A Retrospective Study of Pancreatic Pseudocyst Management

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Purpose: Pancreatic pseudocysts (PP) can be managed by surgery, EUS (endoscopic ultrasound) and CT-guided drainage. There is scant data on the clinical outcomes and the cost of these three procedures. Aim: To study the characteristics of clinical outcomes concerning EUS, Surgical and CT guided techniques of PP drainage, and associated direct cost of hospitalization. Methods: Chart review by searching UMass Memorial Medical Center database between June 2005 and April 2011 was done for all patients with PP who had drainage. Patients were classified on basis of initial procedure. Main outcome is treatment success which was defined as complete resolution or decrease in size of PP to 2 cm, in association with clinical resolution of symptoms at 6 week follow up. Re-intervention was defined as need for repeated procedure because of persistent symptoms with a residual PP more than 4 cm. Direct cost in U.S. dollars included all charges for hospital stay from day of admission to discharge. Results: 58 patients were identified, 19, 31 and 8 patients in EUS, CT and Surgery groups. Clinical characteristics are described in Table 1. CT guided group is slightly older than 2 groups p = 0.02. Albumin level in surgical group is slightly lower than other 2 groups p = 0.03. Mean WBC count is similar for all three groups p = 0.12. Treatment success rate was 74%,54%,62% in EUS, CT and surgical groups respectively p = 0.013. Treatment success rate is highest in PP located in the head and lowest in body there is no statistical difference chi = 7.37 p = .117. Success rate of tail PP drainage in EUS group was 83.3%. Reintervention rate was 36%,33%,50%, in EUS, CT, and surgery groups respectively. Complications were observed in 31%, 12% and 25% in EUS, CT and surgical groups respectively. Total length of stay was significantly different in the three groups 12, 31 and 56 days in EUS, CT and surgery groups respectively. Average cost of hospital stay for patients in EUS group $91186 was less when compared with CT groups $279393 and surgical $458455 p<0.0001.Table 1: . No Caption available.Conclusion: This study shows reasonable success rates in all three modalities when compared to recent studies. EUS guided drainage is increasingly accepted as an initial step in management considering success rate, cost and complications obviating the need for surgery. On average, length of hospital stay and associated cost for patients who were admitted and had PP drainage is very high, which were due to multiple co-morbidities. Major study limitation is lack of stratification based on severity of condition and underlying co-morbidities. A large randomized study is needed to better evaluate and compare costs and outcomes of these three modalities.Table 2: . No Caption available.