Pancreatic Surveillance Program in High-Risk Patients – The Experience From a Tertiary Centre

Aims Pancreatic cancer is a highly lethal malignancy. The most effective way to improve survival is by early detection and treatment of precursor lesions. Individuals with family history or genetic susceptibility have an increased risk and pancreatic screening is now recommended. Our aim was to assess the implementation of guidelines and its effectiveness.

Methods Single-centre retrospective cohort of all patients under pancreatic surveillance at our Gastrointestinal Familial Cancer Risk Clinic from 2012 to 2020 (n = 804). We determined the allocation to screening (through endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI)), surveillance according to suggested intervals, number of precursor lesions detected and outcomes.

Results 3.7 % of patients (n = 30) fulfilled the criteria for pancreatic surveillance: mutation in ATM (n = 2), PALB2 (n = 3), CDKN2A (n = 4), STK11 (n = 5), MSH2 (n = 13), MSH6 (n = 2) and PMS2 (n = 1) genes. 86.7 % of patients (n = 26) had familial history of pancreatic cancer (first-degree relative). 5 of them did not meet the age criteria to initiate image surveillance so they underwent clinical evaluation annually.

From patients who had indication to image surveillance (n = 25), 84 % (n = 21) were submitted to at least one image exam - EUS (n = 18) and MRI (n = 6). Only 16 patients followed recommended surveillance timings. There were no malignant findings throughout surveillance.

3 patients (10 %) were diagnosed with pancreatic cancer and all of them died in a 2-year period. None of them were under an image surveillance program: 2 diagnosed in 2012 – without indication for screening according to the recommendations at the time – and one without knowledge of familial history until diagnosis. 2 of them presented with abnormal fasting glucose levels previously to diagnosis.

Conclusions Although only a small percentage of patients have increased susceptibility to pancreatic cancer, it is important to select and include them in surveillance programs given the high risk of malignancy with short-life expectancy.

Citation Pinto C, Sá I, Pita I et al. eP385 PANCREATIC SURVEILLANCE PROGRAM IN HIGH-RISK PATIENTS – THE EXPERIENCE FROM A TERTIARY CENTRE. Endoscopy 2021; 53: S222.

Publication History

Article published online:
19 March 2021