Endoscopic treatment as first-line therapy for pancreatic ascites and pleural effusion.
BACKGROUND
Ascites and pleural effusion are well recognized complications of pancreatic diseases. Drug therapy of these is limited by high cost, prolonged hospitalization and failure rates; surgery is invasive and is associated with considerable morbidity and mortality.


OBJECTIVE
To analyze the data on patients with pancreatic ascites and/or pleural effusion treated endoscopically over a ten-year period.


METHODS
Patients with symptomatic ascites/pleural effusion for at least 3 weeks with a fluid amylase level of > 1000 S units/dl and underlying pancreatic disease were included. The interventions were a 5 mm sized pancreatic sphincterotomy and placement of a 7 Fr pancreatic stent. Somatostatin/octreotide and parenteral nutrition were not used after endoscopic therapy.


RESULTS
Of the 28 patients included (22 men), 17 (60.7%) had chronic pancreatitis. The causes were tropical pancreatitis (13, 46.4%), alcohol abuse (10, 35.7%), idiopathic acute pancreatitis (4, 14.3%) and resective surgery for gastric cancer (1, 3.6%). Ascites alone was seen in 15, pleural effusion alone in 6 and both in 7 patients. Ten patients (35.7%) had 14 pseudocysts. Endotherapy was successful in 27 (96.4%). Twenty-six (92.8%) patients had complete resolution of ascites/effusion over a median 5 weeks. The stents were removed 3-6 weeks later without any recurrence over the next 6-36 (median = 17) months. Complications (7, 25%) included severe pain in 2 (7.1%) and fever in 5 (17.8%) of which 3 (10.7%) had infection of residual fluid collections. No patient died.


CONCLUSIONS
Endoscopic therapy offers an excellent therapeutic alternative in patients with pancreatic ascites and pleural effusion.
Pai
C Ganesh
CG
Department of Gastroenterology & Hepatology, Kasturba Medical College, Manipal, India. cgpai@yahoo.co.in
Suvarna
Deepak
D
Bhat
Ganesh
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000681:Amylases / Q000032:analysis; D001201:Ascites / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004796:Clinical Enzyme Tests; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D000681:Amylases