American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

Pancreatic cysts are common and increase with age, but the development of invasive adenocarcinoma in these cysts is extremely rare. The management strategy for pancreatic cysts aims to prevent the development of invasive cancer and/or to resect invasive malignancy early when present. Current clinical practice is based on minimal evidence and relies almost exclusively on case series of frequent cross-sectional imaging with or without EUS and/or FNA cytology and surgery for concerning features. The preceding guidelines for asymptomatic mucinous cysts are different from all previously published guidelines in the following areas: 2-year interval for cyst of any size undergoing surveillance, stopping surveillance after 5 years if no change, surgery only if more than one concerning feature on MRI confirmed on EUS and only in centers with high volumes of pancreatic surgery, and no surveillance after surgery if no invasive cancer or dysplasia. Although based on extensive literature review and synthesis, these recommendations may result in significant controversy because they advocate less frequent follow-up and a higher threshold before offering EUS and/or surgery. However, consistent utilization should decrease inadvertent harm to patients and reduce the costs of health care delivery.