Elevated Serum Lipase Levels as a Marker of Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Cross-Sectional Study

Background: Intraductal papillary mucinous neoplasm (IPMN) is a well-established premalignant pancreatic lesion. It is known that mild hyperlipasemia, elevated serum lipase levels, is the risk of malignancy and poor prognosis in patients with IPMN. The purpose of this study is to reveal whether hyperlipasemia is useful in identifying patients with IPMN. Methods: The consecutive 91 patients aged 40-89 years who underwent magnetic resonance cholangio-pancreatography (MRCP) from 2016 to 2019 and who showed elevated serum lipase values above the reference range (>51 U/L) in one year were enrolled. Patients were categorized into three as having IPMN, other pancreatic cystic lesion, and non-cysts groups by MRCP. Results: IPMN was found in 22% and other pancreatic cystic lesion was found in 17% of patients. The prevalence of IPMN was higher in patients with mild hyperlipasemia (60-79 U/L) compared to those with borderline hyperlipasemia (<60 U/L) (36% vs. 17%; odds ratio, 5.2; 95% confidence interval, 1.2-22.4). Patients taking H2-blockers or weight loss >1kg/year also showed higher risk of IPMN (39% vs. 15% and 32% vs. 19%, respectively), and patients with both mild hyperlipasemia and taking H2-blockers showed the highest risk of IPMN compared to those with neither of them (75% vs. 13%). Conclusions: Patients with mild hyperlipasemia showed five times higher risk of having IPMN compared to those with borderline hyperlipasemia. Further investigation with MRCP should be considered for patients with mild hyperlipasemia, especially when they had episodes of epigastric discomfort or weight loss, to find high risk patients for future pancreatic carcinoma.