Endoscopic Ultrasound in the Management of Intraductal Papillary and Mucinous Pancreatic Tumors

Aims Pancreatic cysts, often symptomless, are more frequently detected with advanced imaging. Intraductal papillary mucinous neoplasms (IPMN) are the most common type, categorized into main-duct (MD-IPMN), branch-duct (BD-IPMN), and mixed forms, each with different risks of malignancy. the aim of our work is to study the contribution of biliopancreatic echo-endoscopy to the diagnosis of these tumors.

Methods This study was conducted, from September 2015 to May 2024, and included all patients diagnosed with intraductal papillary mucinous neoplasms (IPMN) on imaging (MRI or CT scan). Epidemiological, clinical, biological and endoscopic ultrasound data were collected from hospital endoscopy registries.

Results Out of 696 biliopancreatic endoscopic ultrasounds conducted, 44 concluded to the diagnosis of IPMN and were included in the study, representing a prevalence of 6.32%. The average age was 60.2 years (range 29-82 years), with a significant female predominance (M: 16, F: 28) (Sex Ratio=0.57). 26 patients were symptomatic and the most common symptoms included abdominal pain 18 cases (40,9%), and jaundice 3 cases (6,8%). A history of acute pancreatitis was present in 5 cases (11,4%). 18 patients (40.9%) were asymptomatic Blood tests showed cholestasis in 10 cases (22.7%), elevated cytolytic enzymes in 5 cases (11.3%), and elevated Ca19-9 in 4 cases (9.1%). Endoscopic ultrasound provided details on tumor location, number,size, classification relative to the extent of involvement of the ductal system, and the Dilatation of the main pancreatic duct The tumors were located in the pancreatic head alone in 21 (47,7%), body alone in 12 (27,2%), tail alone in 7 (15,9%), or were multifocal in 4 (9,1%).the average tumor size was 22.5 mm (range 19-57 mm). In 84.1% of cases (n=37), there was communication solely with the main pancreatic duct (MPD), while in 15.9% (n=7), there was communication with both the main pancreatic duct and secondary ducts, with Wirsung duct dilation in 15 cases (34%). Fine needle biopsy was performed in 23 cases (52%). Histopathological examination confirmed IPMN (Intraductal Papillary Mucinous Neoplasm) of the pancreas in 22 cases, while one case revealed a degenerated IPMN to pancreatic adenocarcinoma.

Conclusions Our study highlights the crucial importance of endoscopic ultrasound (EUS) in the diagnosis of intraductal papillary mucinous neoplasms (IPMN) of the pancreas. EUS has proven instrumental in delineating the tumor characteristics, including its location, size, and communication with pancreatic ducts. Additionally, it facilitated cytology sampling in 52% of cases, revealing adenocarcinoma in 2.27% of cases, underscoring its significant role in the diagnostic management of this complex pathology.

Publication History

Article published online:
27 March 2025