背景:胰腺囊肿通常在常规影像学检查中偶然发现。其中,粘液性囊肿具有恶性潜能。一些指导方针提出了不同的管理策略,在没有专用基础设施的情况下,患者护理的实施不一致。
方法:为了应对胰腺囊肿诊断和治疗的挑战,我们在卫生系统内建立了一个多学科的胰腺囊肿诊所(PCC)。该诊所包括三级护理学术中心和社区医院,在肿瘤外科的领导下,胃肠病学,和放射学。我们PCC的主要目标是为所有胰腺囊肿患者提供准确的诊断和量身定制的治疗建议。此外,我们维持一个前瞻性数据库,以研究疾病的自然史和各种治疗策略的结果。
■诊所在早上通过Zoom每周开会一次,共45分钟。患者通过电子病历(EMR)命令转诊,电话,或来自患者或转介提供者的电子邮件。专门的高级实践提供者每天多次审查推荐,要求患者收集临床数据,确保图像上传,并在专用时间内协调会议的后勤方面。来自外科的代表参加了会议,放射学,医学胰腺学,和介入胃肠病学。对每个患者病例进行详细审查,并通过EMR信息和信函向转诊提供者和患者提交建议。对于需要影像学监测的患者,患者由转诊提供者纵向随访,胃肠病学团队,或者手术团队.对于需要内窥镜超声(EUS)或手术咨询的患者,这些服务的快速转介与随后的迅速评估。
结果:在2020年至2021年之间,对我们卫生系统的1052名患者进行了评估。其中,196(18.6%)接受了EUS,41例(3.9%)接受了前期手术切除,其余患者转诊至胃肠病学(141-13.4%),手术(314-29.8%),或返回他们的转诊提供者(597-56.7%)与他们的初级保健提供者(PCP)合作进行持续监测。被监测的囊肿,61.3%保持稳定,规模增加了13.2%,和2%的大小减少。共有2.3%的患者被建议停止监测。
结论:PCC提供基础设施,为胰腺囊肿患者提供多学科审查和共识建议。这有助于改善指南的应用,同时为每位患者提供个性化建议,同时帮助整个地区的非专家转介提供者。
BACKGROUND: Pancreatic cysts are often incidentally detected on routine imaging studies. Of these, mucinous cysts have a malignant potential. Several guidelines propose different management strategies, and implementation in patient care is inconsistent in the absence of dedicated infrastructure.
METHODS: To address the challenges of pancreatic cyst diagnosis and management, we established a multidisciplinary pancreas cyst clinic (PCC) within our health system. This clinic encompasses both tertiary care academic centers and community hospitals, with leadership from surgical oncology, gastroenterology, and radiology. Our PCC\'s primary goal is to provide accurate diagnosis and tailored management recommendations for all patients with pancreatic cysts. Additionally, we maintain a prospective database to study the disease\'s natural history and the outcomes of various treatment strategies.
UNASSIGNED: The clinic meets once per week for 45 min virtually via Zoom in the mornings. Patients are referred via electronic medical record (EMR) order, telephone call, or email from patient or referring provider. A dedicated advanced practice provider reviews referrals several times per day, calls patients to gather clinical data, ensures imaging is uploaded, and coordinates logistical aspects of the meeting during the dedicated time. Conferences are attended by representatives from surgery, radiology, medical pancreatology, and interventional gastroenterology. Each patient case is reviewed in detail and recommendations are submitted to referring providers and patients via an EMR message and letter. For patients requiring imaging surveillance, patients are followed longitudinally by the referring provider, gastroenterology team, or surgical team. For patients requiring endoscopic ultrasound (EUS) or surgical consultation, expedited referral to these services is made with prompt subsequent evaluation.
RESULTS: A total of 1052 patients from our health system were evaluated between 2020 and 2021. Of these, 196 (18.6 %) underwent EUS, 41 (3.9 %) underwent upfront surgical resection, and the remainder were referred to gastroenterology (141-13.4 %), surgery (314-29.8 %), or back to their referring provider (597-56.7 %) for ongoing surveillance in collaboration with their primary care provider (PCP). Of cysts under surveillance, 61.3 % remained stable, 13.2 % increased in size, and 2 % decreased in size. A total of 2.3 % of patients were recommended to discontinue surveillance.
CONCLUSIONS: The PCC provides infrastructure that has served to provide multidisciplinary review and consensus recommendations to patients with pancreatic cysts. This has served to improve the application of guidelines while providing individualized recommendations to each patient, while aiding non-expert referring providers throughout the region.