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Published in:

01-05-2010

Endoscopic management of pancreatic pseudocysts at atypical locations

Authors: Deepak Kumar Bhasin, Surinder Singh Rana, Mohit Nanda, Vijant Singh Chandail, Ibrahim Masoodi, Mandeep Kang, Navin Kalra, Saroj Kant Sinha, Birinder Nagi, Kartar Singh

Published in: Surgical Endoscopy | Issue 5/2010

Abstract

Background and aims

There is paucity of data on endoscopic management of pseudocysts at atypical locations. We evaluated the efficacy of endoscopic transpapillary nasopancreatic drain (NPD) placement in the management of pseudocysts of pancreas at atypical locations.

Patients and methods

Eleven patients with pseudocysts at atypical locations were treated with attempted endoscopic transpapillary nasopancreatic drainage. On endoscopic retrograde pancreatography (ERP), a 5-F NPD was placed across/near the site of duct disruption.

Results

Three patients each had mediastinal, intrahepatic, and intra/perisplenic pseudocysts and one patient each had renal and pelvic pseudocyst. Nine patients had chronic pancreatitis whereas two patients had acute pancreatitis. The size of the pseudocysts ranged from 2 to 15 cm. On ERP, the site of ductal disruption was in the body of pancreas in five patients (45.4%), and tail of pancreas in six patients (54.6%). All the patients had partial disruption of pancreatic duct. The NPD was successfully placed across the disruption in 10 of the 11 patients (90.9%) and pseudocysts resolved in 4–8 weeks. One of the patients developed fever, 5 days after the procedure, which was successfully treated by intravenous antibiotics. In another patient, NPD became blocked 12 days after the procedure and was successfully opened by aspiration. The NPD slipped out in one of the patient with splenic pseudocyst and was replaced with a stent. There was no recurrence of symptoms or pseudocysts during follow-up of 3–70 months.

Conclusion

Pancreatic pseudocysts at atypical locations with ductal communication and partial ductal disruption that is bridged by NPD can also be effectively treated with endoscopic transpapillary NPD placement.

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Title: Endoscopic management of pancreatic pseudocysts at atypical locations
Authors: Deepak Kumar Bhasin
Surinder Singh Rana
Mohit Nanda
Vijant Singh Chandail
Ibrahim Masoodi
Mandeep Kang
Navin Kalra
Saroj Kant Sinha
Birinder Nagi
Kartar Singh
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 5/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-009-0732-8

At a glance: The STEP trials

Springer Medicine

Endoscopic management of pancreatic pseudocysts at atypical locations

Abstract

Background and aims

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and aims

Patients and methods

Results

Conclusion

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