DOI: 10.1097/MPA.0000000000002276

Pancreatic cysts are an increasingly common finding, largely due to the widespread use of high-resolution abdominal imaging. While some cysts represent benign lesions with no malignant potential, others can herald the onset of pancreatic cancer. Given these differing outcomes, the proper management of pancreatic cysts is crucial. Yet, a recent article in the journal *Pancreas* by Zouridis et al., titled “Poor Adherence to Most Recent Guidelines on Pancreatic Cysts Management: An Ongoing Problem,” outlines that there exists a significant problem with adhering to the latest management guidelines.

Current Surveillance Patterns

The management of incidentally detected pancreatic cysts depends greatly on the risk of malignancy associated with specific cyst types. In 2019, research conducted by Schenck, Miller, and Keswani highlighted the inconsistency in surveillance patterns, noting that adherence to guidelines was infrequent. The most recent guidelines emphasize the balance between surveillance and overtreatment, as the risk of malignancy is low for many cysts, particularly small ones. Ciprani et al. in 2020 validated this by showing that the risk of malignancy in small pancreatic cysts decreases over time.

Adherence to Guidelines

Despite the availability of evidence-based guidelines, such as the American College of Gastroenterology (ACG) Clinical Guideline on the diagnosis and management of pancreatic cysts, adherence remains an issue. Zouridis et al. chose to examine the extent to which recent guidelines are being followed and what factors may contribute to poor adherence. Their study highlights the gap between guideline recommendations and the daily practices observed across healthcare institutions.

Barriers to Adherence

Several barriers to guideline adherence are indicated in the journal Pancreas article:

Knowledge Gap: There may be a lack of awareness or understanding of the current guidelines among healthcare providers.

Diagnostic Ambiguity: The diverse nature of pancreatic cysts can make it difficult to apply a standard guideline, leading to varied interpretations.

Practice Variation: Differences in institutional practices and individual clinician preferences play a role in the inconsistent application of guidelines.

Economic Factors: Cost considerations and the potential financial impacts on both patients and healthcare systems could influence adherence.

Perceived Patient Risk: Clinicians may err on the side of caution, leaning towards more aggressive follow-up, especially in litigious environments.

Implications of Poor Adherence

Non-adherence to guidelines can lead to a range of adverse outcomes such as unnecessary anxiety for patients, increased healthcare costs due to overuse of diagnostic imaging, and potential harm from invasive procedures on benign lesions. Moreover, it could potentially delay the diagnosis and treatment of cysts with a high risk of malignancy.

The Response to Non-adherence

Efforts to improve adherence to guidelines should include educational programs for healthcare providers, standardizing diagnostic criteria, and implementing decision-support tools into electronic health records. Additionally, a more personalized approach to each case may be needed, considering the specifics of the cysts, patient comorbidities, and individual risk factors.

Conclusions by Zouridis et al.

Zouridis et al. call for increased efforts to improve the adherence to guidelines on pancreatic cyst management. Their investigation underscores the importance of understanding guidelines and applying them appropriately to balance patient care’s benefits and risks.

Their study is a call to action for healthcare professionals and healthcare systems to examine their current practices in the management of pancreatic cysts and to make necessary adjustments that align with the most recent evidence-based guidelines.


1. Schenck RJ, Miller FH, Keswani RN. The surveillance patterns of incidentally detected pancreatic cysts vary widely and infrequently adhere to guidelines. Pancreas. 2019;48:883–887.

2. Elta GH, Enestvedt BK, Sauer BG, et al. ACG clinical guideline: Diagnosis and management of pancreatic cysts. Am J Gastroenterol. 2018;113:464–479.

3. Ciprani D, Weniger M, Qadan M, et al. Risk of malignancy in small pancreatic cysts decreases over time. Pancreatology. 2020;20:1213–1217.

4. Zouridis Spyridon S, Liu Jacqueline J, Wadhwa Niki N, Virk Gurjiwan G, Hasak Stephen S. Poor Adherence to Most Recent Guidelines on Pancreatic Cysts Management: An Ongoing Problem. Pancreas. 2024;53(2):e221.

5. “Poor Adherence to Most Recent Guidelines on Pancreatic Cysts Management: An Ongoing Problem.” Pancreas. 2024 Feb 01;53(2):e221.


1. Pancreatic Cyst Management
2. Guidelines Adherence Healthcare
3. Incidental Pancreatic Cysts
4. Pancreatic Cancer Risk
5. Gastroenterology Clinical Guidelines

The guidelines’ implementation can significantly impact patient outcomes and healthcare efficiency. The article by Zouridis et al. serves as a critical reminder of the need to remain focused on evidence-based practices in the ever-evolving field of gastroenterology. As the evidence improves, so must our adherence to the guidelines designed to inform clinical decisions adequately. The healthcare community must take note of these findings, and work collaboratively toward better adherence and, consequently, better patient outcomes in the management of pancreatic cysts.