{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:24:21Z","timestamp":1792167861936,"version":"4.4.0"},"reference-count":152,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Pancreatic pseudocysts (PPs) and walled-off necrosis (WON) are two distinct sequelae of acute and chronic pancreatitis, requiring accurate differentiation to guide appropriate management. Computed tomography (CT) and magnetic resonance imaging (MRI) remain essential for distinguishing PPs from WON, assessing their content, and identifying potential complications. Endoscopic ultrasound (EUS) has emerged as a key modality for both diagnosis and drainage planning, offering high-resolution imaging and the possibility of real-time aspiration. Management strategies have evolved significantly, shifting from surgical to minimally invasive approaches. Endoscopic drainage, including EUS-guided transmural drainage with double-pigtail or lumen-apposing metal stents (LAMS), has become the preferred strategy for symptomatic or infected collections. Endoscopic necrosectomy is increasingly performed for WON, providing a less invasive alternative to surgical debridement. However, patient selection and procedural techniques remain topics of ongoing debate. The aim of this review is to provide a comprehensive synthesis of current evidence regarding the diagnosis and management of pancreatic pseudocyst and walled-off necrosis. We will synthesize current evidence on diagnostic criteria, imaging modalities, and therapeutic algorithms for PPs and WON. We will discuss technical aspects, success rates, and complications associated with drainage modalities, comparing endoscopic, percutaneous, and surgical approaches. Special attention will be given to recent advancements in interventional endoscopy and their impact on patient outcomes. By integrating clinical insights with the latest literature, this review aims to provide an up-to-date reference for clinicians managing pancreatic fluid collections. A literature search was performed using PubMed, Scopus, Web of Science, and MEDLINE databases to identify relevant studies on diagnostic criteria, imaging techniques, and management strategies.<\/jats:p>","DOI":"10.3390\/jcm14217818","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T19:30:27Z","timestamp":1762198227000},"page":"7818","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Clinical, Radiological, and Endoscopic Features of Pancreatic Pseudocyst and Walled-Off Necrosis: How to Diagnose and How to Drain Them"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9395-5468","authenticated-orcid":false,"given":"Giuseppe","family":"Dell\u2019Anna","sequence":"first","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy"},{"name":"Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy"},{"name":"Unit\u00e9 d\u2019Endoscopie Interventionnelle, H\u00f4pital Priv\u00e9 des Peupliers, 75013 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5556-6259","authenticated-orcid":false,"given":"Salvatore","family":"Lavalle","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Biamonte","sequence":"additional","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy"},{"name":"Istituti Ospedalieri Bergamaschi, 24046 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Fanizza","sequence":"additional","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy"},{"name":"Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0810-409X","authenticated-orcid":false,"given":"Edoardo","family":"Masiello","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy"},{"name":"Radiology Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0895-1225","authenticated-orcid":false,"given":"Angelo","family":"Bruni","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, 40100 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9931-7221","authenticated-orcid":false,"given":"Francesco Vito","family":"Mandarino","sequence":"additional","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy"},{"name":"Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6515-7960","authenticated-orcid":false,"given":"Paoletta","family":"Preatoni","sequence":"additional","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Azzolini","sequence":"additional","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6929-4276","authenticated-orcid":false,"given":"Jahnvi","family":"Dhar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Punjab Institute of Liver and Biliary Sciences, Mohal 160062, India"},{"name":"Department of Gastroenterology, Post 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Dell\u2019Anna","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, University of Salento, Piazza Tancredi 7, 73100 Lecce, Italy"},{"name":"Endoscopy Unit, Department of Surgery, Vito Fazzi Hospital, Piazza Filippo Muratore 1, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4036-6819","authenticated-orcid":false,"given":"Marcello","family":"Spampinato","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Surgery, Vito Fazzi Hospital, Piazza Filippo Muratore 1, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4992-9289","authenticated-orcid":false,"given":"Marcello","family":"Maida","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, 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Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Fuccio","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, 40100 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Donatelli","sequence":"additional","affiliation":[{"name":"Unit\u00e9 d\u2019Endoscopie Interventionnelle, H\u00f4pital Priv\u00e9 des Peupliers, 75013 Paris, France"},{"name":"Department of Clinical Medicine and Surgery, University of Naples \u201cFederico II\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7341-1351","authenticated-orcid":false,"given":"Silvio","family":"Danese","sequence":"additional","affiliation":[{"name":"Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy"},{"name":"Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1001\/archsurg.1993.01420170122019","article-title":"A clinically based classification system for acute pancreatitis. 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