Predictors for Surgical Referral in Patients With Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound: Results From a Large Multicenter Cohort Study.
OBJECTIVE
Endoscopic ultrasound (EUS) plays an integral role in the evaluation of pancreatic cysts lesions (PCLs). The aim of the study was to determine predictors of surgical referral in patients with PCLs undergoing EUS.


METHODS
We performed a multicenter retrospective study of patients undergoing EUS for evaluation of PCLs. Demographics, EUS characteristics, and fine-needle aspiration results were recorded. Patients were categorized into surgery or surveillance groups on the basis of post-EUS recommendations. Univariate and multivariate analyses were performed to identify predictors of surgical referral.


RESULTS
1804 patients were included. 1301 patients were recommended to undergo surveillance and 503 patients were referred for surgical evaluation, of which 360 patients underwent surgery. Multivariate analysis revealed the following 5 independent predictors of surgical referral: symptoms of weight loss on presentation (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.44-5.03), EUS findings of associated solid mass (OR, 7.34; 95% CI, 3.81-14.16), main duct communication (OR, 4.13; 95% CI, 1.71-9.98), multilocular macrocystic morphology (OR, 2.79; 95% CI, 1.78-4.38), and fine-needle aspiration findings of mucin on cytology (OR, 3.06; 95% CI, 1.94-4.82).


CONCLUSIONS
This study identifies factors associated with surgical referral in patients with PCLs undergoing EUS. Future studies should focus on creation of risk stratification models to determine the need for surgery or enrollment in surveillance programs.
From the *Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, †Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO; ‡Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO; §Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; ∥Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora; and ¶Division of Gastroenterology, Veterans Affairs Medical Center, Denver, CO.
Phillip S
PS
Ge
Srinivas
S
Gaddam
Joseph W
JW
Keach
Daniel
D
Mullady
Norio
N
Fukami
Steven A
SA
Edmundowicz
Riad R
RR
Azar
Raj J
RJ
Shah
Faris M
FM
Murad
Vladimir M
VM
Kushnir
Kourosh F
KF
Ghassemi
Alireza
A
Sedarat
Rabindra R
RR
Watson
Stuart K
SK
Amateau
Brian C
BC
Brauer
Roy D
RD
Yen
Lindsay
L
Hosford
Thomas
T
Hollander
Timothy R
TR
Donahue
Richard D
RD
Schulick
Barish H
BH
Edil
Martin D
MD
McCarter
Csaba
C
Gajdos
Augustin R
AR
Attwell
V Raman
VR
Muthusamy
Dayna S
DS
Early
Sachin
S
Wani
D000368:Aged; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000000981:diagnostic imaging* / Q000601:surgery*; D016017:Odds Ratio; D010180:Pancreatectomy; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D057832:Watchful Waiting