Abstract
Introduction Branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) require follow-up
to detect worrisome features (WF). Data are missing about endoscopic pancreatic sphincterotomy
(PS) for symptomatic IPMN.
Patients and methods This was a retrospective multicenter study in four expert centers. Patients treated
with endoscopic PS for symptomatic (painful) BD-IPMN without WF were included. Age,
sex, follow-up time, characteristics of IPMNs and endoscopic retrograde cholangiopancreatographies
(ERCPs), and indications for surgery were recorded.
Results In total, 21 patients were included (median age 68 years, range 45 – 87 years). The
median number of cysts was 2 (range 1 – 10), located in the head (59 %), body/tail
(17 %), or multifocal (24 %). ERCP including PS was completed in all of the cases,
with biliary sphincterotomy in 33 %. Clinical efficacy after one session was 81 %
(17/21). Among the failures, one had a second successful PS and three were operated.
The final efficacy was 86 % (18/21). Seven patients were operated after a mean of
19 months: four for WF, three for pain. The histopathology showed four low grade dysplasia,
one high grade dysplasia, and two no dysplasia. No adenocarcinoma occurred during
a follow-up of 99 months (range 14 – 276 months).
Conclusions Endoscopic PS for symptomatic IPMN without WF is effective in more than 80 % of cases,
without increasing the risk for adenocarcinoma.
