Editorial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2025; 31(1): 101082
Published online Jan 7, 2025. doi: 10.3748/wjg.v31.i1.101082
Endoscopic techniques for the diagnosis of pancreatic cystic lesions
Sahib Singh, Saurabh Chandan, Rakesh Vinayek, Jahnvi Dhar, Jayanta Samanta, Gabriele Capurso, Ivo Boskoski, Cristiano Spada, Jorge D Machicado, Stefano Francesco Crinò, Antonio Facciorusso
Sahib Singh, Department of Internal Medicine, Sinai Hospital, Baltimore, MD 21215, United States
Saurabh Chandan, Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68131, United States
Rakesh Vinayek, Department of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, MD 21215, United States
Jahnvi Dhar, Jayanta Samanta, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Gabriele Capurso, Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano 20132, Italy
Ivo Boskoski, Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training, Roma 00168, Italy
Cristiano Spada, Department of Gastroenterology and Endoscopy, Catholic University, Roma 00168, Italy
Jorge D Machicado, Department of Gastroenterology, University of Michigan Health, Ann Arbor, MI 48107, United States
Stefano Francesco Crinò, Department of Endoscopy, University of Verona, Verona 37121, Veneto, Italy
Antonio Facciorusso, Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia 71122, Italy
Author contributions: Chandan S and Facciorusso A designed the overall concept and outline of the manuscript; Singh S wrote the discussion and structured the manuscript; Singh S, Chandan S, Vinayek R, Dhar J, Samanta J, Capurso G, Boskoski I, Spada C, Machicado JD, Crinò SF, and Facciorusso A wrote and edited the manuscript, and reviewed the literature; All authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Antonio Facciorusso, MD, PhD, Associate Professor, Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Via L Pinto 1 Foggia, Foggia 71122, Italy. antonio.facciorusso@virgilio.it
Received: September 3, 2024
Revised: October 17, 2024
Accepted: November 6, 2024
Published online: January 7, 2025
Processing time: 96 Days and 14.8 Hours
Abstract

Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans, with few patients presenting with abdominal pain or other symptoms. The accurate diagnosis of cysts is important as management depends on the type (neoplastic or non-neoplastic). Cross-sectional imaging is fast being replaced with endoscopic ultrasound (EUS) and various techniques based on that such as EUS-guided fine needle aspiration, EUS-guided needle confocal laser endomicroscopy, EUS-through-the-needle biopsy, and contrast-enhanced EUS. Clinical studies have reported varying diagnostic and adverse event rates with these modalities. In addition, American, European, and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations. In this editorial, we elaborate on the clinical guidelines, recent studies, and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.

Keywords: Endoscopic ultrasound; Fine needle aspiration; Needle confocal laser endomicroscopy; Through-the-needle biopsy; Contrast-enhanced endoscopic ultrasound

Core Tip: Endoscopic ultrasound has been the core diagnostic modality for patients found to have pancreatic cystic lesions on imaging, with subsequent differentiation based on techniques such as cystic fluid analysis (metabolites, molecular markers, and cytology), confocal laser endomicroscopy (to study the cyst epithelium), and microforceps biopsy. A combination of modalities, such as fluid analysis with microvasculature imaging, can further improve the diagnostic performance.