The Future of Diagnosis and Treatment of Pancreatic Cystic Lesions

Advances continue to be made in the understanding and management of pancreatic cystic lesions (PCLs). Given the potential risks of operative intervention, current research strives to improve the accuracy of preoperative diagnosis by a number of different modalities. Developments in imaging, such as contrast-enhanced ultrasound and high-resolution cross-sectional imaging, may provide more definitive morphologic data, whereas new devices may provide better yields from EUS-guided tissue sampling. Furthermore, the most exciting area of PCL diagnosis may be genetic analysis. Initial results of studies of PCR analysis, loss of heterozygosity, and specific mutations such as k-ras may allow accurate risk stratification of PCLs with regard to their malignant potential. Treatment of PCLs may also change in the near future. Alternatives to surgery, such as ethanol lavage, are currently being investigated as potential treatment options. With such an array of innovation in the field, the management of PCLs is likely to continue to change and progress in the foreseeable future.