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Diagnosis and management of intraductal papillary mucinous neoplasia

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 316–322 (2005)Cite this article

Abstract

Intraductal papillary mucinous neoplasia (IPMN) encompasses a spectrum of neoplastic change in the epithelial lining of the pancreatic duct. As such, it is difficult to predict the presence of malignancy, and pancreatic resection is established as the only effective treatment for IPMN. There is controversy about the natural history, evaluation, surgical management and surveillance of IPMN; as IPMN is being increasingly recognized, this controversy is being brought to the forefront of clinical practice. This review presents pooled surgical data, future directions and a proposed algorithm for the management of patients with IPMN.

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Figure 1: Main-duct intraductal papillary mucinous neoplasia in a pancreaticoduodenectomy specimen.
Figure 2: Imaging intraductal papillary mucinous neoplasia.
Figure 3: Intraductal papillary mucinous neoplasia of the proximal main duct.
Figure 4: The University of Pittsburgh Medical Center algorithm for the management of patients with intraductal papillary mucinous neoplasia.

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Acknowledgements

The authors thank Terri Wetmore for her assistance in the preparation of the manuscript.

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Authors and Affiliations

  1. Gastrointestinal Lab,

    Kevin McGrath & Adam Slivka

  2. Division of Gastroenterology, Hepatology and Nutrition, at the University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Kevin McGrath & Adam Slivka

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  1. Kevin McGrath
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  2. Adam Slivka
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Correspondence to Adam Slivka.

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The authors declare no competing financial interests.

Glossary

AMPULLARY STENOSIS

Fibrosis or scarring of the pancreatic sphincter that can lead to increased resistance to the flow of pancreatic juice, resulting in pancreatic duct dilation

MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP)

MRI of the biliary tree and pancreatic duct system

ENDOSCOPIC ULTRASONOGRAPHY (EUS)

A staging and diagnostic technique performed via an ultrasound probe mounted at the tip of an endoscope

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

Endoscopic technique of injecting contrast dye into the ampulla of Vater for radiologic visualization of the pancreatic and biliary ducts

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McGrath, K., Slivka, A. Diagnosis and management of intraductal papillary mucinous neoplasia. Nat Rev Gastroenterol Hepatol 2, 316–322 (2005). https://doi.org/10.1038/ncpgasthep0213

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