Journal of Gastroenterology

, Volume 44, Issue 9, pp 964–975 | Cite as

Suppressive effect of sulindac on branch duct-intraductal papillary mucinous neoplasms

  • Tsuyoshi Hayashi
  • Hirotoshi Ishiwatari
  • Hideyuki Ihara
  • Yutaka Kawano
  • Koichi Takada
  • Koji Miyanishi
  • Masayoshi Kobune
  • Rishu Takimoto
  • Tomoko Sonoda
  • Tetsuji Takayama
  • Junji Kato
  • Yoshiro NiitsuEmail author
Original Article—Liver, Pancreas, and Biliary Tract



When considering surgery for branch duct-intraductal papillary mucinous neoplasms (BD-IPMNs) with suspected malignancy, it should be recognized that these lesions are frequently multifocal and are usually found in elderly patients with potential comorbidities that could affect the outcome of surgery. Clinical trials of chemoprevention have been conducted for a wide variety of malignancies.


Twenty-two BD-IPMN patients participated in the trial at our institution from June 2004 to January 2007. Ten of the 22 patients who rejected surgical therapy although their lesions or clinical symptoms met the criteria for surgical resection of the International Association of Pancreatology guidelines were assigned to the treatment group. Sulindac (150 mg twice daily) and omeprazole (20 mg once daily) were administered to these patients for 18 months. The remaining 12 patients comprised the control group. Branch duct diameter and mural nodule heights were monitored by either magnetic resonance cholangiopancreatography (MRCP) or computed tomography (CT) and by endoscopic ultrasonography (EUS).


Both branch duct diameter and mural nodule height of BD-IPMNs in the treatment group were significantly reduced, while those in the control group were unchanged. Immunohistochemical staining for cyclooxygenase-1 and -2 was negative in hyperplasia, adenoma and carcinoma portions of resected pancreatic specimens but was clearly positive for glutathione-S-transferase π (GST-π), suggesting that GST-π is a putative target molecule for sulindac.


Although a larger scale randomized controlled study is needed in future, the present results suggest the promise of chemoprevention of carcinoma derived from BD-IPMNs by sulindac.


Intraductal papillary-mucinous neoplasm Chemoprevention Non-steroidal anti-inflammatory drugs Glutathione-S-transferase π 



International Association of Pancreatology


Branch duct intraductal papillary-mucinous neoplasm


Main duct intraductal papillary-mucinous neoplasm


Endoscopic retrograde pancreatography


Computed tomography


Magnetic resonance cholangiopancreatography


Endoscopic ultrasonography


Non-steroidal anti-inflammatory drugs






Glutathione-S-transferase π


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Copyright information

© Springer 2009

Authors and Affiliations

  • Tsuyoshi Hayashi
    • 1
  • Hirotoshi Ishiwatari
    • 1
  • Hideyuki Ihara
    • 1
  • Yutaka Kawano
    • 1
  • Koichi Takada
    • 1
  • Koji Miyanishi
    • 1
  • Masayoshi Kobune
    • 1
  • Rishu Takimoto
    • 1
  • Tomoko Sonoda
    • 2
  • Tetsuji Takayama
    • 3
  • Junji Kato
    • 1
  • Yoshiro Niitsu
    • 4
    Email author
  1. 1.Fourth Department of Internal MedicineSapporo Medical University School of MedicineSapporoJapan
  2. 2.Department of Public HealthSapporo Medical University School of MedicineSapporoJapan
  3. 3.Department of Gastroenterology and Oncology, Institute of Health BiosciencesThe University of Tokushima Graduate SchoolSapporoJapan
  4. 4.Department of Molecular Target ExplorationSapporo Medical University School of MedicineHokkaidoJapan

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