be low risk.SummaryInternational collaboration and incentive large-scale prospective registries of individuals undergoing cyst surveillance are needed to accumulate unbiased data and develop evidence-based guidelines. Additionally, development of non-invasive, accurate diagnostic tools (e.g. biomarkers) is needed to differentiate between neoplastic and non-neoplastic pancreatic cysts and detect malignant transformation at an early stage (i.e. high-grade dysplasia).

Early Detection of Pancreatic Cancer: Opportunities and Challenges

“…Some patients may present with abdominal discomfort, abdominal pain, malaise, and nausea; however, these symptoms are typically not attributable to the IPMN, even if they were the initial indication for abdominal imaging. 28 Other symptoms that include back pain, weight loss, NOD, and obstructive jaundice are more often associated with malignant transformation of an IPMN but, once again, are not entirely specific. [29][30][31][32]34,35,37,[46][47][48][49][50][51][52] Considering the lack of symptoms in most patients, conventional imaging modalities play a crucial role in the identification of IPMNs and IPMN-associated PDAC, as well as in the detection of a concomitant carcinoma.…”

“…27 Because approximately half of all pancreatic cysts are BD-IPMNs, advanced age is a well-recognized risk factor for both BD-IPMNs and BD-IPMN-associated PDAC. 28 In addition to non-IPMN associated PDAC, a causative link between diabetes and IPMNs has been described. Among BD-IPMN patients, 10%-45% have a history of diabetes and, in the setting of diabetes, the incidence of detecting a BD-IPMN is higher.…”

Intraductal papillary mucinous neoplasm complicated with intraductal bleeding in a young woman mimicked a cystic solid pseudo-papillary tumor: a case report

“…IPMN can complicate with acute pancreatitis (AP) [ 3 , 4 ], duct perforation, fistula formation into the adjacent lumen organs (the duodenum, common bile duct, stomach, colon and small intestine) [ 5 , 6 ] and spleen solid organ [ 7 ], intraductal bleeding or a massive abdominal cavity hematoma caused by rupture [ 1 , 2 ], and cyst infection [ 8 ], according to previous studies. AP is the most common complications of IPMN, approximately 20% of IPMN complicated with acute pancreatitis of mild to moderate severity [ 4 ].…”

“…Road, Gulou District, Fuzhou, China. 3 Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.…”

Endoscopic Management and Follow-Up of Intraductal Papillary Mucinous Neoplasia (IPMN)

“…Total pancreatectomy is only indicated in selected cases and after carefully weighing the consequences against the potential benefits [12,14]. The overall recurrence rate of IPMN after resection is significant (up to 65%), and therefore lifelong surveillance is recommended by most guidelines and the intensity of follow-up is guided by the grade of dysplasia [12,14,15,132]. Risk factors for recurrence or progression include advanced dysplasia, multifocal disease, increased age, elevated BMI, and a positive family history for pancreatic cancer [133,134].…”