{
  "abstract": "Introduction Incidental pancreatic cysts are increasingly detected, with reported prevalence of 2-45%. European guidelines (Gut 2018) recommend conservative, risk-stratified surveillance for most low-risk cysts, resulting in prolonged follow-up. Expanding surveillance cohorts, exacerbated by COVID-19 backlogs, have placed significant pressure on clinic capacity. This has created a need for alternative models of care that maintain patient safety whilst improving service efficiency. In response, a nurse-led surveillance pathway was introduced to provide structured, guideline-based follow-up with clear escalation criteria.Methods A retrospective review was performed of consecutive patients managed in a regional nurse-led pancreatic cyst clinic with consultant supervision between December 2022 and October 2025. Data collected included demographics, radiological characteristics, Endoscopic Ultrasound (EUS) findings, histological diagnosis and clinic endpoints including surveillance, discharge, mortality or surgical referral.Results Following review at the regional HPB MDT, 321 patients (female [192] and male [129]; median age 69 [IQR 61-75]) were managed in the clinic, accounting for 519 encounters (338 telephone appointments; 5% non-attendance). Radiological assessment identified IPMN in 110 (34%) patients and indeterminate or benign-appearing cysts in 211 (66%) patients. EUS was performed in 79 patients with worrisome radiological features, with histological diagnosis obtained in 32: IPMN (17), mucinous cystic neoplasm (5), serous cystic neoplasm (6) and non-specific diagnoses (4).Only 9 (3%) patients were referred for surgical management: 3 underwent resection, 2 deemed unfit for surgery, 3 opted for continued surveillance and 1 is awaiting resection. Ongoing radiological surveillance was continued in 258 (80%) patients, with a mean scan interval of 18 months. Under this model, 54 (17%) patients were discharged (stable low-risk cysts [15], too frail or comorbid [38], transfer of care [1]), of whom 9 died following discharge from non-pancreatic causes. None of the discharged patients developed malignancy.Conclusion Nurse-led pancreatic cyst surveillance pathway delivers safe guideline-based follow-up with effective MDT integration and appropriate escalation to EUS and surgery. This model enables discharge of low-risk and frail patients, timely surveillance and escalation of higher risk cysts for surgical intervention. It also improves service capacity by reducing consultant-led follow-up, whilst maintaining patient safety. This offers a scalable response to the growing demand for pancreatic cyst surveillance.Abstract P269 Figure 1Nurse-led pancreatic cyst clinic outcomes flowchart",
  "authors": [
    {
      "affiliations": [
        "Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Jeremy Victor"
    },
    {
      "affiliations": [
        "Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Mohamed Elnagar"
    },
    {
      "affiliations": [
        "Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Maria Appleyard"
    },
    {
      "affiliations": [
        "Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom",
        "NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom",
        "University of Nottingham, Nottingham, United Kingdom"
      ],
      "name": "Suresh Venkatachalapathy"
    }
  ],
  "title": "P269 Improving efficiency in pancreatic cyst surveillance: outcomes of a regional nurse-led pancreatic cyst clinic",
  "uid": "4a515bce-8f04-549f-8cbc-9b2e9744e23c"
}