A simple, safe technique for the drainage of pancreatic pseudocysts.
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.
Thomasset
Sarah C
SC
Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK. sarahthomasset@hotmail.com
Berry
David P
DP
Garcea
Giuseppe
G
Ong
Seok L
SL
Hall
Thomas
T
Rees
Yvonne
Y
Sutton
Christopher D
CD
Dennison
Ashley R
AR
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