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3127953 
Journal Article 
Pancreatic Cyst Epithelial Denudation: a Natural Phenomenon in the Absence of Treatment 
Gómez, V; Majumder, S; Smyrk, TC; Topazian, MD; Chari, ST; Gleeson, FC; Harmsen, WS; Enders, FT; Abu Dayyeh, BK; Iyer, PG; Pearson, RK; Petersen, BT; Rajan, E; Takahashi, N; Vege, SS; Wang, KK; Levy, MJ 
2016 
Yes 
Gastrointestinal Endoscopy
ISSN: 0016-5107 
English 
27060714 
BACKGROUND AND AIMS: The presence and significance of epithelial denudation among treatment-naïve pancreatic cystic lesions (PCLs) remain undetermined. The aims of this study were to determine the prevalence, extent and predictors of epithelial denudation in treatment-naïve PCLs.

METHODS: Single-center retrospective study including patients who underwent EUS preceded by cross-sectional imaging and who subsequently underwent surgical resection of treatment-naïve PCLs. Surgically resected PCLs were reviewed by a pathologist in a fashion that allowed evaluation from evenly distributed regions of the cyst.

RESULTS: 140 subjects were identified (60% female, mean age 63). Eighty-five cysts (60.7%) were classified as IPMN, 33 (23.5%) as MCN, 11 (7.9%) as serous cystadenoma (SCA), and 11 (7.9%) composed of other cyst subtypes. A greater extent of epithelial denudation was seen in MCN compared with IPMN and SCA (mean % denuded epithelium 45.1%, 10.8%, and 22.4%, respectively [P<0.0001]). An association existed between the extent of denuded epithelium and degree of cyst epithelial dysplasia for IPMN and MCN combined (mean % denuded epithelium for low-, moderate- and high-grade dysplasia being 23.3%, 4.5%, 1.2%, respectively, P=0.02). PCLs resected from the neck/body/tail of pancreas were associated with greater extent of mean % denuded epithelium than PCLs resected from the head/uncinate of pancreas (23.9% versus 13.4%; P=0.035).

CONCLUSIONS: The presence and extent of cyst epithelial denudation of treatment-naïve PCLs vary with cyst histology and other factors. The observation of denudation after intracystic ablative therapy may not provide an adequate metric of successful intervention. Further studies are needed to validate these findings.