An American Gastroenterological Association clinical practice update in Clinical Gastroenterology and Hepatology (30 September) addresses a question most surveillance guidelines leave open: when to stop. It is expert advice from a literature review, without formal evidence grading.
For pancreatic cysts, it advises counselling against routine surveillance in people with significant comorbidity (age-adjusted Charlson index of about 3 to 5 or more), especially for low-risk cysts. Over 65, cysts of 15 mm or less that have been stable for five years without worrisome features may be considered for stopping after shared decision-making; over 75, the same applies to stable cysts under 30 mm. Stable means growth under 3 mm a year or 6 mm over two years. New comorbidity that would rule out surgery should prompt the same discussion. For liver cancer, surveillance should be considered in older adults with cirrhosis of any cause, guided by fibrosis stage and risk rather than age alone, and stopped when life expectancy is under one to two years or with decompensated disease where transplant is not an option.
Pancreatic cysts are found incidentally in over a quarter of people over 70, and indefinite imaging carries costs, anxiety and the risk of harmful intervention. This update gives clinicians concrete thresholds for a stopping conversation.
- Discuss stopping pancreatic cyst surveillance in people over 65 with cysts of 15 mm or less, stable for five years without worrisome features.
- Extend that discussion to people over 75 with stable cysts under 30 mm.
- Counsel against starting cyst surveillance in people with significant comorbidity who would not be fit for pancreatic surgery.
- Continue liver cancer surveillance in older adults with cirrhosis unless life expectancy is under one to two years.
- Stop liver cancer surveillance in decompensated cirrhosis where transplant is not an option.
Why it matters
Surveillance that could never lead to treatment exposes frail older patients to scans, anxiety and procedures without benefit.
Don't overread it
These are expert best-practice statements, not graded recommendations from a systematic review.
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