Hernandez-Barco Yasmin G, Fernandez-Del Castillo Carlos, Fradelos Evangelos, Matos Ruiz Paola M, Bazerbachi Fateh, Dhandibhotla Sarvani, Lillemoe Keith D, Casey Brenna W, Kambadakone Avinash, Qadan Motaz
Pancreas and Biliary Program, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
Pancreatology. 2024 Aug;24(5):764-770. doi: 10.1016/j.pan.2024.05.525. Epub 2024 May 19.
Pancreatic cysts are often incidentally detected on routine imaging studies. Of these, mucinous cysts have a malignant potential. Several guidelines propose different management strategies, and implementation in patient care is inconsistent in the absence of dedicated infrastructure.
To address the challenges of pancreatic cyst diagnosis and management, we established a multidisciplinary pancreas cyst clinic (PCC) within our health system. This clinic encompasses both tertiary care academic centers and community hospitals, with leadership from surgical oncology, gastroenterology, and radiology. Our PCC's primary goal is to provide accurate diagnosis and tailored management recommendations for all patients with pancreatic cysts. Additionally, we maintain a prospective database to study the disease's natural history and the outcomes of various treatment strategies.
The clinic meets once per week for 45 min virtually via Zoom in the mornings. Patients are referred via electronic medical record (EMR) order, telephone call, or email from patient or referring provider. A dedicated advanced practice provider reviews referrals several times per day, calls patients to gather clinical data, ensures imaging is uploaded, and coordinates logistical aspects of the meeting during the dedicated time. Conferences are attended by representatives from surgery, radiology, medical pancreatology, and interventional gastroenterology. Each patient case is reviewed in detail and recommendations are submitted to referring providers and patients via an EMR message and letter. For patients requiring imaging surveillance, patients are followed longitudinally by the referring provider, gastroenterology team, or surgical team. For patients requiring endoscopic ultrasound (EUS) or surgical consultation, expedited referral to these services is made with prompt subsequent evaluation.
A total of 1052 patients from our health system were evaluated between 2020 and 2021. Of these, 196 (18.6 %) underwent EUS, 41 (3.9 %) underwent upfront surgical resection, and the remainder were referred to gastroenterology (141-13.4 %), surgery (314-29.8 %), or back to their referring provider (597-56.7 %) for ongoing surveillance in collaboration with their primary care provider (PCP). Of cysts under surveillance, 61.3 % remained stable, 13.2 % increased in size, and 2 % decreased in size. A total of 2.3 % of patients were recommended to discontinue surveillance.
The PCC provides infrastructure that has served to provide multidisciplinary review and consensus recommendations to patients with pancreatic cysts. This has served to improve the application of guidelines while providing individualized recommendations to each patient, while aiding non-expert referring providers throughout the region.
胰腺囊肿常在常规影像学检查中偶然发现。其中，黏液性囊肿具有恶变潜能。多项指南提出了不同的管理策略，但在缺乏专门基础设施的情况下，这些策略在患者护理中的实施并不一致。
为应对胰腺囊肿诊断和管理的挑战，我们在医疗系统内设立了一个多学科胰腺囊肿诊所（PCC）。该诊所涵盖三级医疗学术中心和社区医院，由外科肿瘤学、胃肠病学和放射学专家牵头。我们的PCC的主要目标是为所有胰腺囊肿患者提供准确的诊断和量身定制的管理建议。此外，我们维护一个前瞻性数据库，以研究该疾病的自然史和各种治疗策略的结果。
诊所每周通过Zoom在上午进行一次45分钟的虚拟会诊。患者通过电子病历（EMR）医嘱、电话或患者或转诊医生的电子邮件转诊。一名专门的高级执业提供者每天多次审查转诊情况，致电患者收集临床数据，确保上传影像资料，并在指定时间协调会诊的后勤事宜。外科、放射科、医学胰腺病学和介入胃肠病学的代表参加会诊。每个患者病例都经过详细审查，并通过EMR消息和信件将建议提交给转诊医生和患者。对于需要影像监测的患者，由转诊医生、胃肠病学团队或外科团队进行纵向随访。对于需要内镜超声（EUS）或手术咨询的患者，会加快转诊至这些科室，并及时进行后续评估。
2020年至2021年期间，我们医疗系统共评估了1052例患者。其中，196例（18.6%）接受了EUS检查，41例（3.9%）接受了 upfront手术切除，其余患者被转诊至胃肠病学（141例-13.4%）、外科（314例-29.8%）或转回转诊医生处（597例-56.7%），以便与他们的初级保健提供者（PCP）合作进行持续监测。在接受监测的囊肿中，61.3%保持稳定，13.2%大小增加，2%大小减小。共有2.3%的患者被建议停止监测。
PCC提供了基础设施，为胰腺囊肿患者提供多学科审查和共识建议。这有助于改进指南的应用，同时为每个患者提供个性化建议，同时帮助该地区的非专家转诊医生。
