CHARM II: Chemotherapy for Ablation and Resolution of Mucinous Pancreatic Cysts

Inclusion Criteria: * Adult subjects over the age of 18. * Patients with a previously-detected pancreatic cyst(s) 2-5 cm in diameter which is consistent with a mucinous type cyst as per ASGE guidelines, including indeterminate type cysts. * Able to give written informed consent. * Capable of safely undergoing endoscopy with deep sedation or general anesthesia. Exclusion Criteria: * Lesions which are consistent with a benign cyst by clinical, cytological, chemical, and radiographic evaluation as per ASGE guidelines (i.e., consistent with a pseudocyst or serous cystadenoma). * Known or suspected pancreatic cancer or pathologic lymphadenopathy. * Cysts with the following high-risk features: main pancreatic duct dilation of \> 5mm, epithelial type mural nodules (\> 2mm)33, pathologically thick wall/septation (\> 2mm), cytology showing high grade dysplasia or "suspicious for malignancy", signs of common bile duct or pancreatic duct obstruction, solid mass component within or associated with the cyst (\> 2mm), pancreatic duct stricture associated with tail atrophy, or previous fine needle aspiration failure due to excessive cyst fluid viscosity. (Of note, the following higher-risk features ARE eligible: recent growth in size, atypical cells on cytology, and symptoms referable to the pancreas.) * Septated cysts with \> 4 compartments. * Confirmed acute pancreatitis within the last 6 months. * Baseline lab values (must be within 6 months of consent date) in the following ranges: w…