Minimally invasive treatment of pancreatic pseudocysts

Table 1 Indications for therapeutic intervention for pancreatic pseudocysts

Clinical presentations and complications
Local complications
Infection of pancreatic pseudocyst
Hemorrhage into pancreatic pseudocyst
Rupture (can cause pancreatic ascites, shock and peritonitis)
Involving adjacent organs
Gastrointestinal tract:
Esophagus (secondary achalasia, mechanical dysphagia)
Stomach (clinically relevant gastric outlet stenosis, fistula, intramural gastric mass)
Duodenum (clinically relevant duodenal stenosis, fistula)
Colon (clinically relevant colonic stenosis and/or rectal bleeding)
Liver (stenosis of the common bile duct with jaundice due to compression)
Vascular:
Arterial (erosion of gastroduodenal and/or splenic artery)
Venous (thrombosis of portal and/or splenic vein)
Spleen (splenic rupture)
Genitourinary tract (stricture, fistula, ureter obstruction)
Chest (pancreaticopleural fistula, pleural effusion, mediastinal extension)
Skin (subcutaneous fat necrosis)
Symptomatic pancreatic pseudocyst
Abdominal distension
Nausea and vomiting
Pain
Upper gastrointestinal bleeding
Relative indications for intervention in asymptomatic pancreatic pseudocyst
Pseudocyst > 5 cm, unchanged in size and morphology for more than 6 wk[15]
Pseudocyst > 4 cm and extrapancreatic complications in patients with chronic alcoholic pancreatitis[31]
Cyst wall > 5 mm (mature cyst)[32]
Chronic pancreatitis with advanced pancreatic duct changes[31]
Suspected cystic pancreatic tumor (requiring surgery)[33,34]