Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients

Abstract

One hundred and forty-three patients presenting with 170 cysts and pseudocysts complicating chronic pancreatitis were followed between 1980 and 1990. Thirteen patients were managed conservatively and pseudocysts spontaneously disappeared in 11 patients. Cysts were small (average 28 mm), often communicating with the ductal system without dilatation of the main pancreatic duct. Percutaneous puncture was performed in 47 patients with a low morbidity rate (5%) but a high rate of recurrence (57%). Thirteen of 39 patients (33%) who underwent percutaneous puncture as initial treatment did not require further therapy. Communication of pancreatic cysts with the ductal system was associated with poorer results after percutaneous puncture. Percutaneous drainage was performed in 9 patients with a low morbidity rate (12%). The mean duration of drainage was 10.4 days. Five patients were definitively cured. Seventy-eight endoscopic cystoenterostomies were performed in 71 patients. Complications occurred in 12 patients (15.3%) and one patient died (1.3%). Endoscopic cystoenterostomy was effective in 39 of 54 patients initially treated with this technique (72.2%). Sixty-three patients underwent surgical management, principally internal drainage (83%), with a morbidity rate of 13.2% and a mortality rate of 1.3%. Twenty-one of the 29 patients (72%) who underwent surgery as initial treatment did not require further therapy. Endoscopic cystoenterostomy is an efficient treatment of cysts and pseudocysts complicating CP when anatomical conditions are favorable. Percutaneous drainage also appears to be a satisfactory treatment modality. Surgery should be considered in cases of failure or technical impossibility of endoscopic or percutaneous approaches.