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Survey Study on the Practice Patterns of the Evaluation and Management of Incidental Pancreatic Cysts

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Abstract

Background and Aims

Various gastrointestinal societies have released guidelines on the evaluation of asymptomatic pancreatic cysts (PCs). These guidelines differ on several aspects, which create a conundrum for clinicians. The aim of this study was to evaluate preferences and practice patterns in the management of incidental PCs in light of these societal recommendations.

Methods

An electronic survey distributed to members of the American Society for Gastrointestinal Endoscopy (ASGE). Main outcomes included practice setting (academic vs. community), preferences for evaluation, management, and surveillance strategies for PCs.

Results

A total of 172 subjects completed the study (52% academic-based endoscopists). Eighty-six (50%) and 138 (80%) of the participants responded that they would recommend EUS surveillance of incidental PCs measuring less than 2 cm and 3 cm, respectively. Nearly half of the endosonographers (42.5% community and 44% academic; p = 1.0) would routinely perform FNA on PCs without any high-risk features. More academic-based endoscopists (57% academic vs. 32% community; p = 0.001) would continue incidental PC surveillance indefinitely.

Conclusions

There is significant variability in the approach of incidental PCs among clinicians, with practice patterns often diverging from the various GI societal guideline recommendations. Most survey respondents would routinely recommend EUS-FNA and indefinite surveillance for incidental PCs without high-risk features. The indiscriminate use of EUS-FNA and indefinite surveillance of all incidental PCs is not cost-effective, exposes the patient to unnecessary testing, and can further perpetuate diagnostic uncertainty. Well-designed studies are needed to improve our diagnostic and risk stratification accuracy in order to formulate a consensus on the management of these incidental PCs.

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Abbreviations

AGA:

American Gastroenterological Association

ASGE:

American Society of Gastrointestinal Endoscopy

CT:

Computed tomography

EUS:

Endoscopic ultrasound

EUS-FNA:

Endoscopic ultrasound with fine-needle aspiration

MRI:

Magnetic resonance imaging

PCs:

Pancreatic cysts

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Florida, Gainesville, FL, USA

    Donevan Westerveld & Justin Forde

  2. Division of Gastroenterology and Hepatology, College of Medicine, University of Florida, 1329 SW 16th Street, Suite 5251, Gainesville, FL, 32608, USA

    April Goddard, Nieka Harris, Vikas Khullar, Peter V. Draganov, Chris E. Forsmark & Dennis Yang

Authors
  1. Donevan Westerveld
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  2. April Goddard
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  3. Nieka Harris
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  4. Vikas Khullar
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  5. Justin Forde
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  6. Peter V. Draganov
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  7. Chris E. Forsmark
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  8. Dennis Yang
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Contributions

DW, DY, and PD conceived of the presented idea and developed the theory. DW and DY wrote the survey questions. NK, VK, JF, and AG computed and ran the statistics. DW, PD, DY, and CF wrote the manuscript and all revisions. DY gave final approval.

Corresponding author

Correspondence to Dennis Yang.

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Conflict of interest

None of the authors have relevant disclosures or conflicts of interest to declare related to this study.

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Westerveld, D., Goddard, A., Harris, N. et al. Survey Study on the Practice Patterns of the Evaluation and Management of Incidental Pancreatic Cysts. Dig Dis Sci 64, 689–697 (2019). https://doi.org/10.1007/s10620-018-5368-x

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  • DOI: https://doi.org/10.1007/s10620-018-5368-x

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