The International Association of Pancreatology (IAP) reported an algorithm for managing a patient with a branch duct intraductal papillary mucinous neoplasm (IPMN).
Patient selection: branch duct IPMN
Parameters:
(1) diameter of the lesion in cm
(2) high-risk stigmata
(2a) mural nodules
(2b) dilatation of the main pancreatic duct
(2c) positive cytology
Indications for surgical resection:
(1) diameter > 3 cm (especially if symptomatic)
(2) diameter > 1 cm AND high-risk stigmata
Monitoring if not a candidate for resection:
(1) < 1 cm: MR or thin slice CT every year while < 1 cm
(2) 1-2 cm: EUS and MRCP/ERCP initially, then CT or MR every 6-12 months
(3) 2-3 cm: EUS and MRCP/ERCP initially, thenCT or MR every 3-6 months
where:
• EUS = endoscopic ultrasonography
• ERCP = endoscopic retrograde cholangiopancreatography
