Pancreas

Clin Gastroenterol Hepatol. 2023;21(7):1792–801.e3

Hamada T, Oyama H, Nakai Y, Tange S, Arita J, Hakuta R, Ijichi H, Ishigaki K, Kanai S, Kawaguchi Y, Kogure H, Mizuno S, Saito K, Saito T, Sato T, Suzuki T, Takahara N, Tanaka M, Tateishi K, Ushiku T, Hasegawa K, Fujishiro M

Clinical outcomes of intraductal papillary mucinous neoplasms with dilatation of the main pancreatic duct

Background and aims: Dilatation of the main pancreatic duct (MPD) has been a surgical indication for intraductal papillary mucinous neoplasms (IPMNs). Few studies have investigated long-term outcomes of IPMNs with MPD dilatation.
Methods: Among 3610 patients diagnosed with pancreatic cysts between 1994 and 2021, the authors identified 2829 IPMN patients, including 282 patients with MPD ≥ 5 mm, and examined short-term (≤ 6 months) and long-term risks of pancreatic carcinoma. Utilizing competing risks proportional hazards models, they estimated subdistribution hazard ratios for incidence of pancreatic carcinoma with adjustment for potential confounders.
Results: In analyses of short-term outcomes of the 282 patients with MPD dilatation, 72 patients (26%) were diagnosed with pancreatic carcinoma based on surgical or non-surgical exploration. During long-term follow-up of 168 patients, 24 patients (14%) diagnosed with pancreatic carcinoma (18 with IPMN-derived carcinoma and 6 with concomitant ductal adenocarcinoma) were documented. The patients with the MPD = 5–9.9 mm had cumulative incidence rates of pancreatic carcinoma diagnosis of 8.1% (95% confidence interval [CI]: 4.3–13.5%) and 10.0% (95% CI: 5.5–15.9%) at 2 and 5 years, respectively; and the patients with the MPD ≥ 10 mm had the corresponding rates of 16.0% (95% CI: 3.6–36.5%) and 33.3% (95% CI: 10.3–58.8%). The multivariable subdistribution hazard ratios were 2.78 (95% CI: 1.57–4.90) and 7.00 (95% CI: 2.58–19.0) for the MPD = 5–9.9 mm and ≥ 10 mm (vs. < 5 mm), respectively.

Conclusions: Intraductal papillary mucinous neoplasms (IPMNs) with main pancreatic duct (MPD) dilatation at baseline were associated with higher prevalence and incidence of pancreatic carcinoma compared with IPMNs with no MPD dilatation.

Dr. Dr. T. Hamada, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan, E-Mail: hamada-tky@umin.ac.jp

and

Dr. Dr. Y. Nakai, Associate Professor, Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Bunkyo City, Tokyo, Japan, E-Mail: ynakai-tky@umin.ac.jp

DOI: 10.1016/j.cgh.2023.01.032

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A protocolized management of walled-off necrosis (WON) reduces time to WON resolution and improves outcomes

Clin Gastroenterol Hepatol. 2023;21(10):2543–50.e1