Diagnosis and Management of Pancreatic Cysts

In the last 4 decades, the diagnosis and management of pancreatic cysts has developed into one of the most controversial fields in digestive disease. It is estimated that up to $3.6 million is spent on cyst surveillance for each cancer detected in the United States, without making any appreciable change in cyst-related pancreatic adenocarcinoma mortality. 1 Lobo J.M. Scheiman J.M. Zaydfudim V.M. et al. Clinical and economic outcomes of patients undergoing guideline-directed management of pancreatic cysts. Am J Gastroenterol. 2020; 115: 1689-1697 Crossref PubMed Scopus (15) Google Scholar ,2 Chhoda A. Singh S. Sheth A.H. et al. Benefit of extended surveillance of low-risk pancreatic cysts after 5-year stability: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023; 21: 1430-1446 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The increase in cyst incidence, which is likely due to ubiquitous cross-sectional imaging, has fueled a surge of diagnostic and management recommendations—many of which lack high- or medium-quality evidence. As a result, patients and their providers are often routed into a lifetime cycle of surveillance and sometimes even pancreatic resection. This review will summarize the current state of pancreatic cystic disease, focusing on the types of cysts, their diagnosis and treatment, and current management controversies.