The American Gastroenterological Association Institute’s updated guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts offers a reliable strategy for identifying the small minority of cysts with early invasive cancer and calls for a conservative approach to surveillance and care. Highlights of the recommendation include:

• High-risk features are cysts 3 cm or larger, a dilated main pancreatic duct, or the presence of an associated solid component.

• Cysts with at least 2 high-risk features should be examined with endoscopic ultrasonography (EUS) with fine-needle aspiration (FNA).

• Cysts with both a solid component and dilated pancreatic duct and/or concerning features on EUS and FNA should be surgically removed to reduce the risk of mortality from carcinoma.

• Cysts without high-risk features should be monitored by MRI in one year, and again every 2 years for 5 years.

• Cysts without concerning EUS-FNA results should be monitored by MRI in one year, and again every 2 years for 5 years to ensure no change in malignancy.

• Significant changes in the characteristics of the cyst, including the development of high-risk features are indications for EUS-FNA.

Citation: Vege SS, Ziring B, Jain R, Moayyedi P; Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148(4):819-822. doi: 10.1053/j.gastro.2015.01.015.