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2015 AGA guideline on pancreatic cysts results in 60% fewer surgeries

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SAN DIEGO — If applied to the previous decade, the 2015 AGA guidelines on managing pancreatic cysts would have resulted in 60% fewer patients referred for surgery, according to a study presented at Digestive Disease Week 2016.

“Even in 2016, the accuracy distinguishing between benign and potentially malignant neoplasms remains sub-optimal,” Phillip S. Ge, MD, GI fellow at UCLA David Geffen School of Medicine, said during a presentation. “Therefore, there have been multiple attempts over the years to create international consensus guidelines.”

In 2015, the AGA released new guidelines for treating and managing pancreatic cystic neoplasms that called for a less aggressive surveillance regimen, Ge said.

To evaluate the performance of the new guidelines, Ge and colleagues performed a retrospective study of 300 patients who underwent endoscopic ultrasonography with fine-needle aspiration (EUS-FNA) and then surgical resection for pancreatic cystic neoplasms at four tertiary referral centers between 2004 and 2014.

Overall, the guidelines would have recommended surgery in 40.3% of patients and surveillance in 59.7%. Of patients who would have been recommended for surgery, 62.8% had no evidence of cancer and no need for operation. Of patients who would have been recommended for surveillance, 5% had cancer that would have been missed.

It is unclear whether the missed cancer in these patients would have been picked up in subsequent surveillance, the researchers wrote.

“Our results overall demonstrated a continued valuable role for EUS-FNA and cytology in a select population,” Ge said. “Although, it appears that at this present time, we don't quite know what that select population is.” – by Will Offit

Reference:

Ge PS, et al. Abstract #205. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosure: Ge reports no relevant financial disclosures. Please visit http://www.ddw.org/DDW_Disclosure_Index.pdf for a list of all other authors’ relevant financial disclosures.