Remaining problems -Surveillance policy for IPMN

Abstract

The management of BD-IPMN changed to more deliberate observation in the revised guidelines, and the occurrence of pancreatic ductal adenocarcinoma (PDAC) concomitant with BD-IPMN was documented. Therefore, careful attention should be paid to not only disease progression, but also the development of PDAC during follow-up.
In the revised guidelines for surveillance, EUS and/or MRI every 3-6 months for size dependent are recommended. Frequencies of progression and malignant transformation in the BD-IPMNs without any sign of malignancy have been reported only at 0-17.8% and 0-2.6%, respectively. Therefore annual surveillance is adequate for disease progression. However, for early detection of PDAC shorter interval and rich modality surveillance may be necessary.
We propose a prospective study for surveillance of BD-IPMN based of a follow-up every 6 months by dynamic CT or MRCP with EUS alternately. Elucidation of the natural history for IPMN and early detection of PDAC is expected.