%0 Journal Article %A Kasper A Overbeek %A Iris J M Levink %A Brechtje D M Koopmann %A Femme Harinck %A Ingrid C A W Konings %A Margreet G E M Ausems %A Anja Wagner %A Paul Fockens %A Casper H van Eijck %A Bas Groot Koerkamp %A Olivier R C Busch %A Marc G Besselink %A Barbara A J Bastiaansen %A Lydi M J W van Driel %A Nicole S Erler %A Frank P Vleggaar %A Jan-Werner Poley %A Djuna L Cahen %A Jeanin E van Hooft %A Marco J Bruno %A , %T Long-term yield of pancreatic cancer surveillance in high-risk individuals %D 2021 %R 10.1136/gutjnl-2020-323611 %J Gut %P gutjnl-2020-323611 %X Objective We aimed to determine the long-term yield of pancreatic cancer surveillance in hereditary predisposed high-risk individuals.Design From 2006 to 2019, we prospectively enrolled asymptomatic individuals with an estimated 10% or greater lifetime risk of pancreatic ductal adenocarcinoma (PDAC) after obligatory evaluation by a clinical geneticist and genetic testing, and subjected them to annual surveillance with both endoscopic ultrasonography (EUS) and MRI/cholangiopancreatography (MRI/MRCP) at each visit.Results 366 individuals (201 mutation-negative familial pancreatic cancer (FPC) kindreds and 165 PDAC susceptibility gene mutation carriers; mean age 54 years, SD 9.9) were followed for 63 months on average (SD 43.2). Ten individuals developed PDAC, of which four presented with a symptomatic interval carcinoma and six underwent resection. The cumulative PDAC incidence was 9.3% in the mutation carriers and 0% in the FPC kindreds (p<0.001). Median PDAC survival was 18 months (range 1–32). Surgery was performed in 17 individuals (4.6%), whose pathology revealed 6 PDACs (3 T1N0M0), 7 low-grade precursor lesions, 2 neuroendocrine tumours <2 cm, 1 autoimmune pancreatitis and in 1 individual no abnormality. There was no surgery-related mortality. EUS detected more solid lesions than MRI/MRCP (100% vs 22%, p<0.001), but less cystic lesions (42% vs 83%, p<0.001).Conclusion The diagnostic yield of PDAC was substantial in established high-risk mutation carriers, but non-existent in the mutation-negative proven FPC kindreds. Nevertheless, timely identification of resectable lesions proved challenging despite the concurrent use of two imaging modalities, with EUS outperforming MRI/MRCP. Overall, surveillance by imaging yields suboptimal results with a clear need for more sensitive diagnostic markers, including biomarkers.All data relevant to the study are included in the article or uploaded as supplementary information. %U https://gut.bmj.com/content/gutjnl/early/2021/04/04/gutjnl-2020-323611.full.pdf