International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas

Takao Ohtsuka, Carlos Fernandez-del Castillo, Toru Furukawa, Susumu Hijioka, Jin Young Jang, Anne Marie Lennon, Yoshihiro Miyasaka, Eizaburo Ohno, Roberto Salvia, Christopher L. Wolfgang, Laura D. Wood

Research output: Contribution to journalReview articlepeer-review

18 Citations (Scopus)

Abstract

This study group aimed to revise the 2017 international consensus guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, and mainly focused on five topics; the revision of high-risk stigmata (HRS) and worrisome features (WF), surveillance of non-resected IPMN, surveillance after resection of IPMN, revision of pathological aspects, and investigation of molecular markers in cyst fluid. A new development from the prior guidelines is that systematic reviews were performed for each one of these topics, and published separately to provide evidence-based recommendations. One of the highlights of these new “evidence-based guidelines” is to propose a new management algorithm, and one major revision is to include into the assessment of HRS and WF the imaging findings from endoscopic ultrasound (EUS) and the results of cytological analysis from EUS-guided fine needle aspiration technique, when this is performed. Another key element of the current guidelines is to clarify whether lifetime surveillance for small IPMNs is required, and recommends two options, “stop surveillance” or “continue surveillance for possible development of concomitant pancreatic ductal adenocarcinoma”, for small unchanged BD-IPMN after 5 years surveillance. Several other points are also discussed, including identifying high-risk features for recurrence in patients who underwent resection of non-invasive IPMN with negative surgical margin, summaries of the recent observations in the pathology of IPMN. In addition, the emerging role of cyst fluid markers that can aid in distinguishing IPMN from other pancreatic cysts and identify those IPMNs that harbor high-grade dysplasia or invasive carcinoma is discussed.

Original languageEnglish
Pages (from-to)255-270
Number of pages16
JournalPancreatology
Volume24
Issue number2
DOIs
Publication statusPublished - 03-2024

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

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