AGA gives advice on when to stop pancreatic cyst and liver cancer surveillance in older adults; cold snare cut complications but doubled residual adenoma

The edition in brief

An AGA Clinical Practice Update, an expert review without formal evidence grading, offers best practice advice on stopping surveillance in older adults: people with significant comorbidity and incidental pancreatic cystic lesions should be counselled against routine surveillance; people over 65 with stable cysts of 15 mm or less for 5 years can be considered for stopping after shared decision-making; and HCC surveillance in cirrhosis can stop when life expectancy is below 1 to 2 years. A 24-week trial of 107 adults with painful chronic pancreatitis found non-enteric-coated pancreatic enzymes did not improve pain at 12 weeks (Izbicki difference -2.5, 95% CI -9.3 to 4.2). In 331 screened asymptomatic first-degree relatives of people with Crohn's disease, 19% had persistently raised faecal calprotectin, and a level above 225 µg/g discriminated presymptomatic Crohn's disease (AUC 0.97); this is research-stage, not a screening recommendation. An individual patient data meta-analysis of four randomised trials (1,509 large polyps) found major adverse events in 1.7% after cold snare and 5.9% after hot snare endoscopic mucosal resection, but residual or recurrent adenoma in 26.5% against 12.8%. The pearl covers hepatitis B screening before chemotherapy or immunosuppression.