Pancreatic Pseudocysts: What Factors Are Associated with Treatment Failure?
Abstracts
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OBJECTIVE: To compare the efficacies of percutaneous, endoscopic, and surgical therapies for pancreatic pseudocysts and to define factors associated with treatment failures. METHODS: We analyzed 202 consecutive patients with pseudocysts managed between 1/1/1990 and 1/1/2001. Patients were categorized by their initial interventional therapy (percutaneous drainage (n = 48), endoscopic drainage (n = 65), or surgery (n = 40)) and whether the initial therapy was effective or failed (requiring additional procedures). 49 patients required no interventional therapy. RESULTS: For the entire group of study patients: the mean age was 52?1 years, 111 (55%) were male, and 67 (33%) had chronic pancreatitis. The overall mortality rate was 0.5%, and the median length-of-stay was 16 days (range 2-164). Patients who required intervention had a larger mean pseudocyst diameter than those who did not (6.6?0.4 vs. 3.3?0.4 cm, respectively, p<0.05). Surgical therapy was associated with a lower failure rate than either percutaneous or endoscopic drainage (12% vs. 48% and 43%, respectively, p<0.05). Factors significantly (p<0.05) associated with treatment failure for patients undergoing percutaneous drainage were: 1) biliary etiology of pancreatitis and 2) presence of a pancreatic ductal stricture detected on ERCP. Factors significantly (p<0.05) associated with treatment failure for patients undergoing endoscopic drainage were: 1) location in the tail of the pancreas and 2) presence of infection in the pseudocyst. No factors significantly (p<0.05) associated with failure of surgical therapy were identified. CONCLUSIONS: Surgery remains the most effective interventional therapy for pancreatic pseudocysts. Percutaneous and endoscopic treatment failures are associated with identifiable patient and pseudocyst characteristics. |
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