Novel endoscopic management for pancreatic pseudocyst with fistula to the common bile duct

Abstract

Pancreatic pseudocyst formation is a well-known complication of pancreatitis. It represents about 75% of the cystic lesions of the pancreas and might be located within or surrounding the pancreatic tissue. Sixty percent of the occurrences resolve spontaneously and only persistent, symptomatic or complicated cysts need to be treated. Complications include infection, hemorrhage, gastric outlet obstruction, splenic infarction and rupture. The formation of fistulas to other viscera is rare and most commonly occurs within the stomach, duodenum or colon. We report a case of a patient with a pancreatic pseudocyst in communication with the common bile duct. There have been only few cases reported in the literature. We successfully managed our case by performing an endoscopic ultrasound-guided drainage of the pancreatic collection and a contemporaneous stenting of the common bile duct. Performed independently, both drainages are effective, safe and well-coded and the expertise on these procedures is widespread. By our knowledge this therapeutic approach was never reported in literature but we retain this is the most correct treatment for this very rare condition. Core tip: In our opinion the combination of endoscopic ultrasound-guided drainage of the pseudocyst and the simultaneous biliary stenting represent the best endoscopic treatment. The advantages of such approach consist in a better evaluation and a more effective drainage of the cystic cavity with the possibility to collect samples for biochemical and bacteriological analysis. Furthermore, the simultaneous biliary stenting can determine, at the same time, a pressure reduction in the bile system and in the pancreatic collection facilitating the healing of the fistula.Crinò SF, Scalisi G, Consolo P, Varvara D, Bottari A, Pantè S, Pallio S. Novel endoscopic management for pancreatic pseudocyst with fistula to the common bile duct. World J Gastrointest Endosc 2014; 6(12): 620-624 Available from: URL:

Pancreatic pseudocyst: Dilemma of its recent management (Review)

“…This technique has now become the preferred therapeutic approach due to being less invasive than surgery; it avoids external drainage with the risk of tube infection and has a high long-term success rate (40,45,46). The aim of ED in the treatment of pancreatic pseudocyst is to make a connection between the pseudocyst and the gastrointestinal tract, either with the stomach, duodenum or even jejunum (36,(47)(48)(49). There are two techniques that are used for ED: Transmural drainage (TMD) and transpapillary drainage (TPD); however, there is a lot of debate surrounding these two types of drainage technique and the determination of which technique is best for treatment (50)(51)(52).…”

Embolization of extrahepatic biliary leakage using NBCA

“…Percutaneous radiological techniques are effective in the 40-85% of cases [8] . The high rate of morbidity and mortality, related to surgical reoperation in such delicate patients, makes endoscopic and interventional radiology techniques the best choice treatments [9] , [10] , [11] .…”

Bilio-cutaneous fistula obliteration with NBCA

“…The high rate of morbidity and mortality related to surgical reoperation in such delicate patients making endoscopic and interventional radiology techniques the best choice treatments. [8910]…”