Drainage Of Pancreatic Pseudocysts Research Articles

S97 Comparative Analysis of Endoscopic and Surgical/Radiological-Guided Drainage of Pancreatic Pseudocysts: A Population-Based study

S97 Comparative Analysis of Endoscopic and Surgical/Radiological-Guided Drainage of Pancreatic Pseudocysts: A Population-Based study

WONDER-02: plastic stent vs. lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic pseudocysts—study protocol for a multicentre randomised non-inferiority trial

BackgroundEndoscopic ultrasound (EUS)-guided transluminal drainage has become a first-line treatment modality for symptomatic pancreatic pseudocysts. Despite the increasing popularity of lumen-apposing metal stents (LAMSs), plastic stents may resolve non-necrotic fluid collections effectively with lower costs and no LAMS-specific adverse events. To date, there has been a paucity of data on the appropriate stent type in this setting. This trial aims to assess the non-inferiority of plastic stents to a LAMS for the initial EUS-guided drainage of pseudocysts.MethodsThe WONDER-02 trial is a multicentre, open-label, non-inferiority, randomised controlled trial, which will enrol pancreatic pseudocyst patients requiring EUS-guided treatment in 26 centres in Japan. This trial plans to enrol 80 patients who will be randomised at a 1:1 ratio to receive either plastic stents or a LAMS (40 patients per arm). In the plastic stent group, EUS-guided drainage will be performed using two 7-Fr double pigtail stents. In the LAMS group, the treatment will be performed in the same way except for LAMS use. The step-up treatment will be performed via endoscopic and/or percutaneous procedures at the trial investigator’s discretion. The primary endpoint is clinical success, which is defined as a decrease in a pseudocyst size to ≤ 2 cm and an improvement in inflammatory indicators (i.e. body temperature, white blood cell count, and serum C-reactive protein). Secondary endpoints include technical success, adverse events including mortality, pseudocyst recurrence, and medical costs.DiscussionThe WONDER-02 trial will investigate the efficacy and safety of plastic stents compared to a LAMS in EUS-guided treatment of symptomatic pancreatic pseudocysts with a particular focus on the non-inferior efficacy of plastic stents. The findings will help establish a new treatment algorithm for this population.Trial registrationClinicalTrials.gov NCT06133023 registered on 9 November 2023. UMIN000052647 registered on 30 October 2023. jRCT1032230444 registered on 7 November 2023.

Endoscopic Drainage of Pancreatic Pseudocysts: Clinical Profile and Outcome Analysis.

Pancreatic pseudocyst is a complication of acute and chronic pancreatitis. Although surgery considered the gold standard, there is a rapid shift towards endoscopic treatment owing to its therapeutic outcome and minimal invasive involvement. This study aims to present the clinical profile and outcome analysis of the endoscopic drainage of pancreatic pseudocysts in Dhulikhel Hospital. This is a retrospective review of all patients who were diagnosed with pancreatic pseudocyst between January 2015 and December 2018 in Dhulikhel Hospital. The retrospective data were on patient characteristics, etiology, location of the cyst, other clinical characteristics. The study included 51 patients and the average age of the patients in this study was 39 years and among them 62.7% were female. The mean size of pseudocyst was 7.89 cm, and the average days of hospital stay was 13.64. The most common etiology was idiopathic and more than half of the patient's cyst was in head and/or body, 15 and 36 underwent conservative and therapeutic management respectively. The technical success rate was at 94% and reported increased pancreatic pseudocyst in Dhulikhel Hospital from 2015-18. The study findings highlight the increased trend of pancreatitis pseudocyst as a complication of acute or chronic pancreatitis. Endoscopic drainage of pseudocyst with plastic stent is an established method of managing it. However, pancreatic pseudocyst even larger than 6 cm can undergo spontaneous resolution.Hence, conservative management should be considered first.

Cost-Effectiveness in Alternative Treatment Options for Pancreatic Pseudocysts

Background and Objectives: Pancreatic pseudocysts often arise as complications of pancreatitis and present unique challenges in clinical management, encompassing considerations for both technical aspects and financial implications. Before the advancements of invasive gastroenterology, pancreatic pseudocysts have been drained surgically for many years. Nowadays, we have less invasive techniques with higher efficiency and lower mortality rates, however, they remain cost-challenging for most countries. Materials and Methods: We present four patients (two males and two females) with pancreatic pseudocysts who underwent endoscopic ultrasound-guided transgastric drainage using plastic stents accompanied by a standard lavage protocol using a nasocystic catheter. Results: All four patients had successful outcomes, and a follow-up at 6 months revealed no traces of the pseudocysts or any significant long-term complications. One acute complication (arterial bleeding) and one late complication (stent migration) were observed. As the study aimed to present a cheaper option for draining pancreatic pseudocysts, we investigated and compared costs for the materials we utilized and those associated with lumen-apposing metal stents. Upon compiling the data, a notable advantage was evident in favour of our method. Conclusions: While EUS-guided drainage of pancreatic pseudocysts using lumen-apposing metal stents (LAMSs) represents a high-end strategy for treating pancreatic pseudocysts, our method demonstrates better cost-effectiveness without compromising efficacy.

Difficult management of pancreatic pseudocyst drainage in a 4-year-old child.

Difficult management of pancreatic pseudocyst drainage in a 4-year-old child.

Neutrophil Gelatinase-Associated Lipocalin for the Differentiation of Mucinous Pancreatic Cystic Lesions.

Undetermined pancreatic cystic lesion (PCL) differentiation benefits from endoscopic ultrasound (EUS) based on morphology and cyst fluid analysis, but room for new biomarkers exists. Our aim was to assess the intracystic and serum diagnostic value of neutrophil gelatinase-associated lipocalin (Ngal) and interleukin 1 beta (IL-1β) for differentiation of PCLs. This prospective study included patients from one tertiary hospital, evaluated between April 2018 and May 2020. EUS fine-needle aspiration or pancreatic pseudocysts drainage was the source of PCL intracystic liquid. The final diagnosis was based on surgery or EUS results (morphology, cytology, glucose, and CEA-carcinoembryogenic antigen). The intracystic samples were tested for Ngal, IL-1β, glucose, and CEA, and serum for Ngal and IL-1β. We evaluated 63 cysts, 33 pseudocysts, and 30 non-inflammatory cysts. The diagnostic sensitivity and specificity for mucinous PCL was 70.8% and 92.3% for intracystic Ngal (cut-off: 500-800 ng/dL), without correlation with serum Ngal, no matter the inclusion of infected pseudocysts. After exclusion of infected pseudocysts, the sensitivity and specificity for glucose were 87% and 75%, respectively, and for CEA, they were 87.1%, and 96.8%, respectively. Intracystic Ngal shows promise in differentiating mucinous PCLs, but researchers need to conduct further studies to confirm its effectiveness. Intracystic IL-1β and serum Ngal made no diagnostic contribution.

Forward viewing liner echoendoscopy for therapeutic interventions.

Therapeutic endoscopic ultrasonography (EUS) procedures using the forward-viewing convex EUS (FV-EUS) have been reviewed based on the articles reported to date. The earliest reported procedure is the drainage of pancreatic pseudocysts using FV-EUS. However, the study on drainage of pancreatic pseudocysts focused on showing that drainage is possible with FV-EUS rather than leveraging its features. Subsequently, studies describing the characteristics of FV-EUS have been reported. By using FV-EUS in EUS-guided choledochoduodenostomy, double punctures in the gastrointestinal tract can be avoided. In postoperative modified anatomical cases, using the endoscopic function of FV-EUS, procedures such as bile duct drainage from anastomosis, pancreatic duct drainage from the afferent limb, and abscess drainage from the digestive tract have been reported. When a perpendicular puncture to the gastrointestinal tract is required or when there is a need to insert the endoscope deep into the gastrointestinal tract, FV-EUS is considered among the options.

Surgical and Endoscopic Intervention for Chronic Pancreatitis in Children: The Kings College Hospital Experience.

Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a primary cause such as a pancreaticobiliary malunion or to deal with secondary complications such as chronic pain. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are two endoscopic modalities that have an established diagnostic role in paediatric CP, and their therapeutic utilisation is increasing in popularity. Surgical decompression of the obstructed and dilated pancreatic duct plays a role in alleviating pancreatic duct hypertension, a common association in CP. Surgery equally has a role in certain anatomical abnormalities of the pancreaticobiliary draining system, or occasionally in some CP complications such as drainage of a symptomatic pancreatic pseudocyst.

A Retrospective Study on Comparison Between Surgical and Endoscopic Management of Pancreatic Pseudocyst and Walled-off Pancreatic Necrosis

BACKGROUND: Surgical management is the standard approach for pancreatic pseudocyst and walled off pancreatic necrosis. With newly evolving procedures and a comprehensive approach, management of walled off pancreatic necrosis and pancreatic pseudocyst is taking a new turn. A multi-centric study comparing surgical and endoscopic management of pancreatic pseudocyst and walled off pancreatic necrosis was performed. METHODS: Data was collected retrospectively from multiple centers and patients were followed up till date since the time of intervention. The outcomes were therapeutic success, post-operative complications, recurrence rate, mortality and duration of hospitalization. RESULTS: At the end of the follow-up period, none of the patients who received endoscopic intervention had a recurrence, compared to 2 patients in the surgical group. There was 16.67% mortality in the surgical group and only 3.33% mortality in the endoscopic group. Significantly high mortality was seen in the patients with Walled-Off Pancreatic Necrosis treated surgically, compared to no mortality in the patients treated endoscopically. 86 % of the patients in the endoscopic group had resolution of the disease following intervention compared to 70% in the other group. There were no statistically significant differences in mortality, resolution or recurrence of disease following intervention between the two groups. However, the length of hospital stay was significantly shorter for patients who underwent endoscopic intervention than open surgery. CONCLUSION: Endoscopic drainage of Pancreatic Pseudocysts and Walled off Pancreatic necrosis have demonstrated a therapeutic success rate, mortality and recurrence statistically comparable to that seen in surgical treatment, but with reduced time of hospitalization, supporting its use as the preferred initial modality for drainage.

Surgical Drainage of Pancreatic Pseudocyst

• A pancreatic pseudocyst is an encapsulated collection of homogenous fluid with little or no necrotic tissue within it. It is usually well circumscribed and located outside of the pancreas, often in the lesser sac. • Regardless of the cause, the overall incidence of pseudocysts is low; 0.5 to 1 per 100,000 adults per year. • Pancreatic pseudocysts are often seen as a complication of chronic pancreatitis and less commonly from acute pancreatitis • The incidence of pseudocysts is higher in males as it follows the incidence of pancreatitis, which is slightly male predominant. • In acute pancreatitis, the incidence of pseudocysts ranges from 5% to 16%. • Pseudocysts tend to be more common in the setting of chronic pancreatitis, with incidence rates between 20% to 40%. • The majority of the cases were alcohol-induced (70%) followed by biliary tract disease (8%), trauma (6%), and the remaining attributed to the idiopathic cause. • Symptoms of pseudocysts are typically non-specific and may present only with vague abdominal pain, nausea, or vomiting. • A contrast-enhanced CT scan of the abdomen is the diagnostic modality of choice. • Most pseudocysts resolve spontaneously, and treatment is usually conservative with supportive care. • In general, larger cysts are more likely to become symptomatic or cause complications. • Potential complications include infection, hemorrhage, pseudocyst rupture, and disruptions of the pancreatic duct system.

Transpapillary Drainage of Pancreatic Pseudocyst via Minor Ampulla in a Patient with Acquired Pancreas Divisum: Case Report

Transpapillary Drainage of Pancreatic Pseudocyst via Minor Ampulla in a Patient with Acquired Pancreas Divisum: Case Report

S161 Outcomes of Endoscopic Drainage of Pancreatic Pseudocysts in Patients With COVID-19: Sepsis Is a Poor Prognostic Marker

S161 Outcomes of Endoscopic Drainage of Pancreatic Pseudocysts in Patients With COVID-19: Sepsis Is a Poor Prognostic Marker

381 A Rare Case of CBD obstruction secondary to Endometriotric cyst

Abstract Background Bile flow obstruction due to bilary tree pathology is well documented. Intramural causes include gallstones and infections such as clonorchis sinensis and Ascaris Lumbriocodes1 mural causes include autoimmune diseases e.g Sclerosing cholangitis. Extrinsic compression are usually due to malignancy e.g Cholangiocarcinoma or pancreatic head carcinoma. we encountered a rare case of common bile duct (CBD) obstruction cause by large endometriotic cyst. Case report A fit & well, 85 year old female presented with gradual onset of Obstructive jaundice. admission Liver function tests indicated a Bilirubin of 485 subsequent Ct scan revealed a large endometriotic Cyst (15cm x10 cm) indenting the CBD and stomach. Endoscopic ultrasound confirmed the presence of a large cystic fluid collection. Patient`s biliary system was indirectly decompressed with AXIOSTM via gastric wall into cyst Copious dark brown non-viscous fluid was drained into stomach. Cytology results reported benign cyst contents without mucin or neoplastic epithelial cells. Fluids Amylase was 121 U/L. the patient recovered well, with resolution of Bilirubin. Discussion Endometriotic cyst have been reported to cause organ obstruction such as CBD and ureter1,2 patient's from previously reported cases had to endure major surgery to achieve symptomatic relief. AXIOSTM stent is a device commonly utilized for drainage of pancreatic pseudocyst and we report the use of it as a Novel and minimally invasive technique in this rare case of CBD obstruction.

Principles of diagnosis and choice of treatment tactics for patients with pancreatic-pleural fistulas

Introduction. Pancreatic-pleural fistula is a rare complication of pancreatitis that has no pathognomonic symptoms and unified approaches to the choice of treatment tactics.The aim of the study was to formulate the principles of diagnosis and choice of treatment tactics in patients with pancreatic-pleural fistulas.Materials and methods. Five patients with pancreatic-pleural fistulas were treated from 2012 to 2022. All patients underwent standard clinical-laboratory and instrumental methods of investigation.Results. The diagnosis of pancreatic-pleural fistula was made at 18−65th day from the disease on the basic of amylase activity in the pleural effusion from 29462 to 51328 U/L. Surgical treatment consisted of pleural cavity and pancreatic pseudocyst drainage in two patients, in one patient we performed pleural cavity drainage and Virsung’s duct stenting, one patient underwent pancreatic duct stenting and repeated pleural punctures, one patient had papillosphincterotomy, video-thoracoscopy and pleural cavity drainage. Discussion Diagnosis of pancreatic-pleural fistulas is based on a set of criteria: history of acute attacks or exacerbation of chronic pancreatitis, presence of pancreatic pseudocyst, recurrent hydrothorax, brown pleural effusion, and high amylase activity in it. Surgical treatment tactics can be staged and characterized by the principle “from simple to complex”.Conclusion. The diagnostic algorithm of pancreatic-pleural fistulas is based on the data on acute pancreatitis, recurrent hydrothorax, hemorrhagic nature of the effusion and high level of amylase in it. The choice of surgical treatment tactics implies combination of pleural cavity drainage with Virsung’s duct stenting, as well as external drainage of pancreatic pseudocyst (if any).

Experience of transmural endoscopic drainage in treatment of pancreatic pseudocysts

Objective. To evaluate the possibilities of transmural endoscopic drainage in the treatment of postnecrotic pancreatic pseudocysts in the immediate and long-term periods. Materials and methods. From 2018 to 2022, a transmural endoscopic drainage method was used in the treatment of 36 patients with pancreatic pseudocysts at Perm Regional Clinical Hospital. The results were evaluated in the immediate postoperative period, 47 months before the removal of the stent and 14 years by the complaints of patients, blood amylase content, the results of ultrasound and CT examination of the abdominal cavity. Results. Two-three days after the endoscopic intervention, the cyst completely disappeared in 30.56 % of patients, decreased by half or more of the diameter in 63.89 % and only in 5.56 % decreased slightly. After 14 years, the absence of cysts was registered in 80 %, small diameter (from 15 to 24 mm) in 10 %. Pancreatic cysts persisted in three patients (10 %). Statistical analysis showed that the wider was the main pancreatic duct and the higher the blood amylase level before transmural endoscopic drainage, the poorer was the treatment result. Conclusions. Transmural endoscopic drainage of pancreatic pseudocysts makes it possible to achieve complete disappearance or significant reduction in the size of pancreatic cysts a year or more after the intervention in 90 % of cases. The clinical result of transmural endoscopic drainage in the treatment of pancreatic pseudocysts depended on the initial width of the main pancreatic duct and the level of blood amylase.

Endoscopic ultrasound-guided pancreatic pseudocyst drainage using a drill dilator.

Endoscopic ultrasound-guided pancreatic pseudocyst drainage using a drill dilator.

A new page in the literature of pancreatic pseudocyst: case report on perirenal pseudocyst presenting as page kidney

BackgroundPancreatic pseudocysts are fluid collections encapsulated by a fibrous wall. They can dissect along any path of least resistance due to extravasation of enzymatic secretions into pancreatic and peripancreatic tissues. Pseudocysts extending into perirenal space are rarely encountered with paucity of data on the occurrence of secondary page kidney. We report one such rare case of pancreatic pseudocyst in the subcapsular plane of left kidney communicating with main pancreatic duct resulting in page kidney phenomenon due to compression. We discuss this case with emphasis on early identification and management of perirenal pancreatic pseudocyst, and to salvage the renal function.Case presentationAn 83-year-old chronic alcoholic male presented with complaints of abdominal pain, generalized weakness, dyspnea and loss of appetite since 2 weeks. On admission, he was diagnosed with newly detected hypertension. Patient was subjected to ultrasound and CECT abdomen and pelvis, which suggested acute pancreatitis and perirenal pseudocyst showing patent communication with main pancreatic duct resulting in decreased renal cortical opacification. Ultrasound-guided fluid aspiration of the perirenal cyst was performed, which showed significantly elevated amylase and lipase levels with inflammatory cells, hinting at pancreatic origin. Subsequently, percutaneous drainage of the cyst was done.ConclusionsPancreatic pseudocysts at distant and atypical locations pose a diagnostic and therapeutic dilemma to the treating physician. Accurate clinical and radiological diagnosis of perirenal pseudocysts is extremely challenging. Early drainage of perirenal pancreatic pseudocyst prevents renal damage with subsequent pancreatic duct stenting avoiding its recurrence. Hence, it is of utmost importance as a radiologist to detect this uncommon complication at the earliest and guide the clinicians for efficient management.

Technical and Clinical Outcomes of Using a Single Wide-Caliber Double-Pigtail Stent for Endoscopic Ultrasound-Guided Pancreatic Pseudocyst Drainage: A Multicenter Prospective Study

Introduction: Endoscopic ultrasound (EUS)-guided pancreatic cysto-gastrostomy/duodenostomy is the current accepted practice for management of symptomatic pancreatic pseudocysts with insertion of two or more double-pigtail (DP) stents. There is no much work on the efficacy of using a single wide-caliber DP stent, aiming to decrease the time, complications, and accessories used in the procedure. Aim of the Work: The aim of this study was to assess technical and clinical outcomes of using a single wide-caliber DP stent in EUSguided pancreatic pseudocyst drainage. Methodology: This multicenter prospective study included 57 patients, from which the 35 patients with symptomatic pancreatic pseudocysts enrolled. Patients with cysts with multiple septations (7 cases) or cyst with >30% necrosis (8 cases) of the cyst content and patients with generalized ascites (4 cases) or patients with major comorbidities (3 cases) were excluded. Patients were followed up within 1 month and 6 months after stent placement to assess complete resolution or a decrease in the sizes of cysts with clinical symptomatic improvement. Results: From 57 patients, 35 patients (19 females/16 males, median age 40 years) with a symptomatic pancreatic pseudocyst were referred for EUS-guided drainage. All used stents were 10 Fr DP plastic stents. The median duration of the whole procedure was 16 min. Technical success was achieved in all cases. Clinical success was encountered in 32 patients (91.4%) without re-accumulation on follow-up. Minor adverse events were encountered in 3 patients (8.6%) including post-procedure abdominal pain (1 case) and fever (2 cases). Conclusion: We suggest that using a wide-caliber single-pigtail stent for EUS-guided cystogastrostomy is safe and effective with short procedure time, with reduced risks from the insertion of another stent(s).

Retrospective assessment of the possibilities of minimally invasive interventions in cases of complicated chronic pancreatitis

The paper presents a description of long-term minimally invasive treatment of a patient with chronic biliary pancreatitis. The treatment consisted in stenting the pancreatic duct with plastic stents, their replacement, bougienage of strictures, drainage of a festering pancreatic pseudocyst, and lithoextraction from the common bile duct. A multidisciplinary assessment of gradually developing complications was not performed. No discussions with pancreatic surgeons on indications for radical resection intervention were held. This treatment strategy led to the syndrome of chronic abdominal pain, recurrent complications after endoscopic minimally invasive treatment, as well as to a significant deterioration in the quality of life. The patient developed depression. Clinical observation clearly demonstrates that it is only possible to determine the optimal timing and indications for resection intervention on the pancreas in complicated chronic pancreatitis within the framework of an interdisciplinary approach.

A novel tube placement technique in EUS-guided drainage for small pancreatic pseudocyst: Spinning lasso method.

This paper discusses a novel tube placement technique; the "spinning lasso method", in EUS-guided drainage for small pancreatic pseudocysts (PC) with video. In general, the placement of a drainage tube can be difficult in a small PC and the tube often deviates during attempted insertions into the cavity. The technique helps to mitigate this problem.