Editorial| Volume 65, ISSUE 4, P620-623, April 2007

What is the best endoscopic treatment for pancreatic pseudocysts?

      Endoscopic transmural drainage is the best technique for bulging pancreatic pseudocysts, whereas EUS-guided drainage is required for nonbulging pancreatic collections and in patients with portal hypertension.
      The management of pancreatic pseudocysts (PPs) has traditionally been surgical. Although highly effective, surgery may be associated with a complication rate of 35% and a mortality rate of 10%. This has encouraged the development of nonsurgical approaches. Percutaneous puncture and aspiration under US or CT guidance have been used, but aspiration alone was found to be ineffective, because of high recurrence rates, up to 71%. Continuous percutaneous drainage with indwelling catheters reduces the relapse rates but may be associated with a complication rate, ranging from 5% to 60%. Complications include fistula formation, infection, and bleeding.
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