scholarly journals Pancreatic Pseudocysts Transpapillary and Transmural Drainage

HPB Surgery ◽  
2000 ◽  
Vol 11 (5) ◽  
pp. 333-338 ◽  
Author(s):  
E. Della Libera ◽  
E. S. Siqueira ◽  
M. Morais ◽  
M. R. S. Rohr ◽  
C. Q. Brant ◽  
...  
Keyword(s):  
Pancreatic Pseudocyst ◽  
Pain Scale ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Intention To Treat ◽  
Persistent Abdominal Pain ◽  
Serial Ct ◽  
Transmural Drainage ◽  
Good Treatment Option

Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period.Patients and Methods: We studied 30 patients with pancreatic pseudocyst that presented some indication for treatment: persistent abdominal pain, infection or cholestasis. Clinical evaluation was performed with a pain scale, 0 meaning absence of pain and 4 meaning continuous pain. Pseudocysts were first evaluated by abdominal CT scan, and after endoscopic retrograde pancreatography the patients were treated by transpapillary or transmural (cystduodenostomy or cystgastrostomy) drainage. Pseudocyst resolution was documented by serial CT scans.Results: 25/30 patients could be treated. Drainage was successful in 21 (70% in an ‘intention to treat’ basis). After a mean follow-up of 42±35.82 weeks, there was only 1 (4.2%) recurrence. A total of 6 complications occurred in 37 procedures (16.2%), and all but 2 were managed clinically and/or endoscopically: there was no mortality related to the procedure. Patients submitted to combined drainage needed more procedures than the other groups. There was no difference in the efficacy when we compared the three different drainage methods.Conclusions: We concluded that pancreatic pseudocyst endoscopic drainage is possible in most patients, with high success rate and low morbidity.

scholarly journals Endoscopic Drainage of Giant Pancreatic Pseudocysts Using Both Lumen-Apposing Metal Stent and Plastic Stent: A Report of Two Cases and Review of the Current Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hussam I. A. Alzeerelhouseini ◽  
Muawiyah Elqadi ◽  
Mohammad N. Elqadi ◽  
Sadi A. Abukhalaf ◽  
Hazem A. Ashhab
Keyword(s):  
Pancreatic Pseudocyst ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Metal Stent ◽  
Case Presentation ◽  
Plastic Stent ◽  
History Of ◽  
Giant Pseudocyst ◽  
The Ideal

Introduction. A pancreatic pseudocyst (PP) with major diameter equal to 10 cm or more is called a giant pseudocyst. The ideal management for giant PPs is controversial. Endoscopic drainage is an alternative nonsurgical approach for PP management. Only a few cases of giant PPs were reported to be managed by endoscopic drainage. Case Presentation. We reported two cases of giant PPs following an episode of acute pancreatitis. Both were resolved following endoscopic cystogastrostomy using metallic and double-pigtail stents with excellent outcomes. There was no history of recurrence or complications on follow-up. In addition, we extensively reviewed all available literature studies of giant pancreatic pseudocyst presentation, management, and complications. We summarized all reported cases and presented them in a comprehensive table. Conclusion. The endoscopic cystogastrostomy approach is cost saving, can avoid surgical complications, and offers an early hospital discharge.

Infeasibility of endoscopic transmural drainage due to pancreatic pseudocyst wall calcifications - case report

2017 ◽  
Vol 89 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Andrzej Krajewski ◽  
Gustaw Lech ◽  
Marcin Makiewicz ◽  
Andrzej Kluciński ◽  
Monika Wojtasik ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Cyst Wall ◽  
Pancreatic Pseudocyst ◽  
Histopathological Examination ◽  
Epigastric Pain ◽  
Gastrointestinal Transit ◽  
The Body ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Transmural Drainage

Postinflammatory pancreatic pseudocysts are one of the most common complications of acute pancreatitis. In most cases, pseudocysts self-absorb in the course of treatment of pancreatitis. In some patients, pancreatic pseudocysts are symptomatic and cause pain, problems with gastrointestinal transit, and other complications. In such cases, drainage or resection should be performed. Among the invasive methods, mini invasive procedures like endoscopic transmural drainage through the wall of the stomach or duodenum play an important role. For endoscopic transmural drainage, it is necessary that the cyst wall adheres to the stomach or duodenum, making a visible impression. We present a very rare case of infeasibility of endoscopic drainage of a postinflammatory pancreatic pseudocyst, impressing the stomach, due to cyst wall calcifications. A 55-year-old man after acute pancreatitis presented with a 1-year history of epigastric pain and was admitted due to a postinflammatory pseudocyst in the body and tail of pancreas. On admission, blood tests, including CA 19-9 and CEA, were normal. An ultrasound examination revealed a 100-mm pseudocyst in the tail of pancreas, which was confirmed on CT and EUS. Acoustic shadowing caused by cyst wall calcifications made the cyst unavailable to ultrasound assessment and percutaneous drainage. Gastroscopy revealed an impression on the stomach wall from the outside. The patient was scheduled for endoscopic transmural drainage. After insufflation of the stomach, a large mass protruding from the wall was observed. The stomach mucosa was punctured with a cystotome needle knife, and the pancreatic cyst wall was reached. Due to cyst wall calcifications, endoscopic drainage of the cyst was unfeasible. Profuse submucosal bleeding at the puncture site was stopped by placing clips. The patient was scheduled for open surgery, and distal pancreatectomy with splenectomy was performed. The histopathological examination confirmed the initial diagnosis of postinflammatory pancreatic pseudocyst. Endoscopic transmural drainage is a highly effective procedure for treating postinflammatory pancreatic pseudocysts. In some patents, especially with large pseudocysts, pseudocysts with calcified walls, and cysts of primary origin, resection should be performed.

scholarly journals Efficacy, Safety, and Long-Term Follow-Up Results of EUS-Guided Transmural Drainage for Pancreatic Pseudocyst

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Shin Kato ◽  
Akio Katanuma ◽  
Hiroyuki Maguchi ◽  
Kuniyuki Takahashi ◽  
Manabu Osanai ◽  
...  
Keyword(s):  
Adverse Event ◽  
Pancreatic Pseudocyst ◽  
Clinical Success ◽  
Pancreatic Pseudocysts ◽  
Technical Success ◽  
Tube Removal ◽  
Long Term Follow Up ◽  
Transmural Drainage

Background and Aim. EUS-guided transmural drainage (EUS-GTD) is now considered a minimally invasive and effective alternative to surgery for drainage of symptomatic pancreatic pseudocysts. However, the technique is rather difficult, and sometimes serious complications occur to patients undergoing this procedure. We retrospectively evaluated efficacy, safety, and long-term follow-up results of EUS-GTD for pancreatic pseudocyst. Methods. Sixty-seven patients with pancreatic pseudocyst who underwent EUS-GTD from April 2000 to March 2011 were enrolled. We retrospectively evaluated (1) technical success, (2) clinical success, (3) adverse event of procedure, and (4) long-term follow-up results. Results. Total technical success rate was 88%. Ninety-one percent of external drainage, 79% of internal drainage, and 66% of puncture and aspiration only achieved clinical success. There was only one case with an adverse event, perforation (1.5%). The case required emergency operation. Total recurrence rate was 23.9%. Median follow-up period was 33.9 months. The recurrence rates in the cases of stent remaining, spontaneously dislodged, removed on schedule, external tube removal, and aspiration only were 10.0%, 12.5%, 42.9%, 50%, and 0%, respectively. Conclusion. EUS-GTD is a relatively safe and effective therapeutic method. However, further analysis should be done by larger series to determine the method of EUS-GTD for pancreatic pseudocyst.

scholarly journals Endoscopic Drainage of Pancreatic Pseudocysts

1990 ◽  
Vol 4 (9) ◽  
pp. 568-571 ◽  
Author(s):  
Claude Liguory ◽  
Jean Francois Lefebvre ◽  
Gary C Vitale
Keyword(s):  
Pancreatic Duct ◽  
Surgical Intervention ◽  
The Body ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Acute Necrotizing ◽  
Head Of The Pancreas ◽  
Serial Scanning

Endoscopic drainage of pancreatic pseudocysts was attempted in 17 patients over an eight year period. There were nine cysts located in the head of the pancreas, six in the body and two in the tail. Endoscopic retrograde cholangiopancreatography was performed in all cases and the pancreatic duct satisfactorily opacified in 16 of the 17 patients. This study identified a communication with the pancreatic duct in seven cases. There were two cases in which multiple cysts were present; in each, one cyst was drained endoscopically and the others surgically. Endoscopic drainage of the cyst was immediately possible in 16 of 17 cases (94%). Late follow-up (mean 26 months) documented cyst disappearance in 11 cases (69%). None of the five patients with persistent cysts has required secondary surgical intervention, and the cysts are asymptomatic and stable or decreasing in size by serial scanning. There was one case (6%) in which a pseudocyst recurred following initial resolution. There were two complications (12%) requiring surgical intervention: gastrointestinal perforation with peritonitis in one patient and hemorrhage at the cyst margin from an arterial bleeder in another. There were no deaths at 30 days, but in one case a recurrent acute necrotizing pancrearitis occurred 36 days following endoscopic drainage and the patient died. This death was felt to be unrelated to the endoscopic procedure. In conclusion, internal drainage of pancreatic pseudocysts by endoscopic means can be proposed as an alternative to surgical drainage when the cyst can be identified as bulging into the stomach or duodenum. Immediate drainage is usually effective with a minimal long term recurrence rate.

scholarly journals Clinical outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts: a large multicenter study

2017 ◽  
Vol 05 (02) ◽  
pp. E130-E136 ◽  
Author(s):  
Dennis Yang ◽  
Sunil Amin ◽  
Susana Gonzalez ◽  
Daniel Mullady ◽  
Steven Edmundowicz ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Clinical Outcomes ◽  
The United States ◽  
Term Treatment ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Technical Success ◽  
Long Term Treatment

Abstract Background and study aims Data on clinical outcomes of endoscopic drainage of debris-free pseudocysts (PDF) versus pseudocysts containing solid debris (PSD) are very limited. The aims of this study were to compare treatment outcomes between patients with PDF vs. PSD undergoing endoscopic ultrasound (EUS)-guided drainage via transmural stents. Patients and methods Retrospective review of 142 consecutive patients with pseudocysts who underwent EUS-guided transmural drainage (TM) from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TM technical success, treatment outcomes (symptomatic and radiologic resolution), need for endoscopic re-intervention at follow-up, and adverse events (AEs). Results TM was performed in 90 patients with PDF and 52 with PSD. Technical success: PDF 87 (96.7 %) vs. PSD 51 (98.1 %). There was no difference in the rates for endoscopic re-intervention (5.5 % in PDF vs. 11.5 % in PSD; P = 0.33) or AEs (12.2 % in PDF vs. 19.2 % in PSD; P = 0.33). Median long-term follow-up after stent removal was 297 days (interquartile range [IQR]: 59 – 424 days) for PDF and 326 days (IQR: 180 – 448 days) for PSD (P = 0.88). There was a higher rate of short-term radiologic resolution of PDF (45; 66.2 %) vs. PSD (21; 51.2 %) (OR = 0.30; 95 % CI: 0.13 – 0.72; P = 0.009). There was no difference in long-term symptomatic resolution (PDF: 70.4 % vs. PSD: 66.7 %; P = 0.72) or radiologic resolution (PDF: 68.9 % vs. PSD: 78.6 %; P = 0.72) Conclusions There was no difference in need for endoscopic re-intervention, AEs or long-term treatment outcomes in patients with PDF vs. PSD undergoing EUS-guided drainage with transmural stents. Based on these results, the presence of solid debris in pancreatic fluid collections does not appear to be associated with a poorer outcome.

scholarly journals The results of endosonography-assisted internal drainage of pancreatic pseudocyst

2019 ◽  
Vol 24 (1) ◽  
pp. 43-52
Author(s):  
Yu. G. Starkov ◽  
R. D. Zamolodchikov ◽  
S. V. Dzhantukhanova ◽  
M. I. Vyborniy ◽  
K. V. Lukich ◽  
...  
Keyword(s):  
Success Rate ◽  
Pancreatic Pseudocyst ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Internal Drainage

Aim.To compare immediate and long-term results of internal drainage of pancreatic pseudocyst by using of endosonography-assisted and open surgical approaches.Material and methods.EUS-assisted internal drainage of pancreatic pseudocyst was performed in 32 patients in 2011–2016. Open drainage procedures were carried out on the other 32 patients.Results.In the group of endoscopic drainage, technical success rate, clinical success rate and complication rate were 97%, 85% and 26%, respectively. There were no recurrent pseudocysts in long-term period. Comparison with open surgery confirmed advantages of endoscopic technique regarding time of operation (p< 0.01), intraoperative blood loss (p< 0.01) and length of hospital-stay (p< 0.01).Conclusion.EUS-assisted internal drainage of pancreatic pseudocysts in the treatment of chronic pancreatitis is characterized by high rate of technical and clinical success, small postoperative morbidity and low incidence of longterm recurrences.

Laparoscopic Transgastric versus Endoscopic Drainage of a Large Pancreatic Pseudocyst. A Case Report

2016 ◽  
Vol 25 (2) ◽  
pp. 243-247 ◽  
Author(s):  
Mircea Beuran ◽  
Ionut Negoi ◽  
Fausto Catena ◽  
Massimo Sartelli ◽  
Sorin Hostiuc ◽  
...  
Keyword(s):  
Case Report ◽  
Pancreatic Pseudocyst ◽  
Clinical Course ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Large Tumor ◽  
Specific Patient ◽  
Invasive Approach ◽  
Feasible Option ◽  
Tailored Approach

Case report: A 37 year-old woman was admitted three months after an episode of severe acute pancreatitis with a large tumor mass located in her left abdomen, abdominal tenderness and asthenia. Abdominal Computed Tomography (CT) revealed a giant pancreatic pseudocyst of 23/15/12 centimeters. We performed an anterior laparoscopic transgastric cystogastrostomy. The postoperative clinical course was uneventful, and she was discharged nine days later. After another month she was re-admitted for general malaise and fever. We performed endoscopic evaluation of the cystogastrostomy patency followed by lavage of the pseudocyst cavity. After five days of broad spectrum antibiotic therapy the clinical course started to improve and the patient was discharged after another eight days. One- and two-year follow-ups revealed no remnant cavity. Conclusions: Laparoscopic transgastric cystogastrostomy is a feasible option for selected patients with pancreatic pseudocysts. Careful patients’ evaluation in a multidisciplinary team, including imaging specialists, dedicated gastroenterologists with experience in advanced interventional techniques and pancreatic surgeons, balancing between watchful waiting and step-up minimally invasive approach offers the best tailored approach for a specific patient.

scholarly journals Pancreatic Pseudocyst with Splenic Artery Erosion, Retroperitoneal and Splenic Hematoma

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Petre V. H. Botianu ◽  
Adrian S. Dobre ◽  
Ana-Maria V. Botianu ◽  
Danusia Onisor
Keyword(s):  
Elevated Level ◽  
Splenic Artery ◽  
Pancreatic Pseudocyst ◽  
Postoperative Morbidity ◽  
Hemodynamic Instability ◽  
Pancreatic Pseudocysts ◽  
Emergency Laparotomy ◽  
Vascular Structures ◽  
Splenic Hematoma

The erosion of the peripancreatic vascular structures is a rare but life-endangering complication of pancreatic diseases. We report a female patient with a multicompartmentalized pancreatic pseudocyst that eroded the splenic artery resulting in a retroperitoneal and splenic hematoma with hemodynamic instability which required emergency laparotomy with splenectomy, partial cystectomy, ligation of the splenic artery at the level of the vascular erosion, cholecystectomy (lithiasis), and multiple drainage. The postoperative course was difficult (elevated level of platelets, pancreatic fistula) but eventually favourable, with no abdominal complaints and no recurrence at 2-year follow-up. The case shows that the pancreatic pseudocysts may present with acute hemorrhagic complications with life-endangering potential and significant postoperative morbidity.

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