Pancreatic Pseudocysts Transpapillaryand Transmural Drainage

Abstract

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.

Stent displacement in endoscopic pancreatic pseudocyst drainage and endoscopic management

“…Previous reports have shown a success rate of > 90% for EUS-PPD in patients with chronic pseudocysts [6,19] . The recurrence rate after EUS-PPD is approximately 4%, and the complication rate is < 16% [20] . In a prospective study with 99 patients, the short-term success rate of EUS-PPD was 93% and the long-term success rate was 84%; complications occurred in 19% of cases [5] .…”

Multiple orifices are better than single in the endoscopic treatment of pancreatic pseudocysts

“…The efficacy of this method was high, but at the same time, there were many complications associated with administration of the obliterating agent, including cyst wall necrosis and peritonitis. With the development of endoscopic techniques and new implantable materials, the surgeons started to perform drainage of pancreatic cysts connecting to the Wirsung's duct during endoscopic retrograde cholangiopancreatography (ECPW) (6,7). A development of this technique is the currently performed cyst marsupialization to the gastrointestinal tract and fixation of the anastomosis site using a pig tail drain (8)(9)(10).…”

La kystogastrostomie guidée par échoendoscopie dans le traitement des collections pancréatiques : expérience de l’hôpital militaire de Rabat (Maroc)

“…Une approche en une seule étape en utilisant uniquement un écho-endoscope est devenue possible avec le développement d'écho-endoscopes linéaires interventionnels à large canal opérateur [19][20][21][22][23]. Les taux de succès global rapportés en utilisant cette méthode, sont supérieurs à 90 % [24], avec un faible taux de récidive de 4 % [25]. Chez nos malades, nous avons réalisé le drainage des collections pancréatiques en utilisant un écho-endoscope en une seule étape.…”