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Pancreatic Cysts in the Elderly

  • Luis F. LaraEmail author
  • Anjuli Luthra
  • Darwin L. Conwell
  • Somashekar G. Krishna
Gastroenterology for Geriatric Patients (S Katz and A Afzali, Section Editors)
  • 1 Downloads
Part of the following topical collections:
  1. Topical Collection on Gastroenterology for Geriatric Patients

Abstract

Purpose of review

Incidental pancreatic cysts are common, and management strategies continue to evolve. This review summarizes diagnostic and management recommendations in older patients with these lesions based on guidelines and best clinical evidence.

Recent findings

Diagnosis of cyst type has been enhanced with improved imaging and cyst fluid analysis and visualization. Recent outcome studies indicate that certain cyst types should be followed independent of patient age as long as certain criteria which are reviewed are met.

Summary

Differentiation of pancreatic cyst type is important as this dictates the need for long-term follow-up. Because most cyst-related neoplasia occurs in older patients, surveillance should continue within certain guidelines.

Keywords

Pancreatic cysts Mucinous cysts Cyst diagnosis Cyst management Cyst treatment 

Abbreviations

PCL

Pancreatic cystic lesions

CT

Computed tomography

MRI

Magnetic resonance imaging

PDAC

pancreatic ductal adenocarcinoma

IPMN

Intraductal papillary mucinous neoplasm

MCN

Mucinous cystic neoplasm

BD-IPMN

Branch-duct intraductal papillary mucinous neoplasm

EUS-FNA

Endoscopic ultrasound-guided fine-needle aspiration

AGA

American Gastroenterological Association

ACR

American College of Radiology

MRCP

Magnetic resonance cholangiopancreatography

CEA

Carcinoembryonic antigen

NGS

Next-generation sequencing

EUS-nCLE

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy

CCI

Charlson Comorbidity Index

OSUWMC

The Ohio State University Wexner Medical Center

MDB

Multidisciplinary Board

KRAS

Kirsten rat sarcoma viral oncogene homolog

GNAS

Guanine nucleotide binding protein, alpha stimulating

TP53

Tumor protein p53

PIK3CA

Phosphoinositide 3-kinase, catalytic, alpha polypeptide

PTEN

Phosphatase and tensin

CDKN2A

Cyclin-dependent kinase Inhibitor 2A

SMAD4

Drosophila protein, mothers against decapentaplegic (Mad), and the Caenorhabditis elegans protein (Sma) homolog 4

VHL

von Hippel-Lindau

y/o

Years old

Notes

Author contribution

Luis F. Lara, MD, and Somashekar G. Krishna, MD, MPH, studied concept and design and drafted, wrote, and reviewed manuscript. Anjuli Luthra, MD, and Darwin L. Conwell, MD, MS, studied concept design and wrote and reviewed the manuscript.

Funding information

Luis F. Lara: none. The companies mentioned in the funding (Covidien, Abbvie, Allergan) should go to conflict of interest for author Luis F. Lara

Compliance with ethical standards

Conflict of interest

Somashekar Krishna reports grant funding for a prospective study (currently recruiting patients) from Mauna Kea Technologies.

Luis Lara declares no conflict of interest.

Anjuli Luthra declares no conflict of interest.

Darwin L. Conwell declares no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Luis F. Lara
    • 1
    Email author
  • Anjuli Luthra
    • 1
  • Darwin L. Conwell
    • 1
  • Somashekar G. Krishna
    • 1
  1. 1.Division of Gastroenterology, Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusUSA

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