Objective: Nonoperative drainage either by the percutaneous or endoscopic r
oute has become a viable alternative to surgical drainage of pancreatic pse
udocysts. Endoscopic drainage has been reported in a few small series with
encouraging short term results, The aim of this study was to determine the
indications, suitability, and long term outcome of transmural endoscopic dr
ainage procedures. Methods: All patients presenting over a 2-yr period to a
tertiary referral hepatobiliary unit with pancreatic pseudocysts were stud
ied. Endoscopic drainage was performed in patients with pseudocysts bulging
into the stomach or duodenal lumen. Outcome measures were successful drain
age of the pseudocyst, complications, and recurrence rates. Results: Of 66
patients presenting with pseudocysts, 34 were considered suitable for endos
copic drainage. Twenty-four (71%) were successfully drained. Failures mere
associated with thick walled pseudocysts (>1 cm), location in the tail of t
he pancreas, and pseudocysts associated with acute necrotizing pancreatitis
. There were three recurrences (7%), two of which were successfully redrain
ed endoscopically. The long term success rate (median follow-up, 46 months)
of the initial procedure was 62%. Conclusion: Transmural endoscopic draina
ge is a safe procedure with minimal complications, It should be the procedu
re of choice for pseudocysts associated with chronic pancreatitis or trauma
, with a wall thickness of <1 cm and a visible bulge into the gastrointesti
nal lumen, Forty percent of pseudocysts fulfilled these criteria in our stu
dy, (C) 1999 by Am. Cell, of Gastroenterology.