Updates in Surgery

, Volume 68, Issue 3, pp 265–271 | Cite as

Treatment of branch-duct intraductal papillary mucinous neoplasms of the pancreas: state of the art

  • Stefano Crippa
  • Alessandra Piccioli
  • Maria Chiara Salandini
  • Chiara Cova
  • Francesca Aleotti
  • Massimo FalconiEmail author
Review Article
Part of the following topical collections:
  1. Pancreatic Surgery


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 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Research involving human participants and/or animals

No animals were involved in the study.

Informed consent

Informed written consent was taken from all the participants involved in the study.


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Copyright information

© Italian Society of Surgery (SIC) 2016

Authors and Affiliations

  • Stefano Crippa
    • 1
  • Alessandra Piccioli
    • 2
  • Maria Chiara Salandini
    • 1
  • Chiara Cova
    • 1
  • Francesca Aleotti
    • 1
  • Massimo Falconi
    • 1
    Email author
  1. 1.Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific InstituteVita e Salute UniversityMilanItaly
  2. 2.Department of SurgeryUniversità Politecnica delle MarcheOspedali RiunitiItaly

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