Surveillance and Intervention in IPMN

The increasing use of cross-sectional imaging, increasing life expectancy, and a trend for healthy individuals to undergo “health checkups” with full-body magnetic resonance imaging (MRI) have markedly increased the detection of intraductal papillary mucinous neoplasms (IPMNs). IPMNs are a heterogeneous group of pancreatic cystic neoplasms arising from the proliferation of mucin-producing cells within the pancreatic ducts. Due to the potential for progression to invasive cancer, most patients with IPMN require long-term follow-up. The primary goal herein is to prevent malignancy and/or alleviate symptoms while avoiding unnecessary surgery. Currently, four guidelines, the 2015 American Gastroenterological Association (AGA), the 2017 International Association of Pancreatology (IAP), the 2018 American College of Gastroenterology (ACG), and the 2018 European Study Group on Cystic Tumours of the Pancreas, provide recommendations on surveillance and surgical resection based on symptoms and perceived risk of malignancy. In the present chapter, we will discuss diagnostic, surveillance, and treatment for IPMNs.