Original Paper

A Clinical and Economic Evaluation of Endoscopic Ultrasound for Patients at Risk for Familial Pancreatic Adenocarcinoma
Joel H. Rubenstein^{a, b}, James M. Scheiman^b, Michelle A. Anderson<sup>b

a</sup>Ann Arbor Veterans Affairs Medical Center, and
^bThe Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Mich., USA

Address of Corresponding Author

Pancreatology 2007;7:514-525 (DOI: 10.1159/000108969)

  Key Words

• Decision support techniques
• Cost-effectiveness
• Endosonography
• Pancreatectomy
• Pancreatic neoplasms
• Precancerous conditions
• Genetic predisposition to disease

  Abstract

Background and Aims: Approximately 10% of pancreatic adenocarcinoma is familial. Approximately 50% of 1st-degree relatives (FDRs) have endoscopic ultrasound (EUS) findings of chronic pancreatitis. We modeled the natural history of these patients to compare 4 management strategies. Methods: We performed a systematic review, and created a Markov model for 45-year-old male FDRs, with findings of chronic pancreatitis on screening EUS. We compared 4 strategies: doing nothing, prophylactic total pancreatectomy (PTP), annual surveillance by EUS, and annual surveillance with EUS and fine needle aspiration (EUS/FNA). Outcomes incorporated mortality, quality of life, procedural complications, and costs. Results: In the Do Nothing strategy, the lifetime risk of cancer was 20%. Doing nothing provided the greatest remaining years of life, the lowest cost, and the greatest remaining quality-adjusted life years (QALYs). PTP provided the fewest remaining years of life, and the fewest remaining QALYs. Screening with EUS provided nearly identical results to PTP, and screening with EUS/FNA provided intermediate results between PTP and doing nothing. PTP provided the longest life expectancy if the lifetime risk of pancreatic cancer was at least 46%, and provided the most QALYs if the risk was at least 68%. Conclusions: FDRs from familial pancreatic cancer kindreds, who have EUS findings of chronic pancreatitis, have increased risk for cancer, but their precise risk is unknown. Without the ability to further quantify that risk, the most effective strategy is to do nothing.

Copyright © 2007 S. Karger AG, Basel and IAP

  Author Contacts

Joel H. Rubenstein, MD, MSc
VA Medical Center (111-D)
2215 Fuller Road
Ann Arbor, MI 48105 (USA)
Tel. +1 734 761 7981, Fax +1 734 761 7549, E-Mail jhr@umich.edu

  Article Information

Received: January 5, 2007
Accepted after revision: June 6, 2007
Published online: October 1, 2007
Number of Print Pages : 12
Number of Figures : 5, Number of Tables : 2, Number of References : 108