The European Study Group on Cystic Tumours of the Pancreas has published evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN). These guidelines replace the 2013 consensus statement and are based on systematic reviews and GRADE methodology. They cover nine topics, including biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm (SCN), rare cysts, (neo)adjuvant treatment, and pathology. Recommendations include conservative management for asymptomatic MCN and IPMN <40 mm without enhancing nodules, and surgery for IPMN with specific risk factors. Lifelong follow-up is recommended for IPMN patients fit for surgery. The guidelines aim to improve diagnosis and management of PCN, identify areas requiring further research, and provide evidence-based recommendations for clinical practice. They emphasize the importance of imaging modalities like MRI and CT, endoscopic ultrasound (EUS), and EUS-guided fine needle aspiration (FNA) for diagnosis and management. The guidelines also address the risk of malignant transformation in IPMN, the surgical management of different PCN types, and the importance of follow-up for patients with PCN. The recommendations are based on a consensus of expert opinion and are supported by high-quality evidence. The guidelines are intended to guide clinical practice and improve patient outcomes.The European Study Group on Cystic Tumours of the Pancreas has published evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN). These guidelines replace the 2013 consensus statement and are based on systematic reviews and GRADE methodology. They cover nine topics, including biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm (SCN), rare cysts, (neo)adjuvant treatment, and pathology. Recommendations include conservative management for asymptomatic MCN and IPMN <40 mm without enhancing nodules, and surgery for IPMN with specific risk factors. Lifelong follow-up is recommended for IPMN patients fit for surgery. The guidelines aim to improve diagnosis and management of PCN, identify areas requiring further research, and provide evidence-based recommendations for clinical practice. They emphasize the importance of imaging modalities like MRI and CT, endoscopic ultrasound (EUS), and EUS-guided fine needle aspiration (FNA) for diagnosis and management. The guidelines also address the risk of malignant transformation in IPMN, the surgical management of different PCN types, and the importance of follow-up for patients with PCN. The recommendations are based on a consensus of expert opinion and are supported by high-quality evidence. The guidelines are intended to guide clinical practice and improve patient outcomes.