Approaches to the drainage of pancreatic pseudocysts.
OBJECTIVE
Review the current methods for the drainage of pancreatic pseudocysts, focusing on the recent developments in the new methods of endoscopic drainage.


RESULTS
Pancreatic pseudocysts are collections of inflammatory fluid associated with acute and chronic pancreatitis. A leak in the pancreatic ductal system is most commonly the source of the fluid accumulation in these inflammatory cavities adjacent to the pancreas. Although most pseudocysts are not symptomatic and many resolve spontaneously over time, drainage of pseudocysts is occasionally required. There are several different approaches to the drainage: surgical, radiologic, and endoscopic. Surgical drainage is accomplished using the creation of a large anastomosis between the gastrointestinal tract and the pseudocyst cavity. Radiologically, pseudocysts are drained externally using a percutaneous, transabdominal drainage catheter. Endoscopy has offered the most recent advance, using the placement of transgastric or transduodenal stents. Most recently, therapeutic endoscopic ultrasound scopes have been used to introduce large stents that provide drainage into the upper gastrointestinal tract.


CONCLUSIONS
Of the three methods for the drainage of a pancreatic pseudocyst, only the endoscopic approach can provide minimally invasive internal drainage.
Brugge
William R
WR
Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachussetts 02114, USA. WBRUGGE@PARTNERS.Org