Intraduktale papillär-muzinöse Neoplasien des Pankreas

 

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Zusammenfassung

Mit der Weiterentwicklung und breiteren Anwendung bildgebender Verfahren, wie Endosonographie (ES), Magnetresonanztomographie (MRT), Magnetresonanz-Cholangio-Pankreatikographie (MRCP) und Computertomographie (CT), werden zystische Pankreasläsionen häufiger diagnostiziert. Die letzten Konsensus-Empfehlungen wie zystische Pankreasläsionen diagnostiziert, therapiert oder im Verlauf beobachtet werden sollen, wurden im Jahr 2006 verfasst. Seither hat das Wissen über diese Krankheitsentitäten zugenommen, so dass eine Überarbeitung der Konsensus-Empfehlungen notwendig wurde. In dieser Übersicht werden die neuen Empfehlungen von zwei Konsenus-Leitlinien zur Diagnostik und Therapie von intraduktalen papillär muzinösen Neoplasien des Pankreas zusammengefasst. Aufgrund des hohen Entartungsrisikos werden Hauptgang-IPMN in der Regel chirurgisch versorgt, wenn dies der Gesundheitszustand des Patienten zulässt. Seitengang-IPMN können im Verlauf beobachtet werden, wenn keine Veränderungen vorliegen, die auf die Möglichkeit einer malignen Veränderung im Verlauf hindeuten. Als Bildgebung sollten die MRT/MRCP und in entsprechend erfahrenen Zentren die Endosonografie eingesetzt werden.

Abstract

The diagnosis of cystic pancreatic lesions is raised more often within the last years. This is due to the fact that diagnostic opportunities and modalities such as endosonography (EUS), magnetic resonance imaging (MRI), magnetic resonance cholangio-pancreatography (MRCP), and computertomography (CT) have both improved and are more widely used. As such new recommendations were needed, since the knowledge on cystic pancreatic lesions has increased after the last consensus statement published in 2006.  In this review the main aspects of the recent consensus statements for diagnosis and therapy or in some cases the surveillance strategy of intraductal papillary mucinous neoplasm will be summarized. Main duct IPMN will in most cases in surgically „fit“ patients be resected, since the risk of malignancy is high in this entity. In patients with branch duct IPMN a careful „watch and wait“ strategy can be applied if no „worrisome features“ or „high-risk stigmata“ can be detected. MRI is the imaging modality of choice, while EUS should be applied in centers with expertise.

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