Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct

World J Gastroenterol. 2024 Mar 14;30(10):1461-1465. doi: 10.3748/wjg.v30.i10.1461.

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 tract neoplasms; Biliary tree diseases; Extrahepatic cholangiocarcinoma; Pancreatic adenocarcinoma; Pancreatic cystic neoplasms.

MeSH terms

  • Bile Duct Neoplasms* / genetics
  • Bile Duct Neoplasms* / surgery
  • Bile Ducts / pathology
  • Bile Ducts, Intrahepatic / diagnostic imaging
  • Bile Ducts, Intrahepatic / pathology
  • Cholangiocarcinoma* / genetics
  • Cholangiocarcinoma* / surgery
  • Humans
  • Pancreatic Ducts / diagnostic imaging
  • Pancreatic Ducts / pathology
  • Pancreatic Neoplasms* / pathology
  • Pancreatic Neoplasms* / surgery