We read with great interest the article by Uehara et al (Gut 2008;57:1561–5) supporting the development of ductal carcinoma during follow-up of branch-duct intraductal papillary mucinous neoplasms of the pancreas (BD-IPMNs). In a cohort of 60 patients, pancreatic ductal carcinoma distinct from IPMN developed in five cases (8%), while intraductal papillary mucinous carcinoma occurred in another two (3%). Uehara and colleagues found a 26-fold increase in the incidence of ductal adenocarcinoma in patients with BD-IPMNs compared with a control group without IPMNs. According to these data, during follow-up of BD-IPMNs the risk of development of ductal adenocarcinoma seems to be higher than the well-known possible “degeneration” of BD-IPMNs. Of note, even patients who undergo partial pancreatectomy for BD-IPMNs …