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Pancreatic Cysts in the Elderly

  • Gastroenterology for Geriatric Patients (S Katz and A Afzali, Section Editors)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

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.

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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

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Funding

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

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Room 226, Columbus, OH, 43210, USA

    Luis F. Lara MD, Anjuli Luthra MD, Darwin L. Conwell MD, MS & Somashekar G. Krishna MD, MPH

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  1. Luis F. Lara MD
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  2. Anjuli Luthra MD
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  3. Darwin L. Conwell MD, MS
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  4. Somashekar G. Krishna MD, MPH
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Contributions

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.

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Correspondence to Luis F. Lara MD.

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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.

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Lara, L.F., Luthra, A., Conwell, D.L. et al. Pancreatic Cysts in the Elderly. Curr Treat Options Gastro 17, 457–469 (2019). https://doi.org/10.1007/s11938-019-00260-3

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