The optimal drainage strategy for symptomatic pancreatic pseudocysts in the setting of chronic pancreatitis remains controversial. Endoscopic therapy has evolved as a primary treatment modality for drainage of these symptomatic pancreatic pseudocysts. Although there are no prospective comparative data between endoscopic, percutaneous (radiological), and surgical drainage of pancreatic pseudocysts, endoscopic therapy appears to have acceptable success, recurrence, and complication rates to be considered first-line therapy. The endoscopic approach of placing stents may be performed through a transpapillary (through the papilla), or transmural (transgastric or transduodenal) approach. Transpapillary drainage is performed when a clear communication between the pseudocyst and the main pancreatic duct exists. Transmural entry and drainage may be performed using a variety of techniques, with or without the use of endoscopic ultrasound guidance. Transduodenal drainage of pancreatic pseudocysts appears to be associated with a lower recurrence rate than transgastric drainage, probably because of the creation of a permanent internal drainage tract. This article summarizes the techniques of endoscopic therapy for draining symptomatic pancreatic pseudocysts arising in the setting of chronic pancreatitis. © 1999 W.B. Saunders Company.