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Introduction The incidence of pancreatic cyst has increased due to widespread use of cross-sectional imaging for variety of indications. Once detected, pancreatic cysts are followed up by cross-sectional imaging (CT or MRI) based on locally agreed pancreatic cyst surveillance guidelines. This has huge resource and cost implications. We share our experience of pancreatic cyst surveillance from a non-tertiary UK teaching hospital.Methods A single centre retrospective cohort study of all adults with pancreatic cysts (excluding patients with previous history of pancreatitis and pancreatic cancer) identified on cross-sectional imaging between 1st January 2013 to 31st December 2022 was carried out at University Hospital of North Tees. Patients were followed up until 31st December 2025. Continuous variables were summarised using mean or median values, as appropriate, and compared using Kruskal–Wallis or ANOVA tests. Categorical variables were compared using Chi-square or Fisher’s exact test, as appropriate.Results A total of 302 patients were included. No patients died from pancreatic cancer during follow-up. Mortality due to non-pancreatic comorbidities during the surveillance period were observed in 29%, 49% and 51% in <10mm. 10-20mm and >20mm respectively (p=0.01). Table 1 summarises comparative outcomes by cysts sizeConclusion Our study shows that most pancreatic cysts remain stable during follow-up. High-risk features and the need for surgical intervention were more frequent in larger cysts. Our study supports a risk-stratified structured surveillance approach, allows effective monitoring and timely intervention while preventing pancreatic cancer-related mortality. The limitation includes retrospective nature of the study with modest median radiological and clinical follow-up. Since 2022 we have established Hepatopancreatobiliary (HPB) nurse led follow-up for all pancreatic cyst to streamline care and enables prospective long-term data collection.Abstract P156 Table 1VariablePancreatic cyst sizeP value<10mm10-20mm>20mmNumber of patients n (%)97(32.11)144(47.69)61(20.20)Median age (years)697374<0.001Female n (%)63(64.94)88(61.11)31(50.81)0.15Incidental detections n (%)94(96.90)139(96.52)61(100)>0.9Mean follow up (years)Radiological 3.933.453.93NSClinical 4.775.924.77NSHigh-risk features, n011120.001Cyst progression, n413180.002EUS performed, n016140.01Surgical resection (%)0(0)5(3.4)9(14.8)0.005Pathology-2- IPMN HGD,1-IPMN LGD1-IPMN INVAISIVE CANCER1-MCN2-IPMN LGD1-IPMN HGD1 MCN2 INVAISIVE CANCER1-COLLOID CANCER1 NET