Lee YC, Chon HK. Letter to the Editor: De-escalating surveillance in branch duct intraductal papillary mucinous neoplasms: Balancing surveillance burden with long-term oncologic risk. World J Gastroenterol 2026; 32(40): 123800 [DOI: 10.3748/wjg.123800]
Corresponding Author of This Article
Hyung Ku Chon, MD, PhD, Professor, Department of Internal Medicine, Wonkwang University College of Medicine, Institute of Wonkwang Medical Science, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Jeonbuk, South Korea. gipb2592@wku.ac.kr
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Gastroenterology & Hepatology
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letter
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Lee YC, Chon HK. Letter to the Editor: De-escalating surveillance in branch duct intraductal papillary mucinous neoplasms: Balancing surveillance burden with long-term oncologic risk. World J Gastroenterol 2026; 32(40): 123800 [DOI: 10.3748/wjg.123800]
World J Gastroenterol. Oct 28, 2026; 32(40): 123800 Published online Oct 28, 2026. doi: 10.3748/wjg.123800
Letter to the Editor: De-escalating surveillance in branch duct intraductal papillary mucinous neoplasms: Balancing surveillance burden with long-term oncologic risk
Yun-Chae Lee, Hyung Ku Chon
Yun-Chae Lee, Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University College of Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Jeonbuk, South Korea
Hyung Ku Chon, Department of Internal Medicine, Wonkwang University College of Medicine, Institute of Wonkwang Medical Science, Wonkwang University Hospital, Iksan 54538, Jeonbuk, South Korea
Author contributions: Lee YC and Chon HK performed the research and wrote the manuscript; and all authors have read and approved the final manuscript.
AI contribution statement: ChatGPT (OpenAI, San Francisco, CA, United States) was used exclusively for minor English grammar correction and wording refinement to improve readability of the manuscript. It played no role in study conception, data analysis, interpretation of findings, or scientific writing. All final scientific content and manuscript preparation were completed solely by the authors.
Supported by Biomedical Research Institute Funds of Jeonbuk National University Hospital.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Corresponding author: Hyung Ku Chon, MD, PhD, Professor, Department of Internal Medicine, Wonkwang University College of Medicine, Institute of Wonkwang Medical Science, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Jeonbuk, South Korea. gipb2592@wku.ac.kr
Received: May 29, 2026 Revised: June 22, 2026 Accepted: June 26, 2026 Published online: October 28, 2026 Processing time: 107 Days and 23.9 Hours
Abstract
A recent observational study published in World Journal of Gastroenterology by Hopley et al provided significant insights into the potential for de-escalating surveillance in patients with branch duct-intraductal papillary mucinous neoplasms. Their findings regarding early front-loaded surgery and the low risk of malignancy in stable cysts measuring < 30 mm with low cancer antigen 19-9 levels (< 43 KU/L) after 2 years represent a valuable contribution to pancreatology. However, the study’s reliance on the timing of discovery rather than the biological history of the disease may introduce discovery-phase enrichment bias. Furthermore, the decision to discharge patients at 5 years must be balanced against the lifelong cumulative risk of concomitant pancreatic cancer and variations in surgical fitness among the elderly. Although de-escalation is clinically promising, individualized risk-adapted surveillance approaches remain essential.
Core Tip: This letter critically appraises the study by Hopley et al on the de-escalation of branch duct-intraductal papillary mucinous neoplasm surveillance. While the proposed criteria for de-escalation are timely, we emphasize that the front-loaded nature of surgery may partly reflect discovery bias and therefore may not fully represent the intrinsic biological timing of disease progression. We highlight the need for tailored surveillance based on individual surgical fitness and the persistent long-term risk of dual carcinogenesis involving both intraductal papillary mucinous neoplasm progression and concomitant pancreatic ductal adenocarcinoma, which continues beyond the 5 years.
