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. 2025 May;25(3):353-358.
doi: 10.1016/j.pan.2024.12.001. Epub 2024 Dec 6.

Trends and impact of endoscopic ultrasound utilization for suspected intraductal papillary mucinous neoplasms

Lillian Wang  1 , Priyanka Vatsavayi  1 , Shounak Majumder  1 , Ferga C Gleeson  1 , Elizabeth Rajan  1 , Barham K Abu Dayyeh  1 , Andrew C Storm  1 , Shifa Umar  1 , Saran T Velaga  1 , William S Harmsen  2 , Santhi S Vege  1 , Vinay Chandrasekhara  3
Affiliations

Trends and impact of endoscopic ultrasound utilization for suspected intraductal papillary mucinous neoplasms

Lillian Wang et al. Pancreatology. 2025 May.

Abstract

Background: Multiple management guidelines for intraductal papillary mucinous neoplasms (IPMNs) have been published to improve risk stratification and resource utilization. This study aims to evaluate trends in endoscopic ultrasound (EUS) use and agreement between cross-sectional imaging and EUS for specific pancreas cystic lesion (PCL) features.

Methods: This retrospective cohort study included consecutive adults undergoing EUS for suspected IPMN detected with cross-sectional imaging (CT/MRCP) between 2013 and 2015 (Cohort 1) and 2018-2020 (Cohort 2). Clinical, radiographic, EUS, cytologic, and outcomes data were collected. IPMN were defined as high-risk/worrisome (having any Fukuoka high risk (HR) or worrisome feature (WF)), low risk (cyst size 10-29.9 mm, without Fukuoka HR or WF), or very low risk (cyst size <10 mm, without Fukuoka HR or WF). Chi-square, Fisher's exact test, Wilcoxon rank-sum test and Kappa statistics were used. Impact of the COVID-19 pandemic was assessed via post-hoc sensitivity analysis.

Results: Of 711 patients, 292 (41.1 %) were in Cohort 1. More patients in Cohort 1 underwent EUS for non-high risk/non-worrisome PCL on pre-EUS imaging (65.8 % vs. 54.9 %, P < 0.01). Good agreement between pre-EUS imaging and EUS for WF (84.1 %) and HR (96.6 %) was seen. EUS-FNA impacted surveillance and surgical referral in 29.5 % (P = 0.51). Median surveillance duration was 917 days (IQR 367, 1439 days), during which pancreatic ductal adenocarcinoma (PDAC) was diagnosed in 7.5 % (P = 0.11).

Conclusions: In this series EUS over-utilization for low risk IPMN improved over time reflecting more conservative guidelines, without changing PDAC diagnosis rates. There was good agreement between cross-sectional imaging and EUS for specific PCL features.

Keywords: Endoscopic ultrasound; Intraductal papillary mucinous neoplasm; Pancreatic cystic lesions.

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Conflict of interest statement

Declaration of interests S.M. is listed as an inventor under an intellectual property development agreement between Mayo Clinic and Exact Sciences and could share potential future royalties as employee of Mayo Clinic, and is on the Editorial Board for Pancreatology. E.R. consults for Olympus and J&J and has intellectual property with Medtronic and Ruhoff. B.A. consults for and receives research support from Boston Scientific and Medtronic; consults for Olympus; and receives research support from ERBE and Endogastric solutions. A.C.S. consults for and receives research support from Boston Scientific; consults for Intuitive, Medtronic, Microtech, and Olympus; and receives research support from Apollo Endosurgery, Endogenex, Endo-TAGSS, Enterasense, Onepass, and SofTac. S.S.V. was the first author of the 2015 AGA guidelines for the diagnosis and management of asymptomatic neoplastic pancreatic cysts, and is an Associate Editor for Pancreatology. V.C. consults for Covidien LP and Boston Scientific, receives research support from Microtech Endoscopy, and is a shareholder of Nevakar Corporation. The following authors and co-authors have no conflicts of interest to disclose: L.W., P.V., F.C.G., S.U., S.T.V., and W.S.H.

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