ABSTRACT
Surgery for pancreatic pseudocyst [PP] is becoming an infrequent-therapeutic option with advances in non-surgical drainage procedures. Actually, endoscopic drainage of PPs has become the preferable treatment for symptomatic PPs. It is indicated when a mature pseudocyst is bulging into the wall of the stomach or the duodenum. The risk of perforation and bleeding is increased when no obvious bulge is visible at endoscopy and when no diagnostic method is used to detect the presence of vascular structures. It seems clear that diagnostic endoscopic ultrasound [EUS] is mandatory before attempted endoscopic drainage because it is the most accurate technique to detect interposed vessels, the distance between pseudocyst and gut lumen [<1 cm] and to distinguish cystic neoplasms from PPs. Now EUS may be used alone for cyst decompression. EUS-directed pseudocyst aspiration and drainage is ideal because of advances in EUS endoscope design with new interventional linear echoendoscope with Doppler and large channel. This technique will completely replace the current standard approach of diagnostic EUS with a radial scan endoscope followed by endoscopic drainage with a side-viewing endoscope. We report a case of pancreatic pseudocyst drainage completely guided by endoscopic ultrasound and perform a literature review