The Role of EUS and Proteomic Analysis in the Management and Surveillance of Pancreatic Cystic Lesions

Abstract

Introduction

Pancreatic cystic lesions (PCL) can be precursors to pancreatic cancer. The incidence of PCL are increasing worldwide with increased patient age and reliance on cross sectional imaging. However, not all PCL will progress and the approach remains unclear on surveillance and intervention. Pancreatic fluid collections remain a challenge for intervention

Methods

This is a three part study. A prospective cohort of PCL undergoing endoscopic ultrasound assessment was recruited for cystic fluid proteomic analysis. We retrospectively identified all PCL under surveillance in a tertiary referral centre over a twenty year period. A multicentre review of outcomes of endoscopic intervention on pancreatic fluid collections.

Results

We identified a low number of PCLs identified over twenty years progressed to surgery, 26 of 28 patients requiring surgery progressed within 2 years of identification of the cyst. This was accompanied by a high cost of surveillance of pancreatic cysts at ¿193000 per premalignant lesion identified on post operative histology.

We identified 4 proteomic biomarkers. MUC6, PIGR, REG1a and LCN2 showed significant difference in expression in patients with high risk cysts compared to low risk.

Endoscopic drainage of pancreatic fluid collections had a high technical success and clinical success. Complications were similar between stent types. LAMS stents were more commonly performed as day case procedures.

Conclusion

PCL are a diagnostic and management challenge. We identified smaller cysts are at a very low risk of progression. We also identified novel markers to improve pre operative diagnostic approach. Pancreatic fluid collections can be effectively managed at endoscopy.