Hintergrund: Die Pankreaspseudozyste ist eine häufige Komplikation der akuten oder chronischen Pankreatitis. Bei symptomatischer Zyste mit Vorliegen von abdominellen Schmerzen, einer Magenausgangsstenose, Gewichtsverlust, Ikterus, Infektion oder Größenzunahme stellt die endoskopische Drainage (transpapillär und/ oder transmural) eine effektive Erstlinientherapie dar. Methode: Die Übersicht basiert auf einer strukturierten Analyse der aktuellen, in Pubmed gelisteten Studien. Ergebnisse: Die Langzeitregressionsraten liegen bei 71–90%; die Komplikationsrate beträgt 3–35% mit einer geringen Mortalität von 0–1%. Die wesentlichen Komplikationen der endoskopischen Pseudozystendrainage sind Blutungen in bis zu 9%, Infektionen in bis zu 8%, retroperitoneale Perforation in bis zu 5% und Zystenrekurrenz in bis zu 14% der Fälle. Differenziert zu betrachten sind die infizierte Nekrose und der Pankreasabszess (walled-off necrosis) nach akuter Pankreatitis. In diesen Fällen ist die endoskopische Therapie technisch komplexer und im Vergleich zur unkomplizierten Pankreaspseudozyste mit höherer Morbidität und geringerem Langzeitansprechen verbunden. Dennoch stellt die endoskopische Drainage bei technischer Machbarkeit für beide Entitäten die Methode der ersten Wahl dar. Dies basiert insbesondere auf der nach aktuellen Daten geringeren Morbidität der Methode im Vergleich zu chirurgischen Drainageverfahren. Schlussfolgerung: Der vorliegende Review gibt einen Überblick über Therapieindikation und Differenzialdiagnose von Pankreaspseudozysten, erläutert die Drainagetechniken und stellt die Daten zu Effektivität und Komplikationen der endoskopischen Zystendrainage umfassend dar.

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