Pancreatic cysts are fluid-filled sacs in the pancreas. While most are benign, some have the potential to become pancreatic cancer. NewYork-Presbyterian has one of the few pancreatic cyst surveillance clinics in the country, offering periodic monitoring of potentially precancerous cysts and treatment for all cysts that cause pain and discomfort.
A Team of Pancreatic Cyst Specialists
Your healthcare team includes gastroenterologists, surgeons, interventional endoscopists, pathologists, radiologists, nurses, and others with experience monitoring and treating people with pancreatic cysts. Your team will assess your health and customize a plan of care that meets your individual needs.
A Special Program for Pancreatic Cyst Monitoring
If you have a pancreatic cyst or an intraductal papillary mucinous neoplasm (IPMN) that places you at increased risk of pancreatic cancer, we offer assessment, monitoring, and treatment through the Pancreatic Cyst Surveillance Program at both New York-Presbyterian/Cornell University Medical Center and NewYork-Presbyterian/Columbia University Irving Medical Center. We take a full personal and family medical history and perform a comprehensive examination, imaging tests, and biopsies. If you don’t need treatment right away, we’ll continue to see you every six months or once a year, depending on your needs.
Diagnosing and Evaluating Pancreatic Cysts
Our doctors are experts in the assessment of pancreatic cysts. Some of the tools we use are not widely available elsewhere.
- Endoscopic ultrasound (EUS). An interventional endoscopist uses a special endoscope with high-energy sound waves ("echoendoscope") to see your pancreas and the pancreatic duct.
- Endoscopic retrograde cholangiopancreatography (ERCP). This technique combines endoscopy and x-rays. An interventional endoscopist guides an endoscope through your mouth to the pancreas and pancreatic duct, releases a dye that assists in imaging, and then x-rays them. ERCP provides a clear image of the structure of your pancreas and can show any abnormalities. NewYork-Presbyterian’s interventional endoscopists routinely perform this procedure and are highly regarded experts in its use.
- Pancreatoscopy. We use this technique to directly visualize the pancreatic duct.
- Confocal imaging. NewYork-Presbyterian is one of few hospitals offering this highly specialized approach, which involves the use of a small microscope to analyze cells to determine if they are normal or precancerous. Tissue may be immediately removed through the endoscope for further examination.
How We Treat Pancreatic Cysts
Most cysts are found accidently, and most will just need to be followed with repeat imaging at intervals determined by the cyst characteristics. If you need surgery, we have surgeons on our team who specialize in the treatment of pancreatic cysts. In addition to the standard options of surgery and surveillance, we are also able to provide “ablation”: injection of alcohol into the cyst cavity, or inserting a probe for to apply radio frequency ablation, which we perform using an endoscopic (nonsurgical) approach.
Care for People with Pancreatic Pseudocysts
A pancreatic pseudocyst is a collection of pancreatic juice encased in tissue, and develops either inside or around the pancreas. Pseudocysts occur most commonly after an episode of pancreatitis or abdominal trauma. Some improve on their own, and those that are not causing symptoms may not need to be treated. Others, such as those causing symptoms, require treatment (typically drainage).
In the past, most people who needed treatment for pancreatic pseudocysts required surgery, but we are now able to drain many of these pseudocysts using echoendoscopy. Using an endoscope with an ultrasound transducer at the tip, the endoscopist uses a stent to drain the pseudocyst by connecting it to an adjacent intestinal organ, such as:
- Cystogastrostomy. The doctor connects the cyst to the back wall of your stomach so it can drain into your stomach. This is the optimal treatment for pseudocysts in the body and tail of the pancreas.
- Cystojejunostomy. The cyst is connected to the jejunum (middle section) of the small intestine so that it can drain directly into that organ.
- Cystoduodenostomy. A connection is created between the duodenum (first section of the small intestine) and the cyst to allow drainage directly into duodenum. This is the best drainage site for pseudocysts in the head of the pancreas.
In some cases, the cyst is not amenable to endoscopic drainage. In these cases, a minimally invasive approach called VARD (videoscopic-assisted retroperitoneal debridement) may be performed surgically.