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Introduction

Cystic pancreatic tumors are rare tumours that are increasingly being discovered incidentally due in part to the improved performance of pancreatic imaging modalities (ultrasound, multidetector CT scan, MRI) and advancements in knowledge regarding the characteristics of these lesions. They are represented by serous cystadenomas (SC), mucinous cystadenomas (MC), intraductal papillary mucinous neoplasms (IPMN), and solid pseudopapillary tumors of the pancreas (SPTP). The aim is to study the epidemiological, clinical, biological, and etiological aspects of these pancreatic tumors.

Aims & Methods

This single-centre study was carried out from September 2015 to August 2023 and included all patients with cystic tumours of the pancreas. False pancreatic cysts were excluded from the study. Epidemiological, clinical, biological and echo-endoscopic data were collected from endoscopic-ultrasounds registers. All endoscopic-ultrasounds were performed under Propofol sedation using a Pentax-type radial and/or linear video echo-endoscope, and cytoponctions were performed using 19 G echotip needles for biochemical analysis of the cystic fluid and/or anatomopathological study.

Results

Out of a total of 649 biliopancreatic endoscopic ultrasounds performed, 53 patients were included, representing a prevalence of 8.16%. The mean age was 62.3 years (29-82 years) with a clear female predominance (Sex Ratio = 0.65). Discovery circumstances were incidental findings in 21 cases (39%), epigastric pain in 17 cases (32%), acute pancreatitis in 6 cases (11.3%), jaundice in 6 cases (11.3%), and abdominal pain in 3 cases (5.6%). Biochemically, cholestasis was found in 12 cases (22.6%), cytolysis in 5 cases (9.4%), and elevated Ca19-9 in 6 cases (11.3%). Endoscopic ultrasound revealed the location, number, and size of the tumor: 21 cases (39.6%) were located in the pancreatic head, 13 cases (24.5%) in the body, 9 cases (17%) in the tail, and 10 cases (18.9%) were multifocal, with an average tumor size of 28.5 mm (1.9-76 mm). Communication with pancreatic ducts was observed in 35 cases (66%), and Wirsung duct dilation in 16 cases (30.1%). Cytology was performed in 27 cases (51%). The endoscopic ultrasound appearance combined with cystic fluid analysis favored IPMN in 42 cases (79.2%), mucinous cystadenoma in 5 cases (9.4%), serous cystadenoma in 3 cases (5.7%), and SPTP in 3 cases (5.7%).

Conclusion

Cystic pancreatic tumors are rare neoplasms predominantly affecting women in their sixties, often discovered incidentally. They predominantly occur in the pancreatic head and are mainly comprised of IPMN followed by mucinous cystadenomas, with serous cystadenomas and SPTPs being less common.

Disclosure

no links of interest

CYSTIC TUMOURS OF THE PANCREAS: THE VALUE OF ENDOSCOPIC ULTRASOUND

ZOULIKHA TAMMOUCH 1, Mouna Salihoun 1, FATIHA BOUHAMOU 1, Acharki Mohamed 1, Serraj Ilham 1, Nawal Kabbaj 2

1 Ibn Sina Hospital, Rabat, Morocco

2 Ibn Sina Hospital, mohamed 5 s EFD-Hepatogastroenterology unit, Rabat, Morocco

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Main recommendations

Prophylaxis

1 ESGE recommends routine rectal administration of 100mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal antiinflammatory drug administration.

Strong recommendation, moderate quality evidence.

2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).

Strong recommendation, moderate quality evidence.

3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.

Weak recommendation, moderate quality evidence.

4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.

Strong recommendation, moderate quality evidence.

5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.

Weak recommendation, moderate quality evidence.

6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.

Weak recommendation, low quality evidence.

Treatment

7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.

Weak recommendation, low quality evidence.

8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.

Weak recommendation, low quality evidence.

9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.

Weak recommendation, low quality evidence.