Sr.no.	Recommendations	SoR	QoE
1	The AGA recommends that before starting any pancreatic cyst surveillance program, patients should have a clear understanding of programmatic risks and benefits.	N/A	N/A
Evidence for Recommendation 1
2	The AGA suggests that patients with pancreatic cysts <3 cm without a solid component or a dilated pancreatic duct undergo MRI for surveillance in 1 year and then every 2 years for a total of 5 years if there is no change in size or characteristics.	Cond	V Low
Evidence for Recommendation 2
3	The AGA suggests that pancreatic cysts with at least 2 high-risk features, such as size ≥3 cm, a dilated main pancreatic duct, or the presence of an associated solid component, should be examined with EUS-FNA.	Cond	V Low
Evidence for Recommendation 3
4	The AGA suggests that patients without concerning EUS-FNA results should undergo MRI surveillance after 1 year and then every 2 years to ensure no change in risk of malignancy.	Cond	V Low
Evidence for Recommendation 4
5	The AGA suggests that significant changes in the characteristics of the cyst, including the development of a solid component, increasing size of the pancreatic duct, and/or diameter ≥3 cm, are indications for EUS-FNA.	Cond	V Low
Evidence for Recommendation 5
6	The AGA suggests against continued surveillance of pancreatic cysts if there has been no significant change in the characteristics of the cyst after 5 years of surveillance or if the patient is no longer a surgical candidate.	Cond	V Low
Evidence for Recommendation 6
7	The AGA suggests that patients with both a solid component and a dilated pancreatic duct and/or concerning features on EUS and FNA should undergo surgery to reduce the risk of mortality from carcinoma.	Cond	V Low
Evidence for Recommendation 7
8	The AGA recommends that if surgery is considered for a pancreatic cyst, patients are referred to a center with demonstrated expertise in pancreatic surgery.	Strong	V Low
Evidence for Recommendation 8
9	The AGA suggests that patients with invasive cancer or dysplasia in a cyst that has been surgically resected should undergo MRI surveillance of any remaining pancreas every 2 years.	Cond	V Low
Evidence for Recommendation 9
10	The AGA suggests against routine surveillance of pancreatic cysts without high‐grade dysplasia or malignancy at surgical resection.	Cond	V Low
Evidence for Recommendation 10

Sr.no.

Recommendations

The AGA recommends that before starting any pancreatic cyst surveillance program, patients should have a clear understanding of programmatic risks and benefits.

N/A

Evidence for Recommendation 1

The AGA suggests that patients with pancreatic cysts <3 cm without a solid component or a dilated pancreatic duct undergo MRI for surveillance in 1 year and then every 2 years for a total of 5 years if there is no change in size or characteristics.

Cond

V Low

Evidence for Recommendation 2

The AGA suggests that pancreatic cysts with at least 2 high-risk features, such as size ≥3 cm, a dilated main pancreatic duct, or the presence of an associated solid component, should be examined with EUS-FNA.

Cond

V Low

Evidence for Recommendation 3

The AGA suggests that patients without concerning EUS-FNA results should undergo MRI surveillance after 1 year and then every 2 years to ensure no change in risk of malignancy.

Cond

V Low

Evidence for Recommendation 4

The AGA suggests that significant changes in the characteristics of the cyst, including the development of a solid component, increasing size of the pancreatic duct, and/or diameter ≥3 cm, are indications for EUS-FNA.

Cond

V Low

Evidence for Recommendation 5

The AGA suggests against continued surveillance of pancreatic cysts if there has been no significant change in the characteristics of the cyst after 5 years of surveillance or if the patient is no longer a surgical candidate.

Cond

V Low

Evidence for Recommendation 6

The AGA suggests that patients with both a solid component and a dilated pancreatic duct and/or concerning features on EUS and FNA should undergo surgery to reduce the risk of mortality from carcinoma.

Cond

V Low

Evidence for Recommendation 7

The AGA recommends that if surgery is considered for a pancreatic cyst, patients are referred to a center with demonstrated expertise in pancreatic surgery.

Strong

V Low

Evidence for Recommendation 8

The AGA suggests that patients with invasive cancer or dysplasia in a cyst that has been surgically resected should undergo MRI surveillance of any remaining pancreas every 2 years.

Cond

V Low

Evidence for Recommendation 9

The AGA suggests against routine surveillance of pancreatic cysts without high‐grade dysplasia or malignancy at surgical resection.

Cond

V Low

Evidence for Recommendation 10

SoR: Strength of Recommendation

QoE: Quality of Evidence

Strong: Strong Recommendation

N/A: Not Applicable

Cond: Conditional Recommendation

V Low: Very Low-Quality Evidence

AGA: American Gastroenterological Association

MRI: Magnetic resonance imaging

EUS: Endoscopic ultrasonography

FNA: Fine-needle aspiration