ASGE Annual Postgraduate Course Endoscopy 2022 (On-Demand): Breakthrough to Excellence-Shami_Approach to PCs Navigating the Algorithm Maze

Shami_Approach to PCs Navigating the Algorithm Maze

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Pancreatic cysts can be concerning because some can be pre-malignant and have the potential to develop into cancer. It is important to understand the different types of cysts and the multiple guidelines available for their management. The Fukuoka Guideline (2012), AGA Guideline (2015), ACG Guideline (2018), and European Guideline (2018) provide recommendations for the management of pancreatic cysts.<br /><br />There are some general concepts to keep in mind when considering the management of pancreatic cysts. If a cyst is symptomatic or associated with a mass, surgery should be considered. Surveillance should only be considered if the patient is a surgical candidate and willing to undergo surgery or systemic therapy.<br /><br />Different guidelines have different surveillance intervals and recommendations. The Fukuoka Guideline has been criticized for its aggressive surveillance intervals and lack of mention of when to stop surveillance. The AGA Guideline suggests surveillance using MRI once a year, while the ACG Guideline recommends less intense surveillance in the first year. The European Guideline suggests EUS and/or MRI in 6 months.<br /><br />None of the guidelines consider fluid aspiration results or molecular markers when making recommendations. A Monte Carlo cost analysis showed that the cost per additional cancer identified varied depending on the guideline used.<br /><br />In conclusion, it is important to use guidelines and clinical judgment when managing pancreatic cysts. It is not necessary to perform surveillance if the patient is not a surgical candidate or refuses surgery and/or systemic therapy. Despite the differences and controversies among the guidelines, they generally suggest evaluating for surgery if certain criteria are met, such as dilated pancreatic duct, mural nodule, associated mass, or positive cytology/biopsy.

Keywords

pancreatic cysts

pre-malignant

cancer potential

types of cysts

guidelines

surgery

surveillance

MRI

EUS

clinical judgment