Endoscopic Ultrasound in the Management of Intraductal Papillary and Mucinous Pancreatic Tumors: What is the Specificity?

Abstract

Background: Pancreatic cysts, often symptomless, are more frequently detected with advanced imaging. Intraductal papillary mucinous neoplasms (IPMN) are the most common type, categorized into main-duct (MD-IPMN), branch-duct (BD-IPMN), and mixed forms, each with different risks of malignancy. Endoscopic ultrasound (EUS) aids precise diagnosis through detailed imaging and cyst fluid analysis, guiding personalized treatment and monitoring based on the patient's risk of malignancy. Method: This study was conducted at the EFD-HGE Unit of Ibn Sina Hospital in Rabat, from September 2015 to May 2024, were included all patients diagnosed with intraductal papillary mucinous neoplasms (IPMN) on imaging (MRI or CT scan). Epidemiological, clinical, biological and endoscopic ultrasound data were collected from EUS registries. Results: Out of 696 biliopancreatic EUS conducted, 44 patients were selected, representing a prevalence of 6.32%. The average age was 60.2 years (range 29-82 years), with a notable female predominance (M: 16, F: 28) (Sex Ratio = 0.57). The circumstances of discovery were incidental in 18 cases (40.9%), epigastric pain in 14 cases (31.8%), acute pancreatitis in 5 cases (11.4%), jaundice in 3 cases (6.8%), and abdominal pain in 4 cases (9.1%).biologically, cholestasis was observed in 10 cases (22.7%), elevated cytolytic enzymes in 5 cases (11.3%), and elevated Ca19-9 in 4 cases (9.1%).Endoscopic ultrasound provided details on tumor location, number, and size: predominantly in the pancreatic head in 21 cases (47.7%), body in 12 cases (27.2%), tail in 7 cases (15.9%), and multifocal in 4 cases (9.1%), with an average tumor size of 22.5 mm (range 19-57 mm). In 84.1% of cases (n = 37), there was communication solely with the main pancreatic duct (MPD), while in 15.9% (n = 7), there was communication with both the main pancreatic duct and secondary ducts, with Wirsung duct dilation in 15 cases (34%). Fine needle biopsy was performed in 23 cases (52%). ............