Management of Pancreaticobiliary Disease: Pseudocyst

  • Garrett Filas Mortensen
  • Vladimir Davidyuk
  • Gary C. Vitale


Endoscopic drainage of pancreatic pseudocysts has become the standard management approach for acute and chronic noninfected pancreatic collections. There are several techniques of performing a pancreatic cyst-gastrostomy including transpapillary, transgastric, and trans-duodenal methods. The technique is most easily performed on larger collections abutting the stomach with bleeding, infection, and perforation being potential complications. Endoscopic ultrasound extends the applicability to smaller pseudocyst which would otherwise be inaccessible endoscopically. Pancreatic necrosectomy via an endoscopic approach is an alternative to traditional operative drainage. Benefits of this nonoperative approach include decreased morbidity and decreased rates of fistula and hernia occurrence. The “step-up” approach to laparoscopic or operative debridement is a potential necessary backup. Endoscopic ultrasound can similarly extend indications and help avoid bleeding complications. Use of newer lumen-apposing metallic stents (LAMS) facilitates initial drainage and subsequent debridement procedures. The risk of bleeding and stent migration limits their longer-term use.


Pseudocyst Cyst-gastrostomy Pancreatic debridement Necrosectomy Endoscopic LAMS 


  1. 1.
    Samuelson AL, Shah RJ. Endoscopic management of pancreatic pseudocysts. Gastroenterol Clin N Am. 2012;41:47–62.CrossRefGoogle Scholar
  2. 2.
    Sharma SS, Bhargawa N, Govil A. Endoscopic drainage of pancreatic pseudocysts: a long-term follow-up. Endoscopy. 2002;34(3):203–7.CrossRefGoogle Scholar
  3. 3.
    Tarleja JP, Kahale M. Endotherapy for pancreatic necrosis and abscess: endoscopic drainage and necrosectomy. J Hepato-Biliary-Pancreat Surg. 2009;16(5):605–12.CrossRefGoogle Scholar
  4. 4.
    Vitale GC, Davis BR, Vitale M, Tran TC, Clemons R. Natural orifice transluminal endoscopic drainage for pancreatic abscesses. Surg Endosc. 2009;23(1):140–6.CrossRefGoogle Scholar
  5. 5.
    Ahn JY, Seo DW, Eum J, Song TJ, Moon SH, Park DH, et al. Single-step EUS-guided transmural drainage of pancreatic pseudocysts: analysis of technical feasibility, efficacy, and safety. Gut Liver. 2010;4(4):524–9.CrossRefGoogle Scholar
  6. 6.
    DeSimone ML, Asombang AW, Berzin TM. Lumen apposing metal stents for pancreatic fluid collections: recognition and management of complications. World J Gastrointest Endosc. 2017;9(9):456–63.CrossRefGoogle Scholar
  7. 7.
    Itoi T, Nageshwar Reddy D, Yasuda I. New fully covered self-expandable metal stent for endoscopic ultrasonography-guided intervention in infectious walled-off pancreatic necrosis. J Hepatobiliary Pancreat Sci. 2013;20(3):403–6.CrossRefGoogle Scholar
  8. 8.
    Aburajab M, Smith Z, Khan A, Dua K. Safety and efficacy of lumen-apposing metal stents with and without simultaneous double-pigtail plastic stents for draining pancreatic pseudocyst. Gastrointest Endosc. 2018 May;87(5):1248–55.CrossRefGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  • Garrett Filas Mortensen
    • 1
    • 2
  • Vladimir Davidyuk
    • 2
    • 3
  • Gary C. Vitale
    • 4
  1. 1.Medical Associates Department of SurgeryDubuqueUSA
  2. 2.ERCP and Pancreaticobiliary Surgery, University of LouisvilleLouisvilleUSA
  3. 3.Albany Medical Center, Department of SurgeryAlbanyUSA
  4. 4.University of Louisville School of Medicine, Department of SurgeryLouisvilleUSA

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