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Introduction: Endoscopic ultrasound (EUS) has been increasingly used to evaluate pancreatic cystic lesions. We investigated the impact of EUS results on the surgical management for patients with pancreatic cystic lesions.Methods: Using IRB approved prospectively maintained data base, all patients with pancreatic cystic lesions presented to a tertiary care center over 20 months were included. All patients had EUS as part their evaluation process. Patients’ demographics, EUS findings and fine needle aspiration (FNA) laboratory and cytological results when applied were analyzed to assess the impact of EUS data on the consequent management.Results: 93 consecutive patients (median age 68 years, M:F 1:1.5) with pancreatic cystic lesions undergoing EUS were included. Pancreatic cysts mean size was 2.3±1.7 cm and they were located at the pancreatic head, body and tail in 29, 36 and 28 patients respectively. 42 patients (45%) had fine needle aspiration (FNA); the size of the cystic lesion in these patients were significantly larger (2.9±1.6 cm vs. 1.8±1.7 cm; p=0.008). There was no correlation between the rate of FNA and the cyst location. After full evaluation 12 patients (12.9%) underwent surgical resection. Resected cystic lesions were larger (3.4±1.1 vs. 2.1±1.7 cm, p=0.02) and cysts were more likely to be resected when located at the pancreatic tail (2% of pancreatic head, 10% of pancreatic body and 28% of pancreatic tail cystic lesions were resected; p=0.005). Surgical resection was not significantly associated with preoperative FNA (8/42 vs. 4/51; p=NS). Cyst aspiration amylase, CEA, CA19-9 levels were not significantly different between surgical and non surgical patients (11753±16954vs. 41537±71294 U/L, 1524 ±2925 vs. 1335±5141 ng/mL, 10234 ±10450 vs. 8522 ±21279 U/mL, respectively; p=NS). Four patients with negative FNA cytology had surgical resection for high clinical suspicion. Final pathology of the resected patients (n=12) revealed IPMN (7), Mucinous neoplasm (2), pancreatic cancer (1), NET(1) and pancreatitis (1).Conclusion: Surgical resection of pancreatic cyst is based on the cyst size, location and patient comorbidities rather than results of the EUS examination. Routine EUS for cystic pancreatic lesions did not dictate the surgical management in this series. EUS can justify a non surgical approach for small cysts and when surgical resection carries a high risk.