Endoscopic Pancreatic Pseudocyst Drainage

A well-described complication of acute and chronic pancreatitis is pancreatic pseudocyst formation. As patients convalesce from acute pancreatic inflammation, it is not uncommon to develop complications from the presence or progression of pseudocyst(s). Likewise, those patients with chronic pancreatitis may experience symptoms from pseudocyst formation. These may include abdominal pain, gastric outlet obstruction, biliary obstruction, pseudocyst infection, or fistulization. In the setting of symptoms or complications from pseudocyst development, drainage of the pseudocyst by percutaneous, endoscopic (transmural or transpapillary), or surgical approach has been described. At present, no prospective studies have been performed comparing methods of pseudocyst drainage. However, endoscopic drainage appears to have acceptable success, recurrence, and complication rates to be considered first-line therapy. Transmural drainage may be either transgastric or transduodenal, and is selected based on the most easily accessible region for drainage. Transpapillary drainage can be performed when communication between the main pancreatic duct and the pseudocyst is demonstrated by pancreatography. The techniques utilized to perform transpapillary and transmural endoscopic drainage of pancreatic pseudocysts are discussed in this article. This chapter will not address the endoscopic approach to management and drainage of pancreatic necrosis or infected pseudocysts.