Abstracts
1997 Digestive Disease Week

Endoscopic drainage of the pancreatic pseudocyst.

G Vitale, D Harrell, G Larson, S MacLeod. Department of Surgery, School of Medicine, University of Louisville, Louisville, KY.

Pancreatic pseudocyst is a relatively common complication of chronic pancreatitis occurring in 20-40% of cases. Pseudocysts can be treated by endoscopic cystenterostomy or transpapillary drainage as an outpatient as an alternative to surgery. Common indications for drainage include pain, pancreatitis, gastric outlet obstruction, biliary obstruction or cyst size greater than 6cm. The purpose of this study is to describe the endoscopic techniques of pseudocyst drainage and to relate our experience with this technique.

From January 1991 to October 1996, we performed 1260 ERCPs, 65% of which had therapeutic endoscopic procedures. Endoscopic pancreatic pseudocyst drainage was performed or attempted in 19 patients. The patients presented with alcohol-related pancreatitis in 37%, gallstone pancreatitis in 21%, and other causes in 42%. Sixty-eight percent presented with chronic pain, 42% had recurrent pancreatitis, and 26% of the patients had either gastric outlet obstruction or a palpable abdominal mass. A total of 24 endoscopic drainages were performed: 17 cystenterostomies and 7 transpapillary drainages. One attempted drainage was aborted because of inability to penetrate a thick cyst wall.

There was complete cyst resolution in 14 patients, with 4 requiring two endoscopic drainages. A total of 4 patients underwent surgery for definitive treatment, with 2 requiring distal pancreatectomy due to their pancreatic pathology, and 2 cystgastrostomy for recurrent cysts. The final patient has a transpapillary stent still in place. The mean follow up after initial drainage is 18.5 months with complete follow up being obtained in 88% of patients. There were no deaths attributed to the procedures and no complications such as bleeding, pancreatititis or perforation requiring surgery or prolonged hospitalization. In summary, endoscopic drainage of pseudocysts can be both safe and effective, with minimal cost and morbidity. It should be considered as an option to standard surgical drainage in selected patients.