DDSEP® 8 Quick Quiz

Question 2

Q2. A 64-year-old male with a recent history of acute pancreatitis has a dilated main pancreatic duct with prominent side branch lesions seen on CT scan. Endoscopic evaluation reveals mucus extruding from a dilated ampulla.

What is the next best step in management of this patient?

EUS +/- FNA

ERCP with pancreatic stent

Surgical resection

Repeat MRI in three years

ERCP with Spyglass

Q2. Correct Answer: C


Rationale
This patient has a main duct IPMN, which has a high potential for malignant transformation and should be resected if possible. Resection is also indicated for branch-duct IPMN's, which are symptomatic (e.g. pancreatitis), associated with obstructive jaundice or main duct involvement, have a solid component within the cyst, or have concerning features on EUS-FNA.

Reference
1. Elta GH, et al, ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts. Am J Gastroenterol. 2018;113:464-79.

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