Percutaneous drainage of pancreatic pseudocyst into the stomach

Sever, Mojca Jensterle; Vidmar, Dubravka; Šurlan, Miloš; Pleskovič, Aleš; Višnar-Perovič, Alenka

doi:10.1007/s004649900830

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…Percutaneous drainage of pseudocysts is one of the well-established relatively inexpensive methods of drainage and is usually performed under local anesthesia with radiologic control (23,24) such as CT, ultrasound, or fluoroscopy, or with endoscopic assistance (25)(26)(27)(28). The access route for drainage depends on the size, location, extent, and the disposition of surrounding viscera, and has used transperitoneal, retroperitoneal, transhepatic, transgastric, transduodenal, and transsplenic (inadvertent) approaches (29).…”

Section: Radiologic (Percutaneous) 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: Radiologic (Percutaneous) Drainagementioning

confidence: 99%

Minimally Invasive Approaches to the Management of Pancreatic Pseudocysts

Bhattacharya

Ammori

2003

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

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“…Percutaneous drainage is usually successful in achieving pseudocyst drainage (70% to 90%) [23•]. The pseudocyst should preferably be greater than 5 cm in diameter and adherent to the posterior wall of the stomach [24]. Use of octreotide or placement of progressively smaller catheters may encourage closure of pancreatic-cutaneous fistulas [26].…”

Section: Percutaneous Drainagementioning

confidence: 99%

Pancreatic pseudocysts

Byrne

Mitchell

Baillie

2002

Curr Treat Options Gastro

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Pseudocysts complicate acute pancreatitis in less than 5% of cases and chronic pancreatitis in 20% to 40% of cases. A pseudocyst is a localized collection of pancreatic fluid surrounded by a wall of granulation tissue and collagen. It takes 4 to 6 weeks for a fluid collection to mature and become a true pseudocyst. Unlike other cystic lesions of the pancreas from which they should be differentiated, pseudocysts lack an epithelial layer. Patients with pseudocysts present with a range of symptoms and signs. Pseudocysts are imaged using transabdominal ultrasound, CT, endoscopic ultrasound (EUS), and MRI. EUS confers an advantage over other imaging modalities in that certain EUS features are suggestive of pseudocysts over other cystic lesions. The diagnostic accuracy of EUS has improved further with the use of EUS-guided fine-needle aspiration. Therapeutic options include watchful observation or intervention. In our opinion, if acute pseudocysts are uncomplicated, asymptomatic, and do not appear to be enlarging on serial imaging, it is preferable to withhold intervention because many of these cysts resolve spontaneously. However, one needs to beware of the possibility of complications such as infection in unresolved pseudocysts. Pseudocysts associated with chronic pancreatitis are less likely to resolve spontaneously and are drained by intervention more frequently. Of the three interventional options, namely endoscopic, percutaneous, and surgical drainage, endoscopic drainage should be the treatment of choice if certain criteria are met. Preinterventional endoscopic retrograde cholangiopancreatography is mandatory to define ductal anatomy. If there is communication between the pseudocyst and the pancreatic duct, a transpapillary approach is preferred. Use of EUS should increase the number of cases in which pseudocysts can be drained endoscopically. Surgery should be reserved for cases in which there is a concern about malignancy or when there is glandular disruption.

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“…It is often done under radiologic control (5,6), by using either computer tomographic ( Fig. 1), ultrasonographic or fluoroscopic guidance or with endoscopic assistance (7)(8)(9)(10). The size, location and extent, as well as the disposing of the surrounding viscera, are the main elements to be considered when choosing the approach Amongst all possible approaches, the transgastric route is most commonly chosen, having the lowest rate of complications (11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Therapeutical Aspects Regarding Pancreatic Pseudocysts

David¹,

Grigorean²

2018

chr

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Chirurgia, 113 (3), 2018 www.revistachirurgia.ro 353 RezumatFrecvent apărute că şi complicaţii ale pancreatitei, pseudochistele pancreatice sunt entităţi rare, pentru tratamentul cărora s-au dezvoltat de-a lungul timpului multiple tehnici terapeutice, variind de la metode minim invazive la tehnici complexe de chirurgie clasică. Pseudochistele simptomatice, cele de mari dimensiuni precum şi cele ce suferă complicaţii evolutive de timpul hemoragiei, suprainfectiei şi rupturii au indicaţie de drenaj. Alegerea metodei optime de drenaj este deseori o provocare, multiplii factori trebuind să fie luaţi în considerare, incluzând locaţia pseudochistului, dimensiunea precum şi starea generală a pacientului şi comorbidităţile acestuia. Astfel, elaborarea unui algoritm terapeutic ar fi de o utilitate incontestabilă, conferind posibilitatea alegerii unei tehnici fezabile leziunii însă adaptată pacientului.Cuvinte cheie: pancreas, pseudochist, tratament, drenaj AbstractFrequently appearing as a complication of pancreatitis, pancreatic pseudocysts are rare appearances in current medical practice. Multiple therapeutical options are available, from minimum invasive methods to complex open surgical techniques. The indications of drainage include symptomatic pseudocysts, large pseudocysts along with the development of complications such as hemorrhage, secondary infection, and rupture. Choosing the best drainage technique is often a challenge. Multiple factors need to be considered in managing a pseudoocyst, including its location, dimension and the patient's

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Percutaneous drainage of pancreatic pseudocyst into the stomach

Abstract: The method is minimally invasive and also feasible in high-risk surgical patients. It requires a team consisting of an interventional radiologist, an ultrasonographer, and an endoscopist. In properly selected patients, the results are excellent.

Cited by 10 publications

References 5 publications

Minimally Invasive Approaches to the Management of Pancreatic Pseudocysts

Minimally Invasive Approaches to the Management of Pancreatic Pseudocysts

Pancreatic pseudocysts

Therapeutical Aspects Regarding Pancreatic Pseudocysts

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