Therapeutic strategies for pancreatic pseudocysts: experience in Taiwan.
OBJECTIVE
A retrospective study of Chinese patients with pancreatic pseudocysts to compare the results between non-conservative and conservative treatments, and the use of serial serum amylase and imaging in monitoring treatment success.


METHODS
One hundred and sixty-two pseudocyst patients, treated between 1974 and 2003, were divided into two groups, conservative treatment and interventions (percutaneous needle drainage, internal drainage, or resection), and treatment results for these groups compared.


RESULTS
Ninety-one cases (56%) showed spontaneous pseudocyst resolution (mean duration to resolution, 33.4 days). Pseudocyst size was less than 5cm in 86 of these cases (94.5%). Excellent symptomatic responses after aggressive treatment were noted in 68 of 71 patients (93.1%) with pseudocysts larger than 5 cm. All percutaneous tube drainage patients had pseudocyst resolution when the pseudocyst size was less than 5 cm. Hyperamylasemia was noted in 114 cases (70.4%) at diagnosis and returned to normal range in those patients whose cysts underwent spontaneous resolution or who had successful operations.


CONCLUSIONS
Pancreatic pseudocysts smaller than 5 cm should have conservative treatment or percutaneous needle drainage. Larger pseudocysts should be treated aggressively. Serum amylase and ultrasound examinations are important to evaluate the occurrence of spontaneous resolution or the need for surgical intervention.
Chen
Kuan-Ho
KH
Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Hsu
Huan-Ming
HM
Hsu
Giu-Cheng
GC
Chen
Teng-Wei
TW
Hsieh
Chung-Bao
CB
Liu
Yao-Chi
YC
Chan
De-Chun
DC
Yu
Jyh-Cherng
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D004322:Drainage; D004766:Enterostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome; D055815:Young Adult