Guidelines say when to start surveillance of pancreatic cystic lesions and hepatocellular carcinoma, but rarely when to stop, and older patients are increasingly over-surveyed. This AGA Clinical Practice Update offers best-practice advice on stopping.
For pancreatic cysts, it advises counselling against routine surveillance in patients with significant comorbidity, considering discontinuation in those over 65 with cysts of 15 mm or less stable for five years with no worrisome features, and a frank discussion of its questionable value in those over 75 with cysts under 30 mm stable for five years. For hepatocellular carcinoma, surveillance in older adults should be driven by fibrosis stage and risk rather than age alone, continued for cirrhosis of any cause unless life expectancy is under one to two years, and stopped when life expectancy is that short or in Child-Pugh C cirrhosis without transplant options.
The practical change is to make stopping an explicit, shared decision, anchored in comorbidity and life expectancy, rather than surveying indefinitely by default.
- AGA best-practice advice on when to stop, not just start, surveillance in older adults.
- Counsel against pancreatic cyst surveillance where significant comorbidity precludes intervention.
- Consider stopping cyst surveillance in those over 65 with small cysts stable for five years.
- Base HCC surveillance on fibrosis stage and risk, not age alone.
- Stop HCC surveillance when life expectancy is under one to two years or in Child-Pugh C without transplant options.
Why it matters
It gives permission and criteria to stop low-value surveillance that exposes frail older patients to harm without benefit.
Don't overread it
These are expert best-practice advice statements, not graded evidence, and each rests on shared decision-making rather than a fixed rule.
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