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Sioulas A, Spinou M, Schizas D, Megapanou M, Frountzas M, Papadaki K, Scotiniotis I. Pancreatic cystic neoplasms: Adherence to management recommendations and associated endosonographic cyst characteristics. Saudi J Gastroenterol 2022; 28:122-126. [PMID: 35142657 PMCID: PMC9007072 DOI: 10.4103/sjg.sjg_505_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The purpose of this study is to assess patients' compliance to recommendations after evaluation of pancreatic cystic neoplasm (PCN) with EUS and investigate how the presence of "worrisome" characteristics including cyst's size, main pancreatic duct dilation and presence of mural nodules might affect the adherence rates of management recommendations. METHODS We performed a retrospective cohort study of patients at a private tertiary hospital who were referred for evaluation with EUS over a 5-year period (2015-2019), after the diagnosis of pancreatic cystic neoplasm during radiological imaging. RESULTS We included 111 patients (mean age 64.1 years, SD = 13.9) with PCN. After the EUS examination, 16 patients were referred for surgical resection, 4 patients needed no further follow up and 91 patients were recommended to follow imaging surveillance. In total, 70 (63.1%) subjects adhered to surveillance recommendations. In the group of subjects who adhered to surveillance, cyst size ≥3cm was found in 27 (38.6%) patients, main pancreatic duct diameter ≥5mm in 12 (17.1%) subjects and only 3 (4.3%) pancreatic cysts demonstrated mural nodules. However, none of the aforementioned cystic "worrisome features" was significantly correlated with increased adherence to follow up (p = 0.709, P = 0.642 and P = 0.630, respectively). CONCLUSIONS Although the majority of patients with PCN adhered to given recommendations after EUS examination, the number of noncompliant subjects was noticeable. The presence of cystic "worrisome" features did not correlate with an increased compliance rate to suggested management plan. Further prospective studies are needed to elucidate the factors that may enhance patients' adherence.
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Affiliation(s)
- Athanasios Sioulas
- Department of Gastroenterology, Hygeia Hospital, Athens, Greece,Address for correspondence: Dr. Athanasios Sioulas, Department of Gastroenterology, Hygeia Hospital, Athens, Greece 4 Erythrou Stavrou Str. & Kifisias Av, 151 23 Marousi, Athens, Greece. E-mail:
| | - Marianna Spinou
- Department of Gastroenterology, Hygeia Hospital, Athens, Greece
| | - Dimitrios Schizas
- Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Maria Megapanou
- Department of Gastroenterology, Hygeia Hospital, Athens, Greece
| | - Maximos Frountzas
- Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
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Chon HK, Moon SH, Park SW, Paik WH, Paik CN, Son BK, Song TJ, Ahn DW, Lee ES, Lee YN, Lee YS, Lee JM, Jeon TJ, Park CH, Cho KB, Lee DW. Current trends in the management of pancreatic cystic neoplasms in Korea: a national survey. Korean J Intern Med 2022; 37:63-72. [PMID: 33045809 PMCID: PMC8747915 DOI: 10.3904/kjim.2020.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND/AIMS The study aimed to investigate the current practice patterns in the management of pancreatic cystic neoplasms in Korea. METHODS An electronic survey was systematically distributed by email to members of the Korean Pancreatobiliary Association from December 2019 to February 2020. RESULTS In total, 115 (110 gastroenterologists, five surgeons) completed the survey, 72.2% of whom worked in a tertiary/academic medical center. Most (65.2%) followed the 2012/2017 International Association of Pancreatology guidelines for the management of pancreatic cystic neoplasms. A gadolinium-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography was the most common first-line diagnostic modality (42.1%), but a contrast-enhanced computed tomography scan was preferred as a subsequent surveillance tool (58.3%). Seventy-four percent of respondents routinely performed endoscopic ultrasound-guided fine needle aspiration for pancreatic cystic neoplasms with suspicious mural nodules. Endoscopic ultrasound-guided fine needle aspiration cytology (94.8%) and cystic fluid carcinoembryonic antigen (95.7%) were used for cystic fluid analysis. Most (94%) typically recommended surgery in patients with high-risk stigmata, but 18.3% also considered proceeding with surgery in patients with worrisome features. Most (96.5%) would continue surveillance of pancreatic cystic neoplasms for more than 5 years. CONCLUSION According to this survey, there was variability in the management of pancreatic cystic neoplasms among the respondents. These results suggest that the development of evidence-based guidelines for pancreatic cystic neoplasms that fit the Korean practice is needed to create an optimal approach to the management of pancreatic cystic neoplasms.
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Affiliation(s)
- Hyung Ku Chon
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Sung Hoon Moon
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Sang Wook Park
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Nyol Paik
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Byoung Kwan Son
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Tae Jun Song
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Won Ahn
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eaum Seok Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yun Nah Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Yoon Suk Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Wook Lee
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
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Canakis A, Maoz A, Tkacz JN, Huang C. Factors affecting the rates of adherence to surveillance recommendations for incidental pancreatic cystic lesions in a large urban safety net hospital. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000430. [PMID: 32665396 PMCID: PMC7359056 DOI: 10.1136/bmjgast-2020-000430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/04/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background Pancreatic cystic lesions (PCLs) are a heterogenous group of lesions with varying degrees of malignant potential. PCLs are often incidentally detected on imaging. Management for patients without an immediate indication for resection or tissue sampling entails radiographic surveillance to assess for features concerning for malignant transformation. This study aims to determine the rates of adherence to surveillance recommendations for incidental PCLs, and identify factors associated with adherence or loss of follow-up. Methods We conducted a single-centre retrospective study of patients at a tertiary safety net hospital with incidentally discovered asymptomatic PCLs. Follow-up was defined as having undergone repeat imaging as recommended in the radiology report. Data were analysed using logistic regression. Results Within our cohort (n=172), 123 (71.5%) subjects completed follow-up imaging. Attending a gastroenterology appointment was most strongly associated with completing follow-up for PCLs and remained significant (p=0.001) in a multivariate logistic regression model. Subjects without a documented primary care provider were less likely to have follow-up (p=0.028). Larger cyst size was associated with completion of follow-up in univariate only (p=0.067). Conclusion We found that follow-up of an incidentally discovered PCLs was completed in the majority of our subjects. Incomplete follow-up for PCLs occurred in up to one in three to four patients in our cohort. Access to primary care and utilisation of subspecialty gastroenterology care are associated with completion of follow-up for PCLs. If validated, our findings can guide potential interventions to improve follow-up rates for PCLs.
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Affiliation(s)
- Andrew Canakis
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Asaf Maoz
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Jaroslaw N Tkacz
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Christopher Huang
- Section of Gastroenterology, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
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