Endoscopic ultrasonography-guided pancreatic drainage.

Surgery for pancreatic pseudocysts (PPCs) may be associated with high rates of complication and mortality. Since its introduction in the late 1980s, endoscopic drainage of PPCs has become established as an alternative nonsurgical approach. The obvious limitation of this technique is its relatively blind approach. The ideal approach for PPC puncture combines endoscopy with real-time endosonography using an interventional echoendoscope. Endoscopic ultrasonographic longitudinal scanners can be used for guidance of transmural punctures and drainage procedures, as well as to access a dilated pancreatic duct if the duct cannot be drained by conventional methods because of complete obstruction. In this chapter, we will review the indications, techniques and clinical algorithm for EUS-guided pseudocyst drainage and pancreaticogastrostomy.