Letter to the Editor
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2024; 30(10): 1461-1465
Published online Mar 14, 2024. doi: 10.3748/wjg.v30.i10.1461
Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct
Efstathios T Pavlidis, Ioannis N Galanis, Theodoros E Pavlidis
Efstathios T Pavlidis, Ioannis N Galanis, Theodoros E Pavlidis, 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Author contributions: Pavlidis TE designed research, contributed new analytic tools, analyzed data and review; Galanis IN analyzed data and review; Pavlidis ET performed research, analyzed data, review, and wrote the paper.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Theodoros E Pavlidis, Doctor, PhD, Emeritus Professor, Surgeon, 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 54642, Greece. pavlidth@auth.gr
Received: January 2, 2024
Peer-review started: January 2, 2024
First decision: January 17, 2024
Revised: January 19, 2024
Accepted: February 26, 2024
Article in press: February 26, 2024
Published online: March 14, 2024
Abstract

Pancreatobiliary intraductal papillary neoplasms (IPNs) represent precursors of pancreatic cancer or bile duct cholangiocarcinoma that can be detected and treated. Despite advances in diagnostic methods, identifying these premalignant lesions is still challenging for treatment providers. Modern imaging, biomarkers and molecular tests for genomic alterations can be used for diagnosis and follow-up. Surgical intervention in combination with new chemotherapeutic agents is considered the optimal treatment for malignant cases. The balance between the risk of malignancy and any risk of resection guides management policy; therefore, treatment should be individualized based on a meticulous preoperative assessment of high-risk stigmata. IPN of the bile duct is more aggressive; thus, early diagnosis and surgery are crucial. The conservative management of low-risk pancreatic branch-duct lesions is safe and effective.

Keywords: Biliary tree diseases, Pancreatic cystic neoplasms, Biliary tract neoplasms, Extrahepatic cholangiocarcinoma, Pancreatic adenocarcinoma

Core Tip: The balance between overlooking a potential malignancy and the outcomes of a high-risk major operation should be accounted for in the decision-making process of the therapeutic plan. Despite the use of modern diagnostic modalities, overtreatment may occur in many patients; thus, the correct management of pancreatobiliary intraductal papillary neoplasms (IPNs) must be individualized. The proper management of pancreatobiliary IPNs is based on a precise preoperative diagnosis that correctly evaluates the defined high-risk stigmata and worrisome features.