Clinical usefulness of a treatment algorithm for pancreatic pseudocysts

• Published in: Gastrointestinal endoscopy Vol. 67; no. 2; pp. 245 - 252
• Main Authors: Barthet, Marc, Lamblin, Gatien, Gasmi, Mohamed, Vitton, Veronique, Desjeux, Ariadne, Grimaud, Jean-Charles
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2008; Elsevier
• Subjects: Adolescent; Adult; Aged; Algorithms; Biochemistry; Biochemistry, Molecular Biology; Biological and medical sciences; Child; Child, Preschool; Computerized, statistical medical data processing and models in biomedicine; Digestive system. Abdomen; Drainage; Drainage - methods; Endoscopy; Endoscopy, Gastrointestinal; Endoscopy, Gastrointestinal - methods; Endosonography; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Hypertension, Portal; Hypertension, Portal - epidemiology; Investigative techniques, diagnostic techniques (general aspects); Life Sciences; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical management aid. Diagnosis aid; Medical sciences; Middle Aged; Pancreatic Pseudocyst; Pancreatic Pseudocyst - diagnostic imaging; Pancreatic Pseudocyst - epidemiology; Pancreatic Pseudocyst - etiology; Pancreatic Pseudocyst - surgery; Pancreatitis; Pancreatitis - complications; Prospective Studies; Tomography, X-Ray Computed; Tumors; CTPD; PC; EUS-GTD; CTMD; conventional endoscopic transmural drainage; pseudocysts; conventional transpapillary drainage; EUS-guided transmural drainage; Pseudotumor; Human; Pancreas pseudocyst; Treatment; Pancreatic pseudocyst; Decision aid; Digestive diseases; Benign neoplasm; Algorithm; Pancreatic disease
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2007.06.014

Endoscopic procedures have become a first-line approach to the treatment of pancreatic pseudocysts. Our purpose was to determine the results of a therapeutic algorithm including EUS-assisted drainage, transpapillary drainage, and conventional endoscopic drainage in terms of (1) feasibility and efficacy of the endoscopic procedure and (2) morbidity. Prospective study with a treatment algorithm drawn up before the endoscopic procedure, including either conventional endoscopic transmural drainage (CTMD), conventional transpapillary drainage (CTPD), or EUS-guided transmural drainage (EUS-GTD). A total of 50 patients, including 15 women and 35 men with a mean age of 51 years, were included in this prospective study. The mean size of the pseudocysts was 8.2 cm (range 3-12 cm). A total of 29 pseudocysts did not bulge into the digestive wall (58%); 24 (48%) neither bulged nor communicated with the pancreatic duct. EUS-GTD was performed on 28 patients (56%), CTMD on 13 patients (26%), and CTPD on 8 patients (16%), and endoscopic procedures failed in 1 patient. Technical feasibility was 98% (49/50), and clinical success was achieved in 90% of the cases and disappearance of the pseudocysts in 96% of the cases without significant differences among the 3 groups. The morbidity rate was 18% (9 cases). Five superinfections occurred in the EUS-GTD group and 1 in the CTMD group. One death occurred from late bleeding in the CTMD group. Randomization of patients in this prospective study was not possible because of the different characteristics of the pseudocysts. With this algorithm, clinical success was achieved in 45 (90%) of the cases and disappearance of the pseudocysts in 48 (96%) of the cases with a reasonable morbidity rate. In half of the cases, EUS is required for treating pancreatic pseudocyst.