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.
