title: Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial.
abstract: OBJECTIVE
  Although surgery is the standard technique for drainage of pancreatic pseudocysts, use of endoscopic methods is increasing. We performed a single-center, open-label, randomized trial to compare endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage.
  
  
  METHODS
  Patients with pancreatic pseudocysts underwent endoscopic (n = 20) or surgical cystogastrostomy (n = 20). The primary end point was pseudocyst recurrence after a 24-month follow-up period. Secondary end points were treatment success or failure, complications, re-interventions, length of hospital stay, physical and mental health scores, and total costs.
  
  
  RESULTS
  At the end of the follow-up period, none of the patients who received endoscopic therapy had a pseudocyst recurrence, compared with 1 patient treated surgically. There were no differences in treatment successes, complications, or re-interventions between the groups. However, the length of hospital stay was shorter for patients who underwent endoscopic cystogastrostomy (median, 2 days, vs 6 days in the surgery group; P < .001). Although there were no differences in physical component scores and mental health component scores (MCS) between groups at baseline on the Medical Outcomes Study 36-Item Short-Form General Survey questionnaire, longitudinal analysis showed significantly better physical component scores (P = .019) and mental health component scores (P = .025) for the endoscopy treatment group. The total mean cost was lower for patients managed by endoscopy than surgery ($7011 vs $15,052; P = .003).
  
  
  CONCLUSIONS
  In a randomized trial comparing endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage, none of the patients in the endoscopy group had pseudocyst recurrence during the follow-up period, therefore there is no evidence that surgical cystogastrostomy is superior. However, endoscopic treatment was associated with shorter hospital stays, better physical and mental health of patients, and lower cost.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00826501.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA. svaradarajulu@yahoo.com
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Bang
authors.forename: Bryce S
authors.initials: BS
authors.lastname: Sutton
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Trevino
authors.forename: John D
authors.initials: JD
authors.lastname: Christein
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D004322:Drainage / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D057194:Intention to Treat Analysis; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D010192:Pancreatic Pseudocyst / Q000191:economics / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012044:Regression Analysis; D015607:Stents; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Biliary Tract Obstruction; CT; Clinical Trial; Comparison; ERCP; EUS; HRQoL; MCS; MRCP; Medical Outcomes Study 36-Item Short-Form General Health Survey; PCS; Pancreas; SF-36; computed tomography; endoscopic retrograde cholangiopancreatogram; endoscopic ultrasound; health-related quality of life; magnetic resonance cholangiopancreatogram; mental component score; physical component score