Pancreatic pseudocysts transpapillary and transmural drainage.
BACKGROUND
Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period.


METHODS
We studied 30 patients with pancreatic pseudocyst that presented some indication for treatment: persistent abdominal pain, infection or cholestasis. Clinical evaluation was performed with a pain scale, 0 meaning absence of pain and 4 meaning continuous pain. Pseudocysts were first evaluated by abdominal CT scan, and after endoscopic retrograde pancreatography the patients were treated by transpapillary or transmural (cystduodenostomy or cystgastrostomy) drainage. Pseudocyst resolution was documented by serial CT scans.


RESULTS
25/30 patients could be treated. Drainage was successful in 21 (70% in an 'intention to treat' basis). After a mean follow-up of 42 +/- 35.82 weeks, there was only 1 (4.2%) recurrence. A total of 6 complications occurred in 37 procedures (16.2%), and all but 2 were managed clinically and/or endoscopically: there was no mortality related to the procedure. Patients submitted to combined drainage needed more procedures than the other groups. There was no difference in the efficacy when we compared the three different drainage methods.


CONCLUSIONS
We concluded that pancreatic pseudocyst endoscopic drainage is possible in most patients, with high success rate and low morbidity.
Libera
E D
ED
Fellows of Gastroenterology, Endoscopy Unit, Universidade Federal de São Paulo, Brazil.
Siqueira
E S
ES
Morais
M
M
Rohr
M R
MR
Brant
C Q
CQ
Ardengh
J C
JC
Ferrari
A P
AP
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000601:surgery*; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome