Endoscopic Drainage of Pancreatic Pseudocysts

Abstract

Purpose: Pancreatic pseudocysts (PP) are the most common cystic lesion of the pancreas and commonly occur as a complication of acute or chronic pancreatitis. The etiology, age of presentation, and symptoms related to PP are varied. Presently, there are 3 forms of therapy available: percutaneous, surgical, and endoscopic drainage. Endoscopic drainage of PP may be trans-gastric, trans-enteric, or trans-papillary and may be performed via ERCP alone, via ERCP with EUS-assistance, or with EUS-guidance alone. Methods: A single-center, retrospective review was performed. From 2002 to 2005, 13 patients with a total of 14 PP underwent 14 endoscopic drainage procedures. One patient with a large, bi-lobed, communicating cyst was treated via two drainage techniques (trans-gastric and trans-duodenal). The median diameter of PP was 81 mm (range: 20 mm-240 mm). Etiology of PP was acute pancreatitis in 8 patients, acute-recurrent pancreatitis in 1 patient, and chronic pancreatitis in 5 patients. Indications for drainage included one or more of the following: abdominal pain, nausea and vomiting, or biliary obstruction. Mechanism of PP drainage was via cystduodenostomy in 5 patients and cystgastrostomy in 6 patients. Trans-papillary drainage alone was used in 4 patients with small cysts communicating with the pancreatic duct. ERCP alone was used in 3 procedures, ERCP with EUS-assistance in 6 procedures, and EUS-guided alone in 5 procedures. Mean patient age was 49 years (range: 14–73 years). Results: Successful drainage of PP was achieved in 12/13 patients (13/14 procedures). Trans-papillary PP drainage failed in one patient. After a median follow-up of 23.3 months (range: 1.5–40), 9 patients had complete resolution of PP and 2 patients developed partial recurrence of PP without symptoms. One patient developed infection that was successfully treated with antibiotics. No patient required additional drainage procedures for recurrent PP. One patient was lost to follow-up. The PP drainage success rates among the 3 endoscopic techniques did not appear to differ. Conclusions: In selected patients, endoscopic drainage of PP is a safe, minimally invasive, and highly effective procedure. This benefit is seen across a wide range of patients with respect to age and etiology of PP. In addition, the type of endoscopic drainage technique performed does not appear to have an affect on the outcome.