title: A simple, safe technique for the drainage of pancreatic pseudocysts.
abstract: BACKGROUND
  A number of methods are available for the drainage of pancreatic pseudocysts, including percutaneous, endoscopic and open approaches. In Leicester, we developed a combined radiological and endoscopic technique (predating the use of endoscopic/ultrasound) to allow drainage of pancreatic pseudocysts into the stomach. The aim of the study was to evaluate the long-term results of this approach.
  
  
  METHODS
  This is a retrospective study of patients undergoing combined endoscopic/ultrasound-guided percutaneous stenting between 1994 and 2007. Data were extracted from case records and our computerised radiology database.
  
  
  RESULTS
  Thirty-seven combined endoscopic/ultrasound-guided procedures were undertaken. Median patient age was 52 years (range 26-84 years). Nineteen pseudocysts were secondary to acute pancreatitis and 18 were in patients with chronic pancreatitis. The diameter of pseudocysts on pre-procedure imaging ranged from 4 to 21 cm (median 11 cm). Median duration of hospital stay was 7 days (range 1-44 days) and 30-day mortality was 0%. Stents were inserted in 70.3% of patients (n= 26). Of those patients stented during the combined procedure, three developed infection of the pseudocyst, necessitating open cystgastrostomy within the first month. During a mean follow-up period of 41 months, two patients developed recurrent pseudocysts which were successfully drained with a further combined procedure (16 and 43 months). Repeat imaging in the remainder of patients failed to show any evidence of a persistent or recurrent pseudocyst beyond 2 months.
  
  
  CONCLUSIONS
  Combined radiological and endoscopic drainage is safe, cost-effective and highly efficient in preventing recurrent pseudocyst formation.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK. sarahthomasset@hotmail.com
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Thomasset
authors.forename: David P
authors.initials: DP
authors.lastname: Berry
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
authors.forename: Seok L
authors.initials: SL
authors.lastname: Ong
authors.forename: Thomas
authors.initials: T
authors.lastname: Hall
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Rees
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Sutton
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome