Information on the natural history of intraductal papillary mucinous neoplasia(IPMN) is currently inadequate due to a lack of carefully orchestrated long-term followup on a large cohort of patients with asymptomatic disease.Based on the available data,one can draw the conclusions that main duct IPMN is commonly associated with malignancy and an aggressive operative stance should be taken with resection being offered to most patients who are suitable operative candidates.In contrast,the majority of branch type IPMN with a diameter of less than 3 cm can be safely followed with routine surveillance imaging provided they lack the high-risk covariates of age,symptomatology,nodularity or wall thickness. Information on the natural history of intraductal papillary mucinous neoplasia (IPMN) is currently inadequate due to a lack of carefully orchestrated long-term followup on a large cohort of patients with asymptomatic disease.Based on the available data, one can draw the correspondence that main duct IPMN is commonly associated with malignancy and an aggressive operation stance should be taken with resection being offered to most patients who are suitable for the operative candidates. In contrast, the majority of branch type IPMN with a diameter of less than 3 cm can be safely followed with routine surveillance imaging provided they lack the high-risk covariates of age, symptomatology, nodularity or wall thickness.