20 // THE NEW GASTROENTEROLOGIST: INSIGHTS FOR FELLOWS & YOUNG GIS WINTER 2015
SECTION
developing cancer. However, multiple
questions remain unanswered. The
natural history of BD-IPMNs needs
to be characterized with high-quality studies. The optimal method for
surveillance of nonresected cysts is
unclear. Whether surveillance can be
stopped in some cases is not known.
Additionally, the risk of developing
synchronous or metachronous pancreatic cancer during surveillance needs
to be defined by high-quality studies.
Whether some MD-IPMNs and MCNs
can be managed nonoperatively also
needs to be determined. Postsurgery
surveillance intervals and methods
are also unclear.
Large, multicenter prospectively
followed cohort studies are needed
to generate data that can inform evi-
dence-based guidelines for manage-
ment of pancreatic cysts. Additionally,
biomarkers that can accurately define
both histologic type of a cyst and the
presence of high-grade dysplasia/
early cancer within a cyst are needed
to further risk-stratify patients. If such
goals are achieved one can envision
potentially considering approaches to
chemo-prevention of cancer in prema-
lignant pancreatic cysts. n
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