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In the last decade, the number of diagnosed pancreatic cystic lesions has dramatically increased (Clin Gastroenterol Hepatol 2012; 10:555), largely because of a corresponding increase in both the use and resolution of cross-sectional imaging with computed tomography (CT) or magnetic resolution imaging (MRI). Intraductal papillary mucinous neoplasms (IPMNs) are characterized by variable natural histories and indolence. These tumor features, combined with the lack of a corresponding increase in pancreatic adenocarcinoma incidence, have contributed to the difficulty clinicians face in deciding whether to proceed with further diagnostic exploration (typically with endoscopic ultrasound; EUS) or resection. Now, increased use of EUS and advances …