Dilated pancreatic duct: Should I get a second opinion?

Is it unusual to proceed to surgery w/o a biopsy or some other definitive proof there is an IPMN?

The surgeon believes the CT scan, EUS w/o biopsy and MRI/MRPC provide sufficient proof of IPMN even though none conclusively identified an IPMN and recommends the surgery.

The surgeon offered to request a new EUS with biopsy if I wish but they said they didn’t believe it was necessary and that it could result in pancreatitis which could be problematic.

The surgeon seems quite competent but I just have little knowledge to base my decision upon.

Really hoping Mayo will see me as I know they have much experience with these topics.

My reply didn’t end up where expected so replying again.

I have been referred to the gastro team at Mayo Rochester and have an appointment to speak with a nurse next week.

Praying that Mayo will see me as the local resources are fine but do only a handful of these surgeries each year.

I have been in contact with Mayo in Rochester and referred to their gastro team. Have an appointment next week to speak with a nurse there.

Have you had opinions about surgery from more than one surgeon?

The information has been helpful, thank you all.

My doctors think the observations noted above are enough to diagnose a MD IPMN in the pancreas head, along with the digestive issues. My concern is that there has been no confirmation through biopsy though surgery has been recommended.

That’s why I asked if any of the imaging done so far could conclusively determine an IPMN presence, as apparently none has directly. Perhaps papillary projections and fishmouth ampulla are indicative enough. I just don’t know and also wish to be sure before surgery.

My 8mm main duct pancreatic dilation was found incidental to a bout of diverticulitis. No connection. I do have an IPMN but biopsies have come back negative after an EUS/ERCP. I am currently monitoring any changes vis MRI/MRCP every 6 months. Have had no pain or symptoms at all. I did seek other opinions and the feeling is I should consider a prophylactic Whipple because of my current good health with no underlying conditions. I have had this for 9 years but only recently was told about the dilation. Still conflicted what to do, but as long as I feel fine I am hesitant to do that surgery. Hope this helps.

The MRI/MRCP found the gallbladder and bile ducts appear unremarkable.

To recap they decided not to do a biopsy with the first EUS to avoid pancreatitis (which I believe may already be present since I have digestive symptoms) and now after a recent MRI/MRCP are again recommending EUS with possible biopsy.

Is it possible for pancreatitis by itself to dilate the pancreatic duct to 8-10 mm? Also, should the various imaging already done have shown an IPMN if there was one?

Thank you

I too have dilated pancreatic and liver ducts. Have you had an MCRP? I believe this is the gold standard in investigating the type of problem you describe. I recently had a follow up CT scan which did not show any changes in the size of the dilation, but I still suffer the consequences of having the problems that come with dilation of both liver and pancreatic ducts/
Best of luck

Also, the MRI/MRCP found dilation up to 8 mm when it was previously measured at 10 mm.

A biopsy during the EUS wasn’t taken to avoid pancreatitis. I have since had an MRI with and without contrast as well as MRCP. No ductal obstruction or focal lesion was found.

They are recommending another EUS with biopsy, since they can’t exclude possibly of IPMN.

I’ve had a CT scan, EUS w/o biopsy and now MRI/ MRCP. If I do have an IPMN, shouldn’t one of these imagings have shown it?