ENDOSCOPIC MANAGEMENT OF PANCREATIC PSEUDOCYSTS

Background Pancreatic pseudocysts may produce pain, or biliary or duod enal obstruction. Those over 6 cm in diameter or associated with chron ic pancreatitis are unlikely to resolve and usually require interventi on. There are a number of treatment modalities available and this pape r reviews the role of endoscopic drainage. Methods AU articles and cas e reports quoted on Medline (National Library of Medicine, Washington DC, USA) containing the text words 'endoscopy' and 'pseudocyst', and c itations from these references mere reviewed. Results Endoscopic drain age is technically feasible in around 50 per cent of pancreatic pseudo cysts associated with chronic pancreatitis. Successful drainage occurr ed in 82-89 per cent, The major complication is bleeding which require d surgery for control in 5 per cent of procedures. One death attributa ble to the procedure has been reported, Recurrence rates range from 6 to 18 per cent with up to 4 years' follow-up. As in open surgery, recu rrence is highest with drainage via the stomach. Conclusion Endoscopic drainage provides a minimally invasive approach to pseudocyst managem ent, with success and recurrence rates similar to those of open surger y but with lower morbidity and mortality rates, It should be considere d the treatment of choice for pseudocysts less than 1 cm thick which b ulge into the stomach or duodenum, or for those which communicate with the main pancreatic duel.