PANCREATIC PSEUDOCYSTS - DEVELOPMENT OF T HERAPEUTIC APPROACHES

Objective: To reassess the therapeutic options for pancreatic pseudocy sts, resulting from the refinement of imaging techniques of the pancre as over the past 15 years. Data Sources: An extensive review of the li terature for the period 1970 to 1994. When pertinent, the authors' exp erience with 45 patients was added to the literature data. Study Crite ria: In the literature review the following selection criteria were us ed: diagnostic modalities (clinical, endoscopic and radiologic); clini cal context (etiology and clinical presentation); and therapeutic moda lities (observation and drainage). Data Extraction and Synthesis: Data collection was retrospective in most series. Whenever possible data c ollected before 1980 were differentiated from those collected after 19 80 because diagnostic modalities were quite different in these two per iods. Conclusions: Pancreatic pseudocysts are now diagnosed with more certainty and followed with more precision. Long-term observation is a safe and valuable approach. In symptomatic patients, some form of dra inage should be considered. In an elective situation, internal drainag e (endoscopic or surgical) is favoured. Cystogastrostomy should not be associated with an increased risk of bleeding.