title: The safety and benefit of pancreatic juice cytology under ERCP in IPMN patients.
abstract: BACKGROUND
  International consensus guidelines 2012 for intraductal papillary mucinous neoplasia (IPMN), defined two characteristics: high-risk stigmata (HRS) and worrisome features (WF). Patients with WF require detailed examination including cytology. However, routine endoscopic retrograde cholangiopancreatography (ERCP) for cytology is not recommended in the guidelines due to risk of post-ERCP pancreatitis (PEP). Our aim was to clarify what types of IPMN were susceptible for PEP and gain benefit of ERCP.
  
  
  METHODS
  We examined 138 consecutive IPMN patients who underwent ERCP in our hospital, retrospectively. Patients were classified into HRS, WF and the others (N) based on imaging findings before ERCP. We assessed pancreatic juice cytology, PEP frequency and rate of malignant IPMN at 12 months after ERCP.
  
  
  RESULTS
  The rates of cytological malignancy were 0% (N), 4.8% (WF) and 19.5% (HRS). The PEP frequency was 14.5%, and these risk factors were branch duct (BD)-IPMN, body/tail cysts and brush cytology by multivariate logistic analysis. The rates of malignant IPMN were 0% (N), 16.4% (WF) and 48.8% (HRS). Furthermore, we examined patients with WF in detail. The PEP frequency/rate of malignancy were 3.6%/23.1% in patients with main pancreatic duct (MPD) dilatation (5-9 mm), and the sensitivity of cytology was 33.3%. On the other hand, the PEP frequency/rate of malignancy were 17.2%/0% in patients with BD-IPMN fulfilling only cyst size over 30 mm.
  
  
  CONCLUSIONS
  Routine ERCP for IPMN, especially for BD-IPMN, is not recommended. ERCP may be beneficial for WF patients with MPD dilatation based on a balance between PEP risk and presence of malignancy.
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Teppei
authors: T
authors: Yoshioka
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Minoru
authors: M
authors: Shigekawa
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Takuo
authors: T
authors: Yamai
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Takahiro
authors: T
authors: Suda
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Tadashi
authors: T
authors: Kegasawa
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Kiyoshi
authors: K
authors: Iwahashi
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Kenji
authors: K
authors: Ikezawa
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Ryotaro
authors: R
authors: Sakamori
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Takayuki
authors: T
authors: Yakushijin
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Naoki
authors: N
authors: Hiramatsu
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan.
authors: Tomohide
authors: T
authors: Tatsumi
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita 565-0871, Osaka, Japan. Electronic address: takehara@gh.med.osaka-u.ac.jp.
authors: Tetsuo
authors: T
authors: Takehara
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D002291:Carcinoma, Papillary / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D010189:Pancreatic Juice / Q000166:cytology*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis*; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Endoscopic retrograde cholangiopancreatography; Intraductal papillary mucinous neoplasm; Post-ERCP pancreatitis