Elsevier

Gastrointestinal Endoscopy

Volume 69, Issue 4, April 2009, Pages 813-820.e17
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Awareness of guidelines and trends in the management of suspected pancreatic cystic neoplasms: survey results among general gastroenterologists and EUS specialists

https://doi.org/10.1016/j.gie.2008.05.036Get rights and content

Background

Although pancreatic cystic neoplasms are widely recognized, practice habits among physicians and awareness of consensus guidelines are currently unknown.

Objectives

To assess the awareness of guidelines and describe variability in practice habits among 2 groups: (1) “general group” of gastroenterologists and surgeons and (2) “EUS group” of specialists in EUS.

Design

An online survey was sent to randomly selected gastroenterologists and surgeons and e-mailed to members of the American Society for Gastrointestinal Endoscopy (ASGE) Special Interest Group in EUS (EUS-SIG).

Results

Response rate for the general group was 8.8% (220/2500) and 9.7% for the EUS group (42/431). EUS specialists were mostly in academic practice (66.7% vs 36.3%, P < .001) and reported seeing 21 to 50 cysts per year (54.8% vs 12.3%, P < .001). The majority of the general group (64.1%) was unaware of any published practice guidelines, compared with 33.3% of EUS specialists (P < .001). Awareness of ASGE guidelines was more frequently reported than other guidelines in both groups and yet was still <50% for each group. Both demonstrated moderate consistency with the International Association of Pancreatology guidelines, appropriately answering 66.7% of the questions. For 9-mm lesions, only 25% of the questions were correctly answered in each group. EUS specialists were less likely to refer main-duct intraductal papillary mucinous neoplasms (IPMN) for surgery and more likely to opt for EUS-guided FNA (compared with high-resolution CT, MRCP, or surgery) for 9-mm, 22-mm, and 34-mm branch-duct IPMNs (P ≤ .001).

Limitations

Low response rate and recall bias.

Conclusions

Awareness of practice guidelines about the management of suspected pancreatic cystic neoplasms is lower among general GI physicians compared with EUS specialists. Among all physicians, the greatest variability in practice is in small (<1 cm) lesions.

Section snippets

Study participants

This study was approved by the Johns Hopkins University School of Medicine Institutional Review Board. An Internet, Web-based survey was designed to address the different practice habits of 2 groups of physicians: (1) a general group of gastroenterologists and GI surgeons (general group) and (2) a group of EUS specialists (EUS group). General group members were contacted by e-mail on 2 occasions, between March and May 2006, alerting them to a Web site link that contained the online

Section 1: respondent demographics

Questionnaire response rates were tabulated for both groups of participants. In the general group of GI specialists, 8.8% of the people who received the e-mail solicitation completed the survey (220/2500). In the EUS group, 9.7% of EUS-SIG members responded (42/431).

The characteristics of both groups of respondents are shown in Table 1. In the general group, 28.2% of respondents were GI surgeons compared with 4.8% in the EUS group (P < .001). Both groups were predominantly men (P = .59) and

Discussion

Noninflammatory pancreatic cysts are increasingly discovered with the expanding use of modern-day CT scanners and MRI machines.18, 19 Often, patients are incidentally found to have a small cystic lesion in their pancreas on a CT done for the evaluation of renal calculi or another benign disease. After discussion with their primary care physician, they are frequently referred to a gastroenterologist or a GI surgeon for guidance regarding the management of such lesions. The specialist is then

Acknowledgments

We thank James Harper and the Internet technology team of Olympus America for assistance. We appreciate their support in designing the survey Web site and for maintaining the data collection.

References (20)

There are more references available in the full text version of this article.

Cited by (21)

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This study was conducted in collaboration with Olympus America.

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