ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day One) | March 2026-Radiology Studies Case 1- Pancreatic Cystic Lesions and IPMNs

Video Transcription

Video Summary

The speakers review how to evaluate and risk‑stratify pancreatic cysts, emphasizing imaging and selective use of endoscopic ultrasound (EUS). Pancreatic cysts are common incidental findings (about 13–18% prevalence, increasing after age 50). Key clinical questions are whether a cyst is mucinous vs non‑mucinous, its malignancy potential, and whether to resect, surveil, or do nothing.<br /><br />They outline guideline-based “high‑risk stigmata” (e.g., jaundice/obstructed bile duct with a head cyst, definite mural nodules, markedly dilated main pancreatic duct) and “worrisome features” (larger size, thickened wall, intermediate duct dilation, abrupt duct caliber change, lymphadenopathy, elevated/rising CA19‑9, rapid growth). EUS-FNA is generally safe and helps via cyst fluid markers: CEA (high suggests mucinous; very high may imply malignancy), amylase (high suggests duct communication), and newer cyst fluid glucose (low suggests neoplasia).<br /><br />Case examples highlight management of main-duct/branch-duct IPMN, mucinous cystic neoplasm (surgery), and benign serous cystadenoma (often no follow-up). Surveillance is recommended only for patients who could be surgical candidates.

Asset Subtitle

Sarah Enslin, PA-C, and Vivek Kaul, MD, FASGE

Keywords

pancreatic cysts

risk stratification

high-risk stigmata and worrisome features

endoscopic ultrasound (EUS-FNA)

cyst fluid biomarkers (CEA, amylase, glucose)

IPMN and mucinous cystic neoplasm management