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Pancreatic Cysts

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Key Points Î Pancreatic cysts are common and increase with age, but the development of invasive adenocarcinoma in these cysts is extremely rare. Î The incidental identification of pancreatic cysts is common with the growing use of sophisticated abdominal imaging techniques. • Approximately 15% of patients undergoing abdominal magnetic resonance imaging (MRI) for other indications harbor unsuspected pancreatic cysts. Î The management strategy for pancreatic cysts aims to prevent the development of invasive cancer and/or to resect invasive malignancy early when present. Î Current clinical practice is based on minimal evidence and relies almost exclusively on case series of frequent cross- sectional imaging with or without endoscopic ultrasonography (EUS) and/or fine-needle aspiration (FNA) cytology and surgery for concerning features. Î The AGA recommends that before starting any pancreatic cyst surveillance program, patients should have a clear understanding of programmatic risks and benefits. GRADE Strength of Recommendations and Implications Grade Implications of strong and conditional (weak) guideline recommendations Strong • Patients: Most individuals in this situation would want the recommended course of action and only a small proportion would not. • Clinicians: Most individuals should receive the recommended course of action. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. Conditional (weak) • Patients: The majority of individuals in this situation would want the suggested course of action, but many would not. • Clinicians: Different choices will be appropriate for different patients. Decision aids may well be useful in helping individuals making decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision. Reprinted with permission from Sultan et al. Clin Gastroenterol Hepatol. 2013;11:329–332.

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