How to do Pancreatic Cyst FNA

Pancreatic cysts remain a challenge to diagnose and manage. Evaluation should focus on whether the cyst is malignant and, if not, the risk of malignant transformation. While magnetic resonance imaging should be performed on all patients with pancreatic cysts if possible, endoscopic ultrasound (EUS) is an important complementary diagnostic tool for indeterminate cysts and cysts with concerning features. The value of EUS lies not only with its imaging of the cyst size, border, content, and surrounding structures, but also in its ability to aspirate cyst fluid and tissue via fine needle aspiration (FNA) or fine needle biopsy (FNB) for analyses. Esophagogastroduodenoscopy is often performed prior to EUS to ensure there are no anatomical abnormalities that may interfere with passing the echoendoscope or with visualizing the pancreas and surrounding structures, for example an unknown surgery. Linear echoendoscope is preferred over radial echoendoscope since it allows for FNA or FNB.