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

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

Methods: 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).

Results: 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.

Conclusion: 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.
0930-2794
1518-1525
Cavallini, Alvise
4450ceaf-6b84-4864-a737-547873f0cbff
Butturini, Giovanni
99a20832-9016-4b1c-a9fc-5b6c090b7d30
Malleo, Giuseppe
84090221-cfd5-4b80-8736-7aae9e649c0d
Bertuzzo, Francesca
651363e5-8b4a-4884-9490-c19e6ab0c862
Angelini, Gianpaolo
e3bddbe5-f4df-4cb5-9696-d8c8576e2a58
Hilal, Mohammad Abu
384e1c60-8519-4eed-8e92-91775aad4c47
Pederzoli, Paolo
cded2d0a-267a-4414-855d-a1840621de2e
Bassi, Claudio
247ade4b-d6a6-4816-ade1-292031a4ec92
Cavallini, Alvise
4450ceaf-6b84-4864-a737-547873f0cbff
Butturini, Giovanni
99a20832-9016-4b1c-a9fc-5b6c090b7d30
Malleo, Giuseppe
84090221-cfd5-4b80-8736-7aae9e649c0d
Bertuzzo, Francesca
651363e5-8b4a-4884-9490-c19e6ab0c862
Angelini, Gianpaolo
e3bddbe5-f4df-4cb5-9696-d8c8576e2a58
Hilal, Mohammad Abu
384e1c60-8519-4eed-8e92-91775aad4c47
Pederzoli, Paolo
cded2d0a-267a-4414-855d-a1840621de2e
Bassi, Claudio
247ade4b-d6a6-4816-ade1-292031a4ec92

Cavallini, Alvise, Butturini, Giovanni, Malleo, Giuseppe, Bertuzzo, Francesca, Angelini, Gianpaolo, Hilal, Mohammad Abu, Pederzoli, Paolo and Bassi, Claudio (2011) Endoscopic transmural drainage of pseudocysts associated with pancreatic resections or pancreatitis: a comparative study. Surgical Endoscopy, 25 (5), 1518-1525. (doi:10.1007/s00464-010-1428-9). (PMID:20976483)

Record type: Article

Abstract

Background: 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.

Methods: 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).

Results: 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.

Conclusion: 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.

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More information

e-pub ahead of print date: 26 October 2010
Published date: May 2011

Identifiers

Local EPrints ID: 172959
URI: http://eprints.soton.ac.uk/id/eprint/172959
ISSN: 0930-2794
PURE UUID: 58690d33-d947-4871-bda6-0bbedc6a2268

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Date deposited: 01 Feb 2011 09:52
Last modified: 14 Mar 2024 02:30

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Contributors

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

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