Abstract
Natural History of Branch Duct Type Intraductal Papillary-Mucinous Neoplasms of the Pancreas: A Role of Endoscopic Ultrasonography in Follow-Up Satoshi Tanno, Yasuhiro Nakano, Tsutomu Izawa, Yusuke Mizukami, Toshikatsu Okumura, Yutaka Kohgo Background/Aim: The aim of this study was to elucidate the natural history and serial changes of the pancreatic duct system in the patients with branch duct type intraductal papillary-mucinous neoplasms of the pancreas (IPMNs). Methods: Sixtyfive patients (forty-seven men and eighteen women) with branch duct type IPMNs were selected for follow-up and examined by endoscopic ultrasonography (EUS) two or more times (mean, 3 times). All patients who had apparent mural nodules were excluded from follow-up study. The observation periods ranged from 14 to 131 months (mean, 61 months), and all patients underwent initial endoscopic retrograde pancreatography (ERP) and computed tomography (CT). Serial changes of the pancreatic duct system, such as maximum cystic diameter and the presence of mural nodule, were studied. Results: Five (8%) of 65 patients exhibited obvious progression of cystic dilatation. New apparent mural nodules were detected in 5 cases (8%) during the observation periods. These obvious changes were observed after a 19 to 112 months follow-up period (mean, 74 months). Of five patients with mural nodules, four cases underwent surgery after follow-up study, and the pathologic diagnosis was adenoma in two and non-invasive carcinoma in two. Mural nodules were accurately diagnosed in 5 cases (100%) by EUS, whereas in one (20%) by CT and in 0 (0%) by MRCP. Five patients with cystic size enlargement were followed up without surgical resection. None of the remaining 55 patients (84%) showed increases in cystic diameter. Conclusions: Most of branch duct type IPMNs without apparent mural nodules remained unchanged. Mural nodule is an important factor affecting the follow-up. EUS is the most sensitive method to detect mural nodules in follow-up. Abstracts
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