BACKGROUND Endoscopic therapy of pancreatic pseudocysts has been reported mainly in small series. METHODS The results of endoscopic transpapillary cyst drainage (ETCD) were evaluated prospectively in 30 patients with pancreatic pseudocysts. RESULTS There were 24 men and 6 women with an average age of 45 years (SD 16). Twenty-eight had chronic pancreatitis (25 with alcoholic pancreatitis). Transpapillary cystopancreatic stents, with the tip into the cyst cavity, were inserted in 12 patients. Pancreatic stents with the tip as close as possible from the cyst cavity were inserted in the remaining 18 patients. Ten patients underwent an additional endoscopic cystenterostomy. The average duration of stenting was 4.4 months (range 15 days to 12 months). Patients were followed up for 15 months (range 2 to 60 months). All pseudocysts communicated with the pancreatic ductal system. The size of the pseudocysts ranged from 15 to 120 mm (average 50 mm). Pseudocysts were mainly located in the head of the pancreas (17 cases). Four minor complications occurred. There were no deaths. Twenty-six patients had pseudocyst resolution by ETCD, but 7 ultimately required surgery, 3 for early recurrence and 4 for failure of initial therapy. CONCLUSIONS ETCD appears to be a safe and efficient modality for the drainage of pancreatic pseudocysts communicating with the pancreatic ductal system.