title: Follow-up of asymptomatic pancreatic cysts in clinical practice: A vignette questionnaire.
abstract: OBJECTIVE
  In absence of evidence-based guidelines of pancreatic cystic neoplasms (PCN), the management might vary among physicians. The aim of this survey was to assess the attitude of Dutch gastroenterologists (GE) towards the management of asymptomatic PCNs.
  
  
  METHODS
  An anonymous online questionnaire was distributed to all practicing GE (n = 381) in The Netherlands, in which four vignette patients with PCN were presented.
  
  
  RESULTS
  In total 45% of GE responded. Most respondents would perform surveillance for a 10 mm PCN (78%) mainly with an interval of one year (57%). A shorter interval of three (26%) or six (57%) months was chosen for a 25 mm BD-IPMN. Ultrasound was recommended for surveillance by 19% for a 10 mm cyst. GE with EUS experience were more likely to apply EUS for surveillance of 10 mm cyst than those without (56% vs 28%; p < 0.001). The presence of a branch-duct intraductal mucinous neoplasm (BD-IPMN) with a mural nodule, dilated pancreatic duct (8 mm) or increased serum CA 19.9 (300 U/ml) were considered an indication for resection by respectively 88%, 68% and 51% of respondents.
  
  
  CONCLUSIONS
  Dutch GE demonstrate substantial variability in the management of asymptomatic PCNs. A significant proportion of general GE still use ultrasound for surveillance of small PCNs, while GE with EUS experience were more likely to perform EUS. The presence of risk factors for malignant degeneration of IPMN were not recognized by a substantial proportion of GE. Data on the natural history of PCNs is required to provide input for evidence-based guidelines, which should lead to a more uniform approach.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: l.hol.1@erasmusmc.nl.
authors.forename: Lieke
authors.initials: L
authors.lastname: Hol
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Djuna L
authors.initials: DL
authors.lastname: Cahen
mesh_terms: D000328:Adult; D000359:Aftercare / Q000379:methods*; D058070:Asymptomatic Diseases; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D019160:Endosonography; D005260:Female; D000072102:Gastroenterologists; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
keywords: Incidental pancreatic cysts; Intraductal papillary mucinous neoplasm; Management; Pancreatic cystic neoplasm; Questionnaire; Surveillance