Endoscopic Drainage of Giant Pancreatic Pseudocysts Using Both Lumen-Apposing Metal Stent and Plastic Stent: A Report of Two Cases and Review of the Current Literature.

Hussam I A Alzeerelhouseini,Hazem A Ashhab,Sadi A Abukhalaf,Mohammad N Elqadi,Muawiyah Elqadi,Yoshifumi Nakayama

doi:10.1155/2021/6610610

Hussam I A Alzeerelhouseini, Hazem A Ashhab + Show 4 more

Open Access

https://doi.org/10.1155/2021/6610610

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Abstract

Introduction A pancreatic pseudocyst (PP) with major diameter equal to 10 cm or more is called a giant pseudocyst. The ideal management for giant PPs is controversial. Endoscopic drainage is an alternative nonsurgical approach for PP management. Only a few cases of giant PPs were reported to be managed by endoscopic drainage. Case Presentation. We reported two cases of giant PPs following an episode of acute pancreatitis. Both were resolved following endoscopic cystogastrostomy using metallic and double-pigtail stents with excellent outcomes. There was no history of recurrence or complications on follow-up. In addition, we extensively reviewed all available literature studies of giant pancreatic pseudocyst presentation, management, and complications. We summarized all reported cases and presented them in a comprehensive table. Conclusion The endoscopic cystogastrostomy approach is cost saving, can avoid surgical complications, and offers an early hospital discharge.

Highlights

A pancreatic pseudocyst (PP) with major diameter equal to 10 cm or more is called a giant pseudocyst. e ideal management for giant PPs is controversial
Pancreatic pseudocysts are collections of high concentrations of digestive enzymes in the retroperitoneum or the peripancreatic tissue planes that are lined by fibrous tissues and may contain necrotic debris or blood but lack a true epithelial lining [2]
PPs’ incidence is relatively low [29], and they are more in chronic pancreatitis compared to acute pancreatitis [30]

Summary

Introduction

Pancreatic pseudocyst (PP) is a peripancreatic fluid collection (PFC) and is a well-known complication of pancreatic diseases. Symptomatic, persistent, large, or complicated pseudocysts require internal drainage [4, 5]. Endoscopic drainage of PPs is an alternative nonsurgical approach. Since the first reports by Sahel et al [8] and Cremer et al [9], endoscopic drainage of PPs has become an established procedure; it entails the creation of a fistulous tract between the PP and the gastric lumen (cystogastrostomy) or duodenal lumen (cystoduodenostomy) [8, 9]. We describe two cases in which giant pancreatic pseudocysts were resolved following endoscopic cystogastrostomy. A few cases of giant pancreatic pseudocysts were found in the literature review

Case Presentation

Findings

Discussion