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Erschienen in: Current Treatment Options in Gastroenterology 4/2019

09.11.2019 | Gastroenterology for Geriatric Patients (S Katz and A Afzali, Section Editors)

Pancreatic Cysts in the Elderly

verfasst von: Luis F. Lara, MD, Anjuli Luthra, MD, Darwin L. Conwell, MD, MS, Somashekar G. Krishna, MD, MPH

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 4/2019

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Abstract

Purpose of review

Incidental pancreatic cysts are common, and management strategies continue to evolve. This review summarizes diagnostic and management recommendations in older patients with these lesions based on guidelines and best clinical evidence.

Recent findings

Diagnosis of cyst type has been enhanced with improved imaging and cyst fluid analysis and visualization. Recent outcome studies indicate that certain cyst types should be followed independent of patient age as long as certain criteria which are reviewed are met.

Summary

Differentiation of pancreatic cyst type is important as this dictates the need for long-term follow-up. Because most cyst-related neoplasia occurs in older patients, surveillance should continue within certain guidelines.
Literatur
1.
Zurück zum Zitat •• Tanaka M, Fernandez-el Castillo C, Kamisawa T, et al. Revisions of the international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17:738–53 Recent updated multidisciplinary guidelines on IPMN surveillance. •• Tanaka M, Fernandez-el Castillo C, Kamisawa T, et al. Revisions of the international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17:738–53 Recent updated multidisciplinary guidelines on IPMN surveillance.
2.
Zurück zum Zitat Zhang XM, Mitchell DG, Dohke M, et al. Pancreatic cysts: depiction on single-shot fast spin-echo MR Images. Radiology. 2002;223:547–53.PubMed Zhang XM, Mitchell DG, Dohke M, et al. Pancreatic cysts: depiction on single-shot fast spin-echo MR Images. Radiology. 2002;223:547–53.PubMed
3.
Zurück zum Zitat Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. Am J Roentgenol. 2008;191:802–7. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. Am J Roentgenol. 2008;191:802–7.
4.
Zurück zum Zitat Brugge WR. Approach to cystic pancreatic lesions. Gastrointest Endosc Clin N Am. 2005;15:485–96.PubMed Brugge WR. Approach to cystic pancreatic lesions. Gastrointest Endosc Clin N Am. 2005;15:485–96.PubMed
5.
Zurück zum Zitat Kimura W, Nagai H, Kuroda A, et al. Analysis of small cystic lesions of the pancreas. Int J Pancreatol. 1995;18:197–206.PubMed Kimura W, Nagai H, Kuroda A, et al. Analysis of small cystic lesions of the pancreas. Int J Pancreatol. 1995;18:197–206.PubMed
6.
Zurück zum Zitat •• European evidence-based guidelines on pancreatic cystic neoplasms. The European Study Group on Cystic Tumours of the Pancreas. Gut. 2018;67:789–804 Most recently updated guidelines on all type of pancreatic cyst management. •• European evidence-based guidelines on pancreatic cystic neoplasms. The European Study Group on Cystic Tumours of the Pancreas. Gut. 2018;67:789–804 Most recently updated guidelines on all type of pancreatic cyst management.
7.
Zurück zum Zitat Vege SS, Ziring B, Jain R, et al. American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148:819–22.PubMed Vege SS, Ziring B, Jain R, et al. American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148:819–22.PubMed
8.
Zurück zum Zitat Estrella JS, Li L, Rashid A, et al. Solid pseudopapillary neoplasm of the pancreas: clinicopathologic and survival analyses of 64 cases from a single institution. Am J Surg Pathol. 2014;38:147–57.PubMed Estrella JS, Li L, Rashid A, et al. Solid pseudopapillary neoplasm of the pancreas: clinicopathologic and survival analyses of 64 cases from a single institution. Am J Surg Pathol. 2014;38:147–57.PubMed
9.
Zurück zum Zitat Law JK, Ahmed A, Singh VK, et al. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas. 2014;43:331–7.PubMedPubMedCentral Law JK, Ahmed A, Singh VK, et al. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas. 2014;43:331–7.PubMedPubMedCentral
10.
Zurück zum Zitat Kimura W, Moriya T, Hirai I, et al. Multicenter study of serous cystic neoplasm of the Japan pancreas society. Pancreas. 2012;41:380–7.PubMed Kimura W, Moriya T, Hirai I, et al. Multicenter study of serous cystic neoplasm of the Japan pancreas society. Pancreas. 2012;41:380–7.PubMed
11.
Zurück zum Zitat Lee LS, Clancy T, Kadiyala V, et al. Interdisciplinary management of cystic neoplasms of the pancreas. Gastroenterol Res Pract. 2012;2012:513163.PubMedPubMedCentral Lee LS, Clancy T, Kadiyala V, et al. Interdisciplinary management of cystic neoplasms of the pancreas. Gastroenterol Res Pract. 2012;2012:513163.PubMedPubMedCentral
12.
Zurück zum Zitat Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97.PubMed Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97.PubMed
13.
Zurück zum Zitat Schmidt CM, White PB, Waters JA, et al. Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg. 2007;246:644–51.PubMed Schmidt CM, White PB, Waters JA, et al. Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg. 2007;246:644–51.PubMed
14.
Zurück zum Zitat Waters JA, Schmidt CM, Pinchot JW, et al. CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg. 2008;12:101–9.PubMed Waters JA, Schmidt CM, Pinchot JW, et al. CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg. 2008;12:101–9.PubMed
15.
Zurück zum Zitat Reid-Lombardo KM, St. Sauver J, Li Z, et al. Incidence, prevalence, and management of intraductal papillary mucinous neoplasm in Olmsted County, Minnesota, 1984-2005: a population study. Pancreas. 2008;37:139–44.PubMedPubMedCentral Reid-Lombardo KM, St. Sauver J, Li Z, et al. Incidence, prevalence, and management of intraductal papillary mucinous neoplasm in Olmsted County, Minnesota, 1984-2005: a population study. Pancreas. 2008;37:139–44.PubMedPubMedCentral
16.
Zurück zum Zitat Sahora K, Mino-Kenudson M, Brugge W, et al. Branch duct intraductal papillary mucinous neoplasms: does cyst size change the tip of the scale? A critical analysis of the revised international consensus guidelines in a large single-institutional series. Ann Surg. 2013;258(3):466–75.PubMed Sahora K, Mino-Kenudson M, Brugge W, et al. Branch duct intraductal papillary mucinous neoplasms: does cyst size change the tip of the scale? A critical analysis of the revised international consensus guidelines in a large single-institutional series. Ann Surg. 2013;258(3):466–75.PubMed
17.
Zurück zum Zitat • Goh BK, Tan DM, Thng CH, et al. Are the Sendai and Fukuoka consensus guidelines for cystic mucinous neoplasms of the pancreas useful in the initial triage of all suspected pancreatic cystic neoplasms? A single-institution experience with 317 surgically-treated patients. Ann Surg Oncol. 2014;21:1919–26 A comparison trial of the effectiveness of the proposed guidelines in patients who ultimately had surgery.PubMed • Goh BK, Tan DM, Thng CH, et al. Are the Sendai and Fukuoka consensus guidelines for cystic mucinous neoplasms of the pancreas useful in the initial triage of all suspected pancreatic cystic neoplasms? A single-institution experience with 317 surgically-treated patients. Ann Surg Oncol. 2014;21:1919–26 A comparison trial of the effectiveness of the proposed guidelines in patients who ultimately had surgery.PubMed
18.
Zurück zum Zitat Fritz S, Klauss M, Bergmann F, et al. Pancreatic main-duct involvement in branch-duct IPMNs. Ann Surg. 2014;260:848–56.PubMed Fritz S, Klauss M, Bergmann F, et al. Pancreatic main-duct involvement in branch-duct IPMNs. Ann Surg. 2014;260:848–56.PubMed
19.
Zurück zum Zitat • Elta GH, Enestvedt BK, Sauer BG, et al. ACG Clinical Guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol. 2018;113:464–79 A clinically appropriate guideline for all pancreatic cysts. • Elta GH, Enestvedt BK, Sauer BG, et al. ACG Clinical Guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol. 2018;113:464–79 A clinically appropriate guideline for all pancreatic cysts.
20.
Zurück zum Zitat Megibow AJ, Baker ME, Morgan DE, et al. Management of incidental pancreatic cysts: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017;14:911–23.PubMed Megibow AJ, Baker ME, Morgan DE, et al. Management of incidental pancreatic cysts: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017;14:911–23.PubMed
21.
Zurück zum Zitat •• Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32 First proposed guidelines for cystic mucinous lesions of the pancreas.PubMed •• Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32 First proposed guidelines for cystic mucinous lesions of the pancreas.PubMed
22.
Zurück zum Zitat Pelaez-Luna M, Chari ST, Smyrk TC, et al. Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients. Am J Gastroenterol. 2007;102:1759–64.PubMed Pelaez-Luna M, Chari ST, Smyrk TC, et al. Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients. Am J Gastroenterol. 2007;102:1759–64.PubMed
23.
Zurück zum Zitat Tang RS, Weinberg B, Dawson DW, et al. Evaluation of the guidelines for management of pancreatic branch-duct intraductal papillary mucinous neoplasm. Clin Gastroenterol Hepatol. 2008;6:815–9.PubMed Tang RS, Weinberg B, Dawson DW, et al. Evaluation of the guidelines for management of pancreatic branch-duct intraductal papillary mucinous neoplasm. Clin Gastroenterol Hepatol. 2008;6:815–9.PubMed
24.
Zurück zum Zitat Kaimakliotis P, Riff B, Pourmand K, et al. Sendai and Fukuoka consensus guidelines identify advanced neoplasia in patients with suspected mucinous cystic neoplasms of the pancreas. Clin Gastroenterol Hepatol. 2015;13:1808–15.PubMed Kaimakliotis P, Riff B, Pourmand K, et al. Sendai and Fukuoka consensus guidelines identify advanced neoplasia in patients with suspected mucinous cystic neoplasms of the pancreas. Clin Gastroenterol Hepatol. 2015;13:1808–15.PubMed
25.
Zurück zum Zitat Ma GK, Goldberg DS, Thiruvengadam N, et al. Comparing American Gastroenterological Association pancreatic cyst management guidelines with Fukuoka consensus guidelines as predictors of advanced neoplasia in patients with suspected pancreatic cystic neoplasms. J Am Coll Surg. 2016;223:729–37.PubMed Ma GK, Goldberg DS, Thiruvengadam N, et al. Comparing American Gastroenterological Association pancreatic cyst management guidelines with Fukuoka consensus guidelines as predictors of advanced neoplasia in patients with suspected pancreatic cystic neoplasms. J Am Coll Surg. 2016;223:729–37.PubMed
26.
Zurück zum Zitat •• Singhi AD, Zeh HJ, Brand RE, et al. American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathological study of 225 patients with supporting molecular data. Gastrointest Endosc. 2016;83:1107–17 A major study indicating the poor ability of the AGA guidelines in identifying high risk lesions. •• Singhi AD, Zeh HJ, Brand RE, et al. American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathological study of 225 patients with supporting molecular data. Gastrointest Endosc. 2016;83:1107–17 A major study indicating the poor ability of the AGA guidelines in identifying high risk lesions.
27.
Zurück zum Zitat Kwong WT, Hunt GC, Fehmi SM, et al. Low rates of malignancy and mortality in asymptomatic patients with suspected neoplastic pancreatic cysts beyond 5 years of surveillance. Clin Gastroenterol Hepatol. 2016;14:865–71.PubMed Kwong WT, Hunt GC, Fehmi SM, et al. Low rates of malignancy and mortality in asymptomatic patients with suspected neoplastic pancreatic cysts beyond 5 years of surveillance. Clin Gastroenterol Hepatol. 2016;14:865–71.PubMed
28.
Zurück zum Zitat Watanabe Y, Endo S, Nishihara K, et al. The validity of the surgical indication for intraductal papillary mucinous neoplasm of the pancreas advocated by the 2017 revised International Association of Pancreatology consensus guidelines. Surg Today. 2018;48:1011–9.PubMed Watanabe Y, Endo S, Nishihara K, et al. The validity of the surgical indication for intraductal papillary mucinous neoplasm of the pancreas advocated by the 2017 revised International Association of Pancreatology consensus guidelines. Surg Today. 2018;48:1011–9.PubMed
29.
Zurück zum Zitat Pérez-Cuadrado-Robles E, Uribarri-González L, Borbath I, et al. Risk of advanced lesions in patients with branch-duct IPMN and relative indications for surgery according to European evidence-based guidelines. Dig Liver Dis. 2019;51:882–6.PubMed Pérez-Cuadrado-Robles E, Uribarri-González L, Borbath I, et al. Risk of advanced lesions in patients with branch-duct IPMN and relative indications for surgery according to European evidence-based guidelines. Dig Liver Dis. 2019;51:882–6.PubMed
30.
Zurück zum Zitat Nguyen AH, Toste PA, Farrell JJ. Current recommendations for surveillance and surgery of intraductal papillary mucinous neoplasms may overlook some patients with cancer. J Gastrointest Surg. 2015;19:258–65.PubMed Nguyen AH, Toste PA, Farrell JJ. Current recommendations for surveillance and surgery of intraductal papillary mucinous neoplasms may overlook some patients with cancer. J Gastrointest Surg. 2015;19:258–65.PubMed
31.
Zurück zum Zitat Oh HC, Brugge WR. EUS-guided pancreatic cyst ablation: a critical review (with video). Gastrointest Endosc. 2013;77:526–33.PubMed Oh HC, Brugge WR. EUS-guided pancreatic cyst ablation: a critical review (with video). Gastrointest Endosc. 2013;77:526–33.PubMed
32.
Zurück zum Zitat Khalid A, Brugge W. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol. 2007;102:2339–49.PubMed Khalid A, Brugge W. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol. 2007;102:2339–49.PubMed
33.
Zurück zum Zitat Maker AV, Lee LS, Raut CP, et al. Cytology from pancreatic cysts has marginal utility in surgical decision-making. Ann Surg Oncol. 2008;15:3187–92.PubMed Maker AV, Lee LS, Raut CP, et al. Cytology from pancreatic cysts has marginal utility in surgical decision-making. Ann Surg Oncol. 2008;15:3187–92.PubMed
34.
Zurück zum Zitat Singhi AD, Nikiforova MN, McGrath K. DNA testing of pancreatic cystic fluid: is it ready for prime time? Lancet Gastroenterol Hepatol. 2017;2:63–72.PubMed Singhi AD, Nikiforova MN, McGrath K. DNA testing of pancreatic cystic fluid: is it ready for prime time? Lancet Gastroenterol Hepatol. 2017;2:63–72.PubMed
35.
Zurück zum Zitat • Wu J, Matthaei H, Maitra A, et al. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Transl Med. 2011;3:92ra66 First study to report DNA mutation analysis and correlation with outcomes.PubMedPubMedCentral • Wu J, Matthaei H, Maitra A, et al. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Transl Med. 2011;3:92ra66 First study to report DNA mutation analysis and correlation with outcomes.PubMedPubMedCentral
36.
Zurück zum Zitat Sreenarasimhaiah J, Lara LF, Jazrawi SF, et al. A comparative analysis of pancreas cyst fluid CEA and histology with DNA mutational analysis in the detection of mucin producing or malignant cysts. JOP. 2009;10:163–8.PubMed Sreenarasimhaiah J, Lara LF, Jazrawi SF, et al. A comparative analysis of pancreas cyst fluid CEA and histology with DNA mutational analysis in the detection of mucin producing or malignant cysts. JOP. 2009;10:163–8.PubMed
37.
Zurück zum Zitat Jones M, Zheng Z, Wang J, et al. Impact of next-generation sequencing on the clinical diagnosis of pancreatic cysts. Gastrointest Endosc. 2016;83:140–8.PubMed Jones M, Zheng Z, Wang J, et al. Impact of next-generation sequencing on the clinical diagnosis of pancreatic cysts. Gastrointest Endosc. 2016;83:140–8.PubMed
38.
Zurück zum Zitat Garcia-Carracedo D, Chen ZM, Qiu W, et al. PIK3CA mutations in mucinous cystic neoplasms of the pancreas. Pancreas. 2014;43:245–9.PubMedPubMedCentral Garcia-Carracedo D, Chen ZM, Qiu W, et al. PIK3CA mutations in mucinous cystic neoplasms of the pancreas. Pancreas. 2014;43:245–9.PubMedPubMedCentral
39.
Zurück zum Zitat Khalid A, Zahid M, Finkelstein SD, et al. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a rare report of the PANDA study. Gastrointest Endosc. 2009;69:1095–102.PubMed Khalid A, Zahid M, Finkelstein SD, et al. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a rare report of the PANDA study. Gastrointest Endosc. 2009;69:1095–102.PubMed
40.
Zurück zum Zitat • Das A, Brugge W, Mishra G, et al. Managing incidental pancreatic cystic neoplasms with integrated molecular pathology is a cost-effective strategy. Endosc Int Open. 2015;3:E479–86 A large surgical case series showing the benefits of confocal laser endomicroscopy for the evaluation of pancreatic cysts.PubMedPubMedCentral • Das A, Brugge W, Mishra G, et al. Managing incidental pancreatic cystic neoplasms with integrated molecular pathology is a cost-effective strategy. Endosc Int Open. 2015;3:E479–86 A large surgical case series showing the benefits of confocal laser endomicroscopy for the evaluation of pancreatic cysts.PubMedPubMedCentral
41.
Zurück zum Zitat Krishna SG, Hart PA, Malli A, et al. Endoscopic ultrasound-guided confocal laser endomicroscopy increases accuracy of differentiation of pancreatic cystic lesions. Clin Gastroenterol Hepatol. 2019. Krishna SG, Hart PA, Malli A, et al. Endoscopic ultrasound-guided confocal laser endomicroscopy increases accuracy of differentiation of pancreatic cystic lesions. Clin Gastroenterol Hepatol. 2019.
42.
Zurück zum Zitat Maguchi H, Tanno S, Mizuno N, et al. Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: a multicenter study in Japan. Pancreas. 2011;40:364–70.PubMed Maguchi H, Tanno S, Mizuno N, et al. Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: a multicenter study in Japan. Pancreas. 2011;40:364–70.PubMed
43.
Zurück zum Zitat • LaFemina J, Katabi N, Klimstra D, et al. Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol. 2013;20:440–7 A study indicating that cyst growth rate is associated with malignant transformation.PubMed • LaFemina J, Katabi N, Klimstra D, et al. Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol. 2013;20:440–7 A study indicating that cyst growth rate is associated with malignant transformation.PubMed
44.
Zurück zum Zitat Kolb JM, Argiriadi P, Lee K, et al. Higher growth rate of branch duct intraductal papillary mucinous neoplasms associates with worrisome features. Clin Gastroenterol Hepatol. 2018;16:1481–7.PubMed Kolb JM, Argiriadi P, Lee K, et al. Higher growth rate of branch duct intraductal papillary mucinous neoplasms associates with worrisome features. Clin Gastroenterol Hepatol. 2018;16:1481–7.PubMed
45.
Zurück zum Zitat Akahoshi K, Ono H, Akasu M, et al. Rapid growth speed of cysts can predict malignant intraductal mucinous papillary neoplasms. J Surg Res. 2018;231:195–200.PubMed Akahoshi K, Ono H, Akasu M, et al. Rapid growth speed of cysts can predict malignant intraductal mucinous papillary neoplasms. J Surg Res. 2018;231:195–200.PubMed
46.
Zurück zum Zitat Mukewar SS, Sharma A, Phillip N, et al. Risk of pancreatic cancer in patients with pancreatic cysts and family history of pancreatic cancer. Clin Gastroenterol Hepatol. 2018;16:1123–30.PubMed Mukewar SS, Sharma A, Phillip N, et al. Risk of pancreatic cancer in patients with pancreatic cysts and family history of pancreatic cancer. Clin Gastroenterol Hepatol. 2018;16:1123–30.PubMed
47.
Zurück zum Zitat Mandai K, Uno K, Yasuda K. Does a family history of pancreatic ductal adenocarcinoma and cyst size influence the follow-up strategy for intraductal papillary mucinous neoplasms of the pancreas? Pancreas. 2014;43:917–21.PubMed Mandai K, Uno K, Yasuda K. Does a family history of pancreatic ductal adenocarcinoma and cyst size influence the follow-up strategy for intraductal papillary mucinous neoplasms of the pancreas? Pancreas. 2014;43:917–21.PubMed
48.
Zurück zum Zitat Das A, Ngamruengphong S, Nagendra S, et al. Asymptomatic pancreatic cystic neoplasm: a cost-effectiveness analysis of different strategies of management. Gastrointest Endosc. 2009;70:690–9.PubMed Das A, Ngamruengphong S, Nagendra S, et al. Asymptomatic pancreatic cystic neoplasm: a cost-effectiveness analysis of different strategies of management. Gastrointest Endosc. 2009;70:690–9.PubMed
49.
Zurück zum Zitat Kwok K, Chang J, Duan L, et al. Competing risks for mortality in patients with asymptomatic pancreatic cystic neoplasms: implications for clinical management. Am J Gastroenterol. 2017;112:1330–6.PubMed Kwok K, Chang J, Duan L, et al. Competing risks for mortality in patients with asymptomatic pancreatic cystic neoplasms: implications for clinical management. Am J Gastroenterol. 2017;112:1330–6.PubMed
50.
Zurück zum Zitat Gaujoux S, Brennan MF, Gonen M, et al. Cystic lesions of the pancreas: changes in the presentation and management of 1424 patients at a single institution over a 15-year time period. J Am Coll Surg. 2011;212:590–600.PubMed Gaujoux S, Brennan MF, Gonen M, et al. Cystic lesions of the pancreas: changes in the presentation and management of 1424 patients at a single institution over a 15-year time period. J Am Coll Surg. 2011;212:590–600.PubMed
51.
Zurück zum Zitat Spinelli K, Fromwiller T, Daniel R, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg. 2004;239:651–9.PubMedPubMedCentral Spinelli K, Fromwiller T, Daniel R, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg. 2004;239:651–9.PubMedPubMedCentral
52.
Zurück zum Zitat Bellin MD, Gelrud A, Arreaza-Rubin G, et al. Total pancreatectomy with islet autotransplantation: summary of an NIDDK workshop. Ann Surg. 2015;261:21–9.PubMedPubMedCentral Bellin MD, Gelrud A, Arreaza-Rubin G, et al. Total pancreatectomy with islet autotransplantation: summary of an NIDDK workshop. Ann Surg. 2015;261:21–9.PubMedPubMedCentral
53.
Zurück zum Zitat Lara LF, Takita M, Burdick JS, et al. A study of the clinical impact of a 20-minute secretin-stimulated endoscopic pancreas function test and performance according to clinical variables. Gastrointest Endosc. 2017;86:1048–55.PubMed Lara LF, Takita M, Burdick JS, et al. A study of the clinical impact of a 20-minute secretin-stimulated endoscopic pancreas function test and performance according to clinical variables. Gastrointest Endosc. 2017;86:1048–55.PubMed
54.
Zurück zum Zitat Scheiman JM, Hwang JH, Moayeddi P. American Gastroenterological Association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148:824–48.PubMed Scheiman JM, Hwang JH, Moayeddi P. American Gastroenterological Association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148:824–48.PubMed
55.
Zurück zum Zitat Roch AM, DeWitt JM, Al-Haddad MA, et al. Non operative management of main pancreatic duct-involved intraductal papillary mucinous neoplasm might be indicated in select patients. J Am Coll Surg. 2014;219:122–9.PubMed Roch AM, DeWitt JM, Al-Haddad MA, et al. Non operative management of main pancreatic duct-involved intraductal papillary mucinous neoplasm might be indicated in select patients. J Am Coll Surg. 2014;219:122–9.PubMed
Metadaten
Titel
Pancreatic Cysts in the Elderly
verfasst von
Luis F. Lara, MD
Anjuli Luthra, MD
Darwin L. Conwell, MD, MS
Somashekar G. Krishna, MD, MPH
Publikationsdatum
09.11.2019
Verlag
Springer US
Erschienen in
Current Treatment Options in Gastroenterology / Ausgabe 4/2019
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-019-00260-3

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