Incidental pancreatic cysts warranting watchful waiting

Assuming a general practitioner’s perspective, could you define the key features of incidental pancreatic cystic lesions that warrant watchful waiting and those that require surgical treatment?

Paul Moayyedi: The simple message is most [lesions] require watchful waiting. Most are not going to be malignant. Our data suggest only 0.25% of cysts are malignant at the time of their presentation.

The only time you should be worried is if there are at least 2 of the following features: a cyst greater than 3 cm in size, a solid component to that cyst, or a dilation of the main pancreatic duct. If you follow up a cyst and there is interval growth, that is also a feature that might suggest concern, but you need at least 2 of those features before you would consider surgery.