Endosonography-Guided Drainage of Pancreatic Pseudocyst without Gastric or Duodenal Compression

Jc, Ardengh; E, Della Libera; Ap, Ferrari Júnior

doi:10.1055/s-2007-1001355

Cited by 13 publications

(7 citation statements)

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“…During the study EUS was not available at our institution, and maybe both complications that needed surgery (bleeding and perforation) could be avoided, besides allowing drainage in those cases in which we were unable to identify gastroduodenal compression. More recently we started to perform EUS guided transmural drainage whenever gastric or duodenal wall is not detected during endoscopy [28]. Our success (pseudocyst regression) rate was similar to other published series [12,14,17].…”

Section: Discussionsupporting

confidence: 84%

Pancreatic Pseudocysts Transpapillaryand Transmural Drainage

et al. 2000

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Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period. Patients and Methods: We studied 30 patients with pancreatic pseudocyst that presented some indication for treatment: persistent abdominal pain, infection or cholestasis. Clinical evaluation was performed with a pain scale, 0 meaning absence of pain and 4 meaning continuous pain. Pseudocysts were first evaluated by abdominal CT scan, and after endoscopic retrograde pancreatography the patients were treated by transpapillary or transmural (cystduodenostomy or cystgastrostomy) drainage. Pseudocyst resolution was documented by serial CT scans. Results: 25/30 patients could be treated. Drainage was successful in 21 (70% in an ‘intention to treat’ basis). After a mean follow-up of 42±35.82 weeks, there was only 1 (4.2%) recurrence. A total of 6 complications occurred in 37 procedures (16.2%), and all but 2 were managed clinically and/or endoscopically: there was no mortality related to the procedure. Patients submitted to combined drainage needed more procedures than the other groups. There was no difference in the efficacy when we compared the three different drainage methods. Conclusions: We concluded that pancreatic pseudocyst endoscopic drainage is possible in most patients, with high success rate and low morbidity.

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Section: Discussionsupporting

confidence: 84%

Pancreatic Pseudocysts Transpapillaryand Transmural Drainage

et al. 2000

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“…In our large series we verified that the use of EUS is not necessary before attempting necrosectomy: we did not have any free perforation of the peritoneum after opening of the gastric and duodenal wall, probably due to the firm inflammatory adherence of the collection cavity with the alimentary canal. However, the use of EUS in selected cases may be of great value [36][37][38][39][40][41] , but our institution does not have this resource available. We had one massive hemorrhage, after attempting a cystoduodenostomy opening with the sphincterotome, that stopped with endoscopic maneuvers.…”

Section: Discussionmentioning

confidence: 99%

“…In another patient, ED failed because no bulge was present. Probably, if we had used EUS [36][37][38][39][40] , we would have successfully entered the cavity by the transmural approach [9,10] .…”

Section: Discussionmentioning

confidence: 99%

Management of Infected and Sterile Pancreatic Necrosis by Programmed Endoscopic Necrosectomy

Coelho

Ardengh

Eulálio

et al. 2008

Dig Dis

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Introduction: Necrosectomy is the gold standard treatment for infected pancreatic necrosis (IPN). A percutaneous and endoscopic approach has been accepted in selected cases. Endoscopic drainage (ED) of IPN can be performed by using transpapillary or transmural procedures, or a combination of both with or without endoscopic ultrasound. Aims: The aim of this study was to determine the indications, complications, success rate, and the importance of assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography (ERP) in patients with IPN. Methods: Records of all patients who underwent endoscopic necrosectomy from January 2002 to December 2007 at Rio de Janeiro Federal University Hospital were reviewed. A total of 56 patients were included. ED was performed using daily transmural and transpapillary drainage. A diagnostic pancreatogram (ERP) to search for communications between the pancreatic duct and the collection were performed in all cases and in cases where communication existed. A pre-cut needle knife was used to puncture the cyst wall, aspirate the content and then enter at the cyst cavity (contrast was injected to ensure opacification of the cyst and subsequent drainage). Sphincterotomy catheter or balloons were used to enlarge and ensure a wide cystoenterostomy. All patients were followed with computerized tomography scans or ultrasound to ensure clinical resolution. Mean follow-up was 21 months. Results: 49/56 patients could be successfully treated. ED was successful in 49 patients (87%) and in 3 (13%) it failed. Mean follow-up was 21 months. During this period, there were 2 (10.5%) pseudocyst recurrences and only 1 (5.2%) recurrence of new episodes of pancreatic necrosis, and all were managed clinically and/or endoscopically. No mortality was related to the procedure. Conclusion: ED with daily necrosectomy is a useful method to remove infected and sterile pancreatic necrosis.

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“…A complication rate up 6-10% has been reported with transmural drainage without EUS guidance [6,8,16] . But the major role of EUS is the drainage of pancreatic pseudocyst appearing in patients without apparent luminal bulge [17,18] .…”

Section: Discussionmentioning

confidence: 99%

Single-Step EUS-Guided Endoscopic Treatment for Sterile Pancreatic Collections: A Single-Center Experience

Ardengh

Coelho

et al. 2008

Dig Dis

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Background and Aims: Endoscopic ultrasound (EUS) is useful for the treatment of sterile pancreatic fluid collections (PFC), either by means of transmural drainage or by complete aspiration. The aim of this study was to evaluate the efficacy and safety of single-step EUS-guided endoscopic approaches for treatment of sterile PFC. Patients and Methods: During a 3-year period, 77 consecutive patients with symptomatic, persistent sterile PFC were evaluated and treated with the linear EUS. We excluded patients with grossly purulent collections, chronic pseudocyst and those whose cytology diagnostic was neoplastic cyst of pancreas. 44 patients received a single 10-Fr plastic straight stent under EUS or fluoroscopic control (group I) and 33 of these underwent a single-step complete aspiration with a 19-gauge needle (group II). Results: The mean size of the sterile PFC was 48 mm in group I and 28 mm in group II (p < 0.001). Overall, endoscopic treatment was successful in 70 (90.9%) patients. The mean volume aspirated was 25 (18–65) ml. The total number of procedures was 50 in group I and 41 punctures in group II. After a mean follow-up of 64 ± 15.6 weeks there were 6 complications (13.6%): 2 recurrences (referred to surgery), 2 developing abscesses (submitted a new EUS-guided endoscopic drainage with success), 1 perforation that died (2.2%), and 1 case of bleeding (sent to surgery) in group I. In group II there were only 6 (18.1%) recurrences (submitted a new EUS-guided aspiration). None of the patients undergoing single-step aspiration developed infections, perforation or hemorrhage. Conclusion: The recurrence of pancreatic pseudocysts after endoscopic treatment was similar, either by means of plastic stents or by complete single-step aspiration.

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Endosonography-Guided Drainage of Pancreatic Pseudocyst without Gastric or Duodenal Compression

Cited by 13 publications

References 0 publications

Pancreatic Pseudocysts Transpapillaryand Transmural Drainage

Pancreatic Pseudocysts Transpapillaryand Transmural Drainage

Management of Infected and Sterile Pancreatic Necrosis by Programmed Endoscopic Necrosectomy

Single-Step EUS-Guided Endoscopic Treatment for Sterile Pancreatic Collections: A Single-Center Experience

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