The Risk of a Dilated Pancreatic Duct

Researchers at Johns Hopkins Medicine have identified a previously unknown risk factor for developing pancreatic cancer in high-risk people.

A study published in Gastro Hep Advances in November 2025 showed that mild dilatation (widening) of the main pancreatic duct is an important early warning sign for pancreatic cancer among patients with increased risk. This concerning dilatation occurs when there is no visible mass or lesion.

According to this report, conducted by researchers at The Sol Goldman Pancreatic Cancer Research Center (Johns Hopkins Medicine, Baltimore, Maryland), patients with a widened duct and no lesion had a 16 percent probability of cancer at five years and a 2.6 times higher chance of disease progression.

The study, which was funded in part by the National Institutes of Health, is part of the CAPS5 study, an ongoing long-term prospective cohort study of high-risk individuals with a familial or genetic predisposition for developing pancreatic cancer, explains investigator Mimi Canto, M.D., M.H.S., professor of medicine and oncology at the Johns Hopkins University School of Medicine.

High-Risk Patients Undergo Surveillance

The International Cancer of the Pancreas Screening (CAPS) Consortium, the American Society for Gastrointestinal Endoscopy, and the National Comprehensive Cancer Network all recommend surveillance for high-risk individuals. This includes people with multiple immediate blood relatives who have had pancreatic cancer as well as those identified as having a genetic predisposition through genetic testing. 

“In our pancreas cancer surveillance program, we detect abnormalities that may or may not raise concern for impending development of pancreatic cancer,” explains Canto. “One of these is a mild dilation of the main pancreatic duct without an apparent obstructing stricture or mass.” It’s a challenging situation, she adds, because there is a chance of “missing an occult cancer [cancer that has spread from an unknown source] in a high-risk patient with genetic predisposition versus recommending unnecessary surgery.”

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“We are identifying pancreas duct dilatation as an early sign of pancreatic cancer in high-risk individuals even when there is no visible mass,” Canto notes. “This finding may lead to better survival if cancers are detected early.”

The researchers were not that surprised by the findings, but they needed to prove what they suspected. “We published a paper in 2018 that showed that this abnormality is associated with neoplastic progression but it was not an independently significant finding at that time,” she says. “The current study is a more robust analysis of a large number of patients followed with serial MRI and EUS (endoscopic ultrasound) over a long period of time.”

About the Study

The Johns Hopkins Medicine team evaluated the outcomes of a CAPS cohort of 641 high-risk individuals. During routine surveillance with endoscopic ultrasound and MRI, the researchers measured the participants’ pancreatic ducts and found that in patients with a duct diameter greater than 4 millimeters, the chances of developing either high-grade dysplasia or cancer increased. Moreover, participants with widened pancreatic ducts were more likely to develop cancer early.

Of the 641 participants evaluated, 97 showed enlargement without evidence of an obstructing mass lesion; 10 of those were diagnosed with neoplastic progression within a median of two years after dilatation was first detected. The cumulative probability of pancreatic cancer with baseline duct widening was 16 percent at five years and 26 percent at 10 years. Participants were 2.6 times more likely to progress to a cancer diagnosis, particularly those with more than three pancreatic cysts during surveillance. 

“By identifying this risk factor early, we were able to intervene more quickly,” Canto explains. “The intervention would be to either operate or do much more frequent imaging. It was remarkable how even with the best imaging technology, a pancreatic cancer mass may not be visible even when it is causing structural changes in the gland. We have an opportunity to do better.”

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Canto says the early warning sign of pancreatic duct dilatation could be a valuable finding when used in tandem with other kinds of diagnostic imaging, such as CT performed for unrelated health issues like kidney stones or abdominal pain.

It should be noted a dilated pancreatic duct may be nonspecific and caused by several factors, including chronic pancreatitis, prior surgery, trauma to the abdomen, pancreatic duct stone, or a congenital anomaly called pancreas divisum, she adds. But “the dilatation is a red flag [in high-risk patients],” she adds. “Providers should be aware that it is something that needs to be addressed right away. The dilatation associated with progression in our high-risk individuals can be mild and subtle. But the abnormality needs to be integrated into the individual’s entire risk profile.”

The next step is using AI to analyze imaging and clinical information to make more specific and accurate predictions of risk. “AI can help analyze the entire pancreas for changes that the human eye cannot detect,” Canto says. “It can integrate micro-patterns in tissue texture, integrate imaging with clinical data, and predict an individual’s risk for developing pancreatic cancer before it becomes visible.”