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