Koh Imbe1, Naoyoshi Nagata2, Yuya Hisada1, Yusuke Takasaki1, Katsunori Sekine1, Saori Mishima1,3, Akihito Kawazoe1,3, Tsuyoshi Tajima4, Takuro Shimbo5, Mikio Yanase1, Junichi Akiyama1, Kazuma Fujimoto6, Naomi Uemura7. 1. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan. 2. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan. nnagata_ncgm@yahoo.co.jp. 3. Department of Gastrointestinal Oncology, National Cancer Center East Hospital, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. 4. Departments of Diagnostic Radiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan. 5. Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama city, Fukushima, 963-8558, Japan. 6. Department of Internal Medicine & Gastrointestinal Endoscopy, Faculty of Medicine, Saga University, 1 Honjo-machi, 840-8502, Saga, Japan. 7. Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, 272-8516, Chiba, Japan.
Abstract
OBJECTIVES: Recent guidelines suggest that imaging surveillance be conducted for 5 years for patients with at most one high-risk feature. If there were no significant changes, surveillance is stopped. We sought to validate this follow-up strategy. METHODS: In study 1, data were analysed for 392 patients with intraductal papillary mucinous neoplasms (IPMNs) and at most one high-risk feature who were periodically followed up for more than 1 year with imaging tests. In study 2, data were analysed for 159 IPMN patients without worsening high-risk features after 5 years (stop surveillance group). RESULTS: In study 1, pancreatic cancer (PC) was identified in 12 patients (27.3%) in the endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) indication group and none in the non-EUS-FNA indication group (P < 0.01). In the EUS-FNA indication group, 11 patients (25%) died, whereas 29 (8.3%) died in the non EUS-FNA indication group (P < 0.01). In study 2 (stop surveillance group), PC was identified in three patients (1.9%) at 84, 103 and 145 months. CONCLUSIONS: PC risk and mortality for IPMNs not showing significant change for 5 years is likely to be low, and the non-EUS-FNA indication can provide reasonable decisions. However, three patients without worsening high-risk features for 5 years developed PC. The stop surveillance strategy should be reconsidered. KEY POINTS: • The AGA guidelines provide reasonable clinical decisions for the EUS-FNA indication. • In stop surveillance group, PC was identified in 3 patients (1.9%). • In stop surveillance group, 2 of 3 PC patients died from PC. • Risk of pancreatic cancer in "stop surveillance" group is not negligible.
OBJECTIVES: Recent guidelines suggest that imaging surveillance be conducted for 5 years for patients with at most one high-risk feature. If there were no significant changes, surveillance is stopped. We sought to validate this follow-up strategy. METHODS: In study 1, data were analysed for 392 patients with intraductal papillary mucinous neoplasms (IPMNs) and at most one high-risk feature who were periodically followed up for more than 1 year with imaging tests. In study 2, data were analysed for 159 IPMNpatients without worsening high-risk features after 5 years (stop surveillance group). RESULTS: In study 1, pancreatic cancer (PC) was identified in 12 patients (27.3%) in the endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) indication group and none in the non-EUS-FNA indication group (P < 0.01). In the EUS-FNA indication group, 11 patients (25%) died, whereas 29 (8.3%) died in the non EUS-FNA indication group (P < 0.01). In study 2 (stop surveillance group), PC was identified in three patients (1.9%) at 84, 103 and 145 months. CONCLUSIONS: PC risk and mortality for IPMNs not showing significant change for 5 years is likely to be low, and the non-EUS-FNA indication can provide reasonable decisions. However, three patients without worsening high-risk features for 5 years developed PC. The stop surveillance strategy should be reconsidered. KEY POINTS: • The AGA guidelines provide reasonable clinical decisions for the EUS-FNA indication. • In stop surveillance group, PC was identified in 3 patients (1.9%). • In stop surveillance group, 2 of 3 PC patients died from PC. • Risk of pancreatic cancer in "stop surveillance" group is not negligible.
Authors: Donevan Westerveld; April Goddard; Nieka Harris; Vikas Khullar; Justin Forde; Peter V Draganov; Chris E Forsmark; Dennis Yang Journal: Dig Dis Sci Date: 2018-11-13 Impact factor: 3.199
Authors: Louis de Mestier; Marie Muller; Jérôme Cros; Marie-Pierre Vullierme; Dewi Vernerey; Frédérique Maire; Safi Dokmak; Vinciane Rebours; Alain Sauvanet; Philippe Lévy; Pascal Hammel Journal: United European Gastroenterol J Date: 2019-01-12 Impact factor: 4.623