Endoscopic Drainage of Pancreatic Pseudocyst
Abstract
Background: Endoscopic drainage has become an acceptable alternative to surgical drainage of symptomatic pancreatic pseudocysts. The aim of this study was to evaluate the results of transmural endoscopic drainage procedure at Ratchaburi Hospital, a regional referral center.
Materials and Methods: All patients with pancreatic pseudocysts managed with transmural endoscopic drainage from 2001 through 2006 were retrospectively reviewed. Success rate, complications and recurrence rates were evaluated.
Results: Twelve patients, including 8 males and 4 females, were considered suitable for endoscopic transmural drainage. Successful drainage was achieved in all patients. Complications occurred in 2 patients; one patient had cyst infection and another patient had migration of the stent. There was one early recurrence. All of them were successfully re-drained endoscopically. The median follow-up was 13 months. No further recurrence of the pseudocyst was found.
Conclusions: Endoscopic transmural drainage provides an effective and safe minimally invasive approach to pancreatic pseudocyst management.
References
1. Bradley EL, II. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga. September 11 through 13, 1992. Arch Surg 1993;128:586-90.
2. Yeo CJ, Sarr MG. Cystic and pseudocystic diseases of the pancreas. Curr Probl Surg 1994;31:165-243.
3. Grace PA, Williamson RC. Modern management of pancreatic pseudocysts. Br J Surg 1993;80:573-81.
4. Bartoli E, Delcenserie R, Yzet T, et al. Endoscopic treatment of chronic pancreatitis. Gastroenterol Clin Biol 2005:29:515-21.
5. Bradley EL, Clements JL Jr, Gonzalez AC. The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg 1979;137:135-41.
6. Wade JW. Twenty-five year experience with pancreatic pseudocysts. Are we making progress? Am J Surg 1985;149:705-8.
7. Yeo CJ, Bastidas JA, Lynch-Nyhan A, Fishman EK, Zinner MJ, Cameron JL. The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet 1990; 170:411-7.
8. Vitas GJ, Sarr MG, Selected management of pancreatic pseudocysts: operative versus expectant management. Surgery 1992;111:123-30.
9. D'Egidio A, Schein M. Pancreatic pseudocysts: a proposed classification and its management implications. Br J Surg 1991;78:981-4.
10. Bhattacharya D, Ammori BJ. Minimally invasive approaches to the management of pancreatic pseudocysts: review of the literature. Surg Laparosc Endosc Percutan Tech 2003;13:141-8.
11. Pitchumoni CS, Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed? Gastroenterol Clin North Am 1999:28:615-39.
12. Lohr-Happe A, Peiper M, Lankisch PG. Natural course of operated pseudocysts in chronic pancreatitis. Gut 1994;35:1479-82.
13. Parks RW, Tzovaras G, Diamond T, Rowlands BJ. Management of pancreatic pseudocysts. Ann R Coll Surg Engl 200082:383-7.
14. Usatoff V, Brancatisano R, Williamson RC. Operative treatment of pseudocysts in patients with chronic pancreatitis. Br J Surg 2000;87:1494-9.
15. Cooperman AM. Surgical treatment of pancreatic pseudocysts. Surg Clin North Am 2001;8 1:41 1-9, xii.
16. Sharma Ss, BhargawaN, Govil A. Endoscopic management of pancreatic pseudocyst: a long-term follow-up. Endoscopy 2002:34:203-7.
17. Brugge WR. Approaches to the drainage of pancreatic pseudocysts. Curr Opin Gastroenterol 2004;20:488-92.
18. Fockens P, EUS in drainage of pancreatic pseudocysts. Gastrointest Endosc 2002;56:S93-S97.
19. Neff R. Pancreatic pseudocysts and fluid collections: percutaneous approaches. Surg Clin North Am 2001;81:399-403, xii.
20. Freeny PC, Lewis GP, Traverso LW, Ryan JA. Infected pancreatic fluid collections: percutaneous catheter drainage. Radiology 1988;167:435-41.
21. vanSonnenberg E, Wittich GR, Casola G, et al, Percutaneous drainage of infected and noninfected pancreatic pseudocysts: experience in 101 cases. Radiology 1989;170:757-61.
22. Ahearne PM, Baillie JM, Cotton PB, Baker ME, Meyers WC. Pappas TN. An endoscopic retrograde cholangiopan creatography (ERCP)-based algorithm for the management of pancreatic pseudocysts. Am J Surg 1992;163:111-5.
23. Adams DB, Anderson MC. Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst. Ann Surg 1992:215:571-6.
24. D'Agostino HB, vanSonnenberg E, Sanchez RB, Goodacre BW, Villaveiran RG, Lyche K. Treatment of pancreatic pseudocysts with percutaneous drainage and octreotide. Work in progress. Radiology 1993;187:685-8.
25. Heider R, Meyer AA, Galanko JA, Behrns KE. Percutaneous drainage of pancreatic pseudocysts is associated with a higher failure rate than surgical treatment in unselected patients. Ann Surg 1999:229:781-7.
26. Lansden FT, Adams DB, Anderson MC. Treatment of external pancreatic fistulas with somatostatin. Second place winner: Conrad Jobst award. Am Surg 1989;55:695-8.
27. Baron TH, Harewood GC, Morgan DE, Yates MR. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc 2002:56:7-17.
28. Hershfield NB. Drainage of a pancreatic pseudocyst at ERCP. Gastrointest Endosc 1984:30:269-70.
29. Kozarek RA, Brayko CM, Harlan J, Sanowski RA, Cintora I, Kovac A. Endoscopic drainage of pancreatic pseudocysts. Gastrointest Endosc 1985;31:322-7.
30. Cremer M, Deviere 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.
31. Grimm H, Meyer WH, Nam VC, Soehendra N. New modalities for treating chronic pancreatitis. Endoscopy 1989:21:70-4.
32. Kozarek RA, Ball TJ, Patterson DJ, Freeny PC, Ryan JA, Traverso LW, Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections. Gastroenterology 1991;100:1362-70.
33. Sahel J. Endoscopic drainage of pancreatic cysts. Endoscopy 1991;23:181-4.
34. Catalano MF, Geenen JE, Schmalz MJ, Johnson GK, Dean RS, Hogan WJ. Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis. Gastrointest Endosc 1995;42:214-8.
35. Smits ME, Rauws EA, Tytgat GN, Huibregtse K. The efficacy of endoscopic treatment of pancreatic pseudocysts. Gastrointest Endosc 1995;42:202-7.
36. Binmoeller KF, Seifert H, Walter A, Soehendra N. Transpapillary and transmural drainage of pancreatic pseudocysts. Gastrointest Endosc 1995;42:219-24.
37. Howell DA, Elton E, Parsons WG, Endoscopic management of pseudocysts of the pancreas. Gastrointest Endosc Clin N Am 1998;8:143-62.
38. Beckingham IJ, Krige JE, Bornman PC, Terblanche J, Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 1999;94:71-4.
39. Vitale GC, Lawhon JC, Larson GM, Harrell DJ, Reed DN, Jr., MacLeod s. Endoscopic drainage of the pancreatic pseudocyst, Surgery 1999;126:616-21.
40. Laxson LC, Fromkes JJ, Cooperman M. Endoscopic retrograde cholangiopancreatography in the management of pancreatic pseudocysts. Am J Surg 1985;150:683-6.
41. Sahel J, Bastid C, Pellat B, Schurgers P, Sarles H, Endoscopic cystoduodenostomy of cysts of chronic calcifying pancreatitis: a report of 20 cases. Pancreas 1987;2:447-53.
42. Nealon WH, Townsend CM, Jr., Thompson JC. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with pancreatic pseudocyst associated with resolving
acute and chronic pancreatitis. Ann Surg 1989:209:532-8.
43. Vidyarthi G, Steinberg SE. Endoscopic management of pancreatic pseudocysts. Surg Clin North Am 2001;81:405- 10, xii.
44. Barthet M, Sahel J, Bodiou-Bertei C, Bernard JP. Endoscopic transpapillary drainage of pancreatic pseudocysts. Gastrointest Endosc 1995;42:208-13.
45. Sanchez CE, Maalak A, Le Moine O, et al. Endoscopic cystenterostomy of nonbulging pancreatic fluid collections. Gastrointest Endosc 2002;56:380-6.
46. Giovannini M, Pesenti C, Rolland AL, Moutardier V, Delpero JR. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo
endoscope. Endoscopy 2001:33:473-7.
47. Baron TH. Endoscopic drainage of pancreatic fluid collections and pancreatic necrosis. Gastrointest Endosc Clin N Am 2003;13:743-64.
48. Gerolami R, Giovannini M, Laugier R. Endoscopic drainage of pancreatic pseudocysts guided by endosonography. Endoscopy 1997:29:106-8.
49. Giovannini M, Binmoeller K, Seifert H. Endoscopic ultrasound-guided cystogastrostomy. Endoscopy 2003;35:239-45.
50. Sriram PV, Kaffes AJ, Rao GV, Reddy DN. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts complicated by portal hypertension or by intervening vessels. Endoscopy
2005; 37:231-5.
51. Chak A. Endosonographic-guided therapy of pancreatic pseudocysts. Gastrointest Endosc 2000; 52:S23-S27.
52. Howell DA, Elton E, Parsons WG. Endoscopic management of pseudocysts of the pancreas. Gastrointest Endosc Clin N Am 1998;8:143-62.
53. Norton ID, Clain JE, Wiersema MJ, DiMagno EP, Petersen BT, Gostout CJ. Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients.
Mayo Clin Proc 2001;76:794-8.
54. Monkemuller KE, Baron TH, Morgan DE. Transmural drainage of pancreatic fluid collections without electrocautery using the Seldinger technique. Gastrointest Endosc 1998;48:195-200.
55. Cahen D, Rauws E, Fockens P, Weverling G, Huibregtse K, Bruno M. Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and
successful treatment. Endoscopy 2005;37:977-83.
56. De Palma GD, Galloro G, Puzziello A, Masone S, Persico G. Endoscopic drainage of pancreatic pseudocysts: a long- term follow-up study of 49 patients. Hepatogastroenterology 2002:49:1113-5.
57. Hariri M, Slivka A, Carr-Locke DL, Banks PA. Pseudocyst drainage predisposes to infection when pancreatic necrosis is unrecognized. Am J Gastroenterol 1994;89:1781-4.
58. Clark LA, Pappas TN. Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 1999:94:8-9.
59. Fuchs M, Reimann FM, Gaebel C, Ludwig D, Stange EF. Treatment of infected pancreatic pseudocysts by endoscopic ultrasonography-guided cystogastrostomy. Endoscopy 2000;32:654-7,
60. Seifert H, Faust D, Schmitt T, Dietrich C, Caspary W, Wehrmann T. Transmural drainage of cystic peripancreatic lesions with a new large-channel echo endoscope. Endoscopy
2001:33:1022-6.
61. Park JJ, Kim SS, Koo YS, et al. Definitive treatment of pancreatic abscess by endoscopic transmural drainage, Gastrointest Endosc 2002;55:56-62.
2. Yeo CJ, Sarr MG. Cystic and pseudocystic diseases of the pancreas. Curr Probl Surg 1994;31:165-243.
3. Grace PA, Williamson RC. Modern management of pancreatic pseudocysts. Br J Surg 1993;80:573-81.
4. Bartoli E, Delcenserie R, Yzet T, et al. Endoscopic treatment of chronic pancreatitis. Gastroenterol Clin Biol 2005:29:515-21.
5. Bradley EL, Clements JL Jr, Gonzalez AC. The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg 1979;137:135-41.
6. Wade JW. Twenty-five year experience with pancreatic pseudocysts. Are we making progress? Am J Surg 1985;149:705-8.
7. Yeo CJ, Bastidas JA, Lynch-Nyhan A, Fishman EK, Zinner MJ, Cameron JL. The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet 1990; 170:411-7.
8. Vitas GJ, Sarr MG, Selected management of pancreatic pseudocysts: operative versus expectant management. Surgery 1992;111:123-30.
9. D'Egidio A, Schein M. Pancreatic pseudocysts: a proposed classification and its management implications. Br J Surg 1991;78:981-4.
10. Bhattacharya D, Ammori BJ. Minimally invasive approaches to the management of pancreatic pseudocysts: review of the literature. Surg Laparosc Endosc Percutan Tech 2003;13:141-8.
11. Pitchumoni CS, Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed? Gastroenterol Clin North Am 1999:28:615-39.
12. Lohr-Happe A, Peiper M, Lankisch PG. Natural course of operated pseudocysts in chronic pancreatitis. Gut 1994;35:1479-82.
13. Parks RW, Tzovaras G, Diamond T, Rowlands BJ. Management of pancreatic pseudocysts. Ann R Coll Surg Engl 200082:383-7.
14. Usatoff V, Brancatisano R, Williamson RC. Operative treatment of pseudocysts in patients with chronic pancreatitis. Br J Surg 2000;87:1494-9.
15. Cooperman AM. Surgical treatment of pancreatic pseudocysts. Surg Clin North Am 2001;8 1:41 1-9, xii.
16. Sharma Ss, BhargawaN, Govil A. Endoscopic management of pancreatic pseudocyst: a long-term follow-up. Endoscopy 2002:34:203-7.
17. Brugge WR. Approaches to the drainage of pancreatic pseudocysts. Curr Opin Gastroenterol 2004;20:488-92.
18. Fockens P, EUS in drainage of pancreatic pseudocysts. Gastrointest Endosc 2002;56:S93-S97.
19. Neff R. Pancreatic pseudocysts and fluid collections: percutaneous approaches. Surg Clin North Am 2001;81:399-403, xii.
20. Freeny PC, Lewis GP, Traverso LW, Ryan JA. Infected pancreatic fluid collections: percutaneous catheter drainage. Radiology 1988;167:435-41.
21. vanSonnenberg E, Wittich GR, Casola G, et al, Percutaneous drainage of infected and noninfected pancreatic pseudocysts: experience in 101 cases. Radiology 1989;170:757-61.
22. Ahearne PM, Baillie JM, Cotton PB, Baker ME, Meyers WC. Pappas TN. An endoscopic retrograde cholangiopan creatography (ERCP)-based algorithm for the management of pancreatic pseudocysts. Am J Surg 1992;163:111-5.
23. Adams DB, Anderson MC. Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst. Ann Surg 1992:215:571-6.
24. D'Agostino HB, vanSonnenberg E, Sanchez RB, Goodacre BW, Villaveiran RG, Lyche K. Treatment of pancreatic pseudocysts with percutaneous drainage and octreotide. Work in progress. Radiology 1993;187:685-8.
25. Heider R, Meyer AA, Galanko JA, Behrns KE. Percutaneous drainage of pancreatic pseudocysts is associated with a higher failure rate than surgical treatment in unselected patients. Ann Surg 1999:229:781-7.
26. Lansden FT, Adams DB, Anderson MC. Treatment of external pancreatic fistulas with somatostatin. Second place winner: Conrad Jobst award. Am Surg 1989;55:695-8.
27. Baron TH, Harewood GC, Morgan DE, Yates MR. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc 2002:56:7-17.
28. Hershfield NB. Drainage of a pancreatic pseudocyst at ERCP. Gastrointest Endosc 1984:30:269-70.
29. Kozarek RA, Brayko CM, Harlan J, Sanowski RA, Cintora I, Kovac A. Endoscopic drainage of pancreatic pseudocysts. Gastrointest Endosc 1985;31:322-7.
30. Cremer M, Deviere 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.
31. Grimm H, Meyer WH, Nam VC, Soehendra N. New modalities for treating chronic pancreatitis. Endoscopy 1989:21:70-4.
32. Kozarek RA, Ball TJ, Patterson DJ, Freeny PC, Ryan JA, Traverso LW, Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections. Gastroenterology 1991;100:1362-70.
33. Sahel J. Endoscopic drainage of pancreatic cysts. Endoscopy 1991;23:181-4.
34. Catalano MF, Geenen JE, Schmalz MJ, Johnson GK, Dean RS, Hogan WJ. Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis. Gastrointest Endosc 1995;42:214-8.
35. Smits ME, Rauws EA, Tytgat GN, Huibregtse K. The efficacy of endoscopic treatment of pancreatic pseudocysts. Gastrointest Endosc 1995;42:202-7.
36. Binmoeller KF, Seifert H, Walter A, Soehendra N. Transpapillary and transmural drainage of pancreatic pseudocysts. Gastrointest Endosc 1995;42:219-24.
37. Howell DA, Elton E, Parsons WG, Endoscopic management of pseudocysts of the pancreas. Gastrointest Endosc Clin N Am 1998;8:143-62.
38. Beckingham IJ, Krige JE, Bornman PC, Terblanche J, Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 1999;94:71-4.
39. Vitale GC, Lawhon JC, Larson GM, Harrell DJ, Reed DN, Jr., MacLeod s. Endoscopic drainage of the pancreatic pseudocyst, Surgery 1999;126:616-21.
40. Laxson LC, Fromkes JJ, Cooperman M. Endoscopic retrograde cholangiopancreatography in the management of pancreatic pseudocysts. Am J Surg 1985;150:683-6.
41. Sahel J, Bastid C, Pellat B, Schurgers P, Sarles H, Endoscopic cystoduodenostomy of cysts of chronic calcifying pancreatitis: a report of 20 cases. Pancreas 1987;2:447-53.
42. Nealon WH, Townsend CM, Jr., Thompson JC. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with pancreatic pseudocyst associated with resolving
acute and chronic pancreatitis. Ann Surg 1989:209:532-8.
43. Vidyarthi G, Steinberg SE. Endoscopic management of pancreatic pseudocysts. Surg Clin North Am 2001;81:405- 10, xii.
44. Barthet M, Sahel J, Bodiou-Bertei C, Bernard JP. Endoscopic transpapillary drainage of pancreatic pseudocysts. Gastrointest Endosc 1995;42:208-13.
45. Sanchez CE, Maalak A, Le Moine O, et al. Endoscopic cystenterostomy of nonbulging pancreatic fluid collections. Gastrointest Endosc 2002;56:380-6.
46. Giovannini M, Pesenti C, Rolland AL, Moutardier V, Delpero JR. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo
endoscope. Endoscopy 2001:33:473-7.
47. Baron TH. Endoscopic drainage of pancreatic fluid collections and pancreatic necrosis. Gastrointest Endosc Clin N Am 2003;13:743-64.
48. Gerolami R, Giovannini M, Laugier R. Endoscopic drainage of pancreatic pseudocysts guided by endosonography. Endoscopy 1997:29:106-8.
49. Giovannini M, Binmoeller K, Seifert H. Endoscopic ultrasound-guided cystogastrostomy. Endoscopy 2003;35:239-45.
50. Sriram PV, Kaffes AJ, Rao GV, Reddy DN. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts complicated by portal hypertension or by intervening vessels. Endoscopy
2005; 37:231-5.
51. Chak A. Endosonographic-guided therapy of pancreatic pseudocysts. Gastrointest Endosc 2000; 52:S23-S27.
52. Howell DA, Elton E, Parsons WG. Endoscopic management of pseudocysts of the pancreas. Gastrointest Endosc Clin N Am 1998;8:143-62.
53. Norton ID, Clain JE, Wiersema MJ, DiMagno EP, Petersen BT, Gostout CJ. Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients.
Mayo Clin Proc 2001;76:794-8.
54. Monkemuller KE, Baron TH, Morgan DE. Transmural drainage of pancreatic fluid collections without electrocautery using the Seldinger technique. Gastrointest Endosc 1998;48:195-200.
55. Cahen D, Rauws E, Fockens P, Weverling G, Huibregtse K, Bruno M. Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and
successful treatment. Endoscopy 2005;37:977-83.
56. De Palma GD, Galloro G, Puzziello A, Masone S, Persico G. Endoscopic drainage of pancreatic pseudocysts: a long- term follow-up study of 49 patients. Hepatogastroenterology 2002:49:1113-5.
57. Hariri M, Slivka A, Carr-Locke DL, Banks PA. Pseudocyst drainage predisposes to infection when pancreatic necrosis is unrecognized. Am J Gastroenterol 1994;89:1781-4.
58. Clark LA, Pappas TN. Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 1999:94:8-9.
59. Fuchs M, Reimann FM, Gaebel C, Ludwig D, Stange EF. Treatment of infected pancreatic pseudocysts by endoscopic ultrasonography-guided cystogastrostomy. Endoscopy 2000;32:654-7,
60. Seifert H, Faust D, Schmitt T, Dietrich C, Caspary W, Wehrmann T. Transmural drainage of cystic peripancreatic lesions with a new large-channel echo endoscope. Endoscopy
2001:33:1022-6.
61. Park JJ, Kim SS, Koo YS, et al. Definitive treatment of pancreatic abscess by endoscopic transmural drainage, Gastrointest Endosc 2002;55:56-62.
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2008-03-31
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Marutkarakul M, Samankatiwat N. Endoscopic Drainage of Pancreatic Pseudocyst. Thai J Surg [Internet]. 2008 Mar. 31 [cited 2024 Jul. 18];29(1):16-24. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/240868
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