AGA Clinical Practice Update on Surveillance of Pancreatic Cystic Lesions and Hepatocellular Carcinoma in Older Adults: Expert Review

Description: There is a demographic explosion of patients over the age of 60 expected in the United States and worldwide in the next 20 years. Pancreatic cystic lesions (PCLs) are frequently, incidentally identified in more than a quarter of patients above the age of 70 and while the vast majority of these lesions are indolent, some may develop into malignancy. Similarly, while the risk of hepatocellular carcinoma (HCC) is well established in patients with cirrhosis, the proportion of the elderly population with cirrhosis is rapidly expanding, especially in the setting of metabolic dysfunction-associated steatohepatitis. While multiple guidelines define these high-risk populations and provide recommendations on how and when to implement surveillance, these same guidelines rarely specify when to stop surveillance particularly in cases of advanced age or infirmity where the patient's attributable mortality to the surveyed condition or fitness to receive invasive treatments is unclear. In this Clinical Practice Update (CPU), we review evidence-based, patient-centered, practical approaches to assess appropriateness for PCL and HCC surveillance in older individuals, weighing the balance of potential benefit vs harms and the impact of comorbidities and life expectancy on shared decision-making.