Pancreatic pseudocysts and walled-off necrosis are late pancreatic fluid collections that may complicate acute or chronic pancreatitis or pancreatic trauma. Endoscopic drainage has taken over as the reference technique due to its minimally invasive nature and high success rates reported in international studies.

The objective of our study was to evaluate the technical, clinical and radiological outcomes of endoscopic drainage of pancreatic pseudocysts in a tertiary center.

We conducted a retrospective monocentric study at our endoscopy unit including patients who underwent endoscopic drainage of pancreatic pseudocysts between 2017 and 2024. Epidemiological, clinical, endoscopic, radiological data and follow-up outcomes were collected.

In total, 58 patients were enrolled with a mean age of 47 years [range 9–73] and a male predominance (sex ratio M/F = 1.5). Most pseudocysts were secondary to acute pancreatitis in 86% of cases (N=50), followed by chronic pancreatitis in 10% (N=6). The average size of the cysts was 92 mm [20–170]. These pseudocysts were mostly single in 79% (N = 46). Endoscopic ultrasound guided drainage was performed in 45% of cases (N=26), while classical or cystotome assisted techniques were used in the remainder. Plastic double pigtail stents were placed in 65% of patients (N=38) and lumen apposing metal stents in 15% (N=9). Technical success was achieved in 94% (N=47), clinical success in 80% (N=40) and radiological success in 77.5% (N=31). A moderate positive correlation was found between clinical and radiological success (Pearson r = 0.50, p = 0.002). Complications occurred in 6% of patients (N=3), limited to minor events such as stent migration, secondary infection or minor intrakystic bleeding, with no severe adverse outcomes.

Endoscopic drainage of pancreatic pseudocysts achieved high success rates in our cohort, comparable to international data. Endoscopic ultrasound guidance and dedicated stents improved safety and efficacy, and careful patient selection remains essential to minimize complications.