Endoscopic ultrasound for pancreatic cystic lesions: a narrative review

The incidence of incidental pancreatic cystic lesions (PCLs) has risen in recent years, largely due to advances in and increased use of imaging techniques. Endoscopic ultrasound (EUS) has become a crucial tool for evaluating and characterising PCLs, allowing for detailed morphological assessment and aiding in the identification of lesions with a higher risk of progression to high-grade dysplasia or invasive pancreatic carcinoma. This review aims to outline the key aspects of EUS in the evaluation of PCLs, covering a range of modalities from morphological assessment and contrast-enhanced imaging to elastography, fine-needle aspiration for biomarker analysis, cytology, DNA sequencing, histological evaluation and the emerging role of confocal laser endomicroscopy or artificial intelligence. Additionally, we address therapeutic EUS modalities for PCLs, the current limitations of EUS, anticipated technological advancements and the diverse management strategies recommended by leading scientific societies for the clinical handling of PCLs.