A229 QUALITY ASSESSMENT OF SURVEILLANCE PATTERNS OF PATIENTS WITH BRANCH DUCT TYPE INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS (BD-IPMN)
Notice bibliographique
Résumé
BD-IPMN are typically small neoplastic tumors that are located on the side branches of the main pancreatic duct. These cysts are usually found incidentally with cross-sectional imaging. Although main duct IPMN have high malignant potential, BD-IPMNs are low risk for progression to malignancy therefore surveillance is often appropriate. The 2015 AGA guidelines recommend imaging in one year and then every two years for a total of five years and if the cyst is unchanged, the patient can be discharged from further surveillance. To assess the surveillance pattern of patients diagnosed with BD-IPMN by EUS and compare to AGA guidelines. Secondary objectives included analyzing the proportion of BD-IPMN that progressed and if surveillance methods have changed over the time. A retrospective chart review from 01/11-02/17 of endoscopic ultrasound (EUS) procedures at St. Paul’s Hospital, Vancouver, Canada was performed to identify patients with BD-IPMN. Information acquired included patient demographics, patient co-morbidities, BD-IPMN anatomic location, presence of high-risk features, and surveillance imaging (EUS, CT, MRI) findings. Patient follow up was compared to the recommendations implemented in the AGA guidelines to determine if appropriate surveillance was performed. Acquired data included 324 branch type IPMN patients (out of 1250 EUS procedures) with 30% containing high risk features: 21.6% containing a cyst ≥ 3 cm, 10.5% mural nodularity, and 12.7% having a dilated main pancreatic duct > 5mm. In those undergoing surveillance, recommended follow up was in 98% of patients. From 2011 – 2016, there was a gradual increase in the percentage of patients returning for follow up at our institution with 2016 displaying the highest degree of efficient 1 year follow up at 40%. Despite this, mean percentage of patients undergoing surveillance at year 1, 3 and 5 was 33.4%, 20.2% and 15.7% respectively. No patients developed malignancy during follow up. Although endoscopists recommended follow up routinely in patients with BD-IPMN, only a small proportion of patients adhered to recommendations. The follow up is much better at year one than year 5 and also demonstrates improvement in all parameters over time suggesting increasing compliance. Additionally, the follow up has not demonstrated development of cancer suggesting that these guidelines are reasonable. Other measures to ensure appropriate follow up need to be instituted to ensure compliance with recommended guidelines. None
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».