HPB SO06 - An advanced clinical practitioner (ACP) led pancreatic cyst surveillance programme

Abstract Background The prevalence of pancreatic cysts (PCs), including intraductal papillary mucous neoplasms (IPMNs), has increased substantially over recent decades. This rising prevalence is due largely to the increasing volume and quality of medical imaging technology. Although PC's are often an incidental finding in asymptomatic individuals, a small number do harbour a certain malignant potential and thus raise warranted concern. The challenge therefore is identifying the high-risk lesions for early resection through robust, guideline-driven surveillance. To ensure a consistent and evidence-based approach to PC surveillance, our trust has adopted a dedicated surveillance programme led by an Advanced Clinical Practitioner (ACP) in gastroenterology. Method A PC surveillance clinic was designed and delivered from April 2023. The service underwent a formal inauguration and was promoted at the regional HPB MDT. All patients receive a standardised approach to surveillance in-line with the current international guidelines or regional MDT recommendation. Surveillance diagnostics are arranged by the ACP and patients are updated with regard to their results and next steps during a telephone or face-to-face consultation. A robust database was designed to capture relevant patient details and serve as a future research aid. Results 144 referrals have been received (04/23-04/24). 134 are undergoing surveillance, with discontinuation due to frailty, patient choice, diagnosis of an inflammatory cyst or relocation in 10 cases. Most PCs under surveillance are side-branch IPMNs (70.9%). Malignant transformation has not yet been observed, however 18 cases display worrisome features and 3 have high-risk stigmata. These are undergoing intensive surveillance or awaiting MDT discussion. 93% of surveyed patients (16) report a greater sense of involvement in their PC surveillance and a greater awareness of their surveillance protocol (93%). Referrer feedback (7) has been positive and staff are satisfied with this service (100%). Conclusion Robust surveillance of patients with PC will likely improve early detection and prognosis of pancreatic cancer by enabling early identification of resectable cases. A centralised service that adopts a single agreed guideline will reduce variation in the management of these cysts, ensure these complex lesions are under specialist observation and offer a single point of contact which will improve retainment and follow-up of these patients. It is intended that synchronous data collection will serve to generate a comprehensive repository of information relating to PC. This databases will aid future research into this evolving field and steer future guideline development.