Abstract
Aim
To determine long-term outcome of endoscopic management of pancreatic pseudocyst/walled-off pancreatic necrosis (WOPN) without necrosectomy.
Methods
One-hundred and sixty-five pancreatic pseudocysts/WOPN managed endoscopically over a period of 22 years were analyzed retrospectively for technical success, complications, and recurrence.
Results
Symptomatic 118 males and 47 females with mean age of 35.8 years were included. Alcohol was the most common etiology (41.2 %). Transmural endoscopic drainage was done in 144 patients, while 21 patients underwent transpapillary drainage. All the patients were subjected to contrast computed tomography (CT) abdomen or routine/Doppler ultrasound. Endoscopic ultrasound was done in last 11 patients. One or two double pigtail 7 Fr stents were placed when clear watery fluid came out from cyst (130 patients, 78.8 %), and nasocystic drainage (NCD) tubes were placed in addition to two 7 Fr stents when there were frank pus, thick dark fluid, or solid components inside the cyst (35 patients). All these patients settled on this treatment. Thirty-three of 35 patients of WOPN could be managed endoscopically without necrosectomy. Complications occurred in 9.2 % of pseudocysts and 40 % of WOPN. Thirty-five patients were followed up for more than 5 years (3 patients more than 10 years), and 130 patients were followed up for up to 5 years. Recurrence occurred in 8.1 % of pseudocysts and 5.7 % of WOPN.
Conclusion
Majority of pancreatic pseudocysts/WOPN can be managed with endoscopic drainage without necrosectomy with high success, low complication, and recurrence rates.
Similar content being viewed by others
References
O’Malley VP, Cannon JP, Postier RG. Pancreatic pseudocysts: cause, therapy, and results. Am J Surg. 1985;150:680–2.
Siegelman SS. CT of fluid collections associated with pancreatitis. AJR Am J Roentgenol. 1980;134:1121–32.
Elliott DW. Pancreatic pseudocysts. Surg Clin North Am. 1975;55:339–62.
Barthet M, Bugallo M, Moreira LS, et al. Management of cysts and pseudocysts complicating chronic pancreatitis; a retrospective study of 143 patients. Gastroenterol Clin Biol. 1993;17:270–6.
Rodgers BH, Giarel NJ, Seed RW. Transgastric needle aspiration of pancreatic pseudocyst through an endoscope. Gastrointest Endosc. 1975;21:133–4.
Sharma SS. Endoscopic cystogastrostostomy: preliminary experience. Indian J Gastroenterol. 1995;14:11–2.
Sharma SS, Bhargava N, Govil A. Endoscopic management of pancreatic pseudocyst: a long-term follow-up. Endoscopy. 2002;34:203–7.
Andrén-Sandberg A, Dervenis C. Pancreatic pseudocysts in the 21st century. Part I: classification, pathophysiology, anatomic considerations and treatment. JOP. 2004;5:8–24.
Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145:583–90.
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.
Hookey LC, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Devière J. Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc. 2006;63:635–43.
Banks PA, Bollen TL, Dervenis C, et al. Acute pancreatitis classification working group. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2012;62:102–11.
Kozarek RA, Brayko CM, Harlan J, Sanowski RA, Cintora I, Kovac A. Endoscopic drainage of pancreatic pseudocysts. Gastrointest Endosc. 1985;31:322–7.
Baron TH. Endoscopic drainage of pancreatic fluid collections and pancreatic necrosis. Gastrointest Endosc Clin North Am. 2003;13:743–64.
Varadarajulu S, Noone TC, Tutuian R, Hawes RH, Cotton PB. Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement. Gastrointest Endosc. 2005;61:568–75.
Bhasin DK, Rana SS, Udawat HP, Thapa BR, Sinha SK, Nagi B. Management of multiple and large pancreatic pseudocysts by endoscopic transpapillary nasopancreatic drainage alone. Am J Gastroenterol. 2006;101:1780–6.
Bhasin DK, Rana SS, Nanda M, et al. Comparative evaluation of transpapillary drainage with nasopancreatic drain and stent in patients with large pseudocysts located near tail of pancreas. J Gastrointest Surg. 2011;15:772–6.
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.
Fernandez-del Castillo C, Rattner DW, Makary MA, et al. Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg. 1998;228:676–84.
Uhl W, Warshaw A, Imrie C, et al. Guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002;2:565–73.
Ammori BJ. Laparoscopic transgastric pancreatic necrosectomy for infected pancreatic necrosis. Surg Endosc. 2002;16:1362.
Baron TH, Thaggard WG, Morgan DE, Stanley RJ. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology. 1996;111:755–64.
Rana SS, Bhasin DK, Rao C, et al. Non-fluoroscopic endoscopic ultrasound-guided transmural drainage of symptomatic non-bulging walled-off pancreatic necrosis. Dig Endosc. 2013;25:47–52.
Sharma SS, Maharishi S. Endoscopic management of pancreatic pseudocyst in children—a long-term follow-up. J Pediatr Surg. 2008;43:1636–9.
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.
Bang JY, Mel Wilcox C, Trevino JM, et al. Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts. Surg Endosc. 2014;28:2877–83.
Kimble RM, Cohen R, Williams S. Successful endoscopic drainage of a post-traumatic pancreatic pseudocyst in a child. J Pediatr Surg. 1999;34:1518–20.
Falchetti D, Ubertazzi M, Torri F, et al. Endoscopic cure of pancreatic pseudocyst in a child. J Pediatr Gastroenterol Nutr. 1998;27:446–8.
Haluszka O, Campbell A, Horvath K. Endoscopic management of pancreatic pseudocyst in children. Gastrointest Endosc. 2002;55:128–31.
Patty I, Kalaoui M, Al-Shamali M, Al-Hassan F, Al-Naqeeb B. Endoscopic drainage for pancreatic pseudocyst in children. J Pediatr Surg. 2001;36:503–5.
Sahel J. Endoscopic cysto-enterostomy of cysts of chronic calcifying pancreatitis. Z Gastroenterol. 1990;28:170–2.
Park DH, Lee SS, Moon SH, et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy. 2009;41:842–8.
Panamonta N, Ngamruengphong S, Kijsirichareanchai K, Nugent K, Rakvit A. Endoscopic ultrasound-guided versus conventional transmural techniques have comparable treatment outcomes in draining pancreatic pseudocysts. Eur J Gastroenterol Hepatol. 2012;24:1355–62.
Burnweit C, Wesson D, Stringer D, Filler R. Percutaneous drainage of traumatic pancreatic pseudocyst in children. J Trauma. 1990;30:1273–7.
Abe T, Nagai T, Murakami K, et al. Pancreatic injury successfully treated with endoscopic stenting for major pancreatic duct disruption. Intern Med. 2009;48:1889–92.
Gardner TB, Chahal P, Papachristou GI, et al. A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc. 2009;69:1085–94.
Lin LF, Tung JN. Difficult endoscopic retrieval of a migrated stent inside a pseudocyst. Case Rep Gastroenterol. 2008;2:199–202.
De Palma GD, Galloro G, Puzziello A, Masone S, Diamantis G, Persico G. Personal experience with the endoscopic treatment of pancreatic pseudocysts. Long-term results and analysis of prognostic factors. Minerva Chir. 2001;56:475–81.
Binmoeller KF, Seifert H, Walter A, Soehendra N. Transpapillary and transmural drainage of pancreatic pseudocysts. Gastrointest Endosc. 1995;42:219–24.
Arvanitakis M, Delhaye M, Bali MA, et al. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc. 2007;65:609–19.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
SSS, BS, MJ, SM, SN, BS, and AJ confirm that they have no conflicts of interest to declare.
Ethics statement
The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.
Financial support
The study did not receive any financial support.
Rights and permissions
About this article
Cite this article
Sharma, S.S., Singh, B., Jain, M. et al. Endoscopic management of pancreatic pseudocysts and walled-off pancreatic necrosis: A two-decade experience. Indian J Gastroenterol 35, 40–47 (2016). https://doi.org/10.1007/s12664-016-0624-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12664-016-0624-5