Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management

Table 4 Surveillance in intraductal papillary mucinous neoplasm patients regarding indications for surgery according to the International, European and American Gastroenterological Association guidelines[5,8,13,20-22,41]

Guidelines	Indications	Investigations	Algorithm of follow-up
IAP (2006)	BD-IPMNs ≤ 30 mm; Without: Symptoms, mural nodules, positive cytology	MRI/MRCP or CT	Size ≤ 20 mm: every 6-12 mo; Size 20-30 mm: every 3-6 mo; The interval can be longer after 2 yr without changes
AGA (2015)	BD-IPMNs ≤ 30 mm; Without: Solid component, dilated MPD, HGD/cancer	MRI	Years 1, 2, 5 from initial diagnosis; It can be considered to discontinue; If there is no changes after years
IAP (2017)	No HRS/WF	MRI/MRCP, CT	Size < 10 mm: At 6 mo from diagnosis every 2 yr (if no change)
	No HRS/WF	MRI/MRCP, CT	Size 10-20 mm: At 6 mo from diagnosis yearly per 2 yr
	No HRS/WF	MRI/MRCP, EUS	Size 20-30 mm: EUS in 3-6 mo, yearly EUS or MRI
	No HRS, WF present and size < 30 mm	MRI/MRCPEUS	Every 3-6 mo EUS or MRI
European (2018)	No AI	MRI/MRCP or EUS, CA 19.9	Every 6 mo for the first year; Yearly after first year
	No AI, 1 RI in patient, with comorbidities	MRI/MRCP or EUS, CA 19.9	Every 6 mo

IPMN: Intraductal papillary mucinous neoplasm; IAP: International Association of Pancreatology; AGA: American Gastroenterological Association, MRI: Magnetic resonance imaging; MRCP: Magnetic resonance cholangiopancreatography; MPD: Main pancreatic duct; HGD: High grade dysplasia; EUS: Endoscopic ultrasonography; HRS: High risk stigmata; WF: Worrisome features; AI: Absolute indications for surgery; RI: Relative indications for surgery.