Pancreatic pseudocyst drainage--the needle or the scalpel?

A sizable number of pancreatic pseudocysts resolve spontaneously. Some, however, require intervention. Surgery was the only option available for many years. Recently, however, newer methods, such as percutaneous drainage and endoscopic cystotenterostomy have been used. Percutaneous drainage is inexpensive, has a low complication rate, and is done under local anesthesia. The recurrence rate is high with a one-time needle aspiration; this rate can be reduced to less than 10% by using an indwelling catheter. All these factors tend to make percutaneous continuous catheter drainage the first choice in the management of pseudocysts that require intervention. Experience with the endoscopic technique is still limited.