title: Optimizing management of pancreatic cysts--prospective re-assessment for 157 cases.
abstract: OBJECTIVE
  Ongoing debate continues regarding the appropriate management of pancreatic cysts (PCs). Disagreement prevails regarding frequency of needed follow-up, if and when to perform any PC needle biopsy and indications for surgical resection. EUS is increasingly used to help determine management of PCs.
  
  
  METHODS
  One hundred and fifty seven consecutive patients with PCs were identified out of 5000 patients who underwent EUS between 1995-2007. In 2008, these patients were then prospectively provided clinical follow-up, and CEA, CA19-9 and CRP.
  
  
  RESULTS
  No symptoms could be definitively related to the PCs. Twenty four of 157 patients with suspected malignant cysts, mucinous cysts or IPMN had undergone surgical treatment. Whipple's operation was performed in 14 patients and distal pancreatectomy in 10 patients. Fifty PCs were located in the head of pancreas. In 89 patients prospective blood tests were performed; in 6 of them elevated levels of CA-19-9 were detected, 3 of these also had elevated serum CEA. Twelve patients had increased CRP values. No complication (requiring hospitalization) and no mortality related to EUS had occurred.
  
  
  CONCLUSIONS
  Elements identified as important for assessment of PCs included: size, serum and fluid markers, imaging characteristics and clinical follow-up. These factors should be included in the recommended guidelines.
authors.affiliation: Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel. ramila@netvision.net.il
authors.forename: Jesse
authors.initials: J
authors.lastname: Lachter
authors.forename: Tania
authors.initials: T
authors.lastname: Haj
authors.forename: Yoram
authors.initials: Y
authors.lastname: Kluger
authors.forename: Leonid
authors.initials: L
authors.lastname: Malchin
authors.forename: Ruth
authors.initials: R
authors.lastname: Keren
authors.forename: Edmund
authors.initials: E
authors.lastname: Sabo
authors.forename: Doron
authors.initials: D
authors.lastname: Fischer
authors.forename: Omer
authors.initials: O
authors.lastname: Goldstein
authors.forename: Yael
authors.initials: Y
authors.lastname: Kopelman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000032:analysis; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen