John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


How to survey and to follow patients with IPMN? Volume 24, issue 1, Janvier 2017


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Hôpital Beaujon, service de pancréatologie, gastroentérologie, 100, boulevard du général Leclerc 92110 Clichy, France ; DHU UNITY, INSERM UMR 1149, Université Paris 7
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Intraductal papillary mucinous neoplasms of the pancreas (IPMN) are precancerous cystic lesions involving main or branch ducts. The discovery is mainly fortuitous, thanks to advances in conventional imaging performances. The prevalence is estimated at nearly 15 % in the general population aged more than 60 year-old. A minority of patients will develop invasive lesions, however 3 reasons justify a cautious follow-up : 1) high rate of mortality of pancreatic cancer, 2) the lack of tools to diagnose the dysplasia grade, 3) the absence of knowledge regarding the risk factors of invasive lesions in order to select the population at risk. This follow-up is expensive (no study confirmed the cost effectiveness of the protocols) and imperfect (risk of interval cancer). However, gastroenterologists have to combine the different types of imaging procedures to make an accurate diagnosis and to propose the adapted treatment and follow-up. MRI (with MRCP sequences) is the first line procedure, however endoscopic ultrasound has to be performed at baseline and regularly, notably in case of doubt for a nodule. These lesions are precancerous and the follow up have to be accurate and not neglected. The risk of cancer remains even after years of stability.