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European evidence-based guidelines on pancreatic cystic neoplasms
  1. The European Study Group on Cystic Tumours of the Pancreas
    1. Correspondence to The European Study Group on Cystic Tumours of the Pancreas, Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Center for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm 14186, Sweden; marco.del.chiaro{at}


    Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.

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    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators This guideline has been made possible by a large group of collaborators. These collaborators formed the writing committee, methodology committee, nine review groups and the manuscript committee. The initial draft of the manuscript was written by Marco Del Chiaro (Karolinska) with the help of Lianne Scholten, Marc G Besselink (both AMC). The following collaborators were each involved in one or more of the committees and review groups (see supplementary material for details): Marco Del Chiaro, Marc G Besselink, Lianne Scholten, Marco J Bruno, Djuna L Cahen, Thomas M Gress, Jeanin E van Hooft, Markus M Lerch, Julia Mayerle, Thilo Hackert, Sohei Satoi, Alessandro Zerbi, David Cunningham, Claudio De Angelis, Marc Giovannini, Enrique de-Madaria, Peter Hegyi, Jonas Rosendahl, Helmut Friess, Riccardo Manfredi, Philippe Lévy, Francisco X Real, Alain Sauvanet, Mohammed Abu Hilal, Giovanni Marchegiani, Irene Esposito, Paula Ghaneh, Marc RW Engelbrecht, Paul Fockens, Nadine CM van Huijgevoort, Christopher Wolfgang, Claudio Bassi, Natalya B Gubergrits, Caroline Verbeke, Günter Klöppel, Aldo Scarpa, Giuseppe Zamboni, Anne Marie Lennon, Malin Sund, Nikolaos Kartalis, Lars Grenacher, Massimo Falconi, Urban Arnelo, Kostantin V Kopchak, Kofi Oppong, Colin McKay, Truls Hauge, Kevin Conlon, Mustapha Adham, Güralp O Ceyhan, Roberto Salvia, Christos Dervenis, Peter Allen, François Paye, Detlef K Bartsch, Matthias Löhr, Massimiliano Mutignani, Johanna Laukkarinen, Richard Schulick, Roberto Valente, Thomas Seufferlein, Gabriele Capurso, Ajith Siriwardena, John P Neoptolemos, Aldis Pukitis, Ralf Segersvärd, A Aghdassi, S Andrianello, P Bossuyt, R Bülow, K Cárdenas-Jaén, P Cortegoso, M Fontana, L Haeberle, M Heckler, A Litvin, K Mann, C Michalski, P Michl, G Nappo, G Perri, S Persson, F Scheufele, F Sclafani, M Schmidt, L Venezia, F Volker, M-P Vullierm, and L Wüsten.

    • Correction notice This article has been corrected since it published Online First. Massimo Falconi has been added to the collaborator list.

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