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Pancreatic Pseudocyst — RACP Adult Medicine MCQ

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HardGastroenterologyPancreatic PseudocystRACP Adult Medicine

A 45-year-old man with chronic pancreatitis has recurrent episodes of severe epigastric pain despite abstinence from alcohol, analgesics, and PERT. CT shows a 6 cm pancreatic pseudocyst communicating with the main pancreatic duct, causing gastric outlet obstruction. What is the most appropriate management?

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Correct answer: D — ERCP with sphincterotomy

A large symptomatic pancreatic pseudocyst causing gastric outlet obstruction requires drainage. Options include endoscopic drainage (EUS-guided cystogastrostomy), ERCP with transpapillary drainage if duct communication exists, or surgical cystojejunostomy. For ductal communication, ERCP with pancreatic duct stenting and sphincterotomy can decompress the duct and pseudocyst.

Reference: GESA – 2024 – Chronic Pancreatitis Complications; ESGE 2024