We are grateful for the comments of Lennon and colleagues regarding the AGA guideline1 and technical review2 on the management of asymptomatic pancreatic cysts. They contend that we do not have high-quality evidence to support our conclusions and therefore they are not evidence based and misguided. We agree that the evidence is all of low quality, hence the guideline mostly provides conditional recommendations. However, what applies to the AGA guideline would also probably apply more to any other suggestion for how asymptomatic pancreatic cysts should be managed and the evidence that Lennon et al quote for the cancer progression of cysts may take 15–20 years is even weaker than the evidence we quote for the basis of our guideline.