title: Biliary findings assist in predicting enlargement of intraductal papillary mucinous neoplasms of the pancreas.
abstract: OBJECTIVE
  There is controversy over the optimal management strategy for patients with branch-duct type intraductal papillary mucinous neoplasms of the pancreas (BD-IPMNs), precursors to pancreatic cancer. We aimed to identify factors associated with the presence of BD-IPMNs and changes in their diameter.
  
  
  METHODS
  Two separate analyses were conducted in a cohort of patients who underwent magnetic resonance cholangiopancreatography (MRCP) in a single year (2006). MRCP findings and clinical outcomes of these patients were followed for a maximum of 6 years. We evaluated initial MRCP findings and demographics associated with the presence of BD-IPMNs at baseline and increase in BD-IPMN diameter over time.
  
  
  RESULTS
  During the follow-up period, 154 patients developed BD-IPMN and 322 patients did not. Older age, diabetes mellitus, gallbladder adenomyomatosis, and absence of gallstones were associated with the presence of BD-IPMNs at baseline. Increases in diameter of BD-IPMNs were associated with 3 baseline factors: BD-IPMN diameter greater than 17 mm, gallbladder adenomyomatosis, and a common bile duct diameter less than 5.5 mm. Patients with BD-IPMNs could be stratified into 4 groups with varying risk for the enlargement of BD-IPMNs over time: those with 3 risk factors (hazard ratio [HR], 11.4; 95% confidence interval [CI], 3.4-37.8), 2 risk factors (HR, 4.7; 95% CI, 1.7-12.8), or 1 risk factor (HR, 3.1; 95% CI, 1.2-8.2) compared with those without risk factors.
  
  
  CONCLUSIONS
  For patients with BD-IPMNs, careful follow-up evaluation is particularly important for those with BD-IPMN >17 mm in size, common bile duct diameter <5.5 mm, or gallbladder adenomyomatosis.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Juntaro
authors.initials: J
authors.lastname: Matsuzaki
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Shigeo
authors.initials: S
authors.lastname: Okuda
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tanimoto
authors.forename: Keiko
authors.initials: K
authors.lastname: Asakura
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Sawako
authors.initials: S
authors.lastname: Okada
authors.forename: Kenro
authors.initials: K
authors.lastname: Hirata
authors.forename: Hideki
authors.initials: H
authors.lastname: Mori
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Masaoka
authors.forename: Hajime
authors.initials: H
authors.lastname: Higuchi
authors.forename: Shigenari
authors.initials: S
authors.lastname: Hozawa
authors.forename: Sachio
authors.initials: S
authors.lastname: Kuribayashi
authors.forename: Toru
authors.initials: T
authors.lastname: Takebayashi
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000473:pathology*; D049448:Cholangiopancreatography, Magnetic Resonance; D015331:Cohort Studies; D003135:Common Bile Duct / Q000473:pathology*; D003430:Cross-Sectional Studies; D003710:Demography; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies