Endoscopic drainage of pseudocysts and abscesses in patients with acute and chronic pancreatitis

Abstract

Background: Endoscopic cystogastrostomy or cystoduodenostomy has been proposed as an alternative to surgical treatment in patients with chronic pancreatitis. Recently, endoscopic drainage of infected early pseudocysts or abscess has been performed also in patients with acute pancreatitis. The aim of our current study was to compare the technical success and complications in patients with endoscopic drainage of acute and chronic pancreatitis. Patients and methods: Over a period of 2 years (2005–2006), a total of 14 consecutive patients (7 males, 7 females, mean age: 60.4 years) with pancreatic pseudocysts or abscesses underwent endoscopic cystogastrostomy. After abdominal ultrasound and/or CT scan, the optimal puncture site and distance of the pancreatic fluid collections or pseudocysts was assessed with endoscopic ultrasound. After puncture of the pseudocyst with a specialized cystostom, we passed one or two plastic stents through the gastric wall into the cyst. Resolution of the pancreatitis and regression of the pseudocysts was monitored clinically and with repeated ultrasonography. Results: 9 patients had pseudocysts caused by acute pancreatitis versus 5 whose pseudocysts resulted from chronic pancreatitis. Technically successful drainage was achieved in 13/14 pts (92.8%). Complications of endoscopic treatment were encountered in one patient, in whom arterial bleeding required surgical intervention, but the patient later recovered. All of the 12 pts' pancreatic juice was collected for microbiological culture from the pseudocyst, with 9 positive results and supported by a targeted antimicrobial therapy. In 3 patients a nasocystic drain was also inserted and irrigated continuously. A nasojejunal feeding tube was inserted in all patients after endoscopic cystogastrostomy. Surgical necrosectomy was eventually needed in 3 patients. Only one patient died due to necrotizing pancreatitis. After 8–12 weeks of healing period the stents were removed. Conclusions: Endoscopic drainage provides a successful and safe minimally invasive approach to pancreatic pseudocyst management both in patients with acute necrotizing and in chronic pancreatitis