Endoscopic Drainage Of Pancreatic Pseudocysts Research Articles

Endoscopic Drainage of Pancreatic Pseudocysts: Retrospective Analysis of Variables Influencing the Clinical Effectiveness

Background: Endoscopic drainage is widely used for pancreatic pseudocysts and two different approaches are available. Aims: To retrospectively evaluate if pseudocyst features may influence the drainage approach; to assess risks and efficacy both of trans-papillary and trans-mural drainage. Methods: All consecutive patients with symptomatic acute (APP), chronic (CPP) and acute-on-chronic pancreatic pseudocysts (ACPP) underwent to endoscopic drainage were included. Results: A total of 29 patients with APP, 73 with CPP and 8 with ACPP were evaluated. APP and ACPP had a significantly larger diameter (median 8 cm) than CPP (median 4 cm; P < 0.0001). Infection was present in 18% of APP, in 9% of CPP and 25% of ACPP. The drainage technique of APP compared both to CPP and ACPP was significantly different (P < 0.0001 and P = 0.01), while it was similar for CPP and ACPP (Table). Fourteen (19%) CPP were drained through a combined approach. Independently from the pathogenesis, trans-mural drainage was used for significantly larger pseudocysts (P = 0.002).A naso-cystic drain was used in 83% of trans-mural approaches and a naso-pancreatic drain in 85% of trans-papillary ones. Stents were contemporary placed in 46% and 17% of cases, respectively (P = 0.005). Complications occurred only with trans-mural drainage (P = 0.005). Bleeding from the cysto-enterostomy in 10% of cases was managed endoscopically; super-infections in 8% of patients required further drainage sessions. Extracorporeal shock wave lithotripsy before or during treatment was performed in 21 (30%) patients with CPP, allowing the external drains or stents removal before discharge in 9 cases. Hospital stay (10 days) was similar for trans- papillary and mural drainage. Patients were discharged with stents in place in 55% of trans-papillary cases and in 73% of trans-murally cases. Within a median follow-up of 18 months, both CPP and APP relapsed in 8% of cases. Drainage of the main pancreatic duct was sufficient for relapsed trans-mural drained pseudocysts. Trans-mural drainage was performed in 2 (30%) trans-papillary drained patients, while stents were exchanged in the remaining cases. Conclusions: Endoscopic drainage of pancreatic pseudocysts can offers a definitive solution and is accompanied by an few complications that can be managed endoscopically. Size, pathogenesis and the main pancreatic duct morphology should be evaluated to reduce complications and relapses. Tabled 1Approaches to drainage of pancreatic pseudocysts. Trans-mural Trans-papillary Combined Acute PP 24 (83%) 5 (17%) - Chronic PP 21 (30%) 37 (51%) 14 (19%) Acute-on-chronic PP 3 (38%) 5 (62%) - Open table in a new tab

Endoscopic Drainage of Pancreatic Pseudocysts

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.

Pancreatic Pseudocyst Drainage–Transpapillary or Transmural?

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.

Endoscopic Pancreatic Pseudocyst Drainage

A well-described complication of acute and chronic pancreatitis is pancreatic pseudocyst formation. As patients convalesce from acute pancreatic inflammation, it is not uncommon to develop complications from the presence or progression of pseudocyst(s). Likewise, those patients with chronic pancreatitis may experience symptoms from pseudocyst formation. These may include abdominal pain, gastric outlet obstruction, biliary obstruction, pseudocyst infection, or fistulization. In the setting of symptoms or complications from pseudocyst development, drainage of the pseudocyst by percutaneous, endoscopic (transmural or transpapillary), or surgical approach has been described. At present, no prospective studies have been performed comparing methods of pseudocyst drainage. However, endoscopic drainage appears to have acceptable success, recurrence, and complication rates to be considered first-line therapy. Transmural drainage may be either transgastric or transduodenal, and is selected based on the most easily accessible region for drainage. Transpapillary drainage can be performed when communication between the main pancreatic duct and the pseudocyst is demonstrated by pancreatography. The techniques utilized to perform transpapillary and transmural endoscopic drainage of pancreatic pseudocysts are discussed in this article. This chapter will not address the endoscopic approach to management and drainage of pancreatic necrosis or infected pseudocysts.

Endoscopic Drainage of Pancreatic Pseudocysts: Long-Term Outcome and Procedural Factors Associated with Safe and Successful Treatment

Endoscopic drainage is a widely used treatment modality for pancreatic pseudocysts and has challenged more traditional drainage techniques. This retrospective study evaluates the short-term and long-term results with this technique and aims to identify procedural modifications that may improve its safety and efficacy. All consecutive patients who underwent endoscopic drainage of pancreatic pseudocysts in our hospital between 1983 and 2000 were included in the study. The patients' charts were reviewed, and long-term follow-up data were obtained by written questionnaires sent to the patients at the end of the follow-up period in November 2002. A total of 92 patients were included (66 men, 26 women; median age 49 years). The technical success rate of the drainage procedure was 97 % and the mortality rate was 1 %. Complications occurred in 31 patients (34 %), eight of which (9 %) were major and required surgery: hemorrhage in four cases (three of which were caused by erosion of a straight endoprosthesis through the cyst wall), secondary infection in three, and perforation in one. During a median follow-up period of 43 months, 10 patients (11 %) underwent additional (nonendoscopic) treatment for a persistent cyst and five (5 %) for a recurrent cyst. Overall, endoscopic drainage was successful in 65 patients (71 %). Endoscopic drainage is an effective treatment for pancreatic pseudocysts and offers a definitive solution in almost three-quarters of the cases. The majority of major complications might have been prevented by using pigtail stents instead of straight stents and by taking a more aggressive approach to the prevention and treatment of secondary cyst infection.

Management of Stent Migration during Endoscopic Drainage of Pancreatic Pseudocysts

Management of Stent Migration during Endoscopic Drainage of Pancreatic Pseudocysts

Endosonography-guided transmural drainage of pancreatic pseudocysts using a one-step needle-wire device

Aims: In this open prospective study a one-step endoscopic ultrasound (EUS) guided technique using a needle-wire device was evaluated for safety and effectiveness of transmural endoscopic drainage of pancreatic pseudocysts (PPs).

Utilization of EUS for Endoscopic Drainage of Pancreatic Pseudocysts: Results of a National and an International Survey

Utilization of EUS for Endoscopic Drainage of Pancreatic Pseudocysts: Results of a National and an International Survey Tony E. Yusuf, Todd H. Baron Introduction: Pancreatic pseudocysts are a type of pancreatic fluid collection that can complicate acute and chronic pancreatitis. Pancreatic pseudocysts can be drained endoscopically via the transpapillary or the transmural (transgastric or transduodenal) routes. Aim: The aim of this study was to assess the endoscopic approach and techniques of pancreatic pseudocyst drainage as performed by endoscopists in the United States and internationally. Methods: A web-based survey was designed to assess the type of practice and the endoscopic techniques used in drainage of pancreatic pseudocysts. Questions that addressed imaging modalities used prior to or during drainage were included. An initial electronic message with a link to the web survey followed by a reminder message was sent to endoscopists in the United States and internationally. E-mail addressees were obtained from the ASGE membership directory. Results: The survey was sent to 3,054 endoscopists of whom 266 (8.7%) replied. Of the responders, 198 performed endoscopic drainage of pancreatic pseudocysts. Each endoscopist performed a mean of 69 cases (range, 1-364 cases). The transgastric route was the most commonly used drainage route (98%) versus transduodenal (72%). Transmural entry was performed using a needle knife in 53% of the non EUS-guided transmural drainage. The number of stents placed was 1-4 stents for a period of 2-24 weeks. Imaging studies to guide drainage included CT scan alone (60%) or in combination with other radiographic imaging (35%). EUS imaging was used prior to drainage by 72 of 103 (70%) endoscopists in the US compared to 56 of 95 (59%) international endoscopists (pZ0.1). EUSguided drainage was used by 56% of endoscopists in the US compared to 43% international endoscopists (pZ0.06). Conclusions: The transgastric route is the most common route for transmural endoscopic drainage of pancreatic pseudocysts. Computed tomography is the most commonly used pre-drainage imaging modality. The majority of endoscopists in both the US and abroad utilize EUS prior to and during transmural drainage of pancreatic pseudocysts. The practice of EUS prior to drainage is not significantly different among endoscopist in the United States and internationally. T1226 Role of ERCP in Patients with Pancreatico-Biliary (PB) Disease in the Setting of Hematopoietic Stem Cell Transplant (HSCT) Majed Al Nusair, Margarida C. de Magalhaes-Silverman, William B. Silverman Background: Patients (pts) undergoing HSCT may develop PB complications that may need to be evaluated by ERCP. These pts are immunocompromised and may be at higher risk of procedure related complication than average risk pts. Surprisingly, few data have been published regarding ERCP findings/benefits/risks in this population. Aim: To determine the role of ERCP in the diagnosis, treatment, and outcome ERCP in the setting of HSCT. Materials M 15/ 16 had allogeneic HSCT & 1/16 had autologous HSCT. Indications for HSCTwere: AML (6),CML (3), ALL (1), NHL (2), myeloma (1), met breast ca (2). 26 ERCP procedures were performed in these 16 pts. 10/16 pts were O100days post HSCT. 8/26 had a platelet count! 50x103/L. ERCP indications: obstructive jaundice (4); possible ascending cholangitis (7); post cholecystectomy bile leak (1); relapsing pancreatitis (4).ERCP Findings were: BD lithiasis (7), Ampullary infiltration from GVHD (3), BD stricture(1), BD leak (1),cholangitis (1), Mirrizzi (1), PD stone (1), normal (1). ERCP interventions were: BD sphincterotomy (8), BD lithiasis removal (11), BD stents (13), NB tube(4), PD stent for drainage(1), prophylactic temporary PD mini stents (6), Transpapillary endoscopic GB drain (2). Complications occurred in 3 pts: bleed (1), cholangitis due to late stent occlusion (1), mild pancreatits (1). No deaths. Conclusion: In patients with HSCT, BD lithiasis was the most common finding at ERCP, followed by obstructive ampullary tissue infiltration due to GVHD. ERCP was safe and successful in this population.

Endoscopic drainage of pancreatic pseudocysts in children

Background/Purpose Symptomatic pancreatic pseudocysts have traditionally been managed with surgical, percutaneous, and, more recently, endoscopic drainage. Although the role of the latter is well defined in the adult population, its utility in children needs to be clarified. The authors reviewed their experience with endoscopic drainage of pancreatic pseudocyst (EDPP). Methods A retrospective chart review was conducted, and relevant demographic and clinical data were obtained for all patients with pancreatic pseudocysts managed with endoscopic drainage in the period from 1997 through 2001, inclusive. Results Three children had successful endoscopic drainage of pancreatic pseudocysts. They were 9, 13, and 14 years old, and were all boys. The etiology of the pancreatitis was idiopathic related to anomalous pancreatic divisum ducts in the first 2 and azathioprine induced in the latter. The first 2 patients had endoscopic transpapillary drainage, whereas the third had an endoscopic cystduodenostomy. All patients had complete resolution of the pseudocyst clinically and radiologically after follow-up periods of 3, 31, and 21 months, respectively. The first needed a subsequent pancreaticojejunostomy for persistent symptoms related to chronic pancreatitis. A successful endoscopic drainage of a posttraumatic pancreatic pseudocyst has previously been reported from our institution. Conclusions This experience would indicate that endoscopic drainage of pancreatic pseudocyst is an effective and relatively safe option of managing this problem in children.

One Step Endoscopic Drainage of Pancreatic Pseudocysts: Use of a New Therapeutic Echo Endoscope

Background: Different methods have been proposed for pancreatic pseudocysts (PPC) drainage. We describe our experience in endoscopic drainage of PPC with a one step technique using a new therapeutic echo endoscope with a linear curved array transducer, a 3.7 mm working channel and an elevator (Olympus GF-UCT140-AL5). Methods: 12 patients (8 men, 4 women; mean age 53.9, range 28-77) were referred from October 2002 to October 2003 for endoscopic pseudocyst drainage. The mean size of the pancreatic cysts was 11.2 cm (6.5-25 cm). Either monitored anesthesia with Propofol or general anesthesia was used to sedate the patients. The Olympus GF-UCT140-AL5 was passed into the stomach; the optimal localization of the puncture site was determined. Color Doppler was used to rule out gastric varices and large vessels. Under real time ultrasound guidance a 19 gauge FNA needle (EchoTip, Wilson-Cook) was then inserted into the pseudocyst. A 0.025″ Jagwire (Boston Scientific) was passed through the needle under fluoroscopy and coiled into the pseudocyst. A Needle Knife (HPC-3) was introduced over the wire. Under EUS and endoscopic guidance an electrosurgical puncture was performed using the Needle Knife. The tract was dilated with a 10 mm balloon followed by the placement of 1 to 3 10-Fr double pigtail stents. The stents were removed in 1 to 3 months after the resolution of the cyst. Results: Drainage was not attempted on 2 patients due to large gastric varices on the first and a malignant mass in the cyst of the second, both diagnosed only by EUS. Drainage was attempted on 10 patients; placement of the 10-Fr double pigtail stents was successful in 9 patients. In one case drainage could not be achieved. In one other patient with a large cyst and internal debris surgery was required for a cyst infection that did not resolve with endoscopic management. 8/10 patients had complete resolution of their symptoms and cysts. One patient required 2 procedures due to the presence of debris in the cyst. There were no significant bleeding or other complications noted. Conclusion:In our experience EUS is essential prior to endoscopic drainage of PPC as it affected the clinical management of 2/12 patients. Endoscopic drainage of PPC using the new therapeutic echo endoscope with EUS guided wire placement and puncture allows a safe one step procedure without exchanging scopes.

Endoscopic ultrasound-guided drainage of pancreatic pseudocysts using a large-channel echoendoscope and a conventional polypectomy snare

Background: Endoscopic drainage of pancreatic pseudocysts is becoming common. Recent techniques using endoscopic ultrasound (EUS) have made the procedure safer and easier. However, bleeding related to the procedure is sometimes still experienced and placement of the tube is also sometimes difficult in cases where the cystic wall is thick and hard. We describe a new technique of EUS-guided drainage using a large-channel echoendoscope, a conventional polypectomy snare and a high-frequency current generator with automatic controls. We also evaluate this technique's utility. Methods: Between May 2001 and December 2002, EUS-guided drainage was attempted in consecutive patients with symptomatic pancreatic pseudocysts that had resisted conservative treatments. The EUS device was a recently introduced large-channel linear scanning echoendoscope. A puncture was made with a 19 G needle under EUS guidance and a 0.035 inch guidewire was passed through the puncture and into the pseudocyst. Then, a conventional polypectomy snare was used to enlarge the puncture tract with the new current generator, and a 7 Fr pigtail-type nasocystic drain was placed. Results: The drainage was successful and insertion of the drain was easy in all 13 patients included in the study. No complications related to the procedure, such as bleeding and perforation, were observed. The clinical symptoms resolved after the procedure in all patients. In nine patients, the cyst completely disappeared and the discharge also stopped, allowing the tube to be removed after a mean of 15 days. The median follow-up period for these nine patients was 4 months and no recurrence has been observed. In two other patients, the cysts shrank but did not disappear completely 4 weeks or more after the procedure. Since both of these patients had had previous cystic infections, they were given surgical operations. In the remaining two cases, the cystic lumen completely disappeared but the discharge continued for 4 weeks, so we replaced the 7 Fr nasobiliary tube with a 10 Fr internal drainage tube. Conclusion: This method is an easy and effective treatment for pancreatic pseudocysts. It may also reduce the risk of bleeding related to the procedure.

Endoscopic retrograde cholangiopancreatography for surgeons.

Endoscopic retrograde cholangiopancreatography remains an important tool for the management of biliary and pancreatic disease. Endoscopic removal of common bile duct stones is the procedure of choice for retained stones and is a common option preoperatively with the gallbladder in place. Cholangitis is best treated by endoscopic sphincterotomy and stenting along with intravenous antibiotics initially with the possibility of definitive treatment with endoscopic stone removal and/or dilatation and stenting for strictures. Endoscopic sphincterotomy is also recommended in severe or rapidly worsening gallstone pancreatitis or in those with combined pancreatitis and rising bilirubin or cholangitis. Palliation with internal stents for malignant strictures has been possible with good outcome and very little difference in efficacy, complications, mortality, and long-term survival compared to surgical treatment. Biliary fistulae are easily treated by endoscopic stenting, particularly when the source is the cystic or an accessory duct. Benign biliary strictures can be dilated and stented for prolonged periods with good long-term success in selected cases. Pancreatic stenting is useful to treat pancreatic duct strictures and duct hypertension with considerable improvement of pain. Endoscopic drainage of pancreatic pseudocyst appears to be a safe, effective, and definitive treatment for patients in whom anatomic considerations allow its use. In summary, therapeutic uses of ERCP are of broad interest to the general surgeon and should be understood and utilized appropriately by the surgical community.

Endoscopic management of pancreatic pseudocyst: a long-term follow-up.

No studies with real long-term follow-up after endoscopic drainage of pancreatic pseudocysts are available. The present study was undertaken to investigate the long-term outcome of endoscopic management of pancreatic pseudocyst with a minimum follow-up of 2 years. A total of 38 consecutive patients with pancreatic pseudocyst underwent endoscopic cystogastrostomy (n = 27), endoscopic cystoduodenostomy (n = 6) and transpapillary drainage (n = 5). Patients were monitored at 1 and 3 months after drainage, and finally between 24 and 80 months. Upper gastrointestinal endoscopy was done at 1 and 3 months after drainage while ultrasound was done at 3 months and at the end of follow-up. Endoscopic retrograde cholangiopancreatography (ERCP) was only done before cyst drainage if no cyst bulge was visible in the stomach or duodenum or if obstructive jaundice was present. Biliary pancreatitis was responsible for the pseudocyst in 19 cases while the remaining occurrences were caused by alcohol (n = 12) and trauma (n = 7). All forms of endoscopic drainage were effective in treating pancreatic pseudocyst and there was complete disappearance of the cyst within 3 months of drainage, irrespective of cause. Over a mean follow-up of 44.23 months (24 - 80 months). Three patients had symptomatic recurrences while three had asymptomatic recurrences; all had alcohol-induced pancreatitis. No recurrences were seen in the biliary pancreatitis and trauma group. All symptomatic recurrences were successfully managed with endoscopic cystogastrostomy and stenting. A massive bleed in one patient required surgery while stent block and cyst infection in three patients and perforation in one patient were managed conservatively. ERCP was done before cyst drainage in eight patients because there was no visible bulge into the stomach or duodenum (n = 5), or because obstructive jaundice was present (n = 3). In five patients ERCP revealed cyst duct communication. All these patients were managed by transpapillary drainage and there was only one asymptomatic recurrence in this group. Endoscopic management of pancreatic pseudocyst is quite an effective and safe mode of treatment in experienced hands. ERCP before the procedure is only required when the cyst does not bulge into gut lumen, for a decision about the feasibility of transpancreatic drainage. On long-term follow-up, recurrences were seen only in the alcoholic pancreatitis group. In the biliary pancreatitis group, no recurrences were seen after cholecystectomy and removal of common bile duct (CBD) stones if present. No recurrences were seen in the trauma group.

Long-term outcome of endoscopic drainage of pancreatic pseudocysts.

Long-term outcome of endoscopic drainage of pancreatic pseudocysts.

Utility of Endoscopic Ultrasonography in Endoscopic Drainage of Pancreatic Pseudocysts in Selected Patients

Objectives To determine the effect of endoscopic ultrasonography (EUS) on endoscopic drainage of pancreatic pseudocysts and to determine patency with fistula dilation and placement of multiple stents. Patients and Methods Between September 1995 and January 1999, 19 patients underwent endoscopic drainage of pancreatic pseudocysts, 17 of whom were assessed by EUS before drainage. Radial EUS scanning was used to detect an optimal site of apposition of pseudocyst and gut wall, free of intervening vessels. A fistula was created with a fistulatome, followed by balloon dilation of the fistula tract. Patency was maintained with multiple double pigtail stents. The primary goal of this retrospective study was to determine whether EUS affected the practice of endoscopic drainage of pancreatic pseudocysts. Results In 3 patients, drainage was not attempted based on EUS findings. In the other 13 patients (14 pseudo-cysts), creation of a fistula was successful on 13 occasions, and no immediate complications occurred. However, 1 patient subsequently developed sepsis that required surgery. All other patients were treated with balloon dilation, multiple stents, and antibiotics, with no septic complications. Of 14 pseudocysts (in 13 patients), 13 (93%) resolved. Conclusions Results of EUS may alter management of patients considered for endoscopic drainage of pancreatic pseudocysts. Endoscopic ultrasonography was useful for selecting an optimal and safe drainage site. The combination of balloon dilation, multiple stents, and antibiotics appears to resolve pancreatic pseudocysts without septic complications.

Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients.

To determine the effect of endoscopic ultrasonography (EUS) on endoscopic drainage of pancreatic pseudocysts and to determine patency with fistula dilation and placement of multiple stents. Between September 1995 and January 1999, 19 patients underwent endoscopic drainage of pancreatic pseudocysts, 17 of whom were assessed by EUS before drainage. Radial EUS scanning was used to detect an optimal site of apposition of pseudocyst and gut wall, free of intervening vessels. A fistula was created with a fistulatome, followed by balloon dilation of the fistula tract. Patency was maintained with multiple double pigtail stents. The primary goal of this retrospective study was to determine whether EUS affected the practice of endoscopic drainage of pancreatic pseudocysts. In 3 patients, drainage was not attempted based on EUS findings. In the other 13 patients (14 pseudocysts), creation of a fistula was successful on 13 occasions, and no immediate complications occurred. However, 1 patient subsequently developed sepsis that required surgery. All other patients were treated with balloon dilation, multiple stents, and antibiotics, with no septic complications. Of 14 pseudocysts (in 13 patients), 13 (93%) resolved. Results of EUS may alter management of patients considered for endoscopic drainage of pancreatic pseudocysts. Endoscopic ultrasonography was useful for selecting an optimal and safe drainage site. The combination of balloon dilation, multiple stents, and antibiotics appears to resolve pancreatic pseudocysts without septic complications.

Long-term outcome of endoscopic drainage of pancreatic pseudocysts

Long-term outcome of endoscopic drainage of pancreatic pseudocysts

Long-term outcome of endoscopic drainage of pancreatic pseudocysts

Long-term outcome of endoscopic drainage of pancreatic pseudocysts

Endoscopic drainage of the pancreatic pseudocyst

Pancreatic pseudocyst is a common complication of chronic pancreatitis occurring in 20% to 40% of cases. Pseudocysts can be treated by endoscopic cystenterostomy or transpapillary drainage, percutaneously with computed tomography guidance or operatively. A total of 36 endoscopic pancreatic pseudocyst drainage procedures were performed in 29 patients with 34 pseudocysts. Eighty percent presented with chronic pain, 25% had recurrent pancreatitis, and approximately one half of the patients had either gastric outlet obstruction or a palpable abdominal mass. Thirty-six endoscopic drainage procedures were performed, 27 cystenterostomies and 9 transpapillary drainages. Endoscopic treatment achieved complete resolution of the pseudocyst in 24 of 29 patients (83%), and the other 5 (17%) eventually required surgery. Two patients required distal pancreatectomy because of their pancreatic pathology, 2 cystgastrostomies for persistence of the pseudocyst, and 1 external drainage of an infected pancreatic cyst. The mean follow-up after the initial drainage was 16 months. There were no deaths attributed to the procedures and no complication that required surgery. Only 1 nonadherent pseudocyst (cystadenoma) required immediate operation after attempted endoscopic drainage. The conclude that endoscopic drainage of pancreatic pseudocysts can be both safe and effective, and definitive treatment. It should be considered as an alternative option before standard surgical drainage in selected patients.

Endoscopic drainage of the pancreatic pseudocyst

Background: Pancreatic pseudocyst is a common complication of chronic pancreatitis occurring in 20% to 40% of cases. Pseudocysts can be treated by endoscopic cystenterostomy or transpapillary drainage, percutaneously with computed tomography guidance or operatively. Methods: A total of 36 endoscopic pancreatic pseudocyst drainage procedures were performed in 29 patients with 34 pseudocysts. Eighty percent presented with chronic pain, 25% had recurrent pancreatitis, and approximately one half of the patients had either gastric outlet obstruction or a palpable abdominal mass. Results: Thirty-six endoscopic drainage procedures were performed, 27 cystenterostomies and 9 transpapillary drainages. Endoscopic treatment achieved complete resolution of the pseudocyst in 24 of 29 patients (83%), and the other 5 (17%) eventually required surgery. Two patients required distal pancreatectomy because of their pancreatic pathology, 2 cystgastrostomies for persistence of the pseudocyst, and 1 external drainage of an infected pancreatic cyst. The mean follow-up after the initial drainage was 16 months. There were no deaths attributed to the procedures and no complication that required surgery. Only 1 nonadherent pseudocyst (cystadenoma) required immediate operation after attempted endoscopic drainage. Conclusions: We conclude that endoscopic drainage of pancreatic pseudocysts can be both safe and effective, and definitive treatment. It should be considered as an alternative option before standard surgical drainage in selected patients. (Surgery 1999;126:616-23.)