Pancreatic pseudocyst: The past, the present, and the future

Abstract

A pancreatic pseudocyst is defined as an encapsulated fluid collection with a well-defined inflammatory wall with minimal or no necrosis. The diagnosis cannot be made prior to 4 wk after the onset of pancreatitis. The clinical presentation is often nonspecific, with abdominal pain being the most common symptom. If a diagnosis is suspected, contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the pseudocyst. Endoscopic ultrasound with cyst fluid analysis can be performed in cases of diagnostic uncertainty. Pseudocyst of the pancreas can lead to complications such as hemorrhage, infection, and rupture. The management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications, such as biliary or gastric outlet obstruction. Management options include endoscopic or surgical drainage. The aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions, diagnosis, and management of this condition.

Keywords: Pancreatic pseudocyst; Pancreatic fluid collection; Cystic pancreatic lesions; Pancreatitis; Endoscopic ultrasound

Core Tip: Surgery was the mainstay of treatment for pancreatic pseudocysts in the past until other modalities such as endoscopic and percutaneous drainage emerged as viable alternatives. Endoscopic drainage is currently the preferred modality for drainage of pseudocysts unless indications for surgical intervention are present. Not all pancreatic pseudocysts require intervention, and most can be treated with supportive measures. Intervention is indicated if the patient is symptomatic or if complications are present.