Branch duct intraductal papillary mucinous neoplasms: How ready are we to de-escalate surveillance?

doi:10.3748/wjg.v32.i19.115852

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. May 21, 2026; 32(19): 115852
Published online May 21, 2026. doi: 10.3748/wjg.v32.i19.115852

Table 1 Frequency of endoscopic ultrasounds performed during surveillance relative to the time to surgery and final diagnosis

	IPMN, n = 1130	t-IPMN, n = 49	c-PDAC, n = 12	Other, n = 75	SCN, n = 37	Total, n = 1303
Male/female	450:680	19:30	2:10	31:44	10:27	512:791
Age, median (IQR)	71 (64-78)	74 (67.5-77)	71 (67-73.5)	66 (56-72)	69 (64-75)	71 (64-77)
Discharged	112					112
Total	1018	49	12	75	37	1191
Imaging and EUS during screening
0 EUS, returned to LISP	645, 450	29	4	27, 4	3, 1	708, 455
1^st EUS, returned to LISP	293, 162	11	6	35, 5	26, 6	371, 173
2^nd EUS, returned to LISP	63, 33	8	2	8, 1	6, 3	87, 37
3^rd EUS, returned to LISP	12, 7	1		5, 1	2, 1	20, 9
4^th EUS, returned to LISP	4, 3					4, 3
5^th EUS, returned to LISP	1, 1					1, 1
Overall, returned to LISP	1018, 206	49	12	75, 7	37, 10	1191, 678
Treatment < 2 years by imaging and EUS
0 EUS, surgery < 2 years	28	24	2	3	1	58
1^st EUS, surgery < 2 years	47	2	1	9	4	63
2^nd EUS, surgery < 2 years	7	2	1	1		11
3^rd EUS, surgery < 2 years	2					2
4^th EUS, surgery < 2 years						0
5^th EUS, surgery < 2 years
Overall surgery, < 2 years	84	28	4	13	5	134
Overall palliation, < 2 years		6	1			7
Treatment > 2 years by imaging and EUS
0 EUS, surgery > 2 years	1					1
1^st EUS, surgery > 2 years	3		1	1		5
2^nd EUS, surgery > 2 years	6	1		3		10
3^rd EUS, surgery > 2 years	1			1		2
4^th EUS, surgery > 2 years	1					1
5^th EUS, surgery > 2 years
Overall surgery, > 2 years	12	1	1	5	0	19
Overall palliation, > 2 years		14	6			20
Overall surgery	96	29	5	18	5	153
Overall palliation		20	7			27

LISP: Liverpool intraductal papillary mucinous neoplasm screening pathway; EUS: Endoscopic ultrasound; IQR: Interquartile range; IPMN: Intraductal papillary mucinous neoplasm; t-IPMN: Transformed intraductal papillary mucinous neoplasm; c-PDAC: Concomitant pancreatic ductal adenocarcinoma; SCN: Serous cystic neoplasm.

Full Size Table

Table 2 Longitudinal profiles of physical and biochemical characteristics of cysts for each degree of dysplasia

		LGD	IGD	HGD	Malignant	Not stated	Imaged only	Total
Cyst size (mm)	< 30	33	10	0	7	9	825	884
	> 30	18	11	3	4	5	60	101
	Total	51	21	3	11	14	885	985
Missing		15	5	3	24	6	259	312
Cyst CEA (μg/L)	< 450	56	21	6	32	16	345	476
	> 450	8	4	0	0	0	5	17
	Total	64	25	6	32	16	350	493
Missing		2	1	0	3	4	794	804
Cyst CA19-9 (KU/L)	< 90	54	21	6	17	16	301	415
	> 90	10	4	0	15	0	49	78
	Total	64	25	6	32	16	350	493
Missing		2	1	0	3	4	794	804
Serum CEA (μg/L)	< 5	31	12	3	8	14	635	703
	> 5	2	0	0	0	1	18	21
	Total	33	12	3	8	15	653	724
Missing		33	14	3	27	5	491	573
Serum CA19-9 (KU/L)	< 40	56	22	5	10	15	678	786
	> 40	9	3	1	23	3	55	94
	Total	65	25	6	33	18	733	880
Missing		1	1	0	2	2	411	417

LGD: Low grade dysplasia; IGD: Intermediate grade dysplasia; HGD: High grade dysplasia; CEA: Carcinoembryonic antigen; CA19-9: Cancer antigen 19-9.

Full Size Table

Citation: 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
URL: https://www.wjgnet.com/1007-9327/full/v32/i19/115852.htm
DOI: https://dx.doi.org/10.3748/wjg.v32.i19.115852

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]

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