Endoscopic management of pancreatic cystic neoplasms

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.