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Management of Incidental Pancreatic Cysts - Are we adhering to guidelines?
EP34380
Poster Title: Management of Incidental Pancreatic Cysts - Are we adhering to guidelines?
Submitted on 04 Nov 2020
Author(s): Rezwan Ahmed, Afroza Sharmin
Affiliations: King's College Hospitals NHS Foundation Trust, Royal Free London NHS Trust
Poster Views: 568
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Poster Information
Abstract: Background
The majority of pancreatic cysts are non-neoplastic and incidentally diagnosed. Most NHS Trusts do not have robust pathways to manage incidental pancreatic cysts. We reviewed management of incidental pancreatic cysts and adherence to guidelines.

Methods
Retrospective data was collected across three hospital sites in our Trust between January 2018 to January 2019 when there were no trust guidelines. Re-audit was performed between July 2019 to February 2020 following the introduction of guidelines which recommend all pancreatic cysts to be discussed in specialist multi-disciplinary team (MDT) meetings.

Results
79 patients were identified in the first audit and 28 in the second. 42 (53%) and 18 (64%) patients were referred to specialist HPB/GI (Hepatobiliary/ Gastrointestinal) MDT during the two audit periods. There was 11% increase in MDT referrals (p=0.3 with Chi square test), however 35.71% patients were still not referred to MDT. During the initial audit 62 % (23/37) of patients in the Non-MDT group had no surveillance scans, potentially missing high-risk patients and 38% of patients (14/37) still underwent surveillance scans from non-GI specialists which may have been unnecessary. 44% of patients underwent surveillance following MDT referral in the second period as compared to 83% prior to trust guidelines (p= 0.002 with Chi square test).


Conclusion
Robust guidelines and MDT in place for incidental pancreatic cysts helps identify high risk cysts which warrant future surveillance and appropriate treatment, avoid unnecessary surveillance, thereby releasing radiology capacity.MDT referral ensures malignant transformations are identified early and reduce morbidity and mortality.
Summary: Robust guidelines and MDT in place for incidental pancreatic cysts helps identify high risk cysts which warrant future surveillance and appropriate treatment, avoid unnecessary surveillance, thereby releasing radiology capacity.MDT referral ensures malignant transformations are identified early and reduce morbidity and mortalityReferences: References
1. Karen S L, Aarti S, Nell M R, et al. Prevalence of Incidental Pancreatic Cysts in the Adult Population on MR Imaging. American Journal of Gastroenterology 2010; 105:2079–2084.
2. Ye R C, Joo K P, Jin-Young J, et al. Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals. Medicine 2016;95:51
3. David A K, Kaye M R, Stuart R G, et al. The Clinical Relevance of the Increasing Incidence of Intraductal Papillary Mucinous Neoplasm. Clinical Gastroenterology and Hepatology 2012;10(5): 555–558.
4. Maria M, Mellena D B, Robert A P, et al. Association Between Advances in High-Resolution Cross-Section Imaging Technologies and Increase in Prevalence of Pancreatic Cysts From 2005 to 2014. Clinical Gastroenterology and Hepatology 2016;14:585–593
5. James M S, Joo H H, Paul M. American Gastroenterological Association Technical Review on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts. Gastroenterol
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