Pancreatic Cyst Identified
Incidental or symptomatic finding
All Pathways
Hepatobiliary SurgeryManagement
Pancreatic IPMN Management - Fukuoka/AGA Guidelines
Pancreatic IPMN Management - Fukuoka/AGA Guidelines: Pancreatic Cyst Identified → Cyst Characterization → IPMN Type → Main Duct IPMN → High-Risk Stigmat...
Pathway Overview
11 steps
Algorithm Steps
11 total
01Start 02Action Cyst Characterization
MRI/MRCP, consider EUS
- Size, location, duct communication
- Main duct dilation?
- Solid component/nodule?
03Decision IPMN Type
- Main Duct (MD-IPMN): MPD ≥5mm
- Branch Duct (BD-IPMN): cyst communicates with duct
- Mixed type
04Action Main Duct IPMN
Higher malignancy risk
05Decision High-Risk Stigmata (Fukuoka)
- Enhancing solid component ≥5mm
- MPD ≥10mm
- Obstructive jaundice with cystic lesion
06Action Surgical Resection
If fit for surgery
- MD-IPMN with HRS: resect
- BD-IPMN with HRS: resect
- Oncologic resection (Whipple, distal)
07End Follow-up Plan
Surveillance or post-op monitoring
08Decision Worrisome Features
- Cyst ≥3cm
- Enhancing mural nodule <5mm
- Thickened/enhancing walls
- MPD 5-9mm
- Lymphadenopathy
- Elevated CA 19-9
- Cyst growth ≥5mm/2yr
09Action EUS-FNA
Further characterization
- CEA, amylase, cytology
- Molecular markers if available
- Guides surgery vs surveillance
- Path rejoins step 06Shared downstream outcome
10Action Surveillance
Based on size and features
- <1cm: MRI q2-3y
- 1-2cm: MRI yearly
- 2-3cm: EUS q6-12mo, MRI yearly
- >3cm: close surveillance, consider EUS-FNA
- Path rejoins step 07Shared downstream outcome
- Path rejoins step 10Shared downstream outcome
11Action Branch Duct IPMN
Risk stratify by features
- Path rejoins step 05Shared downstream outcome
Guideline Source
AGA Clinical Practice Update on Pancreatic Cysts
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Fukuoka guidelines for resection, AGA for surveillance
- Main duct IPMN higher risk than branch duct
- EUS-FNA helps but doesn't replace clinical judgment
- Patient factors (age, comorbidities) affect decision
Applicable Regions
USAUUKEU
EU: European consensus on pancreatic cysts
US: AGA 2023 update + Fukuoka 2017
Version 1Next review: 2028-01-01
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Pancreatic IPMN Management - Fukuoka/AGA Guidelines?
The Pancreatic IPMN Management - Fukuoka/AGA Guidelines is a management clinical algorithm for Hepatobiliary Surgery. It provides a structured decision tree to guide clinical decision-making, based on AGA Clinical Practice Update on Pancreatic Cysts.
What guideline is the Pancreatic IPMN Management - Fukuoka/AGA Guidelines based on?
This algorithm is based on AGA Clinical Practice Update on Pancreatic Cysts (DOI: 10.1053/j.gastro.2023.01.014).
What are the limitations of the Pancreatic IPMN Management - Fukuoka/AGA Guidelines?
Known limitations include: Fukuoka guidelines for resection, AGA for surveillance; Main duct IPMN higher risk than branch duct; EUS-FNA helps but doesn't replace clinical judgment; Patient factors (age, comorbidities) affect decision. Individual patient factors may require deviation from these recommendations.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the Pancreatic IPMN Management - Fukuoka/AGA Guidelines appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free