Clinical approach to incidental pancreatic cysts

Table 1 Key differences between 2012 International Association of Pancreatology and 2015 American Gastroenterological Association guidelines for the management of pancreatic cysts[10,20]

Specifics of guidelines	2012 IAP	2015 AGA
Patient population targeted by guideline	Suspected MCN and IPMN	All incidental pancreatic cysts
Recommended imaging modality	Pancreatic protocol CT or MRI	MRI pancreas with MRCP
Threshold for recommending EUS and/or surgery	1 risk factor	At least 2 risk factors
Surveillance recommendations in unresected cysts	Frequent surveillance based on cyst size	MRI in 1 yr and then every 2 yr
Stopping surveillance	No explicit recommendation to stop in unresected cysts Following resection of serous cystadenoma and MCN without invasive cancer	After 5 yr of stable unresected cyst without development of high risk features Surgically unfit patients Select resected cysts including BD-IPMN with no, low or moderate-grade dysplasia

IAP: International Association of Pancreatology; AGA: American Gastroenterological Association; MRI: Magnetic resonance imaging; EUS: Endoscopic ultrasound; MCN: Mucinous cystic neoplasm; IPMN: Intraductal papillary mucinous neoplasms; MRCP: Magnetic resonance cholangiopancreatography; CT: Computed tomography.