Background: There has been a steady increase in the incidental detection of pancreatic cystic neoplasms directly related to the use of cross-sectional imaging in the hospital setting. Although only 1-2 % of mucinous cysts of the pancreas progress to pancreatic adenocarcinoma, we aimed to develop a hospital-based algorithm for the surveillance of asymptomatic pancreatic cysts. A preliminary retrospective review was proposed to justify the prospective nature of a cyst surveillance program based on the 2015 American Gastroenterological Association (AGA) Guidelines. Methods: A query was made from the radiology imaging database, PACS, to identify all dictated reports that had included the term “IPMN” (intraductal papillary mucinous neoplasm) from November 2017- June 2018. 57 cases were identified for preliminary review. Cyst characterization was defined by size, nodule, associated main pancreatic duct dilatation, symptoms, type of cross-sectional imaging, and specialty of ordering physician. Results: Of the 57 cases, 26 were female and 31 were male. Cyst size ranged from 0.2 cm to 4.1 cm, evenly distributed throughout the pancreas and multiple in 27%. 22 of 57 (38.5%) were detected incidentally with computed tomography (CT) scan, (72%). The majority of the scans were ordered by primary care physicians, emergency department, and other specialists unrelated to surgery or gastroenterology. When AGA guidelines were applied, 6/57 (11%) patients had worrisome features such as a dilated pancreatic duct, jaundice, size >3 cm, or associated mass necessitating further intervention such as endoscopic ultrasound and fine needle aspiration (FNA). Conclusion: The majority of pancreatic cystic neoplasms can be safely observed over time. Current AGA guidelines suggest the need for surveillance to reduce the risk of pancreatic adenocarcinoma related mortality. The role for a cyst surveillance program was demonstrated by our preliminary review of incidentally discovered cysts