Endoscopy 2019; 51(04): S18
DOI: 10.1055/s-0039-1681220
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: EUS diagnosis Club D
Georg Thieme Verlag KG Stuttgart · New York

RISK OF ADVANCED LESIONS IN PATIENTS WITH BRANCH-DUCT IPMN AND RELATIVE INDICATIONS FOR SURGERY ACCORDING TO EUROPEAN EVIDENCE-BASED GUIDELINES

E Pérez-Cuadrado-Robles
1   Cliniques Universitaires Saint-Luc, Endoscopy Unit, Brussels, Belgium
,
L Uribarri-González
2   Complejo Hospitalario de Navarra, Digestive System Service, Endoscopy Unit, Navarra, Spain
,
B Ivan
1   Cliniques Universitaires Saint-Luc, Endoscopy Unit, Brussels, Belgium
,
JJ Vila
2   Complejo Hospitalario de Navarra, Digestive System Service, Endoscopy Unit, Navarra, Spain
,
S López-López
2   Complejo Hospitalario de Navarra, Digestive System Service, Endoscopy Unit, Navarra, Spain
,
PH Deprez
1   Cliniques Universitaires Saint-Luc, Endoscopy Unit, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Recently, European evidence-based guidelines proposed surgery for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) based on the presence of 1 – 2 relative indications, depending on the comorbidity burden. However, most of studies to date considered patients with absolute and relative indications together and radiological examinations in the baseline evaluation.

The aim was to assess the accuracy of the guidelines in patients with relative indications, in a surgical cohort of demonstrated BD-IPMNs previously evaluated by endoscopic ultrasound (EUS).

Methods:

This is a multi-centre, observational, retrospective study. All consecutive patients with relative indications and histologically confirmed BD-IPMN were included. Only patients assessed by EUS were included. Radiological examinations (CT, MRI) were not considered is this study. Patients with absolute indications or no indications according to recent guidelines were also excluded. Advanced lesions were invasive cancer or high-grade dysplasia.

The main outcome was risk of advanced lesions and invasive carcinoma in patients with only relative indications.

Results:

Ninety-one patients with BD-IPMN underwent surgery because of absolute (n = 21), relative (n = 60), or no formal indications (n = 10). In total, there were 60 patients (mean age: 66 ± 9, 50% male) with one (n = 35, 58.3%) or ≥2 relative indications (n = 25, 41.7%). The global advanced lesion and invasive carcinoma rates were 40% and 13.3%, respectively. No risk factor was associated with high-grade dysplasia or invasive carcinoma. Patients with one indication had a lower risk of invasive carcinoma than did those with ≥2 relative indications (5.7% vs. 24%, respectively, p = 0.048); however, the advanced lesion rates were comparable (37.1% vs. 44%, p = 0.593).

Conclusions:

Invasive carcinoma is considerably more frequent in patients with two or more relative indications described by EUS. The surgical strategy in these selected cases should be decided on an individual basis.