Pancreatic Pseudocyst

BackgroundPancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period.Patients and methodsWe studied 30 patients with pancreatic pseudocyst that presented some indication for treatment: persistent abdominal pain, infection or cholestasis. Clinical evaluation was performed with a pain scale, 0 meaning absence of pain and 4 meaning continuous pain. Pseudocysts were first evaluated by abdominal CT scan, and after endoscopic retrograde pancreatography the patients were treated by transpapillary or transmural (cystduodenostomy or cystgastrostomy) drainage. Pseudocyst resolution was documented by serial CT scans.Results25/30 patients could be treated. Drainage was successful in 21 (70% in an 'intention to treat' basis). After a mean follow-up of 42 +/- 35.82 weeks, there was only 1 (4.2%) recurrence. A total of 6 complications occurred in 37 procedures (16.2%), and all but 2 were managed clinically and/or endoscopically: there was no mortality related to the procedure. Patients submitted to combined drainage needed more procedures than the other groups. There was no difference in the efficacy when we compared the three different drainage methods.ConclusionsWe concluded that pancreatic pseudocyst endoscopic drainage is possible in most patients, with high success rate and low morbidity.

BackgroundPancreatic pseudocysts arise mostly in patients with alcohol induced chronic pancreatitis causing various symptoms and complications. However, data on the optimal management are rare. To address this problem, we analysed patients with pancreatic pseudocysts treated at our clinic retrospectively.MethodsWe searched our clinical database for the diagnosis pancreatitis from 2004 till 2014, selected patients with pseudocysts larger than 10 mm and entered all relevant information in a database for statistical analysis.ResultsIn total, 129 patients with pancreatic pseudocysts were treated at our institution during the study period. Most patients suffered from alcohol induced chronic pancreatitis (43.4%; 56/129). Pseudocysts were more frequent in female than in male (2:1) and were mainly located in the pancreatic head (47.3%; 61/129). Local complications like obstructive jaundice were associated with the diameter of the cysts (AUC 0.697 in ROC-curve analysis). However, even cysts up to a diameter of 160 mm can regress spontaneously. Besides a lower re-intervention rate in surgically treated patients, endoscopic, percutaneous and surgical drainage are equally effective. Most treatment related complications occur in large pseudocysts located in the pancreatic head.ConclusionConservative management of large pseudocysts is successful in many patients. Therefore, indication for treatment should be made carefully considering the presence and risk of local complications. Endoscopic and surgical drainage are equally effective.

BackgroundDisconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS.MethodsThe PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites.ResultsThirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0-95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7-77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6-90.5) and 87.4% (95%-CI 81.2-91.8), respectively (P = 0.389).ConclusionsEndoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

BackgroundPancreatic collections are a common complication of acute pancreatitis. In Latin America, information on the types of pancreatic collections and their management is limited and may vary between regions depending on the availability of highly specialised and minimally invasive treatment resources.MethodsRetrospective cohort of patients with acute pancreatic collections secondary to acute pancreatitis treated at the Hospital Universitario San Ignacio, Bogotá (Colombia) between 2012-2023. Clinical characteristics, laboratory profiles and treatment received were described, comparing those who had a fatal outcome with those who did not.ResultsOf 689 patients with acute pancreatitis, 113 presented with pancreatic collection (55.1% women, mean age 55 years). Of these, 47.8% presented with acute necrotic collection, 36.3% with acute fluid collection, 9.7% with walled-off necrosis and 6.2% with pancreatic pseudocyst. C-reactive protein, BUN, creatinine levels (at admission and at 48 hours), PaO2/FiO2 (at admission and at 48 hours) and antibiotic use were significantly associated with mortality (PConclusionAcute collections are a common and heterogeneous complication of pancreatitis, requiring intervention more often in complicated collections. Certain laboratory parameters seem to be more associated with mortality.Background• Pancreatic collections are a common complication of acute pancreatitis.Background• Their management depends on the availability of specialized and minimally invasive resources.Background• A study conducted on 689 patients with acute pancreatitis showed that 113 developed pancreatic collections.Background• Acute pancreatic collections are frequent and heterogeneous complications of pancreatitis.Background• Some altered laboratory parameters (creatinine, urea, C-reactive protein, and FiO2) seem to be more associated with mortality.