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

Abstract

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.

Acute pancreatitis with giant pancreatic pseudocyst as a complication of extracorporeal shock wave lithotripsy: A case report and literature review

“…However, symptomatic, persistent, large, or complicated pseudocysts require internal drainage surgically or by using less-invasive percutaneous or endoscopic approaches [ 17 ]. Endoscopic drainage of pancreatic pseudocyst by creation of a fistulous tract between the pseudocyst and the gastric lumen (cystogastrostomy) is an alternative non-surgical approach for pancreatic pseudocysts’ management that lately gained a wide range of acceptance due to its lower morbidity, mortality, and costs [ 3 ].…”

“…The main drawback of LAMS that it was found to be associated with a higher bleeding rate when compared to the plastic stent, including late bleeding at 3–5 weeks after stent insertion which is mainly caused by stent friction to surrounding vasculature around the necrotic cavity promoting pseudoaneurysm formation and subsequent bleeding. This prompted gastroenterologists to change their practice of repeating imaging at 3 weeks to assess the cavity resolution instead of 6 weeks, followed by stent removal if the fluid collection is resolved or placing plastic double pigtail stent inside the LAMS [ 3 ].…”

“…It is mainly characterized by a well-defined inflammatory wall with a homogeneous fluid content that rich in amylase enzyme in the absence of tissue necrosis. A pseudocyst with a major diameter equal to 10 cm or more is called a giant pseudocyst [ 3 ].…”

Current treatment of pancreatic pseudocysts: a systematic review

“…Процедура ЭД была впервые проведена в 1989 году и с тех пор превратилась в наиболее приемлемую альтернативу хирургическому вмешательству [44]. В настоящее время этот метод стал более предпочтительным в лечении псевдокист поджелудочной железы, поскольку он менее инвазивен, чем хирургический, и не требует наружного дренирования с высоким риском инфицирования дренажной трубки, а также имеет высокий показатель эффективности [40,45,46].…”