Treatment Of Pancreatic Pseudocysts Research Articles

Consensus guidelines on the diagnosis and treatment of pancreatic pseudocyst and walled-off necrosis from a Chinese multiple disciplinary team expert panel.

To prepare a set of practice guidelines to standardize the entire process, from diagnosis to treatment and follow-up, for pancreatic pseudocysts and walled-off necrosis. Thirty-six experts in the fields of digestive endoscopy, pancreatic surgery, interventional radiology, and others presented their opinions via discussions in online conferences by referring to the patient, intervention, comparison, and outcomes principles and then reviewed the evidence and statements using the Delphi method to reach a consensus. The consensus of >80% was finally achieved for the items. The experts discussed and reached a consensus on 29 statements including 10 categories: (1) definition and classification, (2) imaging and endoscopic diagnosis, (3) therapeutic implications, (4) surgical therapy, (5) percutaneous catheter drainage, (6) endoscopic retrograde cholangiopancreatography, (7) EUS-guided drainage, (8) stent selection for EUS-guided drainage, (9) complication related to stents for cyst drainage, and (10) drug treatment and follow-up. This consensus based on the clinical experience of experts in various fields and international evidence-based medicine further standardizes the multidisciplinary diagnosis and treatment processes for pancreatic pseudocysts and walled-off necrosis.

Increasing trend of endoscopic drainage utilization for the management of pancreatic pseudocyst: insights from a nationwide database.

The pancreatic pseudocyst (PP) is a type of fluid collection that typically develops as a delayed complication of acute pancreatitis. Drainage is indicated for symptomatic patients and/or associated complications, such as infection and bleeding. Drainage modalities include percutaneous, endoscopic, laparoscopic, and open drainage. This study aimed to assess trends in the utilization of different drainage modalities for treating PP from 2016 to 2020. The trends in mortality, mean length of hospital stay, and mean hospitalization costs were also assessed. The National Inpatient Sample database was used to obtain data. The variables were generated using International Classification of Diseases-10 diagnostic and procedural codes. Endoscopic drainage was the most commonly used drainage modality in 2018-2020, with an increasing trend over time (385 procedures in 2018 to 515 in 2020; p=0.003). This is associated with a decrease in the use of other drainage modalities. A decrease in the hospitalization cost for PP requiring drainage was also noted (29,318 United States dollar [USD] in 2016 to 18,087 USD in 2020, p<0.001). Endoscopic drainage is becoming the most commonly used modality for the treatment of PP in hospitals located in the US. This new trend is associated with decreasing hospitalization costs.

Pancreatic pseudocyst after pegaspargase treatment in six children

Objective: To investigate the clinical characteristics and treatment of pancreatic pseudocyst after pegaspargase treatment in children. Methods: The clinical data of 6 children with pancreatic pseudocyst after pegaspargase treatment in the Department of Pediatrics in Peking University Third Hospital from July 2018 to February 2021 were analyzed retrospectively. Results: There were 4 males and 2 females, and their age of onset was 9.5 (5.8, 13.0) years. The total number of pegaspargase applications was 2.5 (2.0, 3.5) times. The course from the last dose of pegaspargase to the onset of pancreatitis was 11.0 (9.0, 17.2) days, and 42.5 (35.0, 129.5) days from the onset of pancreatitis to the diagnosis of pancreatic pseudocyst. Abdominal pain was the most prominent manifestation of pancreatitis (6/6). All of the 6 children were asymptomatic when pancreatic pseudocyst was noted, and were treated conservatively at first, but one case later developed intermittent abdominal distension or nausea after eating. All the cases had pancreatic pseudocyst enlargement during the conservative treatment. Three children were treated with endoscopic ultrasound-guided transgastric drainage, and the cyst disappeared from 10 days to 4 months after the operation. The other 3 children received endoscopic retrograde cholangiopancreatography (ERCP)-guided transpapillary drainage, but one of them turned to surgery due to pancreatic duct stricture, and in the rest 2 children the cyst disappeared at 1 and 3 months after operation respectively. Regarding safety issues, 1 child who received ERCP-guided transpapillary drainage had acute postoperative pancreatitis, which were improved after treatment, and the other 5 had no complications. Conclusions: Pancreatic pseudocyst after pegaspargase chemotherapy can be asymptomatic in the early stage, and should be diagnosed with a history of pegaspargase treatment and timely imaging examination. Conservative treatment is the first choice for asymptomatic pseudocyst. When the pseudocyst enlarges, different endoscopic drainage treatments are required according to whether the pseudocyst is connected with the main pancreatic duct.

OPTIMIZATION OF SURGICAL TACTICS IN PATIENTS WITH POSTNECROTIC PANCREATIC CYSTS

Summary. The predominance of people of working age (21–60 years) among patients with pancreatic necrosis, the occurrence of permanent disability in a significant part of patients, high overall and postoperative mortality (20–85 %), due to various complications, turns the treatment of pancreatic necrosis into an important social problem. The frequency of formation of false cysts in acute pancreatitis is 5–16 %, and in destructive forms it increases to 60–80 %.&#x0D; Materials and methods. The scope of endoscopic interventions in the treatment of 16 patients with pancreatic cysts of the pancreas directly depended on the preoperative findings and, first of all, on the presence of the connection of the cyst with the pancreatic ducts. Favorable conditions for endoscopic correction in the treatment of pancreatic pseudocysts were a small (less than 10 mm) distance between their cavity and the lumen of the gastrointestinal tract, minimal thickness of the capsule (no more than 2 mm), large dimensions (over 6 cm), as well as localization in the projection body and isthmus of the pancreas.&#x0D; Research results. When analyzing the results of the treatment of complications of pancreatic necrosis, we formulated an algorithm for the rational choice of operative interventions. We believe that rational treatment is based on early diagnosis of PN complications, including hemorrhagic ones.&#x0D; Conclusions. The use of the developed algorithm allowed us to reliably reduce postoperative mortality among patients of this category.

OPTIMIZATION OF SURGICAL TACTICS IN PATIENTS WITH POSTNECROTIC PANCREATIC CYSTS

Summary. The predominance of people of working age (21-60 years) among patients with pancreatic necrosis, the occurrence of permanent disability in a significant part of patients, high overall and postoperative mortality (20-85 %), due to various complications, turns the treatment of pancreatic necrosis into an important social problem. The frequency of formation of false cysts in acute pancreatitis is 5-16 %, and in destructive forms it increases to 60-80 %.&#x0D; Materials and methods. The scope of endoscopic interventions in the treatment of 16 patients with pancreatic cysts of the pancreas directly depended on the preoperative findings and, first of all, on the presence of the connection of the cyst with the pancreatic ducts. Favorable conditions for endoscopic correction in the treatment of pancreatic pseudocysts were a small (less than 10 mm) distance between their cavity and the lumen of the gastrointestinal tract, minimal thickness of the capsule (no more than 2 mm), large dimensions (over 6 cm), as well as localization in the projection body and isthmus of the pancreas.&#x0D; Research results. When analyzing the results of the treatment of complications of pancreatic necrosis, we formulated an algorithm for the rational choice of operative interventions. We believe that rational treatment is based on early diagnosis of PN complications, including hemorrhagic ones.&#x0D; Conclusions. The use of the developed algorithm allowed us to reliably reduce postoperative mortality among patients of this category.

The Role of EUS-Guided Drainage in the Management of Postoperative Fluid Collections after Pancreatobiliary Surgery

Postoperative fluid collection (POFC) is a challenging complication following pancreatobiliary surgery. Traditional treatment with surgical drainage is associated with significant morbidity, while percutaneous drainage is associated with a higher rate of recurrence and the need for repeated interventions. Studies have shown that endoscopic ultrasound (EUS)-guided drainage may offer a promising solution to this problem. There are limited data on the ideal therapeutic protocol for EUS-guided drainage of POFC including the timing for drainage; type, size, and number of stents to use; and the need for endoscopic debridement and irrigation. Current practices extrapolated from the treatment of pancreatic pseudocysts and walled-off necrosis may not be applicable to POFC. There are increasing data to suggest that drainage procedures may be performed within two weeks after surgery. While most authors advocate the use of double pigtail plastic stents (DPPSs), there have been a number of reports on the use of novel lumen-apposing metal stents (LAMSs), although no direct comparisons have been made between the two.

Clinical study on cystogastrostomy and Roux-en-Y-type cystojejunostomy in the treatment of pancreatic pseudocyst: A single-center experience.

The main purpose is to compare the efficacy of cystogastrostomy (CG) and Roux-en-Y-type cystojejunostomy (RCJ) in the treatment of pancreatic pseudocyst (PPC), and to explore the risk factors of recurrence and complications after internal drainage.Two hundred eight patients undergoing either CG or RCJ for PPC Between January 1, 2013and February 1, 2019, at West China Hospital of Sichuan University were retrospectively analyzed. The cure rate, complication rate and related factors were compared between the 2 groups.Two hundred eight patients with PPC underwent either a CG (n = 119) or RCJ (n = 89). The median follow-up time was 42.7 months. Between the 2 cohorts, there were no significant differences in cure rate, reoperation rate, and mortality (all P > .05). The operative time, estimated intraoperative blood loss, install the number of drainage tubes and total expenses in CG group were lower than those in RCJ group (all P < .05). The Logistic regression analysis showed that over twice of pancreatitis’ occurrence was were independent risk factor for recurrence after internal drainage of PPC (OR 2.760, 95% CI 1.006∼7.571, P = .049). Short course of pancreatitis (OR 0.922, 95% CI 0.855∼0.994, P = .035), and RCJ (OR 2.319, 95% CI 1.033∼5.204, P = .041) were independent risk factors for complications after internal drainage of PPC.Both CG and RCJ are safe and effective surgical methods for treating PPC. There were no significant differences in cure rate, reoperation rate, and mortality between the 2 groups, while the CG group had a short operation time, less intraoperative bleeding and less cost.

Treatment of oversize and recurrent pancreatic pseudocyst after an episode of acute pancreatitis: a case report and review management

Pancreatic cysts are being diagnosed more frequently because of the increasing usage of multiple noninvasive imaging modalities. Moreover, pancreatic pseudocysts (PPs) present a challenging problem for physicians dealing with pancreatic disorders, especially in cases where their treatment will be required. The diagnosis of a PP needs imaging with ultrasonography, Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). In most cases, pancreatic pseudocysts are asymptomatic and resolve spontaneously. [1-3] Asymptomatic PPs up to 6 cm in diameter can be safely observed and monitored with serial imaging.[1] If they evolve and increase in size, they become symptomatic through compression of the adjacent organs and need interven-tion.[1, 4-6] Their management demands the cooperation of surgeons, radiologists and gastroenterolo-gists. The treatment of PPs has evolved considerably over the past decade, moving from what was once open surgical management to increasingly minimally invasive techniques, both by surgery and by endoscopy. Thus, many studies have reported successful drainage through the use of various techniques.[1, 3, 4] However, the absence of a large number of cases as well as guidelines for dealing with them raise even today dilemmas regarding the treatment of choice. Here we present a case of a large pancreatic pseudocyst and a brief review of the literature.

Surgical treatment of pancreatic pseudocysts and approaches to the treatment of vascular complications in pseudocysts: literature review

The therapeutic tactics for pancreatic pseudocysts have changed dramatically over the past decade. Currently, due to the rapid development of minimally invasive technologies, the frequency of their use in the treatment of patients with pseudocysts has become widespread, displacing traditional methods of surgical treatment. Nevertheless, surgical treatment of a pseudocyst is justified when other methods of treatment have been ineffective, namely in the case of recurrence of the pseudocyst, with suspected cystic neoplasia of the pancreas, the presence of stenosis of the common bile duct or duodenum, as well as with complicated cysts. The purpose of this article is a literature review of methods and approaches to the surgical treatment of pancreatic pseudocysts, as well as the treatment of vascular complications in this pathology.

Recent advances in treatment of pancreatic pseudocyst with endoscopic ultrasonography guided lumen-apposing metal stents

Recent advances in treatment of pancreatic pseudocyst with endoscopic ultrasonography guided lumen-apposing metal stents

934 Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections Using AXIOS Electrocautery Enhanced Delivery System a Retrospective Experience at a Large Quaternary Care Center

INTRODUCTION: Pancreatic fluid collections (PFC) are common complications of acute pancreatitis, surgery, or trauma. Many PFC reabsorb spontaneously but the remainder create cystic structures filled with fluid and/or with necrotic debris. Since the development of lumen apposing metal stents (LAMS) first line treatment of PFCs are with EUS guided drainage. However, despite the high technical and clinical success of the commonly used Electrocautery Enhanced AXIOS LAMS (EEAL), outcome data is still scarce. METHODS: An IRB approved, retrospective chart review, was performed on EUS-guided drainage of PFC using EEAL at a large quaternary care, teaching hospital. Specific procedural data including technical success rate, adverse events, and length of stay were collected. Descriptive statistics were then used to report outcomes. RESULTS: A total of 43 EEAL were used in the treatment of pancreatic pseudocysts (41.9%) and walled off pancreatic necrosis (65.1%). LAMS were placed successfully in 100% of procedures and required revisions in 28.6% of patients. Adverse events occurred in 16.3% of interventions: 2 bleeding events (4.7%), 3 stent migrations (7%), 1 pigtail stent occlusion (2.4%) and 1 spontaneous pancreatic fistula formation (2.4%). Only 2 patients (4.8%) required subsequent surgical resection. The average hospital stay after the procedure was 6.79 days (median of 3 days) and stents were ultimately removed on average at 24.68 days. CONCLUSION: This study demonstrated 100% technical success rate. Of the recorded adverse events after EEAL use in drainage of PFC most were subclinical and minor. Importantly, only two patients required further surgical intervention to obtain desired outcome. Furthermore, length of stay was particularly low with median hospital stay of 3 days. Ultimately, this study highlights how EEAL provides high value care by providing an efficient intervention in a cost-feasible length of time. Further ongoing prospective studies will help determine the utility of EEAL in the practice setting.

A prospective study on surgical versus endoscopic cystoenterostomy

Background: The aim of the present study was to compare endoscopic and surgical modalities in the treatment of pancreatic pseudocysts. Comparisons were based on clinical success, complication rate, recurrence and hospital stay.Methods: This is a prospective comparative study, enrolling 24 patients, 13 in surgical group and 11 in endoscopic group. The duration of study was from December 2013 to September 2015. The minimum follow up was for atlas 6 months.Results: 13 (54%) of cases were managed surgically, 11 (46%) of cases were treated endoscopically. The clinical success of the endoscopic group was 72.7% versus 100% for the surgical group (p=0.216), with a complication rate of 36.4% and 15.3%, respectively (p= 0.659). The hospital stay was lower for the endoscopic group was 9.82 days compared with 12.08 days in the surgical group. The two recurrences found in the endoscopic group were associated with main pancreatic duct stricture and disconnected pancreatic duct. The duration to oral intake post procedure was lower in endoscopic group 4.36 days (p&lt;0.001). 18.2% of patients in endoscopic group required conversion to open surgery.Conclusions: Non EUS guided cystoenterostomy has to be phased out. 1/3rd of patients undergoing endoscopic cystoenterostomy require more than 6 months of stent placement. In patients with disruption of the main pancreatic duct, endoscopic intervention is more successful when combined with transpapillary ductal stent placement.

Treatment of pancreatic pseudocyst

Pancreatic psudocyst is a late complication of acute pancreatitis. In our environment, cholelithiasis is the most common cause of pancreatitis, and pancreatic pseudocyst occurs in 10% of these patients. We report the case of a patient with a pancreatic psudocyst treated with endoscopic drainage. We highlight that the endoscopic approach is a safe method to treat this complication

Minimally invasive treatment of pancreatic pseudocysts

Minimally invasive treatment of pancreatic pseudocysts

Comparative outcomes of endoscopic ultrasound-guided cystogastrostomy for peripancreatic fluid collections: a systematic review and meta-analysis.

Background:Endoscopic ultrasound–guided cystogastrostomy has become the first-line treatment for symptomatic peripancreatic fluid collections. The aim of this study is to analyze the efficacy and safety of cystogastrostomy via a meta-analysis of the literature.Methods:We performed a systematic search of PubMed and Medline databases for studies published from January 2005 to May 2018. We included randomized controlled trials along with retrospective and prospective observational studies reporting endoscopic ultrasound–guided cystogastrostomy stent placement for peripancreatic fluid collections. The primary outcome for our meta-analysis was complete peripancreatic fluid collection resolution on imaging. Our secondary outcomes included comparative efficacy and safety of the procedure for pseudocysts and walled-off pancreatic necrosis using metal and plastic stents.Results:Seventeen articles involving 1708 patients met our inclusion criteria for meta-analysis. Based upon the random effects model, the pooled technical success rate of cystogastrostomy was 88% (95% confidence interval = 83–92 with I2 = 85%). There was no difference in the technical success rate between pancreatic pseudocysts and walled-off pancreatic necrosis (91% and 86%, respectively p = nonsignificant). The adverse event rates for metal and plastic stents were equivalent (14% and 18%, respectively, p = nonsignificant).Conclusion:Endoscopic ultrasound–guided cystogastrostomy stents are effective in the treatment of pancreatic pseudocysts and walled-off pancreatic necrosis. We found no difference in technical success or adverse event rates of drainage based on peripancreatic fluid collection type or stent used.

Lumen Apposing Metal Stents (LAMSs) for Drainage of Pancreatic and Gallbladder Collections: A Meta-analysis.

Endoscopic ultrasound-guided transmural drainage using lumen apposing metal stents (LAMSs) is becoming a popular and promising therapeutic approach for drainage of intra-abdominal fluid collections. There has been an increasing number of studies evaluating LAMS for drainage of pancreatic pseudocysts (PP), walled-off pancreatic necrosis (WOPN), and gallbladder (GB) drainage. The aim of this meta-analysis is to analyze the literature to date regarding the clinical success, technical success, and adverse events of LAMS in treatment of pancreatic fluid collections and GB drainage. A comprehensive search of multiple literature databases through November 2016 was performed. Human studies with at least 10 subjects that examined the clinical success, technical success, and adverse events of LAMS in treating PP, WOPN, and GB drainage were included. A total of 993 patients (608-WOPN; 204-PP; 181-GB drainage) underwent drainage from 20 trials. For drainage of WOPN, the pooled technical success was 98.9% [95% confidence interval (CI): 98.2% to 99.7%] and clinical success was 90% (95% CI: 87% to 93%) (τ=0.001). For drainage of PP, the pooled technical success was 97% (95% CI: 95% to 99%) and clinical success was 98% (95% CI: 96% to 100%), (τ=0.001). For GB drainage, the pooled technical success was 95% (95% CI: 91% to 99%) and clinical success was 93% (95% CI: 90% to 97%), (τ=0.001). Total adverse events occurred in 11% of patients with higher complication rates observed in GB drainage. There was no evidence of publication bias in this meta-analysis. Endoscopic ultrasound-guided transmural drainage using LAMS is becoming a widely accepted therapeutic approach for the treatment of PP, WOPN, and GB drainage with high clinical and technical success rates and acceptable adverse events. Further prospective randomized trials reporting long-term clinical efficacy and cost-effectiveness are needed to validate LAMS as a therapeutic modality for pancreatic and GB collections.

Treatment of pancreatic pseudocyst with omentalization in a dog

Treatment of pancreatic pseudocyst with omentalization in a dog

Treatment of pancreatic pseudocyst in a developing country: A case reports

Treatment of pancreatic pseudocyst in a developing country: A case reports

Diagnosis and treatment of 50 children with pancreatic pseudocysts

Objective To study the clinical features, diagnosis and treatment of pancreatic pseudocysts in children. Methods A retrospective study was conducted on 50 children with pancreatic pseudocysts diagnosed and treated in the Children's Hospital of Chongqing Medical University from September 2006 to August 2017. 36 of these 50 children were treated with external drainage (including 2 patients after conservative treatment), 5 internal drainage (including 2 patients after external drainage), and 13 conservative treatment. Results 47 patients were diagnosed by clinical symptoms, amylase examinations, ultrasound and CT scans; and 3 patients by surgical exploration. Of the 36 patients who were treated with external drainage, 29 recovered and 5 improved. Two patients relapsed and underwent internal drainage. Five patients who were treated with internal drainage recovered. Of 13 patients who were treated with conservation treatment, 10 were cured, 1 recovered well, and the remaining 2 developed relapse and underwent external drainage. Conclusions The incidence of pancreatic pseudocyst in children was low. The diagnosis depended on clinical symptoms, biochemical and radiological examinations. For patients with small cysts, no complications and asymptomatic, conservative treatment is suggested. There were no obvious differences in the treatment results between internal and external drainage, and external drainage is advocated because of its advantages. Differences in the etiology play a vital role in the choice of treatment. In elective surgery for a pancreatic pseudocyst caused by trauma, external drainage is preferred. For those who developed after pancreatitis, internal drainage is advocated. Key words: Pancreatic pseudocysts, children; Diagnosis; Therapy

Mini-invasive methods of treatment of liquid formations of parhychymatic ogrgans and abdominal cavity in planned and urgent abdominal surgery

The problem of diagnosis and treating-tactical criteria for liquid formations of the abdominal cavity and retroperitoneal space of non-parasitic genesis remains unsolved. The purpose of this study is to improve the results of surgical treatment of patients with liquid formations of the parenchymal organs, abdominal cavity and retroperitoneal space through the complex use of minimally invasive diagnostic methods and surgical treatment. Clinical-physical, then clinical-laboratory methods of examination of patients were performed, during which liquid structures were suspected Comparing different methods of surgical treatment of non-parasitic liquid formations of parenchymal organs and the abdominal cavity, it was established that the use of minimally invasive methods allowed to improve the medical and social indicators in this group of patients significantly. The use of puncture drainage methods in combination with conservative therapy for the treatment of pancreatic pseudocyst is effective. This method is important for diagnosing and determining the connection of a cyst with a duct, as well as for differential diagnosis with tumors. In patients with pancreatic head tumors complicated by obstructive jaundice, decompression of the gall tree by means of percutaneous transhepatic microcholecystostomy for 7–15 days significantly improved and normalized the functional state of the liver, which allowed for the application of bilidigents anastomoses. The use of puncture drainage methods under the control of sonography in liver cysts leads to a positive result of the treatment of this pathology and the prevention of complications. When comparing various methods of surgical treatment of non-parasitic fluid formations of parenchymatous organs, the abdominal cavity, it was found that the use of minimally invasive methods has significantly improved medical and social indicators in this group of patients.