Endoscopic management of pseudocysts

Endoscopic retrograde cholangiopancreatography (ERCP) has gained acceptance as a treatment of pancreatic pseudocysts in patients suited to this procedure. This article describes a standard approach to the technique. Evaluation prior to endoscopic drainage of pseudocysts should involve review of a high-quality computed tomography (CT) scan; most experts agree that endoscopic ultrasound is also useful. Complications of the procedure include perforation, bleeding, and infection. Endoscopists performing the procedure should have a good understanding of these complications and how to minimize risks and should have expert, multidisciplinary backup available at their institution in the event of complication or failure. The endoscopist should try to obtain a complete pancreatogram at the index ERCP. Follow-up involves a CT scan 3 to 6 weeks after the procedure. Pseudocysts can recur and are largely related to ductal anatomy.