Top

Published in:

01-05-2011

Endoscopic transmural drainage of pseudocysts associated with pancreatic resections or pancreatitis: a comparative study

Authors: Alvise Cavallini, Giovanni Butturini, Giuseppe Malleo, Francesca Bertuzzo, Gianpaolo Angelini, Mohammad Abu Hilal, Paolo Pederzoli, Claudio Bassi

Published in: Surgical Endoscopy | Issue 5/2011

Abstract

Background

Endoscopy has been regarded as an effective modality for draining pancreatic collections, pseudocysts, and abscesses. This study analyzes our experience with endoscopic transmural drainage of pancreatic pseudocysts and compares the outcomes in patients with postsurgical and pancreatitis-associated ones.

Methods

Patients who underwent endoscopic drainage of a pancreatic pseudocyst from January 1999 through June 2008 were included in this retrospective analysis. The specific indication for attempting the procedure was the presence of direct contact between the pseudocyst and the gastric wall. All the drainages were carried out via a transgastric approach, and one or two straight plastic stents (10 or 11.5 French) were positioned. A comparative analysis of short- and long-term results was made between patients with postoperative pseudocysts (group A) and patients with pancreatitis-associated pseudocysts (group B).

Results

Fifty-five patients were included in the study, 25 in group A and 30 in group B. Overall, a single stent was inserted in 84.0% of patients, while two stents were needed in the remaining 16.0%. The technical success rate was 78.2%, whereas procedure-related complications were 16.4%. Complications included pseudocyst superinfection and major bleeding and were managed mainly by surgery. Mortality rate was 1.8% (1 patient). There were no significant differences in the technical success rate and procedure-related complications between the two groups (p = 0.532 and 0.159, respectively) Recurrences were 13.9% and significantly more common in group B (p = 0.021). In such cases, a second endoscopic drainage was successfully performed.

Conclusion

Transmural endoscopic treatment of pancreatic pseudocysts is feasible and has a technical success rate of 78.2%, without differences related to the pseudocyst etiology. Recurrences, on the other hand, are more common in patients with pancreatitis. Given the severe complications that may occur after the procedure, we recommend that endoscopic drainage be performed in a tertiary-care center with specific expertise in pancreatic surgery.

Bhattacharya D, Ammori BJ (2003) Minimally invasive approaches to the management of pancreatic pseudocysts. Surg Laparosc Endosc Percutan Tech 13:141–148PubMedCrossRef

Bradley EL III (1993) A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, GA, September 11–13, 1992. Arch Surg 128:586–590PubMed

Andrén-Sandberg A, Dervenis C (2004) Pancreatic pseudocyst in the 21st century: classification, pathophysiology, anatomic consideration and treatment. JOP 5:8–24PubMed

Andrén-Sandberg A, Dervenis C (2004) Pancreatic pseudocyst in the 21st century: natural history. JOP 5:64–70PubMed

Beckingham IJ, Krige JE, Bornman PC (1999) Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol 94:71–74PubMedCrossRef

Parks RW, Tzovaras G, Diamond T, Rowlands BJ (2000) Management of pancreatic pseudocyst. Ann R Coll Surg Engl 82:383–387PubMed

Bradley EL, Clements JL, Gonzales AC (1979) The natural history of pancreatic pseudocyst: a unified concept of management. Am J Surg 137:135–141PubMedCrossRef

Kohler H, Schafmayer A, Ludtke FE (1987) Surgical treatment of pancreatic pseudocysts. Br J Surg 74:813–815PubMedCrossRef

Huibregtse K, Schnider B, Vrij AA (1988) Endoscopic pancreatic drainage in chronic pancreatitis. Gastrointest Endosc 34:9–15PubMedCrossRef

10.

De Palma GD, Galloro G, Puzziello A, Masone S, Persico G (2002) Endoscopic drainage of pancreatic pseudocysts: a long-term follow-up study of 49 patients. Hepatogastroenterology 49:1113–1115PubMed

11.

Sharma S, Bhargawa N, Govil A (2003) Endoscopic management of pancreatic pseudocyst: a long term follow-up. Endoscopy 34:203–207

12.

Andren-Sandberg A, Ansorge C, Eiriksson K, Glomsaker T, Maleckas A (2005) Treatment of pancreatic pseudocysts. Scand J Surg 94:165–167PubMed

13.

Giovannini M (2007) What is the best endoscopic treatment for pancreatic pseudocysts? Gastrointest Endosc 65:620–623PubMedCrossRef

14.

Yusuf TE, Baron TH (2006) Endoscopic transmural drainage of pancreatic pseudocysts: results of a national and an international survey of ASGE members. Gastrointest Endosc 63:223–227PubMedCrossRef

15.

Heyries L, Sahel J (2007) Endoscopic treatment of chronic pancreatitis. World J Gastroenterol 13:6127–6133PubMed

16.

Testoni PA (2007) Endoscopic stenting in benign pancreatic diseases. JOP 8(1 Suppl):141–150PubMed

17.

Monkemuller KE, Kahl S, Malfertheiner P (2004) Endoscopic therapy of chronic pancreatitis. Dig Dis 22:280–291PubMedCrossRef

18.

Baron TH, Harewood GC, Morgan DE, Yates MR (2002) Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts and chronic pancreatic pseudocysts. Gastrointest Endosc 56:7–17PubMedCrossRef

19.

Nealon WH, Walser E (2003) Duct drainage alone is sufficient in the operative management of pancreatic pseudocyst in patients with chronic pancreatitis. Ann Surg 237:614–620PubMed

20.

Aghdassi A, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM (2008) Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis. Pancreas 36:105–112PubMedCrossRef

21.

Arvanitakis M, Delhaye M, Bali MA, Matos C, De Maertelaer V, Le Moine O, Devière J (2007) Pancreatic fluid-collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 65:609–619PubMedCrossRef

22.

Sciumè C, Geraci G, Pisello F, Li Volsi F, Facella T, Modica G (2006) Endoscopic treatment of pancreatic pseudocysts. G Chir 27:272–277PubMed

23.

Bartoli E, Delcenserie R, Yzet T, Brazier F, Geslin G, Regimbeau JM, Dupas JL (2005) Endoscopic treatment of chronic pancreatitis. Gastroenterol Clin Biol 29:515–521PubMedCrossRef

24.

Palanivelu C, Senthilkumar K, Madhankumar MV, Rajan PS, Shetty AR, Jani K, Rangarajan M, Maheshkumaar GS (2007) Management of pancreatic pseudocyst in the era of laparoscopic surgery. Experience from a tertiary centre. Surg Endosc 21:2262–2267PubMedCrossRef

25.

Barthet M, Lamblin G, Gasmi M, Vitton V, Desjeux A, Grimaud JC (2008) Clinical usefulness of a treatment algorithm for pancreatic pseudocysts. Gastrointest Endosc 67:245–252PubMedCrossRef

26.

Cahen D, Rauws E, Fockens P, Weverling G, Huibregtse K, Bruno M (2005) Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy 37:977–983PubMedCrossRef

27.

Weckman L, Kylänpää ML, Puolakkainen P, Halttunen J (2006) Endoscopic treatment of pancreatic pseudocysts. Surg Endosc 20:603–607PubMedCrossRef

28.

Hookey LC, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Devière J (2006) Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc 63:635–643PubMedCrossRef

29.

Subtil C, Moutardier V, Vitton V, Gasmi M, Desjeux A, Grimaud JC, Brunet C, Berdah S, Barthet M (2008) Endoscopic management of postoperative pancreatic collection. Gastroenterol Clin Biol 32:128–133PubMedCrossRef

30.

Trevino JM, Tamhane A, Varadarajulu S (2010) Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections. J Gastroenterol Hepatol 25:526–531PubMedCrossRef

31.

Kozarek RA, Ball TJ, Patterson DJ, Freeny PC, Ryan JA, Traverso LW (1991) Endoscopic transpapillary therapy for disrupted pancreatic duct and pancreatic fluid collection. Gastroenterology 100:1362–1370PubMed

32.

Barthet M, Bugallo M, Moreira LS, Bastid C, Sastre B, Sahel J (1993) Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients. Gastroenterol Clin Biol 17:270–276PubMedCrossRef

33.

Varadarajulu S, Wilcox CM, Tamhane A, Eloubeidi MA, Blakely J, Canon CL (2007) Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage. Gastrointest Endosc 66:1107–1119PubMedCrossRef

34.

Giovannini M (2005) Endoscopic ultrasound-guided pancreatic pseudocyst drainage. Gastrointest Endosc Clin N Am 15:179–188PubMedCrossRef

35.

Kahl S, Glasbrenner B, Zimmermann S, Malfertheiner P (2002) Endoscopic ultrasound in pancreatic diseases. Dig Dis 20:120–126PubMedCrossRef

36.

Varadarajulu S, Christein JD, Tamhane A, Drelichman ER, Wilcox CM (2008) Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 68:1102–1111PubMedCrossRef

37.

Park DH, Lee SS, Moon SH, Choi SY, Jung SW, Seo DW, Lee SK, Kim MH (2009) Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy 41:842–848PubMedCrossRef

38.

Kahaleh M, Shami VM, Conaway MR, Tokar J, Rockoff T, De La Rue SA, de Lange E, Bassignani M, Gay S, Adams RB, Yeaton P (2006) Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy 38:355–359PubMedCrossRef

39.

Chahal P, Papachristou GI, Baron TH (2007) Endoscopic transmural entry into pancreatic fluid collections using a dedicated aspiration needle without endoscopic ultrasound guidance: success and complication rates. Surg Endosc 21:1726–1732PubMedCrossRef

Title: Endoscopic transmural drainage of pseudocysts associated with pancreatic resections or pancreatitis: a comparative study
Authors: Alvise Cavallini
Giovanni Butturini
Giuseppe Malleo
Francesca Bertuzzo
Gianpaolo Angelini
Mohammad Abu Hilal
Paolo Pederzoli
Claudio Bassi
Publication date: 01-05-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 5/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-010-1428-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic transmural drainage of pseudocysts associated with pancreatic resections or pancreatitis: a comparative study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2011

Single-incision laparoscopic cholecystectomy

Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer: a report of short-term outcomes

Right colectomy: is it a safe and feasible totally laparoscopic approach with transvaginal specimen extraction

Analysis of laboratory-based laparoscopic colorectal surgery workshops within the English National Training Programme

Hanging maneuver during pancreaticoduodenectomy: a technique to improve R0 resection

Is it appropriate to apply the enhanced recovery program to patients undergoing laparoscopic rectal surgery?