Controversies in the management of pancreatic pseudocysts: alternative therapies to surgery.
Surgery has been the cornerstone of treatment for pancreatic pseudocysts. This was based on studies that delineated the natural history and showed high morbidity and mortality rates if surgery was not performed. Recently this view has been challenged. Observations using new imaging techniques indicate that pseudocysts may resolve over time and surgery may not be necessary. An additional advantage of modern imaging and technical expertise is that pseudocysts can be successfully drained percutaneously. Also, the ingenuity of interventional endoscopists has led to another form of therapy--endoscopic cystoenterostomy, which is now part of the therapeutic armamentarium. With regard to drug therapy, octreotide acetate has emerged as an important adjunct to the treatment of fistulas complicating percutaneous catheter drainage. Moreover, it has been used as a primary treatment of pseudocysts. The nonsurgical types of treatment provide alternatives to surgery in some patients with pancreatic pseudocysts. However, these modalities should be viewed as complementary rather than conflicting alternatives and should be used selectively on the basis of clinical and radiological observations. This review discusses the major methods of nonsurgical therapy.
Segal
I
I
Gastroenterology Division, Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
D006801:Humans; D010192:Pancreatic Pseudocyst / Q000628:therapy*