EUS characteristics of intraductal papillary mucinous neoplasia (IPMN) – series of 10 consecutive cases

Aims: Intraductal Papillary Mucinous Neoplasie (IPMN) is a well-defined pre-malignant cystic lesion of the pancreas. Patients are either symptomatic (pancreatitis, steatorrhea, weight loss) or the lesion is found incidentally on abdominal imaging.

Methods: We report the utility and characteristics of endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) in a series of 10 consecutive patients over a period of 18 months.

Results: 6 males and 4 females (n=10) with IPMN were identified over an 18-month period in our institution with a mean age of 73.4 years (59–87 years). 7 patients were symptomatic with bouts of pancreatitis, weight loss and steatorrhea. The remainder were incidentally detected on cross-sectional imaging for other reasons. All patients underwent EUS and some EUS-FNA by an experienced endosonographer in a high-volume referral center. 8 patients were classified as main-duct-type IPMN (MDT-IPMN) with a medium main duct diameter of 8.2mm (range: 5 to 12mm) and intraductal nodules ranging from 3 to 12mm in size. Two of the symptomatic MDT-IPMN patients were diagnosed with invasive cancer on EUS-FNA. One underwent curative R0 resection, but the other patient was not an operable candidate due to severe comorbidities. Two further patients with mural nodules >10mm and main duct dilation >10mm underwent pylorus-preserving resection and were histologically staged as borderline neoplasia and are considered cured. The remaining 20% of our cohort had branch-duct IPMN (BDT-IPMN) with cystic dilations of side branches ranging from 4 to 10mm in size and were enrolled in an annual EUS surveillance program.

Conclusion: Our case series of 10 consecutive IPMN patients demonstrates the characteristic EUS features of MDT and BDT-IPMN and the utility of EUS-FNA of mural nodules. EUS is a helpful minimally-invasive tool for risk stratification and surveillance in patients with IPMN.