Differential treatment and early outcome in the interventional endoscopic management of pancreatic pseudocysts in 27 patients.
OBJECTIVE
Pancreatic pseudocysts (PPC) as a complication of pancreatitis are approached only in the case of abdominal pain, infection, bleeding, and compression onto the gastrointestinal tract or biliary tree.


METHODS
From 02/01/2002 to 05/31/2004, all consecutive patients with symptomatic PPC who underwent an interventional endoscopic approach were evaluated in this pilot case-series study: Group (Gr.) I-Primary percutaneous (external), ultrasound-guided drainage. Gr. II-Primary EUS-guided cystogastrostomy. Gr. III-EUS-guided cystogastrostomy including intracystic necrosectomy.


RESULTS
(="follow up": n = 27): Gr. I (n = 9; 33.3%): No complaints (n = 3); change of an external into an internal drainage (n = 4); complications: (a) bleeding (n = 1) followed by 3 d at ICU, discharge after 40 d; (b) septic shock (n = 1) followed by ICU and several laparotomies for programmed lavage and necrosectomy, death after 74 d. Gr. II (n = 13; 48.1%): No complaints (n = 11); external drainage (n = 2); complications/problems out of the 13 cases: 2nd separate pseudocyst (n = 1) with external drainage (since no communication with primary internal drainage); infection of the residual cyst (n = 1) + following external drainage; spontaneous PPC perforation (n = 1) + following closure of the opening of the cystogastrostomy using clips and subsequently ICU for 2 d. Gr. III (n = 5; 18.5%): No complaints in all patients, in average two endoscopic procedures required (range, 2-6).


CONCLUSIONS
Interventional endoscopic management of pancreatic pseudocysts is a reasonable alternative treatment option with low invasiveness compared to surgery and an acceptable outcome with regard to the complication rate (11.1%) and mortality (3.7%), as shown by these initial study results.
Will
Uwe
U
Department of Gastroenterology, Municipal Hospital, Strasse des Friedens 122, D-07548 Gera, Germany. uwe.will@wkg.srh.de
Wegener
Conrad
C
Graf
Kai-Ivo
KI
Wanzar
Igor
I
Manger
Thomas
T
Meyer
Frank
F
D004322:Drainage / Q000379:methods; D019160:Endosonography / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010192:Pancreatic Pseudocyst / Q000401:mortality / Q000628:therapy*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome