Intraductal papillary mucinous neoplasm

Dear friends and dear colleagues, uh, so I just want to present, uh, our new study, which is going to be published in Gastrointes- Gastrointestinal Endoscopy.

And this is a, a, a paper about the treatment by radiofrequency, uh, EUS guided for, uh, side branch IPMN, uh, and, uh, only with worrisome features, but also some cases of high-risk stigmata.

Uh, as you know, we have very few literature about it.

I just published, uh, four years ago the first results in a few patients.

And, uh, if you look to the literature, of course, we have some, uh, detail and data about, uh, neuroendocrine tumor or pancreatic metastasis, but very few about, uh, um, uh, IPMN with worrisome features.

And, uh, we have some papers about ethanol ablation and paclitaxel ablation or low macrohole ablation, but not with, uh, radiofrequency ablation.

So, uh, looking, uh, to the literature, we have a ve- uh, one very interesting paper, but with, uh, uh, ethanol ablation and paclitaxel showing that if you do that instead of surgery, you decrease the risk of, uh, uh, adverse events, uh, and, uh, you improve the long-term outcome.

This was published in, uh, Clinical Gastroenterology and Hepatology, uh, in two thousand and twenty-four.

What they did is they looked at over 20,000 individuals who were purchasing this imaging test And they said, how often do you find something in the pancreas that's a small cystic lesion in the pancreas? This is something that's familiar to a lot of radiologists, where when we do MRI scans and CT scans, we find small cystic lesions in the pancreas.

A lot of times we'll reflexively call them branch duct IPMNs or dilated side branches.

The reason why this was an interesting question is because when one of these is detected, it often triggers a cascade of downstream additional testing.

So there's all sorts of guidelines that talk about how frequently that testing should be performed, but many of them suggest doing follow-ups initially, maybe six to 12 months, and then many cases annually for up to 10 years, in some cases for the rest of somebody's life.

They kind of vary depending on the strength of how many surveillance scans you end up getting, but they are a cause of a lot of healthcare consumption.

The reason why people do it is because there's this belief that there's an association between having these small cystic lesions and the development of pancreas adenocarcinoma, which everyone obviously recognizes as a serious killer.

So the idea is if you have one of these little branch duct IPMNs or small cystic lesions, then maybe your risk will be slightly elevated of having cancer.

So then if you do surveillance of them over a long period of time, maybe you can help patients.

Our team is particularly focused on one of the pathways towards pancreatic cancer, which is through cystic neoplasms.

These are cysts called IPMNs or mucinous cystadenomas that are known precursors.

And yet, They're very common.

Most will not turn malignant, but some do.

This dictates their malignant potential.

Main duct IPMNs are extremely dangerous.

They have a massive surface area of abnormal epithelium carrying a malignancy risk upwards of sixty percent.

So you operate on all main duct IPMNs?

Yes.

The criteria are aggressive.

Serous cysts are benign with low CEA.

Mucinous cysts are premalignant with high CEA.

Exactly.

We’re talking about IPMNs, which are intraductal papillary mucinous neoplasms, MCNs, and SPNs.

Okay.

These are largely premalignant mucin-producing cysts.