E Libby, J Taylor, D Mysh, et al. Combined laparoendoscopic cystgastrostomy 416 GASTROINTESTINAL ENDOSCOPY VOLUME 50, NO. 3, 1999 Combined laparoendoscopic cystgastros- tomy Eric D. Libby, MD, Jonathan Taylor, MD, Dmitry Mysh, MD, Steven D. Schwaitzberg, MD Treatments for large pancreatic pseudocysts con- tinue to evolve. These fluid collections traditionally have been drained by means of creation of large cyst- enterostomies in an open surgical approach. How- ever, percutaneous catheter drainage has proved to be an effective alternative for many patients with pseudocysts, and endoscopic drainage procedures have gained favor. The latter techniques have the advantages of decreased patient discomfort, more rapid recovery, and briefer hospitalizations. The ade- quacy of drainage achieved with these less-invasive techniques has been questioned, however, particularly for patients with residual debris in pseudocysts. 1 It is generally not feasible to obtain a biopsy specimen of the pseudocyst wall, which leaves open the possibility of inappropriate management of mucinous cystic lesions or other neoplastic conditions. Meanwhile, life-threatening hemorrhage, perforation, and infec- tion and the attendant mortality have been reported as complications of endoscopic drainage procedures. 2-5 From the Departments of Medicine and Surgery, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts. Reprint requests: Eric D. Libby, MD, New England Medical Center, 750 Washington St., Boston, MA 02111. Copyright © 1998 by the American Society for Gastrointestinal Endoscopy 0016-5107/99/$8.00 + 0 37/4/97946