Updates in diagnosis and management of pancreatic cysts

Table 1 Key Features of pancreatic cyst guidelines

Specifics of Guidelines	2015 AGA	2017 Fukuoka	2017 ACG	2017 ACR	2018 European Study Group
Patient population	Incidental pancreatic cysts	Suspected MCN and IPMN	All pancreatic cysts	Incidental pancreatic cysts	All pancreatic cysts
Threshold for EUS and/or surgery	At least 2 risk factors	1 risk factor	1 risk factor	1 risk factor	1 risk factor
Surveillance recommendations in unresected cysts	MRI in 1 year, then every 2 yr	Surveillance based on cyst size	Surveillance based on cyst size	Surveillance based on cyst size and age	Surveillance based on cyst size and diagnosis
Stopping surveillance	(1) After 5 yr of stability without development of high-risk features; (2) Surgically unfit; and (3) Select resected cysts including BD-IPMN with no, low or moderate-grade dysplasia	(1) Surgically unfit; and (2) Following resection of serous cystadenoma and MCN without invasive cancer	(1) Surgically unfit; (2) Following resection of serous cystadenoma and MCN without invasive cancer; and (3) Individualize approach to patients > 75	(1) 9-10 yr and stop at age 80; and (2) For cysts discovered > age 80, limited surveillance for 4 yr only if stable	Surgically unfit

AGA: American Gastroenterological Association; ACG: American College of Gastroenterology; EUS: Endoscopic ultrasound; MRI: Magnetic resonance imaging; MCN: Mucinous cystic neoplasm; IPMN: Intraductal papillary mucinous neoplasm; BD-IPMN: Branch duct-intraductal papillary mucinous neoplasm.