Elsevier

Gastrointestinal Endoscopy

Volume 42, Issue 3, September 1995, Pages 214-218
Gastrointestinal Endoscopy

Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis,☆☆

Presented in part at the American Society for Gastrointestinal Endoscopy Annual Meeting, New Orleans, Louisiana, May 1994.
https://doi.org/10.1016/S0016-5107(95)70094-3Get rights and content

Abstract

Background: Endoscopic treatment of pancreatic pseudocysts via cystenterostomy has been recognized as a successful treatment option in carefully selected patients. Pancreatic transpapillary stenting as an alternative treatment option in patients with pancreatic pseudocysts directly communicating with the main duct has received little consideration. The aim of the current study was to assess the safety and utility of transpapillary pancreatic endo-prosthesis in the treatment of communicating pseudocysts.

Methods: Twenty-one patients underwent placement of 33 transpapillary endo-prostheses for the treatment of symptomatic pancreatic pseudocysts. All pseudocysts communicated with the main pancreatic duct and ranged in size from 3 to 9 cm (mean 6 cm). Eight patients had associated pancreatic duct strictures.

Results: Stent placement was successful in all cases: 13 directly into the pseudocyst, 8 beyond the stricture but not into the pseudocyst. Initial resolution of pseudocysts was seen in 17 patients, with 16 patients free of pseudocyst recurrence at mean follow-up of 37 months. All patients with associated strictures were treated successfully. Factors predictive of success included presence of strictures, size of pseudocyst greater than or equal to 6 cm, location in the body of the pancreas, and duration of pseudocyst less than 6 months. Complications included one episode of mild pancreatitis.

Conclusions: Endoscopic treatment of symptomatic pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct stenting is a safe, effective modality and should be considered a first line therapy. (Gastrointest Endosc 1995:42:214-8.)

Section snippets

METHODS

Between April 1986 and January 1993, 21 patients, (14 men and 7 women, age range 26 to 79 years), underwent transpapillary endoprosthesis placement at St. Luke's Hospital, Racine, Wisconsin, and the Medical College of Wisconsin, Milwaukee, Wisconsin, for the treatment of pancreatic pseudocysts. All patients had symptoms including nausea, vomiting, pain, early satiety, or obstructive symptoms (elevated liver function tests). Pseudocysts were diagnosed initially by transabdominal ultrasound or

RESULTS

Endoprosthesis placement was successful in all cases. Thirteen of 21 patients had the stent placed directly into the pseudocyst. Eight patients had pancreatic duct strictures distal to the pancreatic pseudocyst communication. In these patients, the endoprosthesis was placed beyond the stricture but not into the pseudocyst.

Initial success (resolution of pseudocyst) was observed in 17 of 21 patients with 16 patients (76%) free of pancreatic pseudocyst recurrence witha mean follow-up of 37 months

DISCUSSION

Pancreatic pseudocysts are collections of extravasated exocrine pancreatic fluid, encased by a wall of granulation tissue that characteristically lacks an epithelial lining. Pseudocysts represent a serious complication of pancreatitis with a 5% to 15% mortality rate and significant morbidity.5, 24, 25, 26, 27 Up to 50% of pseudocysts disappear spontaneously in the immediate period after diagnosis. However, they require treatment after 6 to 18 weeks, particularly when they are greater than 6 cm

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  • Cited by (0)

    Reprint requests: Marc. F. Catalano, MD, 1333 College Avenue, Racine, WI 53403

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