Table 2

Consensus statements on the optimal management of endoscopic ultrasonography (EUS)-guided pancreatic pseudocyst drainage

StatementsFinal level of agreementEvidence level
Indications for the procedure
1 Acute pseudocysts should be drained if they persist for more than 4–6 weeks, have a mature wall and are ≥6 cm in size, causing symptoms or complicationsAppropriate (9.0)Moderate
Optimal approach for drainage
2 EUS-guided drainage is the optimal drainage approach in uncomplicated pseudocysts that are located adjacent to the stomach or duodenumAppropriate (9.0)High
Pre-drainage evaluation
3 Pre-drainage evaluation includes CECT or MRCP and occasionally prior EUS to decide on the best approach for drainageAppropriate (9.0)Moderate
4 Multidisciplinary involvement including an endoscopist, interventional radiologist and surgeons is required in complicated cases to decide on the best approach to drainageAppropriate (9.0)Low
Pre-procedural preparations
5 Prophylactic antibiotics are recommended and should be continued post-procedurallyAppropriate (8.0)Low
Procedural considerations
6 The use of fluoroscopy is recommended during EUS-guided pseudocyst drainageAppropriate (9.0)Low
7 One or two plastic pigtail stents should be inserted to maintain the patency of the cystogastrostomy after EUS-guided drainageAppropriate (8.0)Moderate
8 The use of metallic stents for pancreatic pseudocyst drainage outside a clinical trial is not recommendedAppropriate (7.0)Moderate
9 The risk of pseudocyst recurrence may be increased in patients with pancreatic ductal disruptionAppropriate (9.0)Moderate
Adjunctive treatments
10 The insertion of a pancreatic ductal stent is suggested in patients with partially disrupted pancreatic ductsAppropriate (8.0)Moderate
11 The use of nasocystic catheters is recommended in large or infected pseudocystsAppropriate (8.0)High
Management of complications
12 Centres performing the procedure should have multidisciplinary support including interventional radiologist, surgeons and anaesthesiologist to prevent and manage complicationsAppropriate (9.0)Low
Competency and training
13 Skills in EUS-guided pseudocyst drainage are best acquired through observation, followed by hands-on training in the porcine model and then performance of the procedure in patientsAppropriate (7.0)Moderate
14 ERCP skills are beneficial to the endoscopist learning EUS-guided pseudocyst drainage and should be incorporated into the training programmeAppropriate (9.0)Low
15 Performance of 5–10 supervised procedures is required to gain competency in EUS-guided pseudocyst drainageAppropriate (7.0)Low
  • CECT, contrast-enhanced computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; MRCP, magnetic resonance cholangiopancreatography.