Endoscopic Drainage of Pancreatic Pseudocysts

Liguory, C; Lefebvre, J. F.; Vitale, Gary C.

doi:10.1155/1990/963419

Cited by 13 publications

(3 citation statements)

References 9 publications

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“…A communication with the pancreatic duct occurs in 40% to 70% of pseudocysts, which renders them potentially suitable for endoscopic transpapillary drainage (44)(45)(46). Pseudocysts that are shown at ERCP to communicate with the main pancreatic duct or one of its side branches may be drained via a transpapillary insertion of a stent that bridges the main pancreatic duct or a disrupted side branch (10).…”

Section: Transpapillary Drainagementioning

confidence: 99%

Minimally Invasive Approaches to the Management of Pancreatic Pseudocysts

Bhattacharya

Ammori

2003

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

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Although one third or more of pancreatic pseudocysts might resolve spontaneously, interventional therapy is required for most. Several minimally invasive management approaches are now available, including percutaneous drainage under radiologic control, endoscopic transpapillary or transmural drainage, and laparoscopic internal drainage. This paper reviews the methodology, applications, advantages, shortcomings, and results of these management approaches. A computerized search was made of the MEDLINE, PREMEDLINE, and EMBASE databases using the search words pancreatic and pseudocysts and all relevant articles in English Language or with English abstracts were retrieved. In addition, cross-references from the identified articles were reviewed. Percutaneous drainage is best applied to pseudocysts complicated with secondary infection and in critically ill patients or those unfit for surgery. Radiologic drainage, however, risks the introduction of secondary infection and the formation of an external pancreatic fistula, and is associated with high recurrence rates. Endoscopic transpapillary drainage is beneficial for pseudocysts that communicate with the pancreatic duct and when a dependent drainage could be established. Endoscopic transmural (transgastric or transduodenal) drainage offers good results in the management of suitably located pseudocysts that complicate chronic pancreatitis, but is associated with high rates of failure to drain, secondary infection, and recurrence when pseudocysts that complicate acute necrotizing pancreatitis are approached. Laparoscopic pseudocyst gastrostomy or pseudocyst jejunostomy achieves adequate internal drainage, facilitates concomitant debridement of necrotic tissue within acute pseudocysts, and achieves good results with minimal morbidity. A randomized controlled trial that compares laparoscopic and endoscopic drainage techniques of retrogastric pseudocysts of chronic pancreatitis is required.

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Section: Transpapillary Drainagementioning

confidence: 99%

Minimally Invasive Approaches to the Management of Pancreatic Pseudocysts

Bhattacharya

Ammori

2003

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

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“…They reported that transpapillary drainage is less invasive and safe, recommending this method as the first choice. Based on previous reports, communication between the pseudocyst and main pancreatic duct is observed in 55-69% of patients [ 4 , 7 , 12 , 13 ], and thus transpapillary drainage is indicated in a large proportion of patients with pseudocysts.…”

Section: Discussionmentioning

confidence: 99%

Pseudocyst in the Pancreatic Tail Associated with Chronic Pancreatitis Successfully Treated by Transpapillary Cyst Drainage

Naitoh

Ohara

Okayama

et al. 2008

Case Rep Gastroenterol

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We report a 50-year-old male with pseudocysts in the pancreatic tail associated with chronic pancreatitis successfully treated by transpapillary cyst drainage. He had previously undergone ultrasonography-guided percutaneous cyst drainage for a pancreatic pseudocyst in our hospital. He was readmitted due to abdominal pain and fever. Computed tomography showed recurrence of a pseudocyst in the pancreatic tail measuring 5 cm in diameter. Since conservative treatment failed, endoscopic retrograde pancreatography was performed. There was communication between the pseudocyst and the main pancreatic duct, and pancreatic duct stenosis proximal to the pseudocyst. First, transpapillary pancreatic duct drainage was performed using a plastic stent, but the pseudocyst did not decrease in size and became infected. After removal of the stent, a pigtail type nasocystic catheter was placed in the pseudocyst via the pancreatic duct. The pseudocyst infection immediately disappeared, and the pseudocyst gradually decreased and disappeared. After removal of the nasocystic catheter, no recurrence was observed. As transpapillary drainage of pancreatic pseudocyst, cyst drainage and pancreatic duct drainage have been reported. In our patient with pseudocyst in the pancreatic tail, duct drainage was ineffective and the pseudocyst was infected, whereas cyst drainage was very effective. We considered that cyst drainage by a nasocystic catheter was the first-line therapy as the transpapillary drainage of the pancreatic pseudocyst.

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“…It is an option when a communication is present between the pseudocyst and the pancreatic ductal system. This scenario is reported to occur in 40-69% of pseudocysts [65][66][67] and is more common in patients with chronic pancreatitis (49%) than those with acute pancreatitis (20%) [68]. In a review of six studies with a total of 117 patients [68][69][70][71][72][73], initial success rates were 84%, with a long-term success rate of 75% after 2 years.…”

Section: Endoscopic Management Of Pancreatic Pseudocystsmentioning

confidence: 99%