Management strategies for pancreatic pseudocysts

Abstract

Very low-quality evidence suggested that the differences in mortality and serious adverse events between treatments were imprecise. Low-quality evidence suggested that short-term HRQoL (four weeks to three months) was worse, and the costs were higher in the open surgical drainage group than in the EUS-guided drainage group. Low-quality or very low-quality evidence suggested that EUS-guided drainage with nasocystic drainage led to fewer adverse events than EUS-guided or endoscopic drainage, and shorter hospital stays when compared to EUS-guided drainage, endoscopic drainage, or open surgical drainage, while EUS-guided drainage led to shorter hospital stays than open surgical drainage. Low-quality evidence suggested that there was a higher need for additional invasive procedures with endoscopic drainage than EUS-guided drainage, while it was lower in the open surgical drainage than in the endoscopic drainage group.Further RCTs are needed to compare EUS-guided drainage, with or without nasocystic drainage, in symptomatic patients with pancreatic pseudocysts that require treatment. Future trials should include patient-oriented outcomes such as mortality, serious adverse events, HRQoL, hospital stay, return-to-normal activity, number of work days lost, and the need for additional procedures, for a minimum follow-up period of two to three years.

Mechanical Duodenal Perforation Due to Complications of Pancreatic Pseudocysts

“…A Cochrane review has looked at the different treatment options for pancreatic pseudocysts [15]. Percutaneous drainage, endoscopic and endoscopic ultrasound drainage and open surgical management have all been described [15,16].…”

“…A Cochrane review has looked at the different treatment options for pancreatic pseudocysts [15]. Percutaneous drainage, endoscopic and endoscopic ultrasound drainage and open surgical management have all been described [15,16]. These procedures are not without serious adverse events but the highest was seen in open surgical drainage (15%)-however, the review did not reach statistical significance [15].…”

Pancreatic pseudocyst treated by laparoscopy, case report

“…3,4 The drainage of this lesions is indicated when the symptoms persist more than 6 weeks, when the cyst is larger than 6cm in diameter, is rapidly enlarging or some complication is present. 4,5 The options for drainage include endoscopic function, open surgical drainage with cystogastrostomy, cystoduodenostomy and Rouxen-Y cystojejunostomy, or these techniques with minimally invasive approach by laparoscopy. The endoscopic drainage is indicated when there is an immature cyst or is infected, is the less invasive but the recurrence is as high as 30%.…”

Complications of Chronic Pancreatitis

“…One randomized controlled trial involving 40 subjects demonstrated endoscopic therapy has similar efficacy to surgical drainage and was associated with improved quality of life and decreased healthcare utilization [36]. A recent meta-analysis showed similar results favoring an endoscopic approach; however, these findings were based on low quality evidence and should be interpreted cautiously [37]. …”