Factors Predictive of Resolution in Pancreatic Pseudocyst Treated Endoscopically

Abstract

OBJECTIVE: Endoscopic pseudocyst management is well described, but no study has identified factors associated with pseudocyst resolution. METHODS: Between Jul 95 and Nov 03, all patients having endoscopic pseudocyst drainage were followed prospectively to complete resolution. Logistic regression analysis was performed on the following variables with regard to their ability to predict complete pseudocyst resolution (see table): age (≤65 or >65 years), gender, presence of bulge, diagnosis (alcoholic or not), collection type (acute or chronic), pancreatic intervention, jejunal feeding and complications. RESULTS: 118 patients (85 male, 33 female), mean age: 50 (range:18-86) were included. Median follow-up was 3 months (range:1-23) with long term enteral feeding given to 82 patients (69%) for a median time of 4 months (1-22). 102 patients (86%) had resolution of their collection confirmed by CT scan. Final etiology included 47 alcohol, 40 gallstone, 12 idiopathic, 7 hypertriglyceremia, 4 trauma, 3 pancreas divisum, 3 post surgery, 1 drug induced and 1 post ERCP pancreatitis. Drainage technique included 73 cystogastrostomy, 6 cystoduodenostomy, 29 transampullary drainage, 8 combined, and 2 cases aborted. Nineteen patients (16%) developed a complication: 3 bleeding, one responding to cautery, one requiring arterial embolization and one requiring surgery. Seven patients had endoscopic revision, three for superinfection of the collection and four for stent migration within the pseudocyst. Two others required luminal stent extraction one endoscopically and one surgically. Two also required surgery for either peritonitis or abscess post endoscopic drainage. Three patients developed pneumoperitoneum and one had retroperitoneal perforation managed conservatively. One patient died following disruption of the collection within the peritoneal cavity. The factor statistically associated with complete resolution of the pseudocyst was enteral feeding. CONCLUSION: Pancreatic pseudocyst can be effectively treated endoscopically. Long term resolution appears associated with enteral feeding. Further studies are required to confirm this data.