{
  "abstract": "Introduction Pancreatic cystic neoplasms, of which Intraductal Papillary Mucinous Neoplasm (IPMN) is a sub-type, are present in up to 45% of the population. 1 IPMN conveys potential for malignant transformation and incidence is increasing, likely due more widespread access to cross-sectional imaging as screening and diagnostic tool.2 There is no clear consensus on surveillance for such patients and therefore significant heterogeneity exists in this area. As these patients are usually asymptomatic, a protocolised nurse-led clinic with a robust clinical framework adapted from pre-existing guidance has the potential to provide effective surveillance.Methods We developed a local protocol ( figure 1) where all index imaging is reviewed by a GI radiologist. Asymptomatic patients without high-risk features and whose performance status are less than 2 are put into this pathway. IPMN clinics are in telephone format. Patients who require ongoing follow-up for other gastroenterological conditions remain under the case of their physician.A retrospective case review of the electronic patient record was performed of IPMN clinic patients from July 2023 to July 2024. Surveillance is only offered to those with fitness suitable for surgery.Results 69 patients were reviewed in the 12 month period. The age ranged from 41-86 years old, with a split of 64% female and 36% male patients. Side branch IPMNs made up 100% of the cases with an average cyst size of 13.3mm. CA19-9 levels ranged from 2-117 kIU/L. 17 patients in total were discussed at MDT and of these, 5 went on to have an EUS and the other 12 continued on surveillance. 1 patient was discharged as no longer fit for surgical management and 1 patient was diagnosed with neuroendocrine tumour following EUS.Conclusions Our experience demonstrates the utility and feasibility of an evidenced-based protocol-driven nurse-led IPMN clinic for surveillance in an asymptomatic population. The caseload has increased from 69/year in this review to at present >200 patients/year on active surveillance, and we anticipate this to increase further as cross sectional imaging becomes more sensitive at picking up ‘incidentalomas’. This clinic has enabled us to re-distribute the workload and improve capacity by allowing physicians to review symptomatic patients in the saved clinic slots.References The European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018;67:789–804.Huang X, et al. Prediction of malignant intraductal papillary mucinous neoplasm: a nomogram based on clinical information and radiological outcomes. Cancer Med. 2023;12(16):16958–16971.Abstract FP19 Figure 1Summary of our local surveillance pathway, adapted from European guidelines that provides the clinical framework for IPMN surveillance that this clinic operates within",
  "authors": [
    {
      "affiliations": [
        "Barnet Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Stefan Browne"
    },
    {
      "affiliations": [
        "Barnet Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Roselyn Polcaro"
    },
    {
      "affiliations": [
        "Barnet Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Chehkuan Tai"
    }
  ],
  "title": "FP19 DGH experience of the design and delivery of an IPMN surveillance pathway and CNS clinic",
  "uid": "954fd002-089e-50c9-b24f-eae3c2d2f2a9"
}