Pancreatic pseudocysts: observation, endoscopic drainage, or resection?
BACKGROUND
Pancreatic pseudocysts are a common complication of acute and chronic pancreatitis. They are diagnosed with imaging studies and can be treated successfully with a variety of methods: endoscopic transpapillary or transmural drainage, percutaneous catheter drainage, laparoscopic surgery, or open pseudocystoenterostomy.


METHODS
Relevant publications that appeared from 1975 to 2008 were retrieved from the MEDLINE, PubMed and EMBASE databases for this review.


RESULTS
Endoscopic pseudocyst drainage has a high success rate (79.2%) and a low complication rate (12.9%). Percutaneous drainage is mainly used for the emergency treatment of infected pancreatic pseudocysts. Open internal drainage and pseudocyst resection are surgical techniques with high success rates (>92%), but also higher morbidity (16%) and mortality (2.5%) than endoscopic treatment (mortality 0.7%). Laparoscopic pseudocystoenterostomy, a recently introduced procedure, is probably similar to the endoscopic techniques with regard to morbidity and mortality.


CONCLUSIONS
An interdisciplinary approach is best suited for the safe and effective stage-specific treatment of pancreatic pseudocysts. The different interventional techniques that are currently available have yet to be compared directly in randomized trials.
Lerch
Markus M
MM
Klinik und Poliklinik für Innere Medizin A, Universitätsklinikum der Ernst-Moritz-Arndt-Universität, Greifswald, Germany. lerch@uni-greifswald.de
Stier
Albrecht
A
Wahnschaffe
Ulrich
U
Mayerle
Julia
J
D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D010192:Pancreatic Pseudocyst / Q000175:diagnosis* / Q000628:therapy*