The diagnosis of branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) has been dramatically increased. BD-IPMNs are frequently discovered as incidental findings in asymptomatic individuals, mainly in elderly patients. An accurate evaluation of BD-IPMNs with high-resolution imaging techniques and endoscopic ultrasound is necessary. Patients with high-risk stigmata (HRS, obstructive jaundice, enhanced solid component) should undergo resection. Patients with worrisome features (WF, cyst size ≥3 cm, thickened enhanced cyst walls, non-enhanced mural nodules, and clinical acute pancreatitis) may undergo either a strict surveillance based on patients’ characteristics (age, comorbidities) or surgical resection. Non-operative management is indicated for BD-IPMNs without HRS and WF. Patients with BD-IPMN who do not undergo resection may develop malignant change over time as well as IPMN-distinct pancreatic cancer. However, non-operative management of BD-IPMNs lacking WF and HRS is safe and the risk of malignant degeneration seems relatively low. The optimal surveillance protocol is currently unclear.
Branch-duct Intraductal papillary mucinous neoplasms Surgery Surveillance Worrisome features High-risk stigmata
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All authors declare that they have no conflict of interest.
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Crippa S, Fernández-Del Castillo C, Salvia R et al (2010) Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics. Clin Gastroenterol Hepatol 8:213–219CrossRefPubMedGoogle Scholar
Rodriguez JR, Salvia R, Crippa S et al (2007) Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 133:72–79CrossRefPubMedPubMedCentralGoogle Scholar
Sahora K, Mino-Kenudson M, Brugge W et al (2013) Branch duct intraductal papillary mucinous neoplasms: does cyst size change the tip of the scale? A critical analysis of the revised international consensus guidelines in a large single-institutional series. Ann Surg 258:466–475CrossRefPubMedGoogle Scholar
Tanaka M, Fernández-del Castillo C, Adsay V, International Association of Pancreatology et al (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197CrossRefPubMedGoogle Scholar
Buscarini E, Pezzilli R, Cannizzaro R et al (2014) Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 46:479–493CrossRefPubMedGoogle Scholar
Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association (2015) American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148:819–822CrossRefPubMedGoogle Scholar
Del Chiaro M, Verbeke C, Salvia R et al (2013) European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 45:703–711CrossRefPubMedGoogle Scholar
Aso T, Ohtsuka T, Matsunaga T et al (2014) “High-Risk Stigmata” of the 2012 international consensus guidelines correlate with the malignant grade of branch duct intraductal papillary mucinous neoplasms of the pancreas. Pancreas 43:1239–1243CrossRefPubMedGoogle Scholar
Morales-Oyarvide V, Mino-Kenudson M, Ferrone CR et al (2015) Acute pancreatitis in intraductal papillary mucinous neoplasms: a common predictor of malignant intestinal subtype. Surgery 158:1219–1225CrossRefPubMedGoogle Scholar
Crippa S, Pergolini I, Rubini C et al (2016) Risk of misdiagnosis and overtreatment in patients with main pancreatic duct dilatation and suspected combined/main-duct intraductal papillary mucinous neoplasms. Surgery 159:1041–1049CrossRefPubMedGoogle Scholar
Kim KW, Park SH, Pyo J et al (2014) Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Ann Surg 259:72–81CrossRefPubMedGoogle Scholar
Anand N, Sampath K, Wu BU (2013) Cyst features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Clin Gastroenterol Hepatol 11:913–921CrossRefPubMedGoogle Scholar
Maker AV, Carrara S, Jamieson NB et al (2015) Cyst fluid biomarkers for intraductal papillary mucinous neoplasms of the pancreas: a critical review from the international expert meeting on pancreatic branch-duct-intraductal papillary mucinous neoplasms. J Am Coll Surg 220:243–253CrossRefPubMedGoogle Scholar
Mandai K, Uno K, Yasuda K (2014) Does a family history of pancreatic ductal adenocarcinoma and cyst size influence the follow-up strategy for intraductal papillary mucinous neoplasms of the pancreas? Pancreas 43:917–921CrossRefPubMedGoogle Scholar
Bartsch DK, Dietzel K, Bargello M et al (2013) Multiple small “imaging” branch-duct type intraductal papillary mucinous neoplasms (IPMNs) in familial pancreatic cancer: indicator for concomitant high grade pancreatic intraepithelial neoplasia? Fam Cancer 12:89–96CrossRefPubMedGoogle Scholar
Crippa S, Bassi C, Salvia R et al (2016) Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis. Gut. doi:10.1136/gutjnl-2015-310162
Turrini O, Schmidt CM, Pitt HA et al (2011) Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation? HPB (Oxford) 13:126–131CrossRefGoogle Scholar
Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P (2007) Enucleation of pancreatic neoplasms. Br J Surg 94:1254–1259CrossRefPubMedGoogle Scholar
He J, Cameron JL, Ahuja N et al (2013) Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm? J Am Coll Surg 216:657–665CrossRefPubMedPubMedCentralGoogle Scholar
Rezaee N, Barbon C, Zaki A et al (2016) Intraductal papillary mucinous neoplasm (IPMN) with high-grade dysplasia is a risk factor for the subsequent development of pancreatic ductal adenocarcinoma. HPB (Oxford) 18:236–246CrossRefGoogle Scholar
Falconi M, Crippa S, Chari S et al (2015) Quality assessment of the guidelines on cystic neoplasms of the pancreas. Pancreatology 15:463–469CrossRefPubMedGoogle Scholar
Uehara H, Nakaizumi A, Ishikawa O et al (2008) Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas. Gut 57:1561–1565CrossRefPubMedGoogle Scholar
Tanno S, Nakano Y, Sugiyama Y et al (2010) Incidence of synchronous and metachronous pancreatic carcinoma in 168 patients with branch duct intraductal papillary mucinous neoplasm. Pancreatology 10:173–178CrossRefPubMedGoogle Scholar
Sahora K, Crippa S, Zamboni G et al (2016) Intraductal papillary mucinous neoplasms of the pancreas with concurrent pancreatic and periampullary neoplasms. Eur J Surg Oncol 42:197–204CrossRefPubMedGoogle Scholar
Crippa S, Capurso G, Cammà C, Delle Fave G, Castillo CF, Falconi M (2016) Risk of pancreatic malignancy and mortality in branch-duct IPMNs undergoing surveillance: a systematic review and meta-analysis. Dig Liver Dis 48:473–479CrossRefPubMedGoogle Scholar
Springer S, Wang Y, Dal Molin M et al (2015) A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology 149:1501–1510CrossRefPubMedPubMedCentralGoogle Scholar