Gastro Journal Club: Surveillance discontinuation for BD-IPMN of the pancreas

The third installment of Gastro Journal Club, features Dr. Giovanni Marchegiani from the University of Padua. He is joined by fellows from Northwell Health for a discussion of the article "Surveillance for Presumed BD-IPMN of the Pancreas: Stability, Size, and Age Identify Targets for Discontinuation," published in the October 2023 issue of Gastroenterology: https://www.gastrojournal.org/article/S0016-5085(23)00935-6/fulltext

The Gastro Journal Club is by and for fellows and residents. During these sessions, fellows and residents have the opportunity to ask authors questions about their recently published work in Gastroenterology. If you are interested in arranging a Gastro Journal Club session at your institution, please contact [email protected].

Outline of the meeting:

[1:13] Article discussion.

[9:30] Because many centers with different radiologists were used to assess imaging, and different imaging modalities were used, was there a way the investigators controlled for margins of error in size calculations and actual diagnosis of BD-IPMN, or does the author believe that these margins are trivial?

[13:30] Were the worrisome features or high-risk stigmata different among the countries, or did they use the same criteria listed in guidelines from the International Association of Pancreatology?

[14:45] What is the approximate cost for surveillance of these cysts? How often do patients older than 75 years get tested for these?

[19:55] Does the author think it would be beneficial to use biomarkers for risk stratification between low-risk and high-risk IPMN?

[22:40] What would be an approach for counseling individuals with family histories of pancreatic cancer?

[26:27] Why did the authors select 5 years of stability as the cutoff, and is there any role of a stepped approach to surveillance discontinuation?

[31:02] Patients who have had stable BD-IPMNs less than or equal to 15mm had no increased risk of developing pancreatic cancer compared with the general population and can theoretically discontinue surveillance. How has this translated to clinical practice?

[33:03] Looking through the supplementary data of the article, it seems that the patients from centers in the United States had higher rates of surgeries compared with patients in centers in Europe. Why does the author think this is?

[36:22] Does a positive family history of pancreatic cancer affect the recommended cutoff values for surveillance discontinuation?

[39:16] Did the rate of cyst growth within the first 5 years of surveillance affect the risk of developing worrisome features or high-risk stigmata after the 5-year mark?

[41:50] Why is the optimal surgical target high-grade dysplasia?

[46:12] Conclusion.