Cystic pancreatic lesions; actual management by endoscopic ultrasound

Authors

Keywords:

pancreatic cystic neoplasms, mucinous cystic neoplasm, endoscopic ultrasound

Abstract

Cystic pancreatic lesions comprise a wide variety of lesions that are being increasingly diagnosed due to the more frequent use of imaging techniques and the aging of the population. Endoscopic ultrasound has become the best test for their characterization because it allows morphological study and fluid analysis obtained by puncture of the lesion, although its diagnostic accuracy for the detection of mucinous and malignant cysts remains low. The importance of proper characterization is the early detection of preneoplastic as well as malignant lesions and to avoid unnecessary surgery. Clinical practice guidelines differ about the indications for endoscopic ultrasound, surgical treatment and follow-up of these lesions. Questions specially remains in the management of side-branch intraductal papillary neoplasm because of their lower risk of degeneration and their association with pancreatic cancer. In this article we reviewed cystic pancreatic lesions, and the accuracy of different techniques, especially endoscopic ultrasound, by etiology diagnosis.

Keywords: pancreatic cystic neoplasms; mucinous cystic neoplasm; endoscopic ultrasound.

Cystic pancreatic lesions comprise a wide variety of lesions that are being increasingly diagnosed due to the more frequent use of imaging techniques and the aging of the population. Endoscopic ultrasound has become the best test for their characterization because it allows morphological study and fluid analysis obtained by puncture of the lesion, although its diagnostic accuracy for the detection of mucinous and malignant cysts remains low. The importance of proper characterization is the early detection of preneoplastic as well as malignant lesions and to avoid unnecessary surgery. Clinical practice guidelines differ about the indications for endoscopic ultrasound, surgical treatment and follow-up of these lesions. Questions specially remains in the management of side-branch intraductal papillary neoplasm because of their lower risk of degeneration and their association with pancreatic cancer. In this article we reviewed cystic pancreatic lesions, and the accuracy of different techniques, especially endoscopic ultrasound, by etiology diagnosis.

Downloads

Download data is not yet available.

Author Biographies

Harlim Rodríguez Rodríguez, Hospital General Docente “Iván Portuondo”. San Antonio de los Baños. Artemisa.

Especialista de I Grado en MGI, Especialista de I Grado en Gastroenterología.

Zucel Danay Cruz Hernández, Hospital General "Leopoldito MartÍnez". San José de las Lajas. Mayabeque.

Especialista de I Grado en MGI, Especialista de I Grado en Gastroenterología.

Teresita Pérez González, Hospital General Docente “Iván Portuondo”. San Antonio de los Baños. Artemisa.

Especialista de I Grado en MGI, Especialista de I Grado en Gastroenterolog?a.

Lissette Chao Gonzáles, Centro de Investigaciones Médico Quirúrgicas

Dra C. Especialista de 2do grado en Gastroenterología. Profesor titular. Investigador auxiliar.

Lisset Barroso Márquez, Centro de Investigaciones Médico Quirúrgicas

Especialista en Gastroenterologóa. Profesor titular. Investigador auxiliar.

References

Argüelloa L, Fernández-Esparrach G, Ginèsb A. Ultrasonografía endoscópica y lesiones quísticas del páncreas. Med Clin (Barc). 2005 [Acceso 05/03/2020];124(7):266-70. Disponible en: https://www.elsevier.es/es-revista-medicina-clinica-2-articulo-ultrasonografia-endoscopica-lesiones-quisticas-del-13072039

Robert W. Enfermedades quísticas del páncreas. En: Pais J, Flores B, Membrillo A, editores. Ultrasonido endoscópico. México: Editorial Alfil; 2013. p. 207-28.

Chiang AL, Lee LS. Clinical approach to incidental pancreatic cysts. World J Gastroenterol. 2016;22(3):1236-45. DOI:https://doi.org/10.3748/wjg.v22.i3.1236

Munigala S, Gelrud A, Agarwal B. Risk of pancreatic cancer in patients with pancreatic cyst. Gastrointest Endosc. 2016;84(1):81-6. DOI:https://doi.org/10.1016/j.cgh.2018.01.049

Kromrey ML, BülowR, Hübner J, Paperlein C, Lerch MM, Ittermann T, et al. Prospective study on the incidence, prevalence and 5-year pancreatic-related mortality of pancreatic cysts in a population-based study. Gut. 2018;67(1):138-45. DOI: https://doi.org/10.1136/gutjnl-2016-313127

Dumonceau JM, Deprez PH, Jenssen C, Iglesias-Garcia J, Larghi A, Vanbiervliet G, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2017;49(7):695-714. DOI: http://dx.doi.org/10.1055/s0043-109021

Herranz R, De la Morena F, Santander C. Neoplasias quísticas pancreáticas: enfoque diagnóstico Rev Colomb Gastroenterol. 2019;34(1). DOI:http://dx.doi.org/10.22516/25007440.242

Clinical applications of endoscopic ultrasonography in gastroenterology-state of the art 1993. Results of a Consensus Conference, Orlando, Florida, 19 January 1993. Endoscopy.1993[Acceso 03/07/2020];25(5):358-66. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=85788

Chacaltana A, Zumaeta E, Larrea P, Chávez H, Vera A. Experiencia inicial en ecoendoscopía en el Hospital Edgardo Rebagliati, EsSalud, Lima, Perú. Rev Gatroenterol Peru.2013 Oct [Acceso 03/07/2020];33(4):293-9. Disponible en http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1022-51292013000400002&Ing=es

Basar O, Brugge WR. Pancreatic cyst guidelines: Which one to the live by?Gastrointest Endosc. 2017;85(5):1032-5. DOI: http://dx.doi.org/10.1016/j.gie.2016.11.003

Lekkerkerker SJ, Besselink MG, Busch OR, Verheij J, Engelbrecht MR, Rauws EA, et al. Comparing 3 guidelines on the management of surgically removed pancreatic cysts with regard to pathological outcome. Gastrointest Endosc.2017;85(5):1025-31. DOI:https://doi.org/10.1016/j.gie.2016.09.027

Malagelada J, Guda N, Goh K, Layer P,Molero X, Pandol S, et al. Directrices mundiales de la Organización Mundial de Gastroenterología. Lesiones quísticas pancreáticas. Marzo de 2019. World Gastroenterology Organization.2019. [Acceso 03/07/2020]. Disponible en: https://www.worldgastroenterology.org/guidelines/global-guidelines/pancreatic-cystic-lesions/pancreatic-cystic-lesions-spanish

Ridtitid W, DeWitt JM, Schmidt CM, Roch A, Stuart JS, Sherman S, et al. Management of branch-duct intraductal papillary mucinous neoplasms: Alarge single-center study to assess predictors of malignancy and long-term outcomes. Gastrointest Endosc. 2016;84(3):436-45. DOI: https://doi.org/10.1016/j.gie.2016.02.008

Banks PA, Bollen TL, Dervenis C. Classification of acute pancreatitis—2012: Revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11. DOI:https://dx.doi.org/10.1136/gutjnl.2012

Casasola LE, Tellez FI. El papel terapéutico del ultrasónico endoscópico en las lesiones quísticas del páncreas. Endoscopia. 2015;27(2):87-94. DOI: https://dz.doi.org/10.1016/j.endornx.2015.07.006

Zárate LA, Mendoza JE, Tovar G, Arenas MA. Drenaje endoscópico transgástrico de pseudoquiste pancreático en paciente pediátrico. Reporte de un caso. Rev Colomb Gastroenterol. 2018;33(2). DOI:http://dx.doi.org/10.22516/25007440.147

Sosa-Valencia L, Navas G, Rodríguez L, Ramos J, Bethelmy A, González V. Ecoendoscopia digestiva radial y lineal como método diagnóstico de las lesiones quísticas del páncreas: hallazgos. Gen. 2014 [Acceso 05/07/2020];68(2):62-75. Disponible en http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0016-35032014000200008&Ing=es

O’Toole D, Palazzo L. Macrocystic pancreatic cistoadenoma: The role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions. Gastrointest Endosc. 2004;59:823-9. DOI: https://doi.org/10.1016/s0016-5107(04)00346-3

Zikos T, Pham K, Bowen R, Chen AM, Banerjee S, Friedland S, et al. Cyst Fluid Glucose is Rapidly Feasible and Accurate in Diagnosing Mucinous Pancreatic Cysts. Am J Gastroenterol. 2015;110(6):909-14. DOI: https://doi.org/10.1038/ajg.2015.148

Singhi AD, Zeh HJ, Brand RE, Nikiforova MN, Chennat JS, Fasanella KE, et al. American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: Aclinicopathologic study of 225 patients with supporting molecular data. Gastrointest Endosc. 2016;83(6):1107-17. DOI: https://doi.org/10.1016/j.gie.2015.12.009

Date K, Ohtsuka T, Nakamura S, Mochidome N, Mori Y, Miyasaka Y,et al. Surveillance of patients with intraductal papillary mucinous neoplasm with and without pancreatectomy with special reference to the incidence of concomitant pancreatic ductal adenocarcinoma. Surgery. 2018;163(2):291-9. DOI: https://doi.org/10.1016/j.surg.2017.09.040

Springer S, Wang Y, Dal Molin M, Masica DL, Jiao Y, Kinde I, et al. A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology. 2015;149(6):1501-10. DOI: https://doi.org/10.1053/j.gastro.2015.07.041

Jones M, Zheng Z, Wang J, Dudley J, Albanese E, Kadayifci A, et al. Impact of next-generation sequencing on the clinical diagnosis of pancreatic cysts. Gastrointest Endosc. 2016;83(1):140-8. DOI: http://dx.doi.org/10.1016/j.gie.2015.06.047

Rodríguez C, LarrosaR. Descripción radiológica de las lesiones quísticas del páncreas. Radiología. 2016;58(5):404-14.DOI: http://dx.doi.org/10.1016/j.rx.2016.06.00125.European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018;67(5):789-804. DOI:http://dx.doi.org/10.1136/gutjnl-2018-316027

Published

2020-07-06

How to Cite

1.
Rodríguez Rodríguez H, Cruz Hernández ZD, Pérez González T, Chao Gonzáles L, Barroso Márquez L. Cystic pancreatic lesions; actual management by endoscopic ultrasound. Arch.cuba.gastroenterol. [Internet]. 2020 Jul. 6 [cited 2025 Mar. 14];2(1). Available from: https://revgastro.sld.cu/index.php/gast/article/view/43

Issue

Section

REVISIONES BIBLIOGRÁFICAS