title: Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.
abstract: OBJECTIVE
  To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.
  
  
  METHODS
  Comparative studies published between January 1980 and May 2014 were identified on PubMed, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities.
  
  
  RESULTS
  Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound (EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies compared EUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.
  
  
  CONCLUSIONS
  In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.
authors.affiliation: Anthony Yuen Bun Teoh, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Anthony Yuen Bun
authors.initials: AY
authors.lastname: Teoh
authors.affiliation: Anthony Yuen Bun Teoh, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Vinay
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Anthony Yuen Bun Teoh, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Zhen-Dong
authors.initials: ZD
authors.lastname: Jin
authors.affiliation: Anthony Yuen Bun Teoh, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kida
authors.affiliation: Anthony Yuen Bun Teoh, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.affiliation: Anthony Yuen Bun Teoh, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Khek Yu
authors.initials: KY
authors.lastname: Ho
keywords: Cystogastrostomy; Cystojejunostomy; Endoscopic ultrasound; Interventional endosonography; Pancreatic pseudocyst; Pseudocyst drainage