English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

imaging studies, resulting in undue anxiety to the patient and the treating physician. Diagnostic differentiation of PCLs continues to be challenging. There have been multiple guidelines for management of PCLs, mostly due to lack of tests with high diagnostic accuracy. Cost-effectiveness studies for managing PCLs have been mostly retrospective and have demonstrated that improvement in diagnostic accuracy effectively prevents unwarranted surgery, thereby reducing healthcare resource utilization. In the last 5 years, molecular analysis of PCL fluid and needle-based confocal laser endomicroscopy (nCLE) have demonstrated promising results with potential to improve diagnostic accuracy of PCLs and thereby impact patient management and outcomes. In a study published in this issue of Endoscopy International Open, Claude Le Pen et al. have performed a cost-effectiveness analysis to evaluate the economic benefit of diagnosing serous cystadenomas (SCA) by augmenting endoscopic ultrasound-guided fine-needle aspiration with nCLE. Despite the increased overall cost of diagnostic evaluation of PCLs, the improved accuracy of diagnosing SCAs and prevention of unwarranted pancreatic surgeries can potentially reduce healthcare resource utilization. Pancreatic cystic lesions are incidentally diagnosed in 13% to 45% of patients undergoing magnetic resonance imaging and 2% of computed tomography scans [1, 2]. Despite judicious utilization of current standard of care including endoscopic ultrasound (EUS), fine-needle aspiration (FNA), cyst fluid analysis (CEA), and cytology, it is challenging to accurately classify PCLs into mucinous or non-mucinous (serous cystadenomas or pseudocysts) PCLs. In fact, preoperative diagnosis of mucinous PCLs is incorrect in up to 30% of cases and these benign cysts are often surgically resected, exposing patients to an operative morbidity of 30% to 40% [3, 4]. Therefore, accurate characterization of PCLs would minimize healthcare costs and resource utilization associated with unwarranted surgical resections. In a previous cost-effectiveness analysis of the 2006 International Consensus Guidelines (ICG) [5, 6], a Markov model was utilized and the authors created 3 scenarios. In Scenario 1, patients with suspected SCAs were followed as a benign disease. In Scenario 2, patients, if deemed fit, underwent surgical resection with no further follow-up. In Scenario 3, patients underwent preoperative EUS-FNA and cyst fluid (CEA and cytology) analysis, and surgery was performed based on the differentiation of PCL [6]. In this analysis, Scenario 2 was the cheapest (US $ 13,200 per patient) but with lowest quality-adjusted life years (QALY) and Scenario 3 accounted for the highest costs ($ 23,337 per patient) and highest QALY. The cost increment to reach Scenario 3 was $11,394, indicating that additional costs were within acceptable range for satisfactory return on investment. In a more recent cost-effectiveness analysis [7], 4 scenarios were tested in a hypothetical cohort of 1,000 asymptomatic patients with incidental PCLs (size ≥3 cm). In Scenario 1, wait and watch with cross-sectional imaging, and surgery was recommended for symptoms or high-risk features based on ICG 2012 guidelines [8]. In Scenario 2, patients were considered for resection without initial EUS. In Scenario 3, patients underwent EUS-FNA and cyst fluid analysis (CEA and cytology) and muciNovel investigative modalities for evaluation of pancreatic cystic lesions: Does increased diagnostic accuracy justify the high costs?