Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine
ABSTRACT
Recently, asymptomatic incidental pancreatic cysts are frequently detected. However, the decision of the treatment plan is not easy because the radiologic differential diagnosis is somewhat difficult due to small cyst size. Until now, it has been also controversial whether the incidental pancreatic cysts should be resected actively or not. If radiologic finding is typical, the decision of resecting the incidental pancreatic cysts is not so difficult. However, the accuracy of endoscopic ultrasonography is around 50-60%, so it is confusing how to manage the indeterminate cyst. Even if cyst aspiration and analysis of fluid including CEA and cytology can increase the diagnostic accuracy, the procedure is invasive and expensive. In addition, the cut-off value of CEA is not established. Fortunately, the natural course of asymptomatic incidental pancreatic cysts is known to be relatively good and safe. Follow-up observations without surgical resection can be done safely if there are no radiologic signs of pre-malignancy or malignancy. Endoscopic ablation therapy using ethanol was introduced for the first time in 2005 and endoscopic ultrasonography guided ethanol lavage with paclitaxel injection therapy was also reported in 2011. Endoscopic ablation therapy is a relatively safe and effective procedure, even if there are no long-term safety results. The rates of complete remission are 35-50% in ethanol lavage and 63% in ethanol lavage with paclitaxel injection therapy. Although the indication of endoscopic ablation therapy is not established, it can be considered if incidental cysts are indeterminate 2-5 cm; unilocular or oligolocuar cysts.
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