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cystic pancreatic , guideline

Aliye Uc, Dana K Andersen, Drucy Borowitz, Marshall J Glesby, Julia Mayerle, Robert Sutton, Stephen J Pandol
A workshop was sponsored by the Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, on July 25, 2018, in Pittsburgh, Penn. The workshop was designed to bring together a multidisciplinary group of experts to accelerate the development of therapeutics for clinical application in inflammatory diseases of the exocrine pancreas. Three separate working groups (acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis) were formed to address the needs, gaps, and opportunities...
November 2018: Pancreas
Christopher J DiMaio
Pancreatic cystic lesions are a common clinical entity. The majority are neoplastic and have the potential for malignant transformation. To assist with patient management, a number of clinical guidelines have been developed over the past decade. However, controversies exist in regards to the various guidelines and treatment strategies they offer. This article will review the various clinical guidelines for management of pancreatic cysts, describe the limitations of these guidelines, and present future directions for improvement in clinical decision making for patients diagnosed with a pancreatic cystic neoplasm...
October 2018: Gastrointestinal Endoscopy Clinics of North America
Jan G D'Haese, Jens Werner
The management of cystic pancreatic neoplasms has increasingly gained clinical attention due to their frequent incidental detection by cross-sectional imaging and their potential for progression to pancreatic cancer. Surgical resection is warranted for all mucinous cystic neoplasms, solid pseudopapillary neoplasms, and main-duct intraductal papillary mucinous neoplasms since these lesions harbor a major risk for malignant transformation. For branch-duct IPMN (BD-IPMN), the risk for malignancy is considerably lower so that some lesions may be safely followed while others require surgical resection...
July 2018: Visceral Medicine
Lianne Scholten, Nadine C M van Huijgevoort, Jeanin E van Hooft, Marc G Besselink, Marco Del Chiaro
Pancreatic cystic neoplasms (PCN) include different types of cysts with various biological behavior. The most prevalent PCN are intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), and serous cystic neoplasm (SCN). Management of PCN should focus on the prevention of malignant progression, while avoiding unnecessary morbidity of surgery. This requires specialized centers with dedicated multidisciplinary PCN teams. The malignant potential of PCN varies enormously between the various types of PCN...
July 2018: Visceral Medicine
Luca Barresi, Matteo Tacelli, Dario Ligresti, Mario Traina, Ilaria Tarantino
Despite the progress achieved by scientific research in recent years, pancreatic cystic lesions (PCLs) remain a challenging clinical problem. A significant percentage of benign PCLs are still wrongly sent to surgery, with all the related risks of a high number of surgery-related complications and mortality. Diagnosis of the type of PCL, and risk stratification for malignancy are essential for a correct management of these lesions. Several guidelines have identified some clinical and morphological aspects suggesting the need for more accurate exams...
August 11, 2018: Digestive and Liver Disease
Stefano Andrianello, Massimo Falconi, Roberto Salvia, Stefano Crippa, Giovanni Marchegiani
The sudden prevalence increase of pancreatic cystic neoplasms (PCN) related to the use of cross-sectional imaging has raised several concerns. Even if there is a tangible risk of progression towards pancreatic cancer (PC), surgical resection cannot be offered to all patients due to the high risk of morbidity and mortality. Available guidelines are useful tools to identify patients at higher risk for harboring cancer thanks to their sensitivity. Because of their low specificity, however, such a risk is often overestimated...
July 2018: Visceral Medicine
Georg Beyer, Elisabetta Goni, Marlies Köpke, Jan G D'Haese, Jens Werner, Jörg Schirra, Julia Mayerle
Cystic pancreatic lesions are common findings in an aging society due to an increasing availability of high-resolution cross-sectional imaging. Although the overall prevalence of malignancy and the rate of malignant conversion are low, especially mucinous pancreatic cystic lesions such as intraductal papillary mucinous neoplasm and mucinous cystic neoplasm harbor significant malignant potential depending on their morphology and size. Recently updated guidelines recommend sophisticated algorithms for initial workup and surveillance based on individual characteristics of the cystic lesion and the patient, thus weighing the lifetime risk for malignancy against the adverse event rate of potentially curative surgery in the light of number and location of cystic lesions, age of the patient, comorbidities, and the resulting life expectancy as well as the effect of repeated follow-up examinations on the patient's quality of life...
July 2018: Visceral Medicine
Jorrit Jv de Vries, Anne B Chang, Catherine M Bonifant, Elizabeth Shevill, Julie M Marchant
BACKGROUND: People with cystic fibrosis (CF) and pancreatic insufficiency are at risk of a deficiency in fat-soluble vitamins, including vitamin A. Vitamin A deficiency predominantly causes eye and skin problems, while excessive levels of vitamin A can harm the respiratory and skeletal systems in children and interfere with the metabolism of other fat-soluble vitamins. Most CF centres administer vitamin A as supplements to reduce the frequency of vitamin A deficiency in people with CF and to improve clinical outcomes such as growth, although the recommended dose varies between different guidelines...
August 9, 2018: Cochrane Database of Systematic Reviews
Krzysztof Dąbkowski, Beata Kos-Kudła, Elżbieta Andrysiak-Mamos, Anhelli Syrenicz, Joanna Pilch-Kowalczyk, Teresa Starzyńska
Cystic pancreatic tumors are detected with increasing frequency and remain a clinical problem. Since they have different potential of malignancy the management and decision making process is a hard task. Guidelines, concerning pancreatic cystic tumors indicate the management with mucinous, serous cystic pancreatic neoplasms and solid pseudopappilary tumor, while the management with pancreatic cystic neuroendocrine tumors is not included into these standards. This review tries to answer the question are the cystic pancreatic neuroendocrine tumors different entity from solid tumors of neuroendocrine origin...
2018: Endokrynologia Polska
Yousuke Nakai, Kazuhiko Koike
Pancreatic cystic lesions (PCLs) are increasingly diagnosed with the advent of cross-sectional imaging and its incidence was as high as 13.7% on MRI in asymptomatic individuals, which increased with age or obesity [1]. Most of those asymptomatic PCLs are not malignant at the time of diagnosis but require surveillance, which can pose physical and psychological burden to those individuals under surveillance as well as the burden of medical costs. Although several guidelines for management of PCLs have been published, they are not necessarily evidence-based...
June 27, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Jon M Harrison, Carlos Fernandez-Del Castillo
PURPOSE OF REVIEW: With recent advances in radiographic testing, there have been increases in the incidental identification of pancreatic cysts. Determining management, specifically, which cysts can be watched versus intervened upon has significant impact on at the patient-physician level as well as globally on resource allocation and healthcare expenditures. This review focuses on the three main guidelines (Fukuoka guidelines, European consensus, and American Gastroenterological Association recommendations) for management of pancreatic cystic disease after incidental identification...
September 2018: Current Opinion in Gastroenterology
Jennifer Phan, V Raman Muthusamy
PURPOSE OF REVIEW: The goal of this review is to critically analyze the current literature regarding the management of incidental pancreatic cysts. Given their increased rates of detection due to the frequent use of cross-sectional imaging, correctly identifying the subset of high risk lesions that are appropriate for surgical resection is critical. However, the existing consensus and societal guidelines discussed in this review lack high quality data to create evidence-based recommendations, making achieving this important aim challenging...
June 9, 2018: Current Gastroenterology Reports
Lianne Scholten, Nadine C M van Huijgevoort, Marco J Bruno, Carlos Fernandez-Del Castillo, Sohei Satoi, Alain Sauvanet, Christopher Wolfgang, Paul Fockens, Suresh T Chari, Marco Del Chiaro, Jeanin E van Hooft, Marc G Besselink
BACKGROUND: The risk of invasive cancer in resected intraductal papillary mucinous neoplasm with main pancreatic duct involvement is 33%-60%. Most guidelines, therefore, advise resection of main duct intraductal papillary mucinous neoplasm and mixed type intraductal papillary mucinous neoplasm in surgically fit patients, although advice on the surgical strategy (partial or total pancreatectomy) differs. We performed a survey amongst international experts to guide the design of future studies and help to prepare for a single international set of guidelines...
May 16, 2018: Surgery
Jose Lariño-Noia, Julio Iglesias-Garcia, Daniel de la Iglesia-Garcia, J Enrique Dominguez-Muñoz
EUS-FNA is often performed in the evaluation of Cystic Pancreatic Lesions (CPL) for a better preoperative characterization. The objective is to identify premalignant lesions as Mucinous Cystic Neoplasms, and/or a malignant transformation of them (adenocarcinoma). The role of cytological evaluation in this setting is discouraging and intracystic markers analysis, mainly CEA, lacks of a good specificity for the detection of mucinous neoplasms. New devices and approaches have emerged to overcome these problems as the cytology brush (Echobrush), the small mini-biopsy foceps, the cystoscopy and the needle Confocal LASER Endomicroscopy (nCLE), showing in some studies good rates of accuracy for distinguishing among mucinosus and non-mucinous neoplasms...
March 2018: Endoscopic Ultrasound
Eline Soer, Lodewijk Brosens, Marc van de Vijver, Frederike Dijk, Marie-Louise van Velthuysen, Arantza Farina-Sarasqueta, Hans Morreau, Johan Offerhaus, Lianne Koens, Joanne Verheij
A pancreatoduodenectomy specimen is complex, and there is much debate on how it is best approached by the pathologist. In this review, we provide an overview of topics relevant for current clinical practice in terms of gross dissection, and macro- and microscopic assessment of the pancreatoduodenectomy specimen with a suspicion of suspected pancreatic cancer. Tumor origin, tumor size, degree of differentiation, lymph node status, and resection margin status are universally accepted as prognostic for survival...
April 2018: Virchows Archiv: An International Journal of Pathology
(no author information available yet)
Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology)...
May 2018: Gut
Stefan Fritz, Regina Küper-Steffen, Katharina Feilhauer, Christoph M Sommer, Götz M Richter, René Hennig, Jörg Köninger
RATIONALE: Intraductal papillary mucinous neoplasms of the pancreas (IPMNs) are benign cystic tumors with a relevant risk of malignant transformation over time. Currently, follow-up after surgical resection of benign IPMNs remains controversial. PATIENT CONCERNS: This is a case report of a 68-year-old male who underwent pancreatic head resection for a multicystic side-branch IPMN with low-grade epithelial dysplasia in March 2009 at the Katharinenhospital Stuttgart, Germany...
February 2018: Medicine (Baltimore)
Matthew Kulzer, Aatur D Singhi, Alessandro Furlan, Matthew T Heller, Venkata S Katabathina, Kevin M Mcgrath, Herbert J Zeh, Amer Zureikat, Anil K Dasyam
Cystic neoplasms in the pancreas are encountered frequently on imaging, often detected incidentally during evaluation for other conditions. They can have a variety of clinical and imaging presentations, and similarly, wide-ranging prognostic and treatment implications. In the majority, imaging helps in diagnosis of pancreatic cystic neoplasms (PCNs) and guides management decisions. But, a significant minority of the PCNs remain indeterminate. There have been multiple recent advances in biomarkers and molecular genetics which will likely prove helpful in risk stratification of PCNs...
September 2018: Abdominal Radiology
Ken Liu, Vikram Joshi, Louise van Camp, Qi-Wei Yang, Judith E Baars, Simone I Strasser, Geoffrey W McCaughan, Avik Majumdar, Payal Saxena, Arthur J Kaffes
AIM: To determine the prevalence, characteristics and clinical course of pancreatic cystic neoplasms (PCNs) in liver transplantation (LT) recipients. METHODS: We retrospectively studied consecutive patients who underwent LT between January 1998 to April 2016. Clinical and laboratory data were obtained from patient medical records. Imaging findings on computed tomography and magnetic resonance cholangiopancreatography were reviewed by two radiologists. RESULTS: During the study period, 872 patients underwent cadaveric LT...
December 28, 2017: World Journal of Gastroenterology: WJG
Vicente Morales-Oyarvide, Zhi Ven Fong, Carlos Fernández-Del Castillo, Andrew L Warshaw
Intraductal papillary mucinous neoplasms (IPMN) are cystic neoplasms with the potential for progression to pancreatic cancer. Recognized by the global medical community just over two decades ago, IPMN have gained great epidemiological and clinical relevance thanks to the widespread use of cross-sectional abdominal imaging, which has led to a surge in the number of incidental pancreatic cysts being diagnosed. As our understanding of this disease has improved, we now know that some IPMN have a very elevated risk of cancer and require surgical resection, while others are low-risk lesions and can be followed...
December 2017: Visceral Medicine
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