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DOI: 10.1055/a-0841-3385
Pancreatic sphincterotomy improves pain symptoms due to branch-duct intrapapillary mucinous neoplasia without worrisome features: a multicenter study
Publication History
submitted 10 August 2018
accepted after revision 27 December 2018
Publication Date:
29 August 2019 (online)
Abstract
Introduction Branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) require follow-up to detect worrisome features (WF). Data are missing about endoscopic pancreatic sphincterotomy (PS) for symptomatic IPMN.
Patients and methods This was a retrospective multicenter study in four expert centers. Patients treated with endoscopic PS for symptomatic (painful) BD-IPMN without WF were included. Age, sex, follow-up time, characteristics of IPMNs and endoscopic retrograde cholangiopancreatographies (ERCPs), and indications for surgery were recorded.
Results In total, 21 patients were included (median age 68 years, range 45 – 87 years). The median number of cysts was 2 (range 1 – 10), located in the head (59 %), body/tail (17 %), or multifocal (24 %). ERCP including PS was completed in all of the cases, with biliary sphincterotomy in 33 %. Clinical efficacy after one session was 81 % (17/21). Among the failures, one had a second successful PS and three were operated. The final efficacy was 86 % (18/21). Seven patients were operated after a mean of 19 months: four for WF, three for pain. The histopathology showed four low grade dysplasia, one high grade dysplasia, and two no dysplasia. No adenocarcinoma occurred during a follow-up of 99 months (range 14 – 276 months).
Conclusions Endoscopic PS for symptomatic IPMN without WF is effective in more than 80 % of cases, without increasing the risk for adenocarcinoma.
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References
- 1 Fernández-del Castillo C, Adsay NV. Intraductal papillary mucinous neoplasms of the pancreas. Gastroenterology 2010; 139: 708-713, 713.e1-2
- 2 Sawai Y, Yamao K, Bhatia V. et al. Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasms. Endoscopy 2010; 42: 1077-1084
- 3 Venkatesh PGK, Navaneethan U, Vege SS. Intraductal papillary mucinous neoplasm and acute pancreatitis. J Clin Gastroenterol 2011; 2045: 755-758
- 4 D’Haese JG, Hartel M, Demir IE. et al. Pain sensation in pancreatic diseases is not uniform: the different facets of pancreatic pain. World J Gastroenterol 2014; 20: 9154-9161
- 5 Jang JW, Kim M-H, Jeong SU. et al. Clinical characteristics of intraductal papillary mucinous neoplasm manifesting as acute pancreatitis or acute recurrent pancreatitis. J Gastroenterol Hepatol 2013; 2028: 731-738
- 6 Warndorf M, Hu H, Papachristou G. et al. Intraductal papillary mucinous neoplasm causing recurrent acute pancreatitis, necrotizing pancreatitis, and multifocal adenocarcinoma. Gastrointest Endosc 2014; 80: 1181-1182 discussion 1182
- 7 Pelletier A-L, Hammel P, Rebours V. et al. Acute pancreatitis in patients operated on for intraductal papillary mucinous neoplasms of the pancreas: frequency, severity, and clinicopathologic correlations. Pancreas 2010; 39: 658-661
- 8 Morales-Oyarvide V, Mino-Kenudson M, Ferrone CR. et al. Acute pancreatitis in intraductal papillary mucinous neoplasms: A common predictor of malignant intestinal subtype. Surgery 2015; 158: 1219-1225
- 9 Tsutsumi K, Ohtsuka T, Oda Y. et al. A history of acute pancreatitis in intraductal papillary mucinous neoplasms of the pancreas is a potential predictive factor for malignant papillary subtype. Pancreatology 2010; 10: 707-712
- 10 Tanaka M, Chari S, Adsay V. et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6: 17-32
- 11 Tanaka M, Fernández-del Castillo C, Adsay V. et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12: 183-197
- 12 Asari S, Matsumoto I, Toyama H. et al. Repeating regional acute pancreatitis in the head of the pancreas caused by intraductal papillary mucinous neoplasms in the tail: report of a case. Surg Today 2012; 42: 398-402
- 13 Oh YS, Dua K. Pancreatic sphincterotomy for pancreatitis associated with main duct intraductal papillary mucinous neoplasm. Endoscopy 2011; 43 (Suppl. 02) UCTN E75
- 14 Elton E, Howell DA, Parsons WG. et al. Endoscopic pancreatic sphincterotomy: indications, outcome, and a safe stentless technique. Gastrointest Endosc 1998; 47: 240-249
- 15 Nocente R, Silveri NG, Gasbarrini A. et al. An apparent idiopathic case of relapsing acute pancreatitis. Hepatogastroenterology 2001; 48: 572-573
- 16 Ringold DA, Shroff P, Sikka SK. et al. Pancreatitis is frequent among patients with side-branch intraductal papillary mucinous neoplasia diagnosed by EUS. Gastrointest Endosc 2009; 70: 488-494
- 17 Gourgiotis S, Ridolfini MP, Germanos S. Intraductal papillary mucinous neoplasms of the pancreas. Eur J Surg Oncol 2007; 33: 678-684
- 18 Schmidt CM, White PB, Waters JA. et al. Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg 2007; 246: 644-651 discussion 651-654
- 19 Rodriguez JR, Salvia R, Crippa S. et al. Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 2007; 133: 72-79 quiz 309-310
- 20 Moris M, Raimondo M, Woodward TA. et al. Risk factors for malignant progression of intraductal papillary mucinous neoplasms. Dig Liver Dis 2015; 47: 495-501