GASTROENTEROLOGY ARTICLE OF THE WEEK\
May 12, 2005
ASGE. ASGE Guideline: The role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas. Gastrointest Endosc 2005;61;363-70
1. Characteristics of pancreatic lesions
a. Asymptomatic cysts <2cm in size have a <5% risk of malignancy
b. Multiple small (<3mm) compartments within a cystic lesion predict a serous cystadenoma.
c. 15% of mucinous cystadenomas may present as a microcystic lesion
d. A hypoechoic mass associated with a cyst strongly suggests adenocarcinoma, particularly if the pancreatic duct is not diffusely dilated.
e, A cystic lesion without septations in a pancreas with calcifications strongly suggest a benign pseudocyst.
True or False:
2. The majority of patients with a an asymptomatic cystic lesion of the pancreas have a benign lesion
3. In IPMN, EUS cannot reliable distinguish the benign from the malignant form.
4. EUS is highly specific and sensitive in determining which mucinous lesions are benign and which are malignant
5. After aspirating a cyst via EUS, antibiotics should be administered for 3-5 days to decrease risk of infection
6. Communicaton of the pancreatic duct with the cyst is more common in pseudocysts and IPMN, but rare in mucinous or serous cystadenomas
7. Infected pseudocysts should always go to surgery and not undergo endoscopic cyst aspiration
8. For pseudocysts which communicate with the main PD, transpapillary drainage with a stent that straddles the leak is the best approach.
9. Endoscopic therapy is sufficient for cystic neoplasms of the pancreas.