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

Sep 21, 2026

Pancreatobiliary intraductal papillary neoplasms (IPNs) act as precursors of pancreatic cancer or bile duct cholangiocarcinoma and are difficult to identify and treat despite advances in diagnostic approaches. Modern imaging, biomarkers, and molecular testing for genomic alterations support diagnosis and follow-up. For malignant cases, surgery combined with new chemotherapeutic agents is considered optimal. Management depends on balancing malignancy risk against resection risk using meticulous preoperative assessment of high-risk stigmata.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Abstract

Core Tip

Key clinical considerations

Citation

| W | J | G | World Journal of
Gastroenterology | | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastroenterol 2024 March 14; 30(10): 1461-1465 DOI: 10.3748/wjg.v30.i10.1461 ISSN 1007-9327 (print) ISSN 2219-2840 (online) LETTER TO THE EDITOR Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct Efstathios T Pavlidis, Ioannis N Galanis, Theodoros E Pavlidis Specialty type: Gastroenterology and hepatology Provenance and peer review: Unsolicited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s scientific quality classification Grade A (Excellent): 0 Grade B (Very good): B Grade C (Good): 0 Grade D (Fair): D Grade E (Poor): 0 P-Reviewer: Mikulic D, Croatia Received: January 2, 2024 Peer-review started: January 2, 2024 First decision: January 17, 2024 Revised: January 19, 2024 Accepted: February 26, 2024 Article in press: February 26, 2024 Published online: March 14, 2024 Efstathios T Pavlidis, Ioannis N Galanis, Theodoros E Pavlidis, 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece Corresponding author: Theodoros E Pavlidis, Doctor, PhD, Emeritus Professor, Surgeon, 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, Thessaloniki 54642, Greece. [pavlidth@auth.gr](pavlidth@auth.gr) 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 followup. 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. Key Words: Biliary tree diseases; Pancreatic cystic neoplasms; Biliary tract neoplasms; Extrahepatic cholangiocarcinoma; Pancreatic adenocarcinoma ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved. Core Tip: The balance between overlooking a potential malignancy and the outcomes of a high-risk major operation should be accounted for in the decision-making process of the therapeutic plan. Despite the use of modern diagnostic modalities, overtreatment may occur in many patients; thus, the correct management of pancreatobiliary intraductal papillary neoplasms (IPNs) must be individualized. The proper management of pancreatobiliary IPNs is based on a precise preoperative diagnosis that correctly evaluates the defined high-risk stigmata and worrisome features. WJG [https://www.wjgnet.com](https://www.wjgnet.com) 1461 March 14, 2024 Volume 30 Issue 10 Pavlidis ET et al. Pancreatobiliary intraductal papillary neoplasms Citation: Pavlidis ET, Galanis IN, Pavlidis TE. Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct. World J Gastroenterol 2024; 30(10): 1461-1465 URL: [https://www.wjgnet.com/1007-9327/full/v30/i10/1461.htm](https://www.wjgnet.com/1007-9327/full/v30/i10/1461.htm) DOI: [https://dx.doi.org/10.3748/wjg.v30.i10.1461](https://dx.doi.org/10.3748/wjg.v30.i10.1461) We read the paper by Mocchegiani et al [1] with great interest, and we wou

FAQs

What are pancreatobiliary intraductal papillary neoplasms and why are they clinically important?

They are precursors of pancreatic cancer or bile duct cholangiocarcinoma that can be detected and treated. Identifying these premalignant lesions remains challenging for treatment providers.

Which diagnostic tools are mentioned for IPNs?

Modern imaging, biomarkers, and molecular tests for genomic alterations can be used for diagnosis and follow-up.

How should treatment decisions be made for IPNs?

Management should balance the risk of malignancy against any risk of resection, guided by meticulous preoperative assessment of high-risk stigmata. Treatment should be individualized.

Sep 21, 2026

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