Background and Study Aims: Endoscopic drainage is a widely used treatment modality for pancreatic pseudocysts and has challenged more traditional drainage techniques. This retrospective study evaluates the short-term and long-term results with this technique and aims to identify procedural modifications that may improve its safety and efficacy. Patients and Methods: All consecutive patients who underwent endoscopic drainage of pancreatic pseudocysts in our hospital between 1983 and 2000 were included in the study. The patients’ charts were reviewed, and long-term follow-up data were obtained by written questionnaires sent to the patients at the end of the follow-up period in November 2002. Results: A total of 92 patients were included (66 men, 26 women; median age 49 years). The technical success rate of the drainage procedure was 97 % and the mortality rate was 1 %. Complications occurred in 31 patients (34 %), eight of which (9 %) were major and required surgery: hemorrhage in four cases (three of which were caused by erosion of a straight endoprosthesis through the cyst wall), secondary infection in three, and perforation in one. During a median follow-up period of 43 months, 10 patients (11 %) underwent additional (nonendoscopic) treatment for a persistent cyst and five (5 %) for a recurrent cyst. Overall, endoscopic drainage was successful in 65 patients (71 %). Conclusions: Endoscopic drainage is an effective treatment for pancreatic pseudocysts and offers a definitive solution in almost three-quarters of the cases. The majority of major complications might have been prevented by using pigtail stents instead of straight stents and by taking a more aggressive approach to the prevention and treatment of secondary cyst infection.
References
1
Beckingham I J, Krige J E, Bornman P C, Terblanche J.
Long term outcome of endoscopic drainage of pancreatic pseudocysts.
Am J Gastroenterol.
1999;
94
71-74
2
Barthet M, Bugallo M, Moreira L S. et al .
Management of cysts and pseudocysts complicating chronic pancreatitis: a retrospective study of 143 patients.
Gastroenterol Clin Biol.
1993;
17
270-276
4
Gouyon B, Levy P, Ruszniewski P. et al .
Predictive factors in the outcome of pseudocysts complicating alcoholic chronic pancreatitis.
Gut.
1997;
41
821-825
7
Yeo C J, Bastidas J A, Lynch-Nyhan A. et al .
The natural history of pancreatic pseudocysts documented by computed tomography.
Surg Gynecol Obstet.
1990;
170
411-417
15
Boggi U, di Candio G, Campatelli A. et al .
Nonoperative management of pancreatic pseudocysts: problems in differential diagnosis.
Int J Pancreatol.
1999;
25
123-133
17
Singer M V, Gyr K, Sarles H.
Revised classification of pancreatitis. Report of the Second International Symposium on the Classification of Pancreatitis in Marseille, France, March 28 - 30, 1984.
Gastroenterology.
1985;
89
683-685
19
Baron T H, Harewood G C, Morgan D E, Yates M R.
Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts.
Gastrointest Endosc.
2002;
56
7-17
20
De Palma G D, Galloro G, Puzziello A. et al .
Endoscopic drainage of pancreatic pseudocysts: a long-term follow-up study of 49 patients.
Hepatogastroenterology.
2002;
49
1113-1115
22
Cremer M, Devière J, Engelholm L.
Endoscopic management of cysts and pseudocysts in chronic pancreatitis: long-term follow-up after 7 years of experience.
Gastrointest Endosc.
1989;
35
1-9
23
Binmoeller K F, Seifert H, Walter A, Soehendra N.
Transpapillary and transmural drainage of pancreatic pseudocysts.
Gastrointest Endosc.
1995;
42
219-224
24
Catalano M F, Geenen J E, Schmalz M J. et al .
Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis.
Gastrointest Endosc.
1995;
42
214-218
29
Smits M E, Rauws E A, Tytgat G N, Huibregtse K.
The efficacy of endoscopic treatment of pancreatic pseudocysts.
Gastrointest Endosc.
1995;
42
202-207
32
Harewood G C, Wright C A, Baron T H.
Impact on patient outcomes of experience in the performance of endoscopic pancreatic fluid collection drainage.
Gastrointest Endosc.
2003;
58
230-235
33
Heider R, Meyer A A, Galanko J A, Behrns K E.
Percutaneous drainage of pancreatic pseudocysts is associated with a higher failure rate than surgical treatment in unselected patients.
Ann Surg.
1999;
229
781-787
