scholarly journals Endoscopic management of pancreatic pseudocyst

2017 ◽  
Vol 4 (8) ◽  
pp. 2577
Author(s):  
Wormi Sharon
Keyword(s):  
Pancreatic Pseudocyst ◽  
High Sensitivity ◽  
Cost Effective ◽  
Good Alternative ◽  
Venous Occlusion ◽  
Diagnostic Tools ◽  
Endoscopic Management ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Cystic Neoplasms

Background: Pancreatic pseudocyst is a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter. It represents 80-90% of cystic lesions of the pancreas. Benign and malignant cystic neoplasms constitute 10-13%, congenital and retention cysts comprising the remainder. Diagnosis is accomplished most often by computed tomographic scanning, by endoscopic retrograde cholangiopancreatography, or by ultrasound, and a rapid progress in the improvement of diagnostic tools enables detection with high sensitivity and specificity. Endoscopic drainage provides a good alternative or supplement to a surgical treatment of pancreatic pseudocysts.Methods: This is a prospective study of 26 patients diagnosed to have Pancreatic Pseudocyst and treated by endoscopic drainage from 1st June 2008 to 30th September 2010 in St. John’s Medical College and Hospital, Bangalore. Transabdominal and endoscopic ultrasound, CT scan were used to determine the number, size, volume, wall thickness, location of pancreatic pseudocysts, the extent of pancreatic parenchymal disease, the nature of the main pancreatic duct and its relationship to the cyst, the presence of portal hypertension, venous occlusion, arterial anomalies and pseudoaneurysm. The indications for endoscopic drainage were symptomatic and/or bigger than 6 cm in major diameter pancreatic pseudocysts with a close opposition to the gastric or duodenal wall.Results: There were 26 patients with pancreatic pseudocyst and all of them are located in lesser sac. It mainly affects the middle-aged males with alcohol as the main etiology. Out of 26 patients 24 underwent endoscopic drainage and 2 patients were abandoned in view of vessel between the cyst wall and stomach which was picked up by EUS. Out of 26 patients, 5 developed infection which was proven by culture. Endoscopic cystogastrostomy was performed in 21 patients (80.8%), endoscopic cystogastrostomy with nasocystic drainage performed in 3 patients (11.5%), and abandoned in 2 patients. 2 patients developed bleeding, and managed conservatively. No intervention done. 5 patients underwent re-procedure (3 underwent nasocystic drainage, 1 aspiration, and the other cystogastrostomy), in view of recollection.Conclusions: Endoscopic drainage is safe and effective in experienced hand, less morbidity, cost effective, short hospital stay, can be repeated.

scholarly journals Endoscopic management of pancreatic pseudocysts

2012 ◽  
Vol 03 (S 05) ◽  
pp. 058-064 ◽  
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.

scholarly journals Laparoscopic management of pancreatic pseudocyst: a prospective study

2019 ◽  
Vol 6 (4) ◽  
pp. 1287
Author(s):  
Pravin D. Bhingare ◽  
Sanjay D. Dakhore ◽  
Sunil B. Wankhade ◽  
Saurabh Lihitkar
Keyword(s):  
Pancreatic Pseudocyst ◽  
Clinical Signs ◽  
Outlet Obstruction ◽  
Signs And Symptoms ◽  
Good Alternative ◽  
Pancreatic Pseudocysts ◽  
Laparoscopic Technique ◽  
Tertiary Healthcare ◽  
Clinical Signs And Symptoms ◽  
A Prospective Study

Background: Pancreatic pseudocysts can be defined as localized fluid collections that have a nonepithelialized wall consisting of fibrous and granulation tissue. These pseudocysts usually appear several weeks after the onset of pancreatitis. Advancement in the management of pseudocyst with laparoscopic drainage provides a good alternative or supplement to the surgical treatment of pancreatic pseudocyst. The purpose of this study is to evaluate the feasibility, effectiveness and outcome of Laparoscopic drainage.Methods: It was a prospective interventional hospital based study carried out among 32 indoor cases of pancreatic pseudocysts operated using laparoscopic procedures admitted under department of general surgery in a tertiary healthcare teaching institute during study period. Cases of pancreatic pseudocysts were evaluated with detailed history, clinical signs and symptoms, the duration and investigations. Details of laparoscopic, its indications, peculiarities, complications rates, recurrence rate and outcome was analyzed.Results: Single and multiple pancreatic pseudocysts were found in 26 (81.25%) and 6 (18.75%) patients and the most common site was found to be body of pancreas (59.37%). Obstructive jaundice (18.50%) and gastric outlet obstruction (15.63%) were the most common complications seen. The common procedures undertaken in the studied cases were laparoscopic cystogastrostomy (65.62%) followed by laparoscopic cystojejunostomy (12.50%) and laparoscopic external drainage (12.50%). Common complications in studied cases were found to be pain (15.65%), fever (12.5%) and external fistula (6.25%).Conclusions: Laparoscopic technique for treatment of pancreatic pseudocysts is safe, efficacious, feasible and is associated with fast recovery. These techniques should be preferred over open surgical drainage.

Laparoscopic Transgastric versus Endoscopic Drainage of a Large Pancreatic Pseudocyst. A Case Report

2016 ◽  
Vol 25 (2) ◽  
pp. 243-247 ◽  
Author(s):  
Mircea Beuran ◽  
Ionut Negoi ◽  
Fausto Catena ◽  
Massimo Sartelli ◽  
Sorin Hostiuc ◽  
...  
Keyword(s):  
Case Report ◽  
Pancreatic Pseudocyst ◽  
Clinical Course ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Large Tumor ◽  
Specific Patient ◽  
Invasive Approach ◽  
Feasible Option ◽  
Tailored Approach

Case report: A 37 year-old woman was admitted three months after an episode of severe acute pancreatitis with a large tumor mass located in her left abdomen, abdominal tenderness and asthenia. Abdominal Computed Tomography (CT) revealed a giant pancreatic pseudocyst of 23/15/12 centimeters. We performed an anterior laparoscopic transgastric cystogastrostomy. The postoperative clinical course was uneventful, and she was discharged nine days later. After another month she was re-admitted for general malaise and fever. We performed endoscopic evaluation of the cystogastrostomy patency followed by lavage of the pseudocyst cavity. After five days of broad spectrum antibiotic therapy the clinical course started to improve and the patient was discharged after another eight days. One- and two-year follow-ups revealed no remnant cavity. Conclusions: Laparoscopic transgastric cystogastrostomy is a feasible option for selected patients with pancreatic pseudocysts. Careful patients’ evaluation in a multidisciplinary team, including imaging specialists, dedicated gastroenterologists with experience in advanced interventional techniques and pancreatic surgeons, balancing between watchful waiting and step-up minimally invasive approach offers the best tailored approach for a specific patient.

scholarly journals Splenic injury following endoscopic drainage of a large pancreatic pseudocyst: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Krittin J. Supapannachart ◽  
Christopher R. Funk ◽  
Lauren M. Gensler ◽  
Matthew P. Butters
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Pancreatic Pseudocyst ◽  
Left Kidney ◽  
Fluid Collection ◽  
Mass Effect ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Left Pleural Effusion ◽  
Splenic Hematoma

Abstract Background Many pancreatic pseudocysts spontaneously resolve, but larger or symptomatic pseudocysts may require procedural management. Though endoscopic ultrasound guided approaches are standard of care and have high success rates, complications can include bleeding, infection, and splenic perforation. This patient case report details an unusual series of complications of endoscopic cystogastrostomy that should encourage clinicians to evaluate for anatomic disruptions caused by mass effects of pancreatic pseudocysts prior to endoscopic pseudocyst drainage. Case presentation A 53-year-old African American male with a past medical history notable for alcohol use disorder, chronic pancreatitis, and insulin dependent diabetes presented with a 4-day history of left upper quadrant abdominal pain. Computed tomography imaging with contrast revealed enlargement of a known pancreatic pseudocyst to 15.9 × 10.4 cm. Due to pseudocyst size and the patient’s symptoms, endoscopic cystogastrostomy stent placement was performed. However, postprocedurally, he developed leukocytosis to 19,800 cells/m3 (from 14,100 cells/m3 preoperatively) as well as acute hypoxemic respiratory failure with a large left pleural effusion. Postprocedural computed tomography with contrast demonstrated a new large subcapsular splenic hematoma in communication with a new subdiaphragmatic fluid collection. Due to suspicion of endoscopic procedural complication, he underwent open laparotomy which revealed grade 4 splenic laceration, septic splenic hematoma, and a subdiaphragmatic abscess. Conclusions While endoscopic drainage of pancreatic pseudocyst was technically successful, this case demonstrates complications from mass effect of a large pancreatic pseudocyst which putatively tore the splenorenal ligament, leading to excessive separation of the left kidney and spleen. If anatomic disruptions caused by mass effect from a pancreatic pseudocyst are recognized through preprocedural abdominal imaging, such cases may be considered for early open repair versus cystogastrostomy.

scholarly journals Endoscopic Drainage of Giant Pancreatic Pseudocysts Using Both Lumen-Apposing Metal Stent and Plastic Stent: A Report of Two Cases and Review of the Current Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hussam I. A. Alzeerelhouseini ◽  
Muawiyah Elqadi ◽  
Mohammad N. Elqadi ◽  
Sadi A. Abukhalaf ◽  
Hazem A. Ashhab
Keyword(s):  
Pancreatic Pseudocyst ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Metal Stent ◽  
Case Presentation ◽  
Plastic Stent ◽  
History Of ◽  
Giant Pseudocyst ◽  
The Ideal

Introduction. A pancreatic pseudocyst (PP) with major diameter equal to 10 cm or more is called a giant pseudocyst. The ideal management for giant PPs is controversial. Endoscopic drainage is an alternative nonsurgical approach for PP management. Only a few cases of giant PPs were reported to be managed by endoscopic drainage. Case Presentation. We reported two cases of giant PPs following an episode of acute pancreatitis. Both were resolved following endoscopic cystogastrostomy using metallic and double-pigtail stents with excellent outcomes. There was no history of recurrence or complications on follow-up. In addition, we extensively reviewed all available literature studies of giant pancreatic pseudocyst presentation, management, and complications. We summarized all reported cases and presented them in a comprehensive table. Conclusion. The endoscopic cystogastrostomy approach is cost saving, can avoid surgical complications, and offers an early hospital discharge.

scholarly journals Plastic stents are more cost-effective than lumen-apposing metal stents in management of pancreatic pseudocysts

2018 ◽  
Vol 06 (07) ◽  
pp. E780-E788 ◽  
Author(s):  
Yen-I Chen ◽  
Mouen Khashab ◽  
Viviane Adam ◽  
Ge Bai ◽  
Vikesh Singh ◽  
...  
Keyword(s):  
Cost Effective ◽  
Sensitivity Analyses ◽  
Plastic Stents ◽  
Pancreatic Pseudocysts ◽  
Metal Stents ◽  
Endoscopic Drainage ◽  
Success Rates ◽  
Initial Management ◽  
Pancreatic Fluid ◽  
Fluid Collections

Abstract Background and study aims Endoscopic ultrasound-guided drainage is an effective and accepted primary modality for management of pancreatic pseudocyst (PP). A lumen-apposing metal stent (LAMS) has recently been developed specifically for drainage of pancreatic fluid collections which may be superior to using traditional plastic stents (PS) but is more expensive. Because use of a stent involves a risk of unplanned endoscopy, percutaneous drainage (PCD) and surgery, their costs should also be included in the comparison and a cost-effectiveness analysis of LAMS and PS should therefore be performed Patients and methods A decision tree was developed assessing both endoscopic drainage strategies for patients with PP: LAMS and PS over a 6-month time horizon. For each strategy, inpatients received a stent and were followed for subsequent need for direct further interventions or adverse events leading to unplanned endoscopy, PCD, surgery, or successful endoscopic drainage using probabilities obtained from the literature. The unit of effectiveness was successful endoscopic drainage without need for PCD or surgery. Sensitivity analyses were performed. Results Success rates were 93.9 % for LAMS and 96.96 % for PS. Respective costs per successful drainage were US $ 18,129 (LAMS) and US $ 10,403 (PS). The LAMS strategy was thus characterized as dominated by the PS approach because it was costlier and less effective than PS. Both deterministic and probabilistic sensitivity analyses confirmed the robustness of these findings. Conclusion Use of LAMS is not less effective and more costly than PS in management of patients with PP. As such, PS should be preferred over LAMS as initial management of these patients.

scholarly journals The results of endosonography-assisted internal drainage of pancreatic pseudocyst

2019 ◽  
Vol 24 (1) ◽  
pp. 43-52
Author(s):  
Yu. G. Starkov ◽  
R. D. Zamolodchikov ◽  
S. V. Dzhantukhanova ◽  
M. I. Vyborniy ◽  
K. V. Lukich ◽  
...  
Keyword(s):  
Success Rate ◽  
Pancreatic Pseudocyst ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Internal Drainage

Aim.To compare immediate and long-term results of internal drainage of pancreatic pseudocyst by using of endosonography-assisted and open surgical approaches.Material and methods.EUS-assisted internal drainage of pancreatic pseudocyst was performed in 32 patients in 2011–2016. Open drainage procedures were carried out on the other 32 patients.Results.In the group of endoscopic drainage, technical success rate, clinical success rate and complication rate were 97%, 85% and 26%, respectively. There were no recurrent pseudocysts in long-term period. Comparison with open surgery confirmed advantages of endoscopic technique regarding time of operation (p< 0.01), intraoperative blood loss (p< 0.01) and length of hospital-stay (p< 0.01).Conclusion.EUS-assisted internal drainage of pancreatic pseudocysts in the treatment of chronic pancreatitis is characterized by high rate of technical and clinical success, small postoperative morbidity and low incidence of longterm recurrences.

scholarly journals Current treatment of pancreatic pseudocysts: a systematic review

2021 ◽  
Vol 28 (4) ◽  
pp. 85-99
Author(s):  
V. M. Durleshter ◽  
S. R. Genrikh ◽  
A. V. Makarenko ◽  
D. S. Kirakosyan
Keyword(s):  
Pancreatic Pseudocyst ◽  
Current Treatment ◽  
Pancreatic Pseudocysts ◽  
Journal Title ◽  
Endoscopic Drainage ◽  
Surgical Drainage ◽  
Ultrasound Guided ◽  
Advantages And Disadvantages ◽  
Large Patient ◽  
Surgical Methods

Background. Pancreatic pseudocysts stand among current challenges in modern medicine. Their treatment uses variant instrumental techniques and implies a multispecialty approach. Trials in surgery and gastroenterology have aimed to identify an optimal strategy to tackle pancreatic pseudocysts for reducing complications and the recurrence rate, suggesting ultrasound-guided percutaneous, laparoscopic and flexible endoscopic drainage as promising treatment choices.Objectives. A summarising review of diagnostic and therapeutic methods for pancreatic pseudocyst treatment and comparison of ultrasound-guided percutaneous vs. surgical and endoscopic drainage techniques.Methods. The review examines the classification, epidemiology and methods for diagnosis and treatment of pancreatic pseudocysts. Only comparative full-text studies published within 2014–2021, as well as selected impactive publications within 2002–2013, have been included. The eLibrary, Elsevier and PubMed resources were queried for the article or journal title fields against the keywords (separate or combined) “pancreatic pseudocyst” [псевдокиста поджелудочной железы], “pseudocyst drainage” [дренирование псевдокисты], “surgical drainage” [хирургическое дренирование], “endoscopic drainage” [эндоскопическое дренирование], cystogastrostomy [цистогастростомия], gastrojejunostomy [гастроеюностомия], “duodenal-cystic anastomosis” [цистодуоденоанастомоз], “transpapillary drainage” [транспапиллярное дренирование], “transmural drainage and esophagogastroduodenoscopy” [трансмуральное дренирование и эзофагогастродуоденоскопия]. Records have been selected for topic-related scientific value.Results. The review systematically surveys 68 scientific papers in the focus area and summarises the most common surgical methods for pancreatic pseudocyst treatment. Based on the main principle, the methods are classified into three categories, ultrasound-guided percutaneous drainage, surgical drainage and flexible endoscopic drainage. The major classifications and treatment techniques are highlighted for their advantages and disadvantages.Conclusion. There exist no generally adopted strategy for pancreatic pseudocyst treatment in current clinical practice and no evidence on a particular method application in a large patient cohort. The publication survey identifies the techniques of percutaneous, surgical and endoscopic drainage with ultrasound control as highly effective overall among other surgical treatments.

scholarly journals Endoscopic Management of Pancreatic Pseudocysts

1994 ◽  
Vol 1 (1) ◽  
pp. 29-35 ◽  
Author(s):  
M. Dohmoto ◽  
K. D. Rupp
Keyword(s):  
Endoscopic Management ◽  
Pancreatic Pseudocysts ◽  
Simultaneous Increase ◽  
Endoscopic Drainage ◽  
Endoscopic Retrograde ◽  
Dominant Position ◽  
Pancreas Head ◽  
Endoscopic Findings ◽  
Reduction Of Pain ◽  
Nonsurgical Therapy

Recently, endoscopic interventional procedures were introduced for nonsurgical therapy of symptomatic pancreas pseudocysts. We reported 25 patients treated by endoscopic retrograde pancreas drainage (ERPD), endoscopic cystogastrostomy (ECG), or endosopic cystoduodenostomy (ECD).ERPD was performed in 9 patients by placement of a 5 Fr. or 7 Fr. endoprosthesis transpapillary into the cyst or the main pancreatic duct. ECG was carried out in 10 cases, in 7 of these, a double pigtail catheter was additionally inserted. Three patients suffering from pseudocysts of the pancreas head were treated by ECD. In a further 3 cases, ERPD and ECG were combined.All patients reported a dramatic reduction of pain with a simultaneous increase of appetite and body weight. The drainage tubes were removed after disappearance of symptoms, and abnormal clinical and endoscopic findings within 2 to 12 months. In 4 cases, a recurrence of the cyst was found 10 and 22 months later, in 3 cases the endoprostheses had to be renewed because of catheter occlusion or dislocation. 2 patient underwent surgical treatment after insufficient endoscopic drainage due to haemorrhage or recurrence.Endoscopic treatment of pancreatic pseudocysts yielded good results with low rates of recurrence and complications. According to our experiences we think endoscopic interventional techniques will oust surgery from its present dominant position in the next years.

scholarly journals Combined EUS-Guided Abdominal Cavity Drainage and Cystogastrostomy for the Ruptured Pancreatic Pseudocyst

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Ge Nan ◽  
Sun Siyu ◽  
Liu Xiang ◽  
Wang Sheng ◽  
Wang Guoxin
Keyword(s):  
Pancreatic Pseudocyst ◽  
Abdominal Cavity ◽  
Gastric Wall ◽  
Endoscopic Management ◽  
Pancreatic Pseudocysts ◽  
Peritoneal Drainage ◽  
Pseudocyst Drainage ◽  
Guided Puncture ◽  
Intraperitoneal Drainage ◽  
Entire Procedure

Background. Endoscopic-Ultrasonography- (EUS-) guided puncture and drainage of pancreatic pseudocyst is currently one of the most widely accepted nonsurgical treatments. To date, this technique has only been used for pancreatic pseudocysts adhesive to the gastric wall. This study introduces the technique of EUS-guided pseudocyst drainage and additional EUS-guided peritoneal drainage for the ruptured pseudocyst.Methods. Transmural puncture and drainage of the cyst were performed with a 19 G needle, cystotome, and 10 Fr endoprosthesis. Intraperitoneal drainage was performed with a nasobiliary catheter when rupture of pseudocyst occurred. The entire procedure was guided by the echoendoscope.Results. A total of 21 patients, 8 men and 13 women, with a mean age of 36 years, were included in this prospective study. All of the pseudocysts were successfully drained by EUS. Peritoneal drainage was uneventfully performed in 4 patients. There were no severe complications. Complete pseudocyst resolution was established in all patients.Conclusion. The technique of EUS-guided transmural puncture and drainage, when combined with abdominal cavity drainage by a nasobiliary catheter, allows successful endoscopic management of pancreatic pseudocysts without adherence to gastric wall.

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