Endoscopy 2005; 37(10): 977-983
DOI: 10.1055/s-2005-870336
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Drainage of Pancreatic Pseudocysts: Long-Term Outcome and Procedural Factors Associated with Safe and Successful Treatment

D.  Cahen1 , E.  Rauws1 , P.  Fockens1 , G.  Weverling2 , K.  Huibregtse1 , M.  Bruno1
  • 1Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
  • 2Dept. of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, the Netherlands
Further Information

Publication History

Submitted 4 April 2004

Accepted after Revision 15 April 2005

Publication Date:
27 September 2005 (online)

Background and Study Aims: Endoscopic drainage is a widely used treatment modality for pancreatic pseudocysts and has challenged more traditional drainage techniques. This retrospective study evaluates the short-term and long-term results with this technique and aims to identify procedural modifications that may improve its safety and efficacy.
Patients and Methods: All consecutive patients who underwent endoscopic drainage of pancreatic pseudocysts in our hospital between 1983 and 2000 were included in the study. The patients’ charts were reviewed, and long-term follow-up data were obtained by written questionnaires sent to the patients at the end of the follow-up period in November 2002.
Results: A total of 92 patients were included (66 men, 26 women; median age 49 years). The technical success rate of the drainage procedure was 97 % and the mortality rate was 1 %. Complications occurred in 31 patients (34 %), eight of which (9 %) were major and required surgery: hemorrhage in four cases (three of which were caused by erosion of a straight endoprosthesis through the cyst wall), secondary infection in three, and perforation in one. During a median follow-up period of 43 months, 10 patients (11 %) underwent additional (nonendoscopic) treatment for a persistent cyst and five (5 %) for a recurrent cyst. Overall, endoscopic drainage was successful in 65 patients (71 %).
Conclusions: Endoscopic drainage is an effective treatment for pancreatic pseudocysts and offers a definitive solution in almost three-quarters of the cases. The majority of major complications might have been prevented by using pigtail stents instead of straight stents and by taking a more aggressive approach to the prevention and treatment of secondary cyst infection.


  • 1 Beckingham I J, Krige J E, Bornman P C, Terblanche J. Long term outcome of endoscopic drainage of pancreatic pseudocysts.  Am J Gastroenterol. 1999;  94 71-74
  • 2 Barthet M, Bugallo M, Moreira L S. et al . Management of cysts and pseudocysts complicating chronic pancreatitis: a retrospective study of 143 patients.  Gastroenterol Clin Biol. 1993;  17 270-276
  • 3 Baillie J. Pancreatic pseudocysts (part I).  Gastrointest Endosc. 2004;  59 873-879
  • 4 Gouyon B, Levy P, Ruszniewski P. et al . Predictive factors in the outcome of pseudocysts complicating alcoholic chronic pancreatitis.  Gut. 1997;  41 821-825
  • 5 Vitas G J, Sarr M G. Selected management of pancreatic pseudocysts: operative versus expectant management.  Surgery. 1992;  111 123-130
  • 6 Beebe D S, Bubrick M P, Onstad G R, Hitchcock C R. Management of pancreatic pseudocysts.  Surg Gynecol Obstet. 1984;  159 562-564
  • 7 Yeo C J, Bastidas J A, Lynch-Nyhan A. et al . The natural history of pancreatic pseudocysts documented by computed tomography.  Surg Gynecol Obstet. 1990;  170 411-417
  • 8 Lehman G A. Pseudocysts.  Gastrointest Endosc. 1999;  49 S81-S84
  • 9 Adkisson K W, Baron T H, Morgan D E. Pancreatic fluid collections: diagnosis and endoscopic management.  Semin Gastrointest Dis. 1998;  9 61-72
  • 10 Boerma D, van Gulik T M, Obertop H, Gouma D J. Internal drainage of infected pancreatic pseudocysts: safe or sorry?.  Dig Surg. 1999;  16 501-505
  • 11 Lohr-Happe A, Peiper M, Lankisch P G. Natural course of operated pseudocysts in chronic pancreatitis.  Gut. 1994;  35 1479-1482
  • 12 Gumaste U V, Dave P B. Pancreatic pseudocyst drainage: the needle or the scalpel?.  J Clin Gastroenterol. 1991;  13 500-505
  • 13 Hancke S, Pedersen J F. Percutaneous pancreatic cyst puncture guided by ultrasound. (in Danish).  Ugeskr Laeger. 1977;  139 700-701
  • 14 Spivak H, Galloway J R, Amerson J R. et al . Management of pancreatic pseudocysts.  J Am Coll Surg. 1998;  186 507-511
  • 15 Boggi U, di Candio G, Campatelli A. et al . Nonoperative management of pancreatic pseudocysts: problems in differential diagnosis.  Int J Pancreatol. 1999;  25 123-133
  • 16 Vitale G C, Lawhon J C, Larson G M. et al . Endoscopic drainage of the pancreatic pseudocyst.  Surgery. 1999;  126 616-621
  • 17 Singer M V, Gyr K, Sarles H. Revised classification of pancreatitis. Report of the Second International Symposium on the Classification of Pancreatitis in Marseille, France, March 28 - 30, 1984.  Gastroenterology. 1985;  89 683-685
  • 18 Balthazar E J. Acute pancreatitis: assessment of severity with clinical and CT evaluation.  Radiology. 2002;  223 603-613
  • 19 Baron T H, Harewood G C, Morgan D E, Yates M R. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts.  Gastrointest Endosc. 2002;  56 7-17
  • 20 De Palma G D, Galloro G, Puzziello A. et al . Endoscopic drainage of pancreatic pseudocysts: a long-term follow-up study of 49 patients.  Hepatogastroenterology. 2002;  49 1113-1115
  • 21 Sharma S S, Bhargawa N, Govil A. Endoscopic management of pancreatic pseudocyst: a long-term follow-up.  Endoscopy. 2002;  34 203-207
  • 22 Cremer M, Devière J, Engelholm L. Endoscopic management of cysts and pseudocysts in chronic pancreatitis: long-term follow-up after 7 years of experience.  Gastrointest Endosc. 1989;  35 1-9
  • 23 Binmoeller K F, Seifert H, Walter A, Soehendra N. Transpapillary and transmural drainage of pancreatic pseudocysts.  Gastrointest Endosc. 1995;  42 219-224
  • 24 Catalano M F, Geenen J E, Schmalz M J. et al . Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis.  Gastrointest Endosc. 1995;  42 214-218
  • 25 Barthet M, Sahel J, Bodiou-Bertei C, Bernard J P. Endoscopic transpapillary drainage of pancreatic pseudocysts.  Gastrointest Endosc. 1995;  42 208-213
  • 26 Clark L A, Pappas T N. Long term outcome of endoscopic drainage of pancreatic pseudocysts.  Am J Gastroenterol. 1999;  94 8-9
  • 27 Gerolami R, Giovannini M, Laugier R. Endoscopic drainage of pancreatic pseudocysts guided by endosonography.  Endoscopy. 1997;  29 106-108
  • 28 Giovannini M, Binmoeller K, Seifert H. Endoscopic ultrasound-guided cystogastrostomy.  Endoscopy. 2003;  35 239-245
  • 29 Smits M E, Rauws E A, Tytgat G N, Huibregtse K. The efficacy of endoscopic treatment of pancreatic pseudocysts.  Gastrointest Endosc. 1995;  42 202-207
  • 30 Beckingham I J, Krige J E, Bornman P C, Terblanche J. Endoscopic management of pancreatic pseudocysts.  Br J Surg. 1997;  84 1638-1645
  • 31 Baillie J. Pancreatic pseudocysts (Part II).  Gastrointest Endosc. 2004;  60 105-113
  • 32 Harewood G C, Wright C A, Baron T H. Impact on patient outcomes of experience in the performance of endoscopic pancreatic fluid collection drainage.  Gastrointest Endosc. 2003;  58 230-235
  • 33 Heider R, Meyer A A, Galanko J A, Behrns K E. Percutaneous drainage of pancreatic pseudocysts is associated with a higher failure rate than surgical treatment in unselected patients.  Ann Surg. 1999;  229 781-787
  • 34 Pavlovsky M, Perejaslov A, Chooklin S, Dovgan Y. Current management of pancreatic pseudocysts.  Hepatogastroenterology. 1998;  45 846-848

D. L. Cahen , M. D.

Dept. of Gastroenterology and Hepatology

Academic Medical Center · Meibergdreef 9 · 1105 AZ Amsterdam · The Netherlands

Fax: +31-20-6917033

Email: d.l.cahen@amc.uva.nl