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AIM: Pancreatic pseudocysts (PPC) as a complication of pancreatitis are approached only in the case of abdominal pain, infection, bleeding, and compression onto the gastrointestinal tract or biliary tree.METHODS: From 02/01/2002 to 05/31/2004, all consecutive patients with symptomatic PPC who underwent an interventional endoscopic approach were evaluated in this pilot case-series study: Group (Gr.) Ⅰ-Primary percutaneous (external), ultrasound-guided drainage. Gr. Ⅱ-Primary EUS-guided cystogastrostomy. Gr. Ⅲ-EUS-guided cystogastrostomy including intracystic necrosectomy.RESULTS: (="follow up": n = 27): Gr. Ⅰ (n = 9; 33.3%):No complaints (n = 3); change of an external into an internal drainage (n = 4); complications: (a) bleeding (n = 1)followed by 3 d at ICU, discharge after 40 d; (b) septic shock (n = 1) followed by ICU and several laparotomies for programmed lavage and necrosectomy, death after 74 d.Gr. Ⅱ (n = 13; 48.1%): No complaints (n = 11); external drainage (n = 2); complications/problems out of the 13cases: 2nd separate pseudocyst (n = 1) with external drainage (since no communication with primary internal drainage); infection of the residual cyst (n = 1) + following external drainage; spontaneous PPC perforation (n = 1) +following closure of the opening of the cystogastrostomy using clips and subsequently ICU for 2 d. Gr. Ⅲ (n = 5;18.5%): No complaints in all patients, in average two ehdoscopic procedures required (range, 2-6).CONCLUSION: Interventional endoscopic management of pancreatic pseudocysts is a reasonable alternative treatment option with low invasiveness compared to surgery and an acceptable outcome with regard to the complication rate (11.1%) and mortality (3.7%), as shown by these initial study results.