Guidelines Clinical Practice
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jan 7, 2009; 15(1): 38-47
Published online Jan 7, 2009. doi: 10.3748/wjg.15.38
Pancreatic pseudocyst
Samir Habashi, Peter V Draganov
Samir Habashi, Peter V Draganov, Department of Gastroenterology Hepatology and Nutrition, University of Florida, Gainesville, Florida 32610, United States
Author contributions: Habashi S and Draganov PV contributed equally to this work.
Correspondence to: Peter V Draganov, MD, Department of Gastroenterology, Hepatology and Nutrition, University of Florida, 1600 SW Archer Rd, Room HD 602, PO Box 100214 Gainesville, Florida 32610, United States.
Telephone: +1-352-3922877
Fax: +1-352-3923618
Received: June 8, 2008
Revised: October 2, 2008
Accepted: October 9, 2008
Published online: January 7, 2009

Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications. The main two indications for some type of invasive drainage procedure are persistent patient symptoms or the presence of complications (infection, gastric outlet or biliary obstruction, bleeding). Three different strategies for pancreatic pseudocysts drainage are available: endoscopic (transpapillary or transmural) drainage, percutaneous catheter drainage, or open surgery. To date, no prospective controlled studies have compared directly these approaches. As a result, the management varies based on local expertise, but in general, endoscopic drainage is becoming the preferred approach because it is less invasive than surgery, avoids the need for external drain, and has a high long-term success rate. A tailored therapeutic approach taking into consideration patient preferences and involving multidisciplinary team of therapeutic endoscopist, interventional radiologist and pancreatic surgeon should be considered in all cases.

Keywords: Pancreatic pseudocyst, Cyst, Pancreatititis, Endoscopic ultrasound, Therapy