Current Considerations in Nonoperative Surveillance of Intraductal Papillary Mucinous Neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) account for the majority of incidentally found pancreatic cystic neoplasms. There are three general subtypes: main-duct (MD-IPMN), branch-duct (BD-IPMN), and mixed-type (MT-IPMN) which all carry varying degrees of malignant potential. The malignant risk of IPMN involving the main pancreatic duct ranges from 40 to 80% for both MD-IPMN and MT-IPMN, while the malignancy risk for BD-IPMN is more variable but considered to be much lower. The management of BD-IPMN is typically non-operative surveillance and remains a topic of debate. In this overview, we discuss the current controversies in management of BD-IPMN such as comparison of surveillance strategies based on consensus guidelines, perceived weight of various worrisome features (WF) and/or high-risk stigmata (HRS), molecular analyses, multifocality, cost effectiveness strategies, and high patient-risk features. This overview should provide a glimpse into the current state and controversies in the care of patients with BD-IPMN.