Dilated pancreatic duct: Should I get a second opinion?

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?

@johnbc, have you had the ultrasound in the meantime? Did they find the cause of the dialation?

I had some recent abdominal pain and CT scan found varying dilation in entire pancreatic duct with 10mm measurement in head. They didn’t see an IPMN but recommended EUS for further evaluation.

Can a single IPMN cause dilation over entire duct?

Thank you

We made an appointment with the UCSD doctor in Oct. UCSD Dr already reviewed his file and didn’t call us in immediately. I hope this is good news. Thank you for checking with us.

@okienana, how are you doing? If I may ask, what did you learn from your recent appointment with the gastroenterologist?

@stageivsurvivor, thank you for the advice! I will look into UCSD program.

UCSD-Moores Cancer Center is an NCI designated treatment center and has a pancreas program with noted surgeons and pancreatic oncologists. It is also a member of the Precision Promise consortium of the Pancreatic Cancer Action Network (PanCan.org) and would be my first choice.
https://health.ucsd.edu/specialties/cancer/programs/pancreatic/Pages/default.aspx
https://pancan.org/research/precision-promise/locations/

My husband had dilated bile duct and a 7mm lesion found by MRCP, but EUS test was negative. Could I check if EUS has high false negative and we should seek second opinion and another EUS or ERCP? Recently, there are more symptoms, such as no appetite, feeling full and bloated, and slight loss of weight, probably a couple of pounds in the recent months. Also had diarrhea for no reason for several weeks, but now is gone. Here is the history of the findings:

Nov 30, 2021 Ultrasound: Dilatation of the common bile duct at the porta hepatis measuring 9.6 mm, of uncertain etiology
Jan 31, 2022, MRCP: Minimal dilatation of the common bile duct which abruptly tapers at the distal aspect where there is a questionable 0.7 cm T2 hypointense lesion
Feb 22, 2022, EUS: Mild dilation of common bile duct with tapering to ampulla. No ampullary or ductal lesion is visualized on EUS.
The pancreas is otherwise normal in appearance with a normal pancreatic duct.
April 7, 2022, MRCP: Unchanged mild prominence of the common bile duct at the porta hepatis with smooth tapering distally. Again noted apparent filling defect in the periampullary common bile duct lumen, near the identical to MRI 1/31/2022, would favor artifact given unremarkable ERCP and normal labs in the interim
Aug 30, 2022, MRCP, results pending.

We live in San Diego, California. UCSD and SCRIPPS are two major medical systems in the area. Does anyone know which system is better and more experienced with pancreatic cancer diagnosis and treatment?