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Guideline review
Pancreatic cystic lesions: risk stratification and management based on recent guidelines
  1. Benjamin M Stutchfield1,
  2. Manu Nayar2,
  3. Ian D Penman3
  1. 1 Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2 Department of Gastroenterology, The Freeman Hospital, Newcastle, UK
  3. 3 Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Benjamin M Stutchfield, Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK; ben.stutchfield{at}


Pancreatic cystic lesions (PCLs) can present complex diagnostic and management challenges with uncertainty as to the most appropriate investigations, interventions and surveillance. Guidelines have been developed to aid decision making, including the European Study Group, American College of Gastroenterology and International Study Group guidelines. This paper presents issues relating to risk stratification and the appropriate management of patients with PCLs, reviewing these recently published guidelines. While there are similarities across these expert guidelines, there are notable differences in terms of features associated with increased risk of malignant transformation, the most appropriate imaging modality and timing of interval imaging. Where variations exist, this reflects differing interpretations of a limited evidence base, and decision making will likely evolve further as experience with these guidelines develops.

  • pancreas
  • pancreatic tumours

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  • Contributors All authors contributed to the design of the work and approved the final manuscript. BMS and MN drafted and revised the article, and IDP contributed to revising the article. MN and IDP contributed images to the manuscript. All conceived the study, did literature search, reviewed and edited the paper. BMS and MN wrote the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.