{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:03:36Z","timestamp":1789736616132,"version":"4.0.1"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,6]],"date-time":"2024-10-06T00:00:00Z","timestamp":1728172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>For branch\u2010duct intraductal papillary mucinous neoplasms (BD\u2010IPMNs) without worrisome features (WFs) or high\u2010risk stigmata (HRS), current guidelines recommend surveillance. However, these intraductal papillary mucinous neoplasm (IPMNs), especially the small and stable\u2010sized ones, carry a low risk of malignant transformation. Our aim was to assess whether small cyst size and absence of rapid growth provide reassurance against the development of WFs\/HRS and malignancy (high\u2010grade dysplasia (HGD) or pancreatic cancer (PC)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed\/Medline, Embase, the Cochrane Library and the Web of Science Core Collection were systematically searched from inception to May 2023 to identify studies investigating surveillance outcomes of low\u2010risk BD\u2010IPMNs. Studies assessing baseline cyst size and\/or growth in relation to WFs\/HRS and\/or HGD\/PC were included. The Newcastle\u2010Ottawa scale tool was used to assess study quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 1937 identified manuscripts, 21 studies were eligible for inclusion. The quality of these studies was considered reasonable. A negative association between cyst size and WFs\/HRS development was found in 11 out of 13 relevant studies, but only one out of nine studies reported a negative association between size and malignancy. Regarding cyst growth, four out of six studies described a negative association with the development of WFs\/HRS, and all six reported a negative association with malignancy. The pooled relative risk (RR) of developing WFs\/HRS or malignancy for cysts \u226415\u00a0mm was 0.37 (95% CI 0.25\u20130.57) and the RR of developing malignancy for cyst growth &lt;2\u20132.5\u00a0mm\/year was 0.04 (95% CI 0.02\u20130.09)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This systematic review and meta\u2010analysis shows that small and stable\u2010sized low\u2010risk BD\u2010IPMNs are associated with a markedly low progression rate, with stable cyst size being the most reassuring feature. Because of substantial heterogeneity in definitions and reported outcome measures, prospective studies are needed to confirm that surveillance of small and stable sized cyst can be de\u2010intensified or even discontinued.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ueg2.12666","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T05:47:04Z","timestamp":1728280024000},"page":"7-20","source":"Crossref","is-referenced-by-count":10,"title":["Small cyst size and lack of growth as negative predictors of malignant transformation in low\u2010risk intraductal papillary mucinous neoplasms of the pancreas: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4205-6860","authenticated-orcid":false,"given":"Jihane","family":"Meziani","sequence":"first","affiliation":[{"name":"Department of Gastroenterology &amp; Hepatology University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marloes L. 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