Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts
Publication Date: April 1, 2015
Last Updated: September 2, 2022
Diagnosis
The AGA suggests that patients with pancreatic cysts <3 cm without a solid component or a dilated pancreatic duct undergo MRI for surveillance in 1 year and then every 2 years for a total of 5 years if there is no change in size or characteristics. ( Very Low , Conditional (weak) )
612
The AGA suggests that pancreatic cysts with at least 2 high-risk features, such as size ≥3 cm, a dilated main pancreatic duct, or the presence of an associated solid component, should be examined with EUS-FNA. ( Very Low , Conditional (weak) )
612
The AGA suggests that patients without concerning EUS-FNA results should undergo MRI surveillance after 1 year and then every 2 years to ensure no change in risk of malignancy. ( Very Low , Conditional (weak) )
612
The AGA suggests that significant changes in the characteristics of the cyst, including the development of a solid component, increasing size of the pancreatic duct, and/or diameter ≥3 cm, are indications for EUS-FNA. ( Very Low , Conditional (weak) )
612
Management
The AGA suggests against continued surveillance of pancreatic cysts if there has been no significant change in the characteristics of the cyst after 5 years of surveillance or if the patient is no longer a surgical candidate. ( Very Low , Conditional (weak) )
612
The AGA suggests that patients with both a solid component and a dilated pancreatic duct and/or concerning features on EUS and FNA should undergo surgery to reduce the risk of mortality from carcinoma. (, )
612
The AGA recommends that if surgery is considered for a pancreatic cyst, patients are referred to a center with demonstrated expertise in pancreatic surgery. ( Very Low , Strong )
612
The AGA suggests that patients with invasive cancer or dysplasia in a cyst that has been surgically resected should undergo MRI surveillance of any remaining pancreas every 2 years. ( Very Low , Conditional (weak) )
612
The AGA suggests against routine surveillance of pancreatic cysts without high-grade dysplasia or malignancy at surgical resection. ( Very Low , Conditional (weak) )
612
Recommendation Grading
Disclaimer
Overview
Title
Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts
Authoring Organization
American Gastroenterological Association
Publication Month/Year
April 1, 2015
Last Updated Month/Year
December 1, 2022
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient, Radiology services
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D010181 - Pancreatic Cyst, D010190 - Pancreatic Neoplasms
Keywords
pancreatic cyst, neoplastic cyst