Inclusion Criteria:

• Patients with pancreatic cystic lesions meeting Fukuoka worrisome (FW) or Fukuoka high-risk (FHR) criteria.
• Patients with suspected cystic neoplasm of the pancreas.
• Age ≥ 18 years old.
• Able to provide written informed consent.

Exclusion Criteria:

• Pregnant and/or nursing.
• Incarcerated.
• Imaging features indicative of pancreatic cancer such as presence of a solid pancreatic mass, encasement of peri-pancreatic vessels, malignant intra-abdominal lymphadenopathy, or hepatic and/or other distant metastasis.
• Prior history of pancreatic cancer or pancreatic surgery/
• History of receiving systemic chemotherapy or abdominal radiation within the last 5 years.
• Previous therapy for a pancreatic cystic lesion (such as ethanol injection or cyst drainage).
• Medical co-morbidities that increase the risk of endoscopy (ASA class ≥ 3); however, the patient can be enrolled despite this criterion if endoscopy will be conducted for clinical indications (not for research alone).
• History of pancreatic necrosis.
• Diagnosis of cancer (other than non-melanoma skin cancer) within the last 5 years.