EUS-guided drainage of pancreatic pseudocysts offers similar success and complications compared to surgical treatment but with a lower cost Angela Saul 1 • Miguel Angel Ramirez Luna 1,2 • Carlos Chan 2 • Luis Uscanga 2 • Francisco Valdovinos Andraca 1,2 • Jorge Hernandez Calleros 2 • Javier Elizondo 1 • Felix Tellez Avila 1,2 Received: 25 February 2015 / Accepted: 15 June 2015 Ó Springer Science+Business Media New York 2015 Abstract Background and aim Pancreatic pseudocysts (PPC) are a complication that occurs in acute and chronic pancreatitis. They comprise 75 % of cystic lesions of the pancreas. There are scarce data about surgical versus endoscopic treatment on PPC. The aim of this study was to compare both treatment modalities regarding clinical success, complication rate, recurrence, hospital stay and cost. Methods Retrospectively, data obtained prospectively from 2000 to 2012 were analyzed. A PPC was defined as a fluid collection in the pancreatic or peripancreatic area that had a well-defined wall and contained no solid debris or recognizable parenchymal necrosis. Clinical success was defined as complete resolution or a decrease in size of the PPC to 2 cm or smaller. Results Overall, 64 procedures in 61 patients were included: 21 (33 %) cases were drained endoscopically guided by EUS and 43 (67 %) cases were drained surgi- cally. The clinical success of the endoscopic group was 90.5 versus 90.7 % for the surgical group (P = 0.7), with a complication rate of 23.8 and 25.6 %, respectively (P = 0.8), and a mortality rate of 0 and 2.3 % for each group, respectively (P = 0.4). The hospital stay was lower for the endoscopic group: 0 (0–10) days compared with 7 (2–42) days in the surgical group (P \ 0.0001). Likewise, the cost was lower in the endoscopic group (P \ 0.001). The recurrence rate was similar in both groups: 9.5 and 4.5 % respectively (P = 0.59). The two recurrences found in the endoscopic group were associated with stent migration, and the recurrence in the surgical group was due to the type of surgery performed (open drainage). Conclusion Endoscopic treatment of PPC offers the same clinical success, recurrence, complication and mortality rate as surgical treatment but with a shorter hospital stay and lower costs. Keywords Pancreatic pseudocyst Á Endoscopic drainage Á Endoscopic ultrasound guidance Á Surgical treatment Background Pancreatic pseudocysts (PPC) are a complication that occurs in 5–15 % of acute pancreatitis [1–3] and in 26–40 % of chronic pancreatitis [4, 5]. They comprise 75 % of cystic lesions of the pancreas and result from inflammation, rupture or obstruction of the pancreatic duct [6]. The 30–60 % of & Angela Saul angelasaulp@gmail.com; angelasaulp@mail.com Miguel Angel Ramirez Luna mangelramirez@yahoo.com Carlos Chan carchan@prodigy.net.mx Luis Uscanga luis.uscangad@gmail.com Francisco Valdovinos Andraca valand_f@hotmail.com Jorge Hernandez Calleros jhcalleros@yahoo.com Javier Elizondo gelisaul@yahoo.com.mx Felix Tellez Avila felixtelleza@gmail.com 1 Department of Gastrointestinal Endoscopy, National Institute of Medical Sciences and Nutrition Salvador Zubira ´n, Mexico City, Mexico 2 Pancreas Clinic, National Institute of Medical Sciences and Nutrition Salvador Zubira ´n, Mexico City, Mexico 123 Surg Endosc DOI 10.1007/s00464-015-4351-2 and Other Interventional Techniques