This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP). The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization. There was no significant difference between treatment success rate (risk difference RD -0.09; 95% confidence interval CI 0.20,0.01; P = .07), drainage-related adverse events (RD -0.02; 95% CI -0.04,0.08; P = .48), general adverse events (RD -0.05; 95% CI -0.12, 0.02; P = .13) and recurrence (RD: 0.02; 95% CI -0.04,0.07; P = .58) between surgical and endoscopic treatment.Regarding time of hospitalization, the endoscopic group had better results (RD: -4.23; 95% CI -5.18, -3.29; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: -4.68; 95% CI -5.43,-3.94; P < .00001). There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.