Abstract
Endoscopic drainage for pancreatic pseudocysts are inferior to surgical drainage with regard to its success rate and the recurrence rate of the disease following the procedure; however, its results in lower morbidity compared to surgical and percutaneous procedures. In Japan, endoscopic drainage is now gaining popularity as it is less invasive than surgical drainage. It is accomplished via a transpapillary approach with endoscopic retrograde cholangiopancreatography or a transmural approach across the stomach or duodenal wall guided by endoscopic ultrasonography. The use of transpapillary drainage is indicated in cases in which the pseudocyst communicate with the main pancreatic duct structures and/or when impacted stones obstruct the main pancreatic duct. These cases correspond to type-II or type-III, respectively, according to D'Egidio's classification. An endoscopic nasopancreatic drainage (ENPD) tube was inserted and left in place for the first time and subsequently replaced with a pancreatic stent, if required. The ENPD tube should be inserted into the cyst cavity and left in places, if possible, or into the pancreatic duct with the tip as close as possible to the cyst beyond the structured segment. If transpapillary drainage is unsuccessful or ineffective, transmural drainage or surgical drainage should be performed immediately.
