Diagnosis and Treatment of Pancreatic Pseudocysts in Chronic Pancreatitis

Abstract

Pancreatic pseudocysts are a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter. Diagnosis is accomplished most often by computed tomographic scanning, by endoscopic retrograde cholangiopancreatography, or by ultrasound, and a rapid progress in the improvement of diagnostic tools enables detection with high sensitivity and specificity. Different strategies contribute to the treatment of pancreatic pseudocysts: endoscopic transpapillary or transmural drainage, percutaneous catheter drainage, or open surgery. The feasibility of endoscopic drainage is highly dependent on the anatomy and topography of the pseudocyst, but provides high success and low complication rates. Percutaneous drainage is used for infected pseudocysts. However, its usefulness in chronic pancreatitis-associated pseudocysts is questionable. Internal drainage and pseudocyst resection are frequently used as surgical approaches with a good overall outcome, but a somewhat higher morbidity and mortality compared with endoscopic intervention. We therefore conclude that pseudocyst treatment in chronic pancreatitis can be effectively achieved by both endoscopic and surgical means. This review entails publications referring to the classification of pancreatic pseudocysts, epidemiology, diagnostic tools, and therapeutic options for pancreatic pseudocysts. Only full articles were considered for the review. Based on a search in PubMed, the MeSH terms "pancreatic pseudocysts and classification," "diagnosis," and "endoscopic, percutaneous, and surgical treatment" were used either alone or in combination.

Italian consensus guidelines for chronic pancreatitis

“…Therefore asymptomatic pseudocysts should be treated conservatively by first instance, irrespective of size or duration. Percutaneous drainage should not be performed in chronic pseudocysts [240,241], whereas both surgical and endoscopic treatments are effective to manage symptomatic pseudocysts [242]. However, percutaneous and endoscopic treatments have sometimes been associated with a high rate of complications, raising doubts on the role of non-operative treatment as the first-line approach [243,244].…”

Uncomplicated spontaneous rupture of the pancreatic pseudocyst into the duodenum: Case report

“…A variety of diagnostic tools including computed tomography, ultrasonography, endoscopic retrograde cholangiopancreaticography, biochemical analysis, cyst aspiration and cytology are used for the diagnosis of pancreatic pseudocysts. There is a consensus that computed tomography is mandatory for planning therapy and follow-up for a pancreatic pseudocyst [1]. The identification of a thickwalled, rounded, fluid-filled mass adjacent to the pancreas on abdominal scan in patient with a history of a acute or chronic pancreatitis is virtually pathognomonic for pancreatic pseudocyst [4].…”

“…Diagnosis is accomplished most often by ultrasound, computed tomography or endoscopic retrograd cholangiopancreatography [1][2][3]. Most pseudocysts resolves spontaneously with supportive care, however chronic or larger pseudocysts are more likely to be symptomatic and may cause complications.…”

Pancreatic cysts: etiology, diagnosis and management

“…Yeo et al [5] noted that 67% of the cysts with a diameter of more than 6 cm, and only 40% of the cysts with a diameter of less than 6 cm required surgical intervention. Cysts caused by acute pancreatitis are characterized by a much greater tendency to spontaneous resorption than cysts in chronic pancreatitis, which is related to the slow process of maturation of cyst wall caused by acute pancreatitis and the presence of a mature cyst wall due to chronic pancreatitis [73][74][75][76]. In chronic pancreatitis, less than 10% of the cysts are likely to spontaneous resorption.…”