Cystic pancreatic lesions; actual management by endoscopic ultrasound
Keywords:
pancreatic cystic neoplasms, mucinous cystic neoplasm, endoscopic ultrasoundAbstract
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
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
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Archivos Cubanos de Gastroenterolog?a

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
La revista reconoce a las personas que firman como autores siempre y cuando estos cumplan con los criterios establecidos universalmente para los autores de los art?culos cient?ficos. Regularmente se solicitar? a los autores de art?culos originales, env?en la declaraci?n de autor?a firmada por cada uno de ellos y donde se explique su rol dentro de la investigaci?n. El comit? editorial se reserva el derecho de aceptar determinados autores en relaci?n con el rol declarado y la envergadura de la investigaci?n.
Esta revista protege los Derechos de autor desde el mismo momento en que se realiza el env?o. Sin embargo, cede parte de los derechos patrimoniales de autor al exhibir una licencia Creative Commons 4.0 (cc-by-nc), que permite el uso de la obra para compartir (copiar y redistribuir el material en cualquier medio o formato) y adaptar (remezclar, transformar y construir a partir del material) siempre y cuando se haga menci?n exclusiva a la publicaci?n en la revista como fuente primaria. ?Sin embargo, no podr? comercializar con ella.
?