Pancreatic Pseudocyst Drainage–Transpapillary or Transmural?

Abstract

Purpose: Endoscopic drainage by transpapillary (TP), transgastric (TG) and transduodenal (TD) route of the pseudocyst is available but there has been a paucity of data comparing the different endoscopic techniques in terms of overall success and complications. The primary aim of this study is to pool available data and provide an overall success rate stratified by the different endoscopic approaches. Methods: Pubmed search was performed by search phrase “Endoscopic pancreatic pseudocyst drainage.” Articles having incomplete data, surgical approaches, transcutaneous approaches were excluded. 7 articles were included for this study. We looked at the technical and overall success for each of the modalities (TP, TG, TD and mixed), including complications for the procedure. The pooled data was analyzed by transpapillary and transmural (TG+TD) approaches. Results: There were 323 pts in the 7 studies. The study period range from 1983–2000 with a mean follow up of 33.7 mths (22–43 mths). TP approach was performed in 115 patients with an overall success in 88 pts (77%). Transmural approach was performed in 183 pts with an overall success in 135 pts (74%). The overall success rate with these procedures is 75%. Outcome analysis was performed on 5 studies (1,2,5,6,7) TP v/s transmural approach (OR 1.35,95% CI 0.7–2.5).Total complications were reported in 63/323 patients (19%), with major complications being pancreatitis (6/323,1.8%), bleeding (17/323,5.2%) and infections (18/323,5.5%). There was only 1 (0.3%) reported mortality. Conclusions: Our pooled analysis reveals that there is no difference in the outcomes of the two approaches. Individual decisions for the route of drainage should depend on the anatomical considerations (ductal disruption, distance from lumen and location), technical feasibility and expertise.Prospective controlled trials are ideally indicated to define outcome between the two approaches.