Management of Pancreatic Cystic Lesions: Making Sense of All the Guidelines

Abstract

Pancreatic cystic lesions are now being identified in increasing frequency, providing an opportunity for early detection of advanced neoplasia. Multiple guidelines have been developed to help risk-stratify pancreatic cystic lesions. However, differences between guidelines provide a source of confusion for most practitioners. In this review, we attempt to highlight the similarities and differences between the guidelines, specifically evaluating their target populations and variations in surveillance/management strategies for pancreatic cystic lesions. The most commonly used guidelines provide varying strategies for the management and surveillance of pancreatic cystic lesions. By providing a consolidated and updated review of the literature, we find no one guideline performs better than the others. Despite existing guidelines, the most optimal risk stratification strategy for pancreatic cystic lesions remains unclear. However, advances in enhanced imaging modalities, cyst fluid analysis, and other biomarkers may offer effective options in the future.