Hopley PJ, Whelan P, Jackson R, Evans J, Andrews T, Ghaneh P, Raraty M, Greenhalf W, Halloran CM. Branch duct intraductal papillary mucinous neoplasms: How ready are we to de-escalate surveillance? World J Gastroenterol 2026; 32(19): 115852 [DOI: 10.3748/wjg.v32.i19.115852]
Corresponding Author of This Article
Christopher M Halloran, MD, Professor, Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 8TX, United Kingdom. halloran@liverpool.ac.uk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
May 21, 2026 (publication date) through May 22, 2026
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastroenterology
ISSN
1007-9327
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Hopley PJ, Whelan P, Jackson R, Evans J, Andrews T, Ghaneh P, Raraty M, Greenhalf W, Halloran CM. Branch duct intraductal papillary mucinous neoplasms: How ready are we to de-escalate surveillance? World J Gastroenterol 2026; 32(19): 115852 [DOI: 10.3748/wjg.v32.i19.115852]
World J Gastroenterol. May 21, 2026; 32(19): 115852 Published online May 21, 2026. doi: 10.3748/wjg.v32.i19.115852
Branch duct intraductal papillary mucinous neoplasms: How ready are we to de-escalate surveillance?
Phillip J Hopley, Philip Whelan, Richard Jackson, Jonathan Evans, Timothy Andrews, Paula Ghaneh, Michael Raraty, William Greenhalf, Christopher M Halloran
Phillip J Hopley, Paula Ghaneh, William Greenhalf, Christopher M Halloran, Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 8TX, United Kingdom
Phillip J Hopley, Philip Whelan, Paula Ghaneh, Michael Raraty, Christopher M Halloran, Department of Pancreatic Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, United Kingdom
Richard Jackson, Institute of Population Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
Jonathan Evans, Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, United Kingdom
Timothy Andrews, Department of Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, United Kingdom
Author contributions: Hopley PJ and Halloran CM designed the study, drafted and critically reviewed the manuscript; Hopley PJ and Whelan P collected the data; Jackson R performed the statistical analysis; Evans J provided radiological interpretation; Andrews T provided pathological interpretation; all authors critically reviewed and approved of manuscript.
Institutional review board statement: This study was approved by the Yorkshire and Humber Research Ethics Committee, No. 19/YH/0250.
Informed consent statement: Informed consent was not required for the inclusion of participant data in the research database.
Conflict-of-interest statement: Dr. Halloran reports grants from National Health Service England, Cancer Research United Kingdom, Pancreatic Cancer United Kingdom, Liverpool University Hospitals NHS Foundation Trust, outside the submitted work; In addition, Dr. Halloran has a patent GB1806002.0 PCT/GB2019/050998 issued.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data available upon reasonable request to the corresponding author.
Corresponding author: Christopher M Halloran, MD, Professor, Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 8TX, United Kingdom. halloran@liverpool.ac.uk
Received: October 29, 2025 Revised: December 20, 2025 Accepted: March 5, 2026 Published online: May 21, 2026 Processing time: 202 Days and 17.6 Hours
Core Tip
Core Tip: This study reports outcomes of 1191 participants with branch duct intraductal papillary mucinous neoplasm under surveillance. There are three important findings: Firstly, surgery is front loaded and the opportunity to resect pancreatic ductal adenocarcinoma appears to occur early in surveillance. Secondly, the incremental return of continued investigations, resulting in risk reducing surgery, dramatically diminishes after two years. Lastly, patients who have been in surveillance for more than two years with a serum cancer antigen 19-9 < 43 KU/L and branch duct intraductal papillary mucinous neoplasm stability at < 30 mm have low rates of malignant transformation and surveillance can be de-escalated, with discharge considered at five years.
