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World J Gastroenterol. May 28, 2026; 32(20): 114867
Published online May 28, 2026. doi: 10.3748/wjg.v32.i20.114867
Published online May 28, 2026. doi: 10.3748/wjg.v32.i20.114867
Optimizing branch-duct intraductal papillary mucinous neoplasms surveillance: Data-driven dimensional grouping for risk stratification and cost-effectiveness
Stefano Kayali, Federica Gaiani, Stefano Fantasia, Luigi Laghi, Department of Medicine and Surgery, University of Parma, Parma 43121, Emilia-Romagna, Italy
Stefano Kayali, Federica Gaiani, Luigi Laghi, Gastroenterology and Endoscopy Unit, University Hospital of Parma, Parma 43126, Emilia-Romagna, Italy
Simone Dibitetto, Claudio G De Angelis, University Division of Gastroenterology, City of Health and Science University Hospital, Turin 10126, Piedmont, Italy
Alberto Busatto, Edoardo V Savarino, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padova 35128, Veneto, Italy
Andrea Pasta, Francesco Calabrese, Edoardo G Giannini, Elisa Marabotto, Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Liguria, Italy
Simone Caprioli, Andrea P Luzzi, Department of Internal Medicine, University of Genoa, IRCCS‐Ospedale Policlinico San Martino, Genoa 16132, Liguria, Italy
Author contributions: Kayali S, Giannini EG and Marabotto E conceptualized the study; Kayali S performed the formal analysis, developed the methodology, administered the project, wrote the original draft and led the review and editing process; Dibitetto S, Busatto A and Fantasia S curated the data; Gaiani F, Pasta A and Calabrese F contributed equally to review and editing; Caprioli S and Luzzi AP provided supervision; De Angelis CG, Savarino EV and Laghi L contributed equally to supervision and to writing, review and editing; Giannini EG and Marabotto E supervised the study and contributed to writing, review and editing; all authors reviewed and approved the final manuscript.
Supported by the Project ROTI 2022 ALTRIMIN POS “Chemogenomica Funzionale Per Il Futuro Delle Terapie Personalizzate Nelle Neoplasie Maligne” (codice T3-AN-05), No. CUP: D93C22000610001.
Institutional review board statement: All data were retrospectively evaluated, preserving patients’ anonymity. According to the Italian Medicines Agency det. 20/03/2008 on retrospective observational studies using anonymous data, approval by an ethics committee was not mandatory. The study complied with the Declaration of Helsinki (2024 revision).
Informed consent statement: According to the Italian Medicines Agency det. 20/03/2008 on retrospective observational studies using anonymous data, approval by an ethics committee was not mandatory, and informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Study data used for the analyses are stored on secure institutional servers. They are available from the corresponding author upon reasonable request.
Corresponding author: Stefano Kayali, MD, PhD, Research Fellow, Department of Medicine and Surgery, University of Parma, Viale Gramsci, 14, Parma 43121, Emilia-Romagna, Italy.
Received: September 30, 2025
Revised: December 3, 2025
Accepted: March 4, 2026
Published online: May 28, 2026
Processing time: 232 Days and 17.5 Hours
Revised: December 3, 2025
Accepted: March 4, 2026
Published online: May 28, 2026
Processing time: 232 Days and 17.5 Hours
Core Tip
Core Tip: Malignant degeneration of branch-duct intraductal papillary mucinous neoplasms is rare. Surveillance strategies can be optimized for both safety and cost-effectiveness. This study identifies data-driven cyst size thresholds of 1.5 cm and 3.0 cm and finds that the presence of at least two worrisome features, not just one, is an independent predictor of malignancy. A new surveillance protocol based on these findings maintains diagnostic accuracy while reducing 3-year costs by up to 21.4% compared to current international guidelines, particularly by safely extending follow-up intervals for the majority of patients with small cysts.