Researchers from Jaipur and Jodhpur, India, investigated the long-term outcome of endoscopic management of pancreatic pseudocyst with a minimum follow-up of 2 years.
A total of 38 consecutive patients with pancreatic pseudocyst underwent endoscopic cystogastrostomy (n = 27), endoscopic cystoduodenostomy (n = 6), and transpapillary drainage (n = 5).
Patients were monitored at 1 and 3 months after drainage, and finally between 24 and 80 months.
Upper gastrointestinal endoscopy was done at 1 and 3 months after drainage, while ultrasound was done at 3 months and at the end of follow-up.
The team found that biliary pancreatitis was responsible for the pseudocyst in 19 cases. The remaining occurrences were caused by alcohol (n = 12) and trauma (n = 7).
All forms of endoscopic drainage were effective in treating pancreatic pseudocyst. There was complete disappearance of the cyst within 3 months of drainage, irrespective of cause.
Over a mean follow-up of 44 months, 3 patients had symptomatic recurrences, while 3 had asymptomatic recurrences; all had alcohol-induced pancreatitis.
No recurrences were seen in the biliary pancreatitis and trauma group.
| Pseudocyst recurrences only seen in the alcoholic pancreatitis group.
| Endoscopy |
All symptomatic recurrences were successfully managed with endoscopic cystogastrostomy and stenting.
The investigators found that a massive bleed in 1 patient required surgery. In addition, stent block and cyst infection in 3 patients, and perforation in 1 patient, were managed conservatively.
Endoscopic retrograde cholangiopancreatography (ERCP) was done before cyst drainage in 8 patients because there was no visible bulge into the stomach or duodenum (n = 5), or because obstructive jaundice was present (n = 3).
In 5 patients ERCP revealed cyst duct communication.
All these patients were managed by transpapillary drainage and there was only 1 asymptomatic recurrence in this group.
Author S. S. Sharma, of the SMS Medical College, Jaipur, said on behalf of the group, "Endoscopic management of pancreatic pseudocyst is quite an effective and safe mode of treatment in experienced hands."
"ERCP before the procedure is only required when the cyst does not bulge into gut lumen, for a decision about the feasibility of transpancreatic drainage."
"On long-term follow-up, recurrences were seen only in the alcoholic pancreatitis group," it was concluded.