Division of Gastroenterology, Chung-Ang University College of Medicine
ABSTRACT
Pancreatic cystic lesions are being recognized with increasing frequency because of the widespread use of cross-sectional imaging. Although most pancreatic cysts are incidentally detected, pancreatic cysts represent a wide spectrum of histopathology, and neoplastic cysts are more prevalent than previously estimated. Some histologic types including mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN) have malignant potential. Discrimination of pancreatic cysts with malignant potential from those with benign nature is an essential step in formulating a management strategy. Recent advances in endoscopic ultrasonography allow not only a morphologic description of a pancreatic cyst in detail but also acquisition of cyst fluid for analysis by fine needle aspiration. Cyst fluid analysis for tumor marker and DNA-related biomarkers has increased the accuracy of differentiating mucinous cyst from non-mucinous cyst, even if a substantial portion of pancreatic cysts remains indeterminate. Considering perioperative morbidity of surgical resection, making a clinical decision as to whether operate or observe an indeterminate pancreatic cyst is challenging. This clinical dilemma has raised the need to develop a minimally invasive approach for treating a pancreatic cyst. EUS-guided pancreatic cyst ablation has been investigated in several clinical trials and has potential to become an alternative to surgical resection. In this review, the diagnostic role of endoscopy in pancreatic cyst, and procedural basics and special considerations of cyst ablation and its clinical outcomes are summarized by reviewing the published literature.
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