Endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) play increasingly prominent roles in the diagnosis and management of
pancreatic cysts. The Asian Consortium of Endoscopic Ultrasound was recently formed to conduct collaborative research in this area. This is a review of literature on true
pancreatic cysts. Due to the lack of systematic studies, there are no robust data on the true incidence of pancreatic cystic lesions in Asia and any change in over the recent decades. Certain EUS morphological features have been used to predict particular types of
pancreatic cysts.
Pancreatic cyst fluid viscosity, cytology, pancreatic
enzymes, and
tumor markers, in particular
carcinoembryonic antigen, can aid in the diagnosis of
pancreatic cysts.
Hemorrhage and
infection are the most common complications of EUS-FNA of
pancreatic cysts.
Pancreatic cysts can either be observed or resected depending on the benign or malignant nature, or malignant potential of the lesions. Guidelines from an international consensus did not require positive cytological findings to be present in their recommendation for resection, which included all mucinous
cystic neoplasms, all main-duct intraductal papillary
mucinous neoplasms (IPMN), all mixed IPMN, symptomatic side-branch IPMN, and side-branch IPMN larger than 3 cm. In patients with poor surgical risks, EUS-guided
cyst ablation of mucinous
pancreatic cysts is an alternative. As long-term prospective data on
pancreatic cysts are still not available in Asia, management strategies are largely based on risk stratification by surgical risk and malignant potential. Gene expression profiling of
pancreatic cyst fluid and confocal
laser endomicroscopic examination of
pancreatic cysts are novel techniques currently being studied.