Endoscopic management of pancreatic cystic neoplasms

Abstract

Pancreatic cystic neoplasms (PCNs) represent a spectrum of heterogeneous lesions with diverse biological behaviors and malignant potential. This category encompasses relatively common subtypes, such as intraductal papillary mucinous neoplasms, serous cystic neoplasms, and mucinous cystic neoplasms, alongside relatively rarer entities, including cystic degeneration of solid pancreatic tumors. The widespread use of cross-sectional imaging has led to increased incidental detection of PCNs, subsequently driving a surge in PCN-related medical consultations and interventions; thus, standardized management of PCNs demands heightened attention. Continuous advancements in endoscopic technologies, particularly endoscopic ultrasound (EUS) and EUS-guided procedures, now offer diversified diagnostic and therapeutic options, establishing EUS as a pivotal tool for diagnosing, surveillance, and treating PCNs. This review synthesizes current evidence and evolving clinical practices in the endoscopic management of PCNs, emphasizing optimizing preoperative diagnostic accuracy, standardizing endoscopic protocols, implementing subtype-specific risk stratification, promoting multidisciplinary team approaches, and addressing challenges in emerging technologies.

Keywords: Pancreatic cystic neoplasms; Endoscopic management; Endoscopic ultrasound; Endoscopic retrograde cholangiopancreatography; Risk stratification; Multidisciplinary team

Core Tip: Pancreatic cystic neoplasms (PCNs) represent a broad spectrum of lesions with variable malignant potential, necessitating precise risk stratification and tailored therapeutic strategies. This review synthesizes current advancements in endoscopic management, emphasizing innovations in imaging-guided risk assessment, minimally invasive interventions, and persistent challenges in clinical decision-making. The continuous development in endoscopic techniques, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, have enabled minimally invasive alternatives to traditional surgeries for certain PCNs. However, unresolved issues persist, including optimal surveillance intervals for diverse PCN subtypes, standardization of endoscopic ablation protocols, and long-term oncologic outcomes. Additionally, resource availability and operator expertise disparities limit the global adoption of advanced endoscopic modalities. This article underscores the need for multidisciplinary collaboration, artificial intelligence-enhanced surveillance protocols, and cost-effectiveness analyses to optimize patient-centric care. The global community can harmonize management and ensure evidence-based, individualized care for this heterogeneous patient population by integrating evolving technologies with evidence-based guidelines.