S113 Influence of Endoscopic Ultrasound Findings on Management Decisions in Patients With Incidental Pancreatic Cysts

Introduction: Although endoscopic ultrasound (EUS) is frequently used to evaluate incidental pancreatic cysts, its influence on clinical decision-making and cost-effectiveness remains unclear. This study aimed to assess the frequency and nature of clinical management changes resulting from EUS findings in patients with incidental pancreatic cysts. Methods: A retrospective chart review was conducted on patients who underwent EUS for incidental pancreatic cysts at Dartmouth Hitchcock Medical Center between 2013 and 2024. Patients with limited follow-up or participation in concurrent studies were excluded. The primary outcome was the proportion of cases in which EUS findings altered clinical management. Secondary outcomes included the type of management changes (e.g., imaging frequency, surveillance modality, surgical referral), pre-EUS diagnostics, EUS findings, cyst fluid analysis, and patient demographics. Results: A total of 209 patients were included (mean age 66 ± 13.8 years; 59.4% women). EUS altered management in 33.0% of cases. Among all patients, 64.6% continued routine imaging surveillance, and 2.4% had comorbidities that rendered EUS findings clinically irrelevant—together comprising the 67.0% with no change in management. Management changes included increased surveillance frequency (13.9%), change in surveillance modality (5.7%), both frequency and modality changes (1.4%), surveillance cessation (5.3%), and surgical referral (5.7%). A new diagnosis was established in 0.96% of cases. Conclusion: EUS led to a change in management in approximately one-third of patients, though most continued routine surveillance. These findings suggest a potentially limited role for EUS in the routine evaluation of incidental pancreatic cysts and highlight the need for multicenter studies to inform cost-effective, evidence-based surveillance strategies.