title: Minimally invasive treatment of pancreatic pseudocysts.
abstract: A pancreatic pseudocyst (PPC) is typically a complication of acute and chronic pancreatitis, trauma or pancreatic duct obstruction. The diagnosis of PPC can be made if an acute fluid collection persists for 4 to 6 wk and is enveloped by a distinct wall. Most PPCs regress spontaneously and require no treatment, whereas some may persist and progress until complications occur. The decision whether to treat a patient who has a PPC, as well as when and with what treatment modalities, is a difficult one. PPCs can be treated with a variety of methods: percutaneous catheter drainage (PCD), endoscopic transpapillary or transmural drainage, laparoscopic surgery, or open pseudocystoenterostomy. The recent trend in the management of symptomatic PPC has moved toward less invasive approaches such as endoscopic- and image-guided PCD. The endoscopic approach is suitable because most PPCs lie adjacent to the stomach. The major advantage of the endoscopic approach is that it creates a permanent pseudocysto-gastric track with no spillage of pancreatic enzymes. However, given the drainage problems, the monitoring, catheter manipulation and the analysis of cystic content are very difficult or impossible to perform endoscopically, unlike in the PCD approach. Several conditions must be met to achieve the complete obliteration of the cyst cavity. Pancreatic duct anatomy is an important factor in the prognosis of the treatment outcome, and the recovery of disrupted pancreatic ducts is the main prognostic factor for successful treatment of PPC, regardless of the treatment method used. In this article, we review and evaluate the minimally invasive approaches in the management of PPCs.
authors.affiliation: Enver Zerem, Predrag Jovanović, Department of Gastroenterology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina.
authors.forename: Enver
authors.initials: E
authors.lastname: Zerem
authors.affiliation: Enver Zerem, Predrag Jovanović, Department of Gastroenterology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina.
authors.forename: Goran
authors.initials: G
authors.lastname: Hauser
authors.affiliation: Enver Zerem, Predrag Jovanović, Department of Gastroenterology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina.
authors.forename: Svjetlana
authors.initials: S
authors.lastname: Loga-Zec
authors.affiliation: Enver Zerem, Predrag Jovanović, Department of Gastroenterology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina.
authors.forename: Suad
authors.initials: S
authors.lastname: Kunosić
authors.affiliation: Enver Zerem, Predrag Jovanović, Department of Gastroenterology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina.
authors.forename: Predrag
authors.initials: P
authors.lastname: Jovanović
authors.affiliation: Enver Zerem, Predrag Jovanović, Department of Gastroenterology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina.
authors.forename: Dino
authors.initials: D
authors.lastname: Crnkić
mesh_terms: D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000601:surgery*; D011237:Predictive Value of Tests; D016896:Treatment Outcome
keywords: Complications; Drainage; Outcomes; Pseudocyst; Treatment