American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts
In April 2015, American Gastroenterological Association Institute came out with Guideline on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts. The major recommendations are as follows
Issues Related to the Conduct of Surveillance
When Can Pancreatic Cyst Surveillance Be Discontinued?
When to Offer Surgery for Pancreatic Cysts
Surveillance After Surgery
For full guidelines click on the following link:
AGAI Guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts
Artical Source: Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association (AGA). American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015 Apr;148(4):819-22; quiz 12-3. [3 references] PubMed
Issues Related to the Conduct of Surveillance
- The American Gastroenterological Association (AGA) recommends that before starting any pancreatic cyst surveillance program, patients should have a clear understanding of programmatic risks and benefits. Note: This is a "motherhood statement" that does not require application of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
- The AGA suggests that patients with pancreatic cysts <3 cm without a solid component or a dilated pancreatic duct undergo magnetic resonance imaging (MRI) for surveillance in 1 year and then every 2 years for a total of 5 years if there is no change in size or characteristics. (Conditional recommendation, Very low quality evidence)
- The AGA suggests that pancreatic cysts with at least two high-risk features, such as size ≥3 cm, a dilated main pancreatic duct, or the presence of an associated solid component, should be examined with endoscopic ultrasonography with fine-needle aspiration (EUS-FNA). (Conditional recommendation, Very low quality evidence)
- The AGA suggests that patients without concerning EUS-FNA results should undergo MRI surveillance after 1 year and then every 2 years to ensure no change in risk of malignancy. (Conditional recommendation, Very low quality evidence)
- The AGA suggests that significant changes in the characteristics of the cyst, including the development of a solid component, increasing size of the pancreatic duct, and/or diameter ≥3 cm, are indications for EUS-FNA. (Conditional recommendation, Very low quality evidence)
When Can Pancreatic Cyst Surveillance Be Discontinued?
- The AGA suggests against continued surveillance of pancreatic cysts if there has been no significant change in the characteristics of the cyst after 5 years of surveillance or if the patient is no longer a surgical candidate. (Conditional recommendation, Very low quality evidence)
When to Offer Surgery for Pancreatic Cysts
- The AGA suggests that patients with both a solid component and a dilated pancreatic duct and/or concerning features on EUS and FNA should undergo surgery to reduce the risk of mortality from carcinoma. (Conditional recommendation, Very low quality evidence)
- The AGA recommends that if surgery is considered for a pancreatic cyst, patients are referred to a center with demonstrated expertise in pancreatic surgery. (Strong recommendation, Very low quality evidence)
Surveillance After Surgery
- The AGA suggests that patients with invasive cancer or dysplasia in a cyst that has been surgically resected should undergo MRI surveillance of any remaining pancreas every 2 years. (Conditional recommendation, Very low quality evidence)
- The AGA suggests against routine surveillance of pancreatic cysts without high-grade dysplasia or malignancy at surgical resection. (Conditional recommendation, Very low quality evidence)
For full guidelines click on the following link:
AGAI Guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts
Artical Source: Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association (AGA). American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015 Apr;148(4):819-22; quiz 12-3. [3 references] PubMed
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