Dilated pancreatic duct: Should I get a second opinion?

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?

John, These tests can reveal enlargement (dilatation) of the pancreatic duct or one of the branches of the pancreatic duct. Sometimes a fine needle aspiration (FNA) biopsy may be necessary to confirm the diagnosis. Has your team suggested a biopsy?

The EUS found the duct dilatation along with papilla projections and possible fishmouth ampulla indicative of IPMN but no IPMN clearly. No biopsy was taken.

Shouldn’t the CT scan or EUS clearly shown an IPMN if one is present?