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Should I do an Endoscopic Ultrasound (EUS) for pancreatic cyst?

Posted by lpaelevated4 @lpaelevated4, Nov 6 9:27pm

I had an MRCP for my incidental finding of a pancreatic cyst of 13 mm a month ago . 18 months prior, the pancreatic cyst was 9 mm.
The MRCP reported Cystic focus of 13mm, No main duct dilation, No mural nodule. Nothing else on report.
I spoke with my GP and have a referral to see a GI who specializes in pancreas. I have the option of doing an EUS. I am concern that there may be side effects or complication such as infection and pancreatitis. Also wondering if it really takes a lot of skills to do an EUS.
Should I have the EUS?

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Turkey, Volunteer Mentor | @tomrennie | Nov 10 8:33am
In reply to @sloped483 "@lpaelevated4, for an EUS this is no colon prep like for a colonoscopy, just fast. For..." + (show)
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@lpaelevated4, for an EUS this is no colon prep like for a colonoscopy, just fast. For me, I'm having a EUS (don't think I'm having a FNA) and a sigmoidoscopy (same as a colonoscopy but with a shorter scope as I've had most of my large intestine removed many years ago) so I would need to do a colon prep.
I've had upper endoscopies before but this is my first EUS and will let you know how it goes, although I feel both procedures will be uneventful.
Good luck with your consultation this Friday.

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@sloped483 I have had EUSs before. Your word "uneventful " is a good word to describe them. Hopefully, yours will be the same.

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199 | @199 | Nov 11 12:18pm

I had my EUS done @ Mayo, Jacksonville. The staff was great! It does take a skilled doctor to do it and the test went very well. I went home (a 2.5-hour drive) after I woke from the anesthesia.

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lpaelevated4 | @lpaelevated4 | Nov 14 10:39pm
In reply to @sloped483 "@lpaelevated4, for an EUS this is no colon prep like for a colonoscopy, just fast. For..." + (show)
Profile picture for sloped483 @sloped483

@lpaelevated4, for an EUS this is no colon prep like for a colonoscopy, just fast. For me, I'm having a EUS (don't think I'm having a FNA) and a sigmoidoscopy (same as a colonoscopy but with a shorter scope as I've had most of my large intestine removed many years ago) so I would need to do a colon prep.
I've had upper endoscopies before but this is my first EUS and will let you know how it goes, although I feel both procedures will be uneventful.
Good luck with your consultation this Friday.

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@sloped483 I had my consultation for almost 40 minutes . Found out that my MRI/CT scans had an 8 mm pancreatic cyst from 2019 to 2023. Then in 2025, it showed 1.3 cm cyst. GI thinks it may be side branch IPMN. Wanted to recommend MRCP in two years. I was concern about it being this long as I had no change for 4 years and then from 8 mm to 13 mm in 2 1/2 years. He said he would offer me EUS and I asked if it could just be EUS without FNE. He didn't want to be restricted but agreed to my wishes. Long story short, I will have another MRCP in December 2025 or January 2026 the latest. Once he reads the MRCP results, I will have an EUS in March or April 2026. If there is change to Pancreatic cyst size and worrisome features found, it would be an earlier EUS with FNE. He said he was the only Pancreatic specialist who does EUS at Kaiser hospital ( My HMO) and said he had done 1000 or so EUS. Do you think he is considered experience? He did say there are a small number of people who end up with pancreatitis after having the EUS done. That doesn't sound good so I am fearful.
What I didn't like was after the MRCP in December or January 2026 and the EUS with or without FNE, the surveillance would be 2 years unless he finds worrisome features.

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sloped483 | @sloped483 | Nov 15 6:33pm
In reply to @lpaelevated4 "@sloped483 I had my consultation for almost 40 minutes . Found out that my MRI/CT scans..." + (show)
Profile picture for lpaelevated4 @lpaelevated4

@sloped483 I had my consultation for almost 40 minutes . Found out that my MRI/CT scans had an 8 mm pancreatic cyst from 2019 to 2023. Then in 2025, it showed 1.3 cm cyst. GI thinks it may be side branch IPMN. Wanted to recommend MRCP in two years. I was concern about it being this long as I had no change for 4 years and then from 8 mm to 13 mm in 2 1/2 years. He said he would offer me EUS and I asked if it could just be EUS without FNE. He didn't want to be restricted but agreed to my wishes. Long story short, I will have another MRCP in December 2025 or January 2026 the latest. Once he reads the MRCP results, I will have an EUS in March or April 2026. If there is change to Pancreatic cyst size and worrisome features found, it would be an earlier EUS with FNE. He said he was the only Pancreatic specialist who does EUS at Kaiser hospital ( My HMO) and said he had done 1000 or so EUS. Do you think he is considered experience? He did say there are a small number of people who end up with pancreatitis after having the EUS done. That doesn't sound good so I am fearful.
What I didn't like was after the MRCP in December or January 2026 and the EUS with or without FNE, the surveillance would be 2 years unless he finds worrisome features.

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@lpaelevated4, I think a 40 minute consultation is good and that the doctor has done a 1000 EUS's. No one knows who will or won't get pancreatitis. It's the luck of the draw. But to be honest, a 1.3 cm cyst might not have enough juice to biopsy and is pretty much is where I'm at with mine. So if a FNA isn't done I would try and not stress. The good news is that you are being monitored. If it would help alleviate some of your stress then perhaps you can talk to your doctor about a year follow up instead of two years. I get an MRCP with contrast every year for the past 4 years. I'm a little concerned about having contrast every year, but it is what it is.

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lpaelevated4 | @lpaelevated4 | Nov 17 10:59am
In reply to @tomrennie "@sloped483 I believe the risk of pancreatitis from an FNA is about 1%. I think it..." + (show)
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@sloped483 I believe the risk of pancreatitis from an FNA is about 1%. I think it is a very small risk compared to the benefits it provides.

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@tomrennie I have Kaiser HMO . I had a consultation with GI. I wasn't happy about repeat MRCP in two years since I had 8mm ( unreported) pancreatic cyst for 4 years before it increase from 8 mm to 13mm in 2 1/2 years. GI said to have another MRCP next month which I scheduled for mid December follow up with EUS in March or April 2026.
I am still concern abut the FNA if done cause he did say that there are cases of pancreatitis from his EUS done on patients.
I checked his profile. It seems like he had one year fellowship for advanced Endoscopy at UC San Francisco and has 16 years experience as GI. Kaiser told me he is the only pancreatic expert who can do EUS. Should I be worry since he said his patients had pancreatitis from EUS before....

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lpaelevated4 | @lpaelevated4 | Nov 17 11:00am
In reply to @sloped483 "An EUS is better than an MRCP without contrast. I think to correctly classify a pancreatic..." + (show)
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An EUS is better than an MRCP without contrast. I think to correctly classify a pancreatic cyst a biopsy (FNA) would be performed. I have 3 pancreatic cysts diagnosed from several MRCP's with contrast and for the most part it's been suggested that they are IPMN's (which are cysts in the side branches from the main pancreatic duct) but I do have my first EUS coming up in a week so I'm hoping it would glean more about them.

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@sloped483 please let me know how it goes with your EUS. Were you in the hospital for procedure?

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Turkey, Volunteer Mentor | @tomrennie | Nov 17 3:03pm
In reply to @lpaelevated4 "@tomrennie I have Kaiser HMO . I had a consultation with GI. I wasn't happy about..." + (show)
Profile picture for lpaelevated4 @lpaelevated4

@tomrennie I have Kaiser HMO . I had a consultation with GI. I wasn't happy about repeat MRCP in two years since I had 8mm ( unreported) pancreatic cyst for 4 years before it increase from 8 mm to 13mm in 2 1/2 years. GI said to have another MRCP next month which I scheduled for mid December follow up with EUS in March or April 2026.
I am still concern abut the FNA if done cause he did say that there are cases of pancreatitis from his EUS done on patients.
I checked his profile. It seems like he had one year fellowship for advanced Endoscopy at UC San Francisco and has 16 years experience as GI. Kaiser told me he is the only pancreatic expert who can do EUS. Should I be worry since he said his patients had pancreatitis from EUS before....

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@lpaelevated4 That is a personal decision. If you are not comfortable, which it seems, I would suggest getting another opinion.

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sloped483 | @sloped483 | Nov 18 7:15pm
In reply to @lpaelevated4 "@sloped483 please let me know how it goes with your EUS. Were you in the hospital..." + (show)
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@sloped483 please let me know how it goes with your EUS. Were you in the hospital for procedure?

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@lpaelevated4, I was in a hospital wing from the main hospital building. I had three procedures done yesterday - endoscopy, EUS, and a sigmoidoscopy. Remember, an EUS is just an ultrasound of all your abdominal organs. You will be put to sleep through an IV and will be able to breathe on your own. An anesthesiologist monitors all that and after the procedure you wake up in recovery where you will have a soda to drink of your choice, then you go home.

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lpaelevated4 | @lpaelevated4 | Nov 18 9:44pm
In reply to @sloped483 "@lpaelevated4, I was in a hospital wing from the main hospital building. I had three procedures..." + (show)
Profile picture for sloped483 @sloped483

@lpaelevated4, I was in a hospital wing from the main hospital building. I had three procedures done yesterday - endoscopy, EUS, and a sigmoidoscopy. Remember, an EUS is just an ultrasound of all your abdominal organs. You will be put to sleep through an IV and will be able to breathe on your own. An anesthesiologist monitors all that and after the procedure you wake up in recovery where you will have a soda to drink of your choice, then you go home.

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@sloped483 Thanks . Hope it all went well for you and results will be favorable.

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