Surgical Endoscopy

, Volume 25, Issue 5, pp 1518–1525

Endoscopic transmural drainage of pseudocysts associated with pancreatic resections or pancreatitis: a comparative study

  • Alvise Cavallini
  • Giovanni Butturini
  • Giuseppe Malleo
  • Francesca Bertuzzo
  • Gianpaolo Angelini
  • Mohammad Abu Hilal
  • Paolo Pederzoli
  • Claudio Bassi



Endoscopy has been regarded as an effective modality for draining pancreatic collections, pseudocysts, and abscesses. This study analyzes our experience with endoscopic transmural drainage of pancreatic pseudocysts and compares the outcomes in patients with postsurgical and pancreatitis-associated ones.


Patients who underwent endoscopic drainage of a pancreatic pseudocyst from January 1999 through June 2008 were included in this retrospective analysis. The specific indication for attempting the procedure was the presence of direct contact between the pseudocyst and the gastric wall. All the drainages were carried out via a transgastric approach, and one or two straight plastic stents (10 or 11.5 French) were positioned. A comparative analysis of short- and long-term results was made between patients with postoperative pseudocysts (group A) and patients with pancreatitis-associated pseudocysts (group B).


Fifty-five patients were included in the study, 25 in group A and 30 in group B. Overall, a single stent was inserted in 84.0% of patients, while two stents were needed in the remaining 16.0%. The technical success rate was 78.2%, whereas procedure-related complications were 16.4%. Complications included pseudocyst superinfection and major bleeding and were managed mainly by surgery. Mortality rate was 1.8% (1 patient). There were no significant differences in the technical success rate and procedure-related complications between the two groups (p = 0.532 and 0.159, respectively) Recurrences were 13.9% and significantly more common in group B (p = 0.021). In such cases, a second endoscopic drainage was successfully performed.


Transmural endoscopic treatment of pancreatic pseudocysts is feasible and has a technical success rate of 78.2%, without differences related to the pseudocyst etiology. Recurrences, on the other hand, are more common in patients with pancreatitis. Given the severe complications that may occur after the procedure, we recommend that endoscopic drainage be performed in a tertiary-care center with specific expertise in pancreatic surgery.


Pancreatic pseudocyst Endoscopy Pancreatic resections Acute pancreatitis Chronic pancreatitis 


  1. 1.
    Bhattacharya D, Ammori BJ (2003) Minimally invasive approaches to the management of pancreatic pseudocysts. Surg Laparosc Endosc Percutan Tech 13:141–148PubMedCrossRefGoogle Scholar
  2. 2.
    Bradley EL III (1993) A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, GA, September 11–13, 1992. Arch Surg 128:586–590PubMedGoogle Scholar
  3. 3.
    Andrén-Sandberg A, Dervenis C (2004) Pancreatic pseudocyst in the 21st century: classification, pathophysiology, anatomic consideration and treatment. JOP 5:8–24PubMedGoogle Scholar
  4. 4.
    Andrén-Sandberg A, Dervenis C (2004) Pancreatic pseudocyst in the 21st century: natural history. JOP 5:64–70PubMedGoogle Scholar
  5. 5.
    Beckingham IJ, Krige JE, Bornman PC (1999) Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 94:71–74PubMedCrossRefGoogle Scholar
  6. 6.
    Parks RW, Tzovaras G, Diamond T, Rowlands BJ (2000) Management of pancreatic pseudocyst. Ann R Coll Surg Engl 82:383–387PubMedGoogle Scholar
  7. 7.
    Bradley EL, Clements JL, Gonzales AC (1979) The natural history of pancreatic pseudocyst: a unified concept of management. Am J Surg 137:135–141PubMedCrossRefGoogle Scholar
  8. 8.
    Kohler H, Schafmayer A, Ludtke FE (1987) Surgical treatment of pancreatic pseudocysts. Br J Surg 74:813–815PubMedCrossRefGoogle Scholar
  9. 9.
    Huibregtse K, Schnider B, Vrij AA (1988) Endoscopic pancreatic drainage in chronic pancreatitis. Gastrointest Endosc 34:9–15PubMedCrossRefGoogle Scholar
  10. 10.
    De Palma GD, Galloro G, Puzziello A, Masone S, Persico G (2002) Endoscopic drainage of pancreatic pseudocysts: a long-term follow-up study of 49 patients. Hepatogastroenterology 49:1113–1115PubMedGoogle Scholar
  11. 11.
    Sharma S, Bhargawa N, Govil A (2003) Endoscopic management of pancreatic pseudocyst: a long term follow-up. Endoscopy 34:203–207Google Scholar
  12. 12.
    Andren-Sandberg A, Ansorge C, Eiriksson K, Glomsaker T, Maleckas A (2005) Treatment of pancreatic pseudocysts. Scand J Surg 94:165–167PubMedGoogle Scholar
  13. 13.
    Giovannini M (2007) What is the best endoscopic treatment for pancreatic pseudocysts? Gastrointest Endosc 65:620–623PubMedCrossRefGoogle Scholar
  14. 14.
    Yusuf TE, Baron TH (2006) Endoscopic transmural drainage of pancreatic pseudocysts: results of a national and an international survey of ASGE members. Gastrointest Endosc 63:223–227PubMedCrossRefGoogle Scholar
  15. 15.
    Heyries L, Sahel J (2007) Endoscopic treatment of chronic pancreatitis. World J Gastroenterol 13:6127–6133PubMedGoogle Scholar
  16. 16.
    Testoni PA (2007) Endoscopic stenting in benign pancreatic diseases. JOP 8(1 Suppl):141–150PubMedGoogle Scholar
  17. 17.
    Monkemuller KE, Kahl S, Malfertheiner P (2004) Endoscopic therapy of chronic pancreatitis. Dig Dis 22:280–291PubMedCrossRefGoogle Scholar
  18. 18.
    Baron TH, Harewood GC, Morgan DE, Yates MR (2002) Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts and chronic pancreatic pseudocysts. Gastrointest Endosc 56:7–17PubMedCrossRefGoogle Scholar
  19. 19.
    Nealon WH, Walser E (2003) Duct drainage alone is sufficient in the operative management of pancreatic pseudocyst in patients with chronic pancreatitis. Ann Surg 237:614–620PubMedGoogle Scholar
  20. 20.
    Aghdassi A, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM (2008) Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis. Pancreas 36:105–112PubMedCrossRefGoogle Scholar
  21. 21.
    Arvanitakis M, Delhaye M, Bali MA, Matos C, De Maertelaer V, Le Moine O, Devière J (2007) Pancreatic fluid-collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 65:609–619PubMedCrossRefGoogle Scholar
  22. 22.
    Sciumè C, Geraci G, Pisello F, Li Volsi F, Facella T, Modica G (2006) Endoscopic treatment of pancreatic pseudocysts. G Chir 27:272–277PubMedGoogle Scholar
  23. 23.
    Bartoli E, Delcenserie R, Yzet T, Brazier F, Geslin G, Regimbeau JM, Dupas JL (2005) Endoscopic treatment of chronic pancreatitis. Gastroenterol Clin Biol 29:515–521PubMedCrossRefGoogle Scholar
  24. 24.
    Palanivelu C, Senthilkumar K, Madhankumar MV, Rajan PS, Shetty AR, Jani K, Rangarajan M, Maheshkumaar GS (2007) Management of pancreatic pseudocyst in the era of laparoscopic surgery. Experience from a tertiary centre. Surg Endosc 21:2262–2267PubMedCrossRefGoogle Scholar
  25. 25.
    Barthet M, Lamblin G, Gasmi M, Vitton V, Desjeux A, Grimaud JC (2008) Clinical usefulness of a treatment algorithm for pancreatic pseudocysts. Gastrointest Endosc 67:245–252PubMedCrossRefGoogle Scholar
  26. 26.
    Cahen D, Rauws E, Fockens P, Weverling G, Huibregtse K, Bruno M (2005) Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy 37:977–983PubMedCrossRefGoogle Scholar
  27. 27.
    Weckman L, Kylänpää ML, Puolakkainen P, Halttunen J (2006) Endoscopic treatment of pancreatic pseudocysts. Surg Endosc 20:603–607PubMedCrossRefGoogle Scholar
  28. 28.
    Hookey LC, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Devière J (2006) Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc 63:635–643PubMedCrossRefGoogle Scholar
  29. 29.
    Subtil C, Moutardier V, Vitton V, Gasmi M, Desjeux A, Grimaud JC, Brunet C, Berdah S, Barthet M (2008) Endoscopic management of postoperative pancreatic collection. Gastroenterol Clin Biol 32:128–133PubMedCrossRefGoogle Scholar
  30. 30.
    Trevino JM, Tamhane A, Varadarajulu S (2010) Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections. J Gastroenterol Hepatol 25:526–531PubMedCrossRefGoogle Scholar
  31. 31.
    Kozarek RA, Ball TJ, Patterson DJ, Freeny PC, Ryan JA, Traverso LW (1991) Endoscopic transpapillary therapy for disrupted pancreatic duct and pancreatic fluid collection. Gastroenterology 100:1362–1370PubMedGoogle Scholar
  32. 32.
    Barthet M, Bugallo M, Moreira LS, Bastid C, Sastre B, Sahel J (1993) Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients. Gastroenterol Clin Biol 17:270–276PubMedCrossRefGoogle Scholar
  33. 33.
    Varadarajulu S, Wilcox CM, Tamhane A, Eloubeidi MA, Blakely J, Canon CL (2007) Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage. Gastrointest Endosc 66:1107–1119PubMedCrossRefGoogle Scholar
  34. 34.
    Giovannini M (2005) Endoscopic ultrasound-guided pancreatic pseudocyst drainage. Gastrointest Endosc Clin N Am 15:179–188PubMedCrossRefGoogle Scholar
  35. 35.
    Kahl S, Glasbrenner B, Zimmermann S, Malfertheiner P (2002) Endoscopic ultrasound in pancreatic diseases. Dig Dis 20:120–126PubMedCrossRefGoogle Scholar
  36. 36.
    Varadarajulu S, Christein JD, Tamhane A, Drelichman ER, Wilcox CM (2008) Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 68:1102–1111PubMedCrossRefGoogle Scholar
  37. 37.
    Park DH, Lee SS, Moon SH, Choi SY, Jung SW, Seo DW, Lee SK, Kim MH (2009) Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy 41:842–848PubMedCrossRefGoogle Scholar
  38. 38.
    Kahaleh M, Shami VM, Conaway MR, Tokar J, Rockoff T, De La Rue SA, de Lange E, Bassignani M, Gay S, Adams RB, Yeaton P (2006) Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy 38:355–359PubMedCrossRefGoogle Scholar
  39. 39.
    Chahal P, Papachristou GI, Baron TH (2007) Endoscopic transmural entry into pancreatic fluid collections using a dedicated aspiration needle without endoscopic ultrasound guidance: success and complication rates. Surg Endosc 21:1726–1732PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Alvise Cavallini
    • 1
  • Giovanni Butturini
    • 1
  • Giuseppe Malleo
    • 1
  • Francesca Bertuzzo
    • 2
  • Gianpaolo Angelini
    • 2
  • Mohammad Abu Hilal
    • 3
  • Paolo Pederzoli
    • 1
  • Claudio Bassi
    • 1
  1. 1.Department of Surgery—General Surgery B, G.B. Rossi HospitalUniversity of VeronaVeronaItaly
  2. 2.Division of Digestive EndoscopyUniversity of VeronaVeronaItaly
  3. 3.University Surgical UnitSouthampton General HospitalSouthamptonUK

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