Awareness of International Consensus Guidelines for the Management of Intraductal Papillary Mucinous Neoplasms (IPMN) and Mucinous Cystic Neoplasms (MCN) and Impact of Guidelines On Current Practice

Abstract

Optimal management of incidental pancreatic cystic neoplasms is not well established. International Consensus Guidelines (ICGs) for the management of IPMN and MCN were developed based on limited data. No previous studies have evaluated awareness or utilization of this guideline among gastroenterologists. Aim: To assess the awareness of clinical guidelines for IPMN and MCN and compare current practice among ASGE endoscopic ultrasound special interest group (EUS-SIG) members and general gastroenterologists. Methods: An online survey about management of IPMN and MCN was developed based on the April 2006 ICG. The survey had 7 multiple choice questions and content was reviewed by pancreatic experts. Clinical scenarios were given and respondents were asked to choose a recommendation based on their clinical practices. Awareness of the guideline was also assessed. The survey was distributed to the ASGE EUS-SIG and AGA members who were not in the special interest group via email. Results: 30% (104/350) of potential respondents completed the survey. 72% (75/104) were from EUS-SIG and 28% (29/104) were general gastroenterologists. Overall, more than 90% of physicians correctly recommended resection for patients presenting with pancreatic cysts with concerning EUS features consistent with main duct IPMN or MCN. 60% recommended surveillance imaging for side branch IPMN with benign EUS features consistent with ICGs. Overall, 47% (49/104) of respondents were not aware of the guidelines. Members of the EUS-SIG were more likely to know about the ICG than general gastroenterologists (56% versus 41%) but this did not reach statistical significance (p = 0.09). Among the 42 physicians of the EUS-SIG who were aware of the guidelines, only 50% correctly identified the appropriate recommendations for management of IPMN and MCN based on the guidelines and this was no better than recommendations from general gastroenterologists. Finally, members of the EUS-SIG were more likely than general gastroenterologists to chose appropriate follow-up for cysts < 3 cm in size (70% versus 34% correct, p = 0.0005) and to recommended appropriate follow-up for patients post resection of IPMN and MCN (64% versus 45%, p < 0.05). Conclusions: Almost 50% of respondents were not aware of the clinical guidelines for management of IPMN and MCN. Despite this, the majority of physicians in EUS-SIG and general gastroenterologists knew correct indications for surgical resection in a cohort of patients with asymptomatic pancreatic cysts. Furthermore, approximately half of all respondents did not select follow-up recommendations in patients post resection of IPMN or MCN which were consistent with ICGs.