# International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas (2024)

Source: https://onco.cc/key-papers/paper-kyoto-2024-evidence-based-guidelines-ipmn-pancreatology-2024/  
OnCo record `paper-kyoto-2024-evidence-based-guidelines-ipmn-pancreatology-2024` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2024 update to the international pancreatic cyst guidelines, which adds faster cyst growth, new diabetes and pancreatitis to the warning signs, allows surveillance to stop in some older patients with small stable cysts, and grades each recommendation by the strength of the evidence.

## Summary

Evidence-graded revision of the Fukuoka guidelines by the International Association of Pancreatology, meeting in Kyoto. High-risk stigmata are retained, with an enhancing mural nodule of 5 mm or more, main duct of 10 mm or more, obstructive jaundice and positive cytology as indications for surgery in fit patients. Worrisome features now include cyst growth of 2.5 mm or more per year, new-onset or worsening diabetes and acute pancreatitis, alongside the earlier criteria.

The guideline addresses when surveillance can be stopped (after five years of stability in cysts under 2 cm in patients who would not be surgical candidates), the role of cyst fluid molecular analysis, management after resection, and the need for randomised trials of surveillance strategies.

## Fields

- Kind: Key paper
- Last checked: 2026-09-21
- Journal: Pancreatology
- Year: 2024
- DOI: 10.1016/j.pan.2023.12.009
- Authors: Ohtsuka T, Fernandez-Del Castillo C, Furukawa T, et al.
- Findings: New worrisome features: cyst growth 2.5 mm or more per year, new-onset or worsening diabetes, acute pancreatitis.; Surveillance may stop after five years of stability in small cysts in patients unfit for surgery.; Recommendations graded by evidence quality for the first time.
- What it means: The current international standard for deciding which pancreatic cysts to operate on, which to watch and for how long.
- Caveats: Most recommendations still rest on low-quality retrospective evidence.; Differences from the European and American guidelines persist, particularly on stopping surveillance.

## Sources

- Pancreatology 2024: https://doi.org/10.1016/j.pan.2023.12.009
- PubMed: https://pubmed.ncbi.nlm.nih.gov/38182527/

## Connected records

- cancers: [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)

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