[Pancreatic pseudocysts in chronic pancreatitis. Differential diagnosis and therapy]

Pancreatic pseudocysts occur as a complication in the natural course of acute or chronic pancreatitis, with a spontaneous resolution rate of 40% to 60%. The incidence of pseudocysts in the course of chronic pancreatitis amounts to 60%. Pseudocysts have to be differentiated from neoplastic or congenital pancreatic cystic lesions. Careful diagnostic work-up including ERCP and CT scanning is mandatory in the management of pancreatic pseudocysts. The indication for treatment depends on the development of symptoms or complications. Pain is present in up to 90% of all patients, and the rate of complications varies between 2% and 55%. Pancreatic pseudocysts are usually an epiphenomenon of chronic pancreatitis. Pancreatic resection therefore represents a causative treatment. New percutaneous and endoscopic techniques for draining pseudocysts are challenging the previous hegemony of the surgeon. However, so far no prospectively collected data are available comparing the results of interventional and surgical drainage procedures. Therefore, in most symptomatic cases surgery is considered the treatment of choice.