Clinical usefulness of a treatment algorithm for pancreatic pseudocysts.
BACKGROUND
Endoscopic procedures have become a first-line approach to the treatment of pancreatic pseudocysts.


OBJECTIVE
Our purpose was to determine the results of a therapeutic algorithm including EUS-assisted drainage, transpapillary drainage, and conventional endoscopic drainage in terms of (1) feasibility and efficacy of the endoscopic procedure and (2) morbidity.


METHODS
Prospective study with a treatment algorithm drawn up before the endoscopic procedure, including either conventional endoscopic transmural drainage (CTMD), conventional transpapillary drainage (CTPD), or EUS-guided transmural drainage (EUS-GTD).


METHODS
A total of 50 patients, including 15 women and 35 men with a mean age of 51 years, were included in this prospective study.


RESULTS
The mean size of the pseudocysts was 8.2 cm (range 3-12 cm). A total of 29 pseudocysts did not bulge into the digestive wall (58%); 24 (48%) neither bulged nor communicated with the pancreatic duct. EUS-GTD was performed on 28 patients (56%), CTMD on 13 patients (26%), and CTPD on 8 patients (16%), and endoscopic procedures failed in 1 patient. Technical feasibility was 98% (49/50), and clinical success was achieved in 90% of the cases and disappearance of the pseudocysts in 96% of the cases without significant differences among the 3 groups. The morbidity rate was 18% (9 cases). Five superinfections occurred in the EUS-GTD group and 1 in the CTMD group. One death occurred from late bleeding in the CTMD group.


CONCLUSIONS
Randomization of patients in this prospective study was not possible because of the different characteristics of the pseudocysts.


CONCLUSIONS
With this algorithm, clinical success was achieved in 45 (90%) of the cases and disappearance of the pseudocysts in 48 (96%) of the cases with a reasonable morbidity rate. In half of the cases, EUS is required for treating pancreatic pseudocyst.
Barthet
Marc
M
Department of Gastroenterology, Hôpital Nord, Marseille, France.
Lamblin
Gatien
G
Gasmi
Mohamed
M
Vitton
Veronique
V
Desjeux
Ariadne
A
Grimaud
Jean-Charles
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed