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Epidemiologically, intraductal papillary mucinous neoplasms (IPMNs) are increasingly detected due to advances in imaging, with a prevalence of up to 25% of the general population in modern prospective studies.1 Conceptually, IPMNs are the only radiographically identifiable precursors of pancreatic cancer. However, opportunities for early cancer detection and surgical resection must be considered within the framework of cost-effective strategies that healthcare systems can sustainably support. The American Gastroenterology Guidelines (AGA) were the first suggesting against continued surveillance of asymptomatic pancreatic cysts, in the absence of significant change in their characteristics after 5 years of surveillance, or once the patient was no longer a surgical candidate.2 Back in 2015, this recommendation was deemed ‘conditional’ and based on ‘very low-quality evidence’ by its authors2 themselves, and it could appropriately be considered scientifically premature.