Management of an asymptomatic pancreatic cyst >5 cm in diameter

2019-06-18
Miroslav Vujasinovic

References

Löhr JM, Dominguez-Munoz E, Rosendahl J, et al; HaPanEU/UEG Working Group. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017 Mar;5(2):153-199. doi: 10.1177/2050640616684695. Epub 2017 Jan 16. Review. PubMed PMID: 28344786; PubMedCentral PMCID: PMC5349368.

What should be the management of an asymptomatic pancreatic cyst >5 cm in diameter?

Miroslav Vujasinovic, MD, PhD: I noticed that there is a problem in understanding of the guidelines [from United European Gastroenterology]. Maybe it was written in a cumbersome way.

These patients are very demanding. In our center in Stockholm, twice per week we have a pancreas conference with a multidisciplinary team and we have an individual approach.

Generally, if the cysts are <5 cm in diameter and if the patient is asymptomatic, we are just observing the patient. We watch and wait. We usually perform either magnetic resonance imaging or endoscopic ultrasound every 6 months. But we warn the patient that if some symptoms occur, they should contact us as soon as possible.

Generally, the larger the cyst, the higher the risk of complications: perforations, bleeding, infections. Also, especially if the cyst is producing strictures, if they push on the structures in that area, that means the stomach, duodenum, or bile ducts, then it is absolutely an indication [for surgery].

We also are very concerned about other diseases connected with pancreas disease and the age of the patient. In older patients in whom anesthesia may be risky, maybe we are a little bit more restrictive.

But generally, in all cysts that are >6 cm we are recommending the drainage. We can discuss if it will be transpapillary or transmural and it is the matter of the conference; we are then deciding individually. But generally, it is nice to perform drainage of all cysts >6 cm in size.

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