Updates in diagnosis and management of pancreatic cysts

Abstract

Incidental pancreatic cysts are commonly encountered with some cysts having malignant potential. The most common pancreatic cystic neoplasms include serous cystadenoma, mucinous cystic neoplasm and intraductal papillary mucinous neoplasm. Risk stratifying pancreatic cysts is important in deciding whether patients may benefit from endoscopic ultrasound (EUS) or surgical resection. Surgery should be reserved for patients with malignant cysts or cysts at high risk for developing malignancy as suggested by various risk features including solid mass, nodule and dilated main pancreatic duct. EUS may supplement magnetic resonance imaging findings for cysts that remain indeterminate or have concerning features on imaging. Various cyst fluid markers including carcinoembryonic antigen, glucose, amylase, cytology, and DNA markers help distinguish mucinous from nonmucinous cysts. This review will guide the practicing gastroenterologist in how to evaluate incidental pancreatic cysts and when to consider referral for EUS or surgery. For presumed low risk cysts, surveillance strategies will be discussed. Managing pancreatic cysts requires an individualized approach that is directed by the various guidelines.

Keywords: Pancreatic cyst, Intraductal papillary mucinous neoplasm, Endoscopic ultrasound-guided fine needle aspiration, Serous cystadenoma, Surveillance, Carcinoembryonic antigen

Core Tip: Incidental pancreatic cysts are common, and some have malignant potential. magnetic resonance imaging of the pancreas should be used to risk stratify pancreatic cysts and decide whether patients may benefit from endoscopic ultrasound or surgical resection. Presumed low risk cysts should undergo surveillance unless the patient is not a surgical candidate or has a pseudocyst or serous cystadenoma. We discuss the approach to diagnosis and management of incidental pancreatic cysts.