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European evidence-based guidelines on pancreatic cystic neoplasms
Open accessAbstract
Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.
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“Guidelines recommend immediate surgical resection for any lesion with high-risk stigmata, and regular surveillance with interval imaging (MRI or endoscopic ultrasound) for all mucinous or indeterminate lesions.21,60”
From Early detection of pancreatic cancer (2020) · cites this paper as [60]
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“Surveillance protocols vary between the different guidelines, but typically recommend cross-sectional imaging once every 6 months in the first year, and annually thereafter if no changes are detected.”
From Early detection of pancreatic cancer (2020) · cites this paper as [60]
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“Current surveillance recommendations for a family history (generally in one blood relative) are the same as for those without a family history.”
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“More frequent surveillance is advocated for larger lesions or lesions with worrisome features.21,60”
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Metadata
- Authors
- The European Study Group on Cystic Tumours of the Pancreas
- Corresponding author
- The European Study Group on Cystic Tumours of the Pancreas
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2018-03-24
- Volume
- 67
- Issue
- 5
- Pages
- 789-804
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC5890653
- OpenAlex
- W2798191310
- Cited by
- 1,417
- References
- 271
- Citations by year
- 2026: 151 · 2025: 173 · 2024: 195 · 2023: 193 · 2022: 184 · 2021: 186 · 2020: 152 · 2019: 131 · 2018: 47
- FWCI
- 48.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Gut (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (publishedVersion, cc-by-nc)
- Tampere University Institutional Repository (Tampere University) (publishedVersion, cc-by-nc)
- SZTE Publicatio Repozitórium (University of Szeged) (acceptedVersion, other-oa)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, cc-by-nc)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (submittedVersion, cc-by-nc)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion, cc-by-nc-sa)
- Tampere University Institutional Repository (Tampere University) (submittedVersion, cc-by-nc)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- Cancer Research UK (11883, 16812, 17680, 15957, 16186)
- National Institute for Health and Care Research (08/29/02)
- Cancerfonden
- European Society of Gastrointestinal Endoscopy
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Oncology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Keywords
- pancreatic cystic neoplasms, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, serous cystic neoplasm, surgical indications, conservative treatment, malignant transformation, main pancreatic duct diameter, mural nodules, follow-up, biomarkers, radiology, endoscopy, adjuvant therapy, pathology
- MeSH terms
- Europe, Humans, Pancreas, Pancreatic Cyst, Pancreatic Neoplasms, Evidence-Based Practice
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