title: Endoscopic treatment as first-line therapy for pancreatic ascites and pleural effusion.
abstract: 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.
authors.affiliation: Department of Gastroenterology & Hepatology, Kasturba Medical College, Manipal, India. cgpai@yahoo.co.in
authors.forename: C Ganesh
authors.initials: CG
authors.lastname: Pai
authors.forename: Deepak
authors.initials: D
authors.lastname: Suvarna
authors.forename: Ganesh
authors.initials: G
authors.lastname: Bhat
mesh_terms: 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
chemical_list: D000681:Amylases