Endoscopic drainage of pancreatic pseudocysts

ABSTRACT Background: We evaluated short‑ and long‑term results of endoscopic drainage (a minimally invasive nonsurgical treatment) of pancreatic pseudocysts (PPCs) and factors associated with its success at a multilevel teaching hospital in Northern India, as such data are scanty from India. Patients and Methods: Retrospective review of records of consecutive patients undergoing endoscopic drainage of PPC from January 2002 to June 2013 was undertaken. Results: Seventy‑seven patients (56 males), median age 36 years (range, 15–73), underwent endoscopic drainage of PPC with 98% technical success. Pseudocysts drained were symptomatic (duration 11 weeks, range, 8–68), large (volume 582 mL [range, 80–2706]), located in head (n = 32, 46%), body and tail (n = 37, 54%), and infected (n = 39, 49%). Drainage procedures included cystogastrostomy (n = 54, 78%), cystoduodenostomy (n = 9, 13%), transpapillary drainage (n = 2, 3%), and multiple route (n = 4, 6%), with additional endoscopic nasocystic drainage (ENCD) in 41 (59%). Sixty‑nine patients were followed up (median 28 months, range 2–156; other eight lost to follow‑up). Complications (n = 21, 30%) included stent occlusion and migration (13), bleeding (5), perforation (2), and death (1). Endoscopic procedure had to be repeated in 19 patients (28%; 16 for sepsis, 3 for recurrence). The reasons for additional nonendoscopic treatment (n = 8, 12%) included incomplete cyst resolution (3), recurrence (2), bleeding (1), and perforation (2). Overall success rate of endoscopic drainage was 88%. Whereas infected pseudocysts were associated with poorer outcome (odds ratio [OR] 0.016; 95% confidence interval [CI] 0.001–0.037), placement of ENCD led to better results (OR 11.85; 95% CI 1.03–135.95). Conclusion: Endoscopic drainage is safe and effective for PPC.

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Endoscopic management of pancreatic pseudocysts

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.95035 ◽

2012 ◽

Vol 03 (S 05) ◽

pp. 058-064 ◽

Cited By ~ 3

Author(s):

Shyam Varadarajulu

Keyword(s):

Percutaneous Drainage ◽

Adjunctive Treatment ◽

Endoscopic Management ◽

Pancreatic Pseudocysts ◽

Endoscopic Drainage ◽

Conventional Management ◽

Prolonged Hospitalization ◽

Treatment Measures ◽

Complications And Mortality

AbstractThe conventional management of pancreatic pseudocysts involves surgery or percutaneous drainage. While surgery is associated with significant complications and mortality, percutaneous drainage is associated with prolonged hospitalization and often times the need for other adjunctive treatment measures. Therefore, the use of endoscopy to drain these pseudocysts is becoming increasingly popular. In this review, we will be examining the techniques, outcomes and costs associated with the endoscopic drainage of pancreatic pseudocysts.

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A rare case of pseudocyst in remnant pancreas after classical pancreaticoduodenectomy- treated by endoscopic drainage

International Surgery Journal ◽

10.18203/2349-2902.isj20171641 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1797

Author(s):

Senthilkumar Perumal ◽

Jeswanth Sathyanesan ◽

Ravichandran Palaniappan

Keyword(s):

Female Patient ◽

Rare Case ◽

Malignant Tumors ◽

Pancreatic Pseudocysts ◽

Endoscopic Drainage ◽

Cystic Lesions ◽

Periampullary Carcinoma ◽

Pancreatic Anastomosis ◽

Remnant Pancreas

Pancreatic pseudocysts comprise more than 80 % of the cystic lesions of the pancreas. Here we report a 45-year-old female patient who developed a symptomatic pseudocyst in the remnant pancreas following classical pancreaticoduodenectomy for periampullary carcinoma. The pancreatic anastomosis was pancreaticogastrostomy- Dunking technique. She underwent endoscopic cystogastrostomy. Recurrence should always be ruled out before diagnosing pseudocyst in remnant pancreas following pancreaticoduodenectomy for malignant tumors.

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Treatment of Pancreatic Pseudocysts

Scandinavian Journal of Surgery ◽

10.1177/145749690509400214 ◽

2005 ◽

Vol 94 (2) ◽

pp. 165-175 ◽

Cited By ~ 24

Author(s):

Å. Andrén-Sandberg ◽

C. Ansorge ◽

K. Eiriksson ◽

T. Glomsaker ◽

A. Maleckas

Keyword(s):

Acute Pancreatitis ◽

Conservative Treatment ◽

Pancreatic Juice ◽

Granulation Tissue ◽

Spontaneous Resolution ◽

Pancreatic Pseudocysts ◽

Endoscopic Drainage ◽

Pancreatic Trauma ◽

Choice Of Procedure ◽

Substantial Risk

According to the Atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of acute pancreatitis or pancreatic trauma, whereas a chronic pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of chronic pancreatitis and lack an antecedent episode of acute pancreatitis. It is generally agreed that acute and chronic pseudocysts have a different natural history, though many reports do not differentiate between pseudocysts that complicate acute pancreatitis and those that complicate chronic disease. Observation — “conservative treatment” — of a patient with a pseudocyst is preponderantly based on the knowledge that spontaneous resolution can occur. It must, however, be admitted that there is substantial risk of complications or even death; first of all due to bleeding. There are no randomized studies for the management protocols for pancreatic pseudocysts. Therefore, today we have to rely on best clinical practice, but still certain advice may be given. First of all it is important to differentiate acute from chronic pseudocysts for management, but at the same time not miss cystic neoplasias. Conservative treatment should always be considered the first option (pseudocysts should not be treated just because they are there). However, if intervention is needed, a procedure that is well known should always be considered first. The results of percutaneous or endoscopic drainage are probably more dependent on the experience of the interventionist than the choice of procedure and if surgery is needed, an intern anastomosis can hold sutures not until several weeks (if possible 6 weeks).

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Endoscopic Drainage of Pancreatic Pseudocysts, Abscesses, and Walled-Off (Organized) Necrosis

Ercp ◽

10.1016/b978-0-323-48109-0.00056-0 ◽

2019 ◽

pp. 525-537.e2

Author(s):

Ryan Law ◽

Todd H. Baron

Keyword(s):

Pancreatic Pseudocysts ◽

Endoscopic Drainage

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A case of mediastinal pancreatic pseudocysts mimicking esophageal varices with successful endoscopic drainage

Digestive and Liver Disease ◽

10.1016/j.dld.2020.10.037 ◽

2020 ◽

Author(s):

Noriko Inomata ◽

Arata Sakai ◽

Shohei Abe ◽

Yuzo Kodama

Keyword(s):

Esophageal Varices ◽

Pancreatic Pseudocysts ◽

Endoscopic Drainage

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Endoscopic Drainage of Pancreatic Pseudocysts

Canadian Journal of Gastroenterology ◽

10.1155/1990/963419 ◽

1990 ◽

Vol 4 (9) ◽

pp. 568-571 ◽

Cited By ~ 8

Author(s):

Claude Liguory ◽

Jean Francois Lefebvre ◽

Gary C Vitale

Keyword(s):

Pancreatic Duct ◽

Surgical Intervention ◽

The Body ◽

Pancreatic Pseudocysts ◽

Endoscopic Drainage ◽

Acute Necrotizing ◽

Head Of The Pancreas ◽

Serial Scanning

Endoscopic drainage of pancreatic pseudocysts was attempted in 17 patients over an eight year period. There were nine cysts located in the head of the pancreas, six in the body and two in the tail. Endoscopic retrograde cholangiopancreatography was performed in all cases and the pancreatic duct satisfactorily opacified in 16 of the 17 patients. This study identified a communication with the pancreatic duct in seven cases. There were two cases in which multiple cysts were present; in each, one cyst was drained endoscopically and the others surgically. Endoscopic drainage of the cyst was immediately possible in 16 of 17 cases (94%). Late follow-up (mean 26 months) documented cyst disappearance in 11 cases (69%). None of the five patients with persistent cysts has required secondary surgical intervention, and the cysts are asymptomatic and stable or decreasing in size by serial scanning. There was one case (6%) in which a pseudocyst recurred following initial resolution. There were two complications (12%) requiring surgical intervention: gastrointestinal perforation with peritonitis in one patient and hemorrhage at the cyst margin from an arterial bleeder in another. There were no deaths at 30 days, but in one case a recurrent acute necrotizing pancrearitis occurred 36 days following endoscopic drainage and the patient died. This death was felt to be unrelated to the endoscopic procedure. In conclusion, internal drainage of pancreatic pseudocysts by endoscopic means can be proposed as an alternative to surgical drainage when the cyst can be identified as bulging into the stomach or duodenum. Immediate drainage is usually effective with a minimal long term recurrence rate.

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