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The Surveillance Patterns of Incidentally Detected Pancreatic Cysts Vary Widely and Infrequently Adhere to Guidelines

Schenck, Robert J. MD*; Miller, Frank H. MD; Keswani, Rajesh N. MD, MS*

doi: 10.1097/MPA.0000000000001352
Original Articles

Objectives We aimed to determine incidental pancreatic cyst (“cyst”) surveillance patterns, predictors of receiving surveillance, and guideline adherence.

Methods We performed a retrospective cohort study of all patients receiving longitudinal care at a single tertiary care center with a newly diagnosed incidental pancreatic cyst over a 2-year period (2010–2011). All follow-up care was abstracted over a 5-year period.

Results Of 3241 eligible imaging studies reviewed, 100 patients with newly diagnosed incidental cysts eligible for surveillance were identified. A majority (53%) received no follow-up. We identified 4 predictors of cyst surveillance: radiology report conclusion mentioning the cyst (odds ratio [OR], 14.9; 95% confidence interval [CI], 1.9–119) and recommending follow-up (OR, 5.5; 95% CI, 2.1–13.9), pancreas main duct dilation (OR, 10.7; 95% CI, 1.3–89), and absence of multiple cysts (OR, 2.5; 95% CI, 1.1–10.0). Of the 47 patients who received surveillance, 66% met minimum surveillance imaging intervals of at least one guideline. Conversely, 21% of patients met the criteria for overutilization in at least one guideline.

Conclusions Although guidelines recommend that surgically fit patients with incidental cysts undergo surveillance, most patients receive no follow-up. When follow-up occurs, surveillance patterns vary widely and infrequently conform to guidelines. Interventions to reduce care variation require study.

From the *Division of Gastroenterology and Hepatology and

Department of Radiology, Northwestern University, Chicago, IL.

Received for publication December 31, 2018; accepted May 17, 2019.

Address correspondence to: Robert J. Schenck, MD, Department of Medicine, 676 North St Clair Street Arkes Suite 2330, Chicago, IL 60611 (e-mail:

This study did not receive any external funding.

The authors declare no conflict of interest.

Online date: July 2, 2019

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