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Review
. 2009 Sep;106(38):614-21.
doi: 10.3238/arztebl.2009.0614. Epub 2009 Sep 18.

Pancreatic pseudocysts: observation, endoscopic drainage, or resection?

Markus M Lerch  1 , Albrecht Stier, Ulrich Wahnschaffe, Julia Mayerle
Affiliations
Review

Pancreatic pseudocysts: observation, endoscopic drainage, or resection?

Markus M Lerch et al. Dtsch Arztebl Int. 2009 Sep.

Abstract

Background: Pancreatic pseudocysts are a common complication of acute and chronic pancreatitis. They are diagnosed with imaging studies and can be treated successfully with a variety of methods: endoscopic transpapillary or transmural drainage, percutaneous catheter drainage, laparoscopic surgery, or open pseudocystoenterostomy.

Methods: Relevant publications that appeared from 1975 to 2008 were retrieved from the MEDLINE, PubMed and EMBASE databases for this review.

Results: Endoscopic pseudocyst drainage has a high success rate (79.2%) and a low complication rate (12.9%). Percutaneous drainage is mainly used for the emergency treatment of infected pancreatic pseudocysts. Open internal drainage and pseudocyst resection are surgical techniques with high success rates (>92%), but also higher morbidity (16%) and mortality (2.5%) than endoscopic treatment (mortality 0.7%). Laparoscopic pseudocystoenterostomy, a recently introduced procedure, is probably similar to the endoscopic techniques with regard to morbidity and mortality.

Conclusions: An interdisciplinary approach is best suited for the safe and effective stage-specific treatment of pancreatic pseudocysts. The different interventional techniques that are currently available have yet to be compared directly in randomized trials.

Keywords: drainage; endoscopy; minimally invasive therapy; pancreatitis; spontaneous remission.

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Figures

Figure 1
Figure 1
The Atlanta classification and its therapeutic implications
Figure 2
Figure 2
The individual steps in the endoscopic treatment of a large pancreatic pseudocyst are shown. (a) A CT scan shows the head of the pancreas with a symptomatic pancreatic pseudocyst due to chronic pancreatitis. There are calcifications in the pseudocyst wall. (b) An avascular area of the gastric wall is located endosonographically and the pseudocyst is punctured with a needle (arrow). (c) A wire (arrow) is introduced through the needle into the pseudocyst; a dilating balloon (arrow in [d]) is then introduced over the wire so that the path of approach can be widened to the diameter of the endoscope. (d) Introduction of the dilatation balloon (arrow) (e) View through the endoscope into the pancreatic pseudocyst, with the opportunity to take biopsies to rule out malignancy (f) The endoscopic path of approach is held open by the introduction of pigtail catheters (usually two to four) between the stomach and the pancreatic pseudocyst; this prevents rapid spontaneous closure and enables regression of the pseudocyst.
See this image and copyright information in PMC

Comment in

  • Course and pathogenesis.
    Nizze H. Nizze H. Dtsch Arztebl Int. 2010 Jan;107(3):42; author reply 42. doi: 10.3238/arztebl.2010.0042a. Epub 2010 Jan 15. Dtsch Arztebl Int. 2010. PMID: 20140181 Free PMC article. No abstract available.

References

    1. Bradley EL., 3rd A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128:586–590. - PubMed
    1. Imrie CW, Buist LJ, Shearer MG. Importance of cause in the outcome of pancreatic pseudocysts. Am J Surg. 1988;156:159–162. - PubMed
    1. Maringhini A, Uomo G, Patti R, et al. Pseudocysts in acute nonalcoholic pancreatitis: incidence and natural history. Dig Dis Sci. 1999;44:1669–1673. - PubMed
    1. Barthet M, Bugallo M, Moreira LS, Bastid C, Sastre B, Sahel J. Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients. Gastroenterol Clin Biol. 1993;17:270–276. - PubMed
    1. Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology. 1984;86:820–828. - PubMed