Of 93 endoscopic drainage procedures of pancreatic pseudocysts carried out since 1985, at least 50% were of lasting success. The authors' approach is explained with a review of the literature on various drainage techniques. We consider the puncture of a pseudocyst justified only on clinical grounds: the patient's complaints rather than morphological criteria lead to the decision to perform a drainage procedure. Obligatory in the therapeutic concept are ERCP and endosonography. Visualization of a pancreatico-cystic communication leads to the attempt of transpapillary drainage as the therapy of choice. Visualization of anatomic details, namely vessels, lowers the risk of punctures. Direct punctures even in difficult anatomical conditions can be attempted under direct endosonographic control. In our hands, drainage of pseudocysts is a part of the endoscopic treatment concept for chronic pancreatitis and is generally preferred to surgical techniques.