Pancreatic cysts are challenging to the gastroenterologist. Detection rate is increasing and neither criteria for a definitive diagnosis, nor a validated surveillance strategy is available. Pancreatic endosonography with or without sampling is necessary in most of the cases. However this technique requires expertise and is not widely available. While some cysts have a malignant potential or already malign at the diagnosis, most are benign and remain so for decades. We are going to review the existing data on this controversial subject.