Hol Lieke, Bruno Marco J, Cahen Djuna L
Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Pancreatology. 2016 May-Jun;16(3):416-22. doi: 10.1016/j.pan.2016.02.007. Epub 2016 Feb 23.
BACKGROUND/OBJECTIVES: In absence of evidence-based guidelines of pancreatic cystic neoplasms (PCN), the management might vary among physicians. The aim of this survey was to assess the attitude of Dutch gastroenterologists (GE) towards the management of asymptomatic PCNs.
An anonymous online questionnaire was distributed to all practicing GE (n = 381) in The Netherlands, in which four vignette patients with PCN were presented.
In total 45% of GE responded. Most respondents would perform surveillance for a 10 mm PCN (78%) mainly with an interval of one year (57%). A shorter interval of three (26%) or six (57%) months was chosen for a 25 mm BD-IPMN. Ultrasound was recommended for surveillance by 19% for a 10 mm cyst. GE with EUS experience were more likely to apply EUS for surveillance of 10 mm cyst than those without (56% vs 28%; p < 0.001). The presence of a branch-duct intraductal mucinous neoplasm (BD-IPMN) with a mural nodule, dilated pancreatic duct (8 mm) or increased serum CA 19.9 (300 U/ml) were considered an indication for resection by respectively 88%, 68% and 51% of respondents.
Dutch GE demonstrate substantial variability in the management of asymptomatic PCNs. A significant proportion of general GE still use ultrasound for surveillance of small PCNs, while GE with EUS experience were more likely to perform EUS. The presence of risk factors for malignant degeneration of IPMN were not recognized by a substantial proportion of GE. Data on the natural history of PCNs is required to provide input for evidence-based guidelines, which should lead to a more uniform approach.
背景/目的：由于缺乏胰腺囊性肿瘤（PCN）的循证指南，医生之间的处理方式可能存在差异。本调查旨在评估荷兰胃肠病学家（GE）对无症状PCN处理的态度。
向荷兰所有执业GE（n = 381）发放一份匿名在线问卷，其中呈现了4例PCN的病例 vignette。
共有45%的GE做出回应。大多数受访者会对10mm的PCN进行监测（78%），主要监测间隔为一年（57%）。对于25mm的分支导管内乳头状黏液性肿瘤（BD-IPMN），选择较短的三个月（26%）或六个月（57%）的监测间隔。对于10mm的囊肿，19%的人推荐使用超声进行监测。有超声内镜（EUS）经验的GE比没有经验的GE更有可能将EUS用于10mm囊肿的监测（56%对28%；p < 0.001）。分别有88%、68%和51%的受访者认为存在壁结节的分支导管内乳头状黏液性肿瘤（BD-IPMN）、扩张的胰管（8mm）或血清CA 19.9升高（300 U/ml）是切除的指征。
荷兰GE在无症状PCN的处理上表现出很大的差异。相当一部分普通GE仍使用超声监测小的PCN，而有EUS经验的GE更有可能进行EUS检查。相当一部分GE未认识到IPMN恶性变的危险因素。需要PCN自然史的数据来为循证指南提供依据，这将导致更统一的处理方法。
